Sleep Apnea Year in Review

1
Sleep Apnea Year in Review

• Richard Costello
• Beaumont Hospital
• Dublin 9

2
(No Transcript)
3
(No Transcript)
4
Weight loss leads to improved OSA
5
Discussion

• A more aggressive treatment of obesity in
  patients with OSA is well founded. Lifestyle
  intervention with an early VLCD is a feasible,
  for patients with mild OSA. VLCD can be
  implemented in a primary care setting after
  diagnosis of OSA.
• Weight reduction also results in an improvement
  of obesity-related risk factors for
  cardiovascular diseases.
• The authors refer to the VLCD as being low-cost
  and curative treatment - ?

6
(No Transcript)
7
Desaturation and not apneic events are related to
liver damage
8
RELATIONSHIPS BETWEEN SEVERITY OF
SLEEP-DISORDERED BREATHING AND SERUM LEVELS OF
LIVER ENZYMES AND C-REACTIVE PROTEIN IN OBESE
INDIVIDUALS
9
Insulin resistance relates to desaturation and
not apneic events
10
(No Transcript)
11
Discussion

• The study demonstrated that the severity of
  nocturnal oxyhemoglobin desaturation, but not the
  RDI, predicted the severity of insulin resistance
  and liver disease ( NASH).
• Severe obesity was associated with high levels of
  serum CRP, but there was no relationship between
  the severity of OSA, nocturnal hypoxemia, and
  serum CRP.
• The findings suggest that obesity and OSA have
  distinct metabolic, inflammatory and hepatic
  profiles.

12
A randomised controlled trial of nurse led care
for symptomatic moderate to severeobstructive
sleep apnea
Nick A. Antic, 1,2 Catherine Buchan, 3 Adrian
Esterman, 4 Michael Hensley, 5 Matthew T.
Naughton, 3 Sharn Rowland, 1 Bernadette
Williamson, 5 Samantha Windler 1 Simon Eckermann6
and R. Doug McEvoy .1,2 1. Adelaide Institute for
Sleep Health, Repatriation General Hospital, Daw
Park, South Australia, Australia. 2. Department
of Medicine, Flinders University, Bedford Park
South Australia Australia. 3. Department of
Allergy, Immunology and Respiratory Medicine,
Alfred Hospital and Monash University, Melbourne,
Victoria Australia. 4. University of South
Australia, Adelaide, Australia 5000 5. Department
of Respiratory and Sleep Medicine, John Hunter
Hospital and School of Medicine and Public
Health, the University of Newcastle, Newcastle
New South Wales Australia. 6. Flinders Centre for
Clinical Change and Health Care Research,
Flinders University, South Australia, Australia.
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Dicussion

• This study introduces a package of care involving
  simplified OSA diagnosis, APAP titration in the
  home and the expansion of the sleep medicine
  workforce using skilled CPAP nurses
• The study highlights a potential to add to the
  field of sleep medicine and improve access to
  care for those with OSA.

18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
Conclusion

• Mild sleep apnea may be treated with weight loss
• Severe OSA, detected by screening may be treated
  in audited grouped practices with nursing
  specialists and technicians along with sleep
  specialists
• The relationship of sleep apnea to the metabolic
  syndrome is being defined
• Design of sleep studies is improving and focusing
  on the process of patient outcome and cost
  effectiveness

23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
Parents of Patients with congenital central
hypoventilation also have genetic mutations of
the PHOX2B gene
27
Discussion

• The findings suggest a differential sensitivity
  for neurons within the ventilatory pathways as
  compared with those within the enteric nervous
  system (absent in Hirschsprung disease).
• All types of PHOX2B mutations, even in a mosaic
  state, can lead to ventilatory symptoms. However,
  some mutations are more prone to ventilatory
  phenotype than others (i.e., alanine expansions
  and 1 frameshift mutations).
• When a PHOX2B mutation is identified in a C-CHS
  proband, parents should be tested.
• Those parents who are found to be mutation
  carriers, either germinal or somatic, should be
  periodically evaluated, and counseled on the
  increased risk potentially brought about by
  situations such as respiratory infections or
  anesthesia.
• Finally, PHOX2B gene mutations should be
  systematically examined in any adult with
  unexplained central hypoventilation.