OSAHS Obstructive Sleep Apnoea Hypopnoea Syndrome

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OSAHSObstructive Sleep Apnoea Hypopnoea Syndrome

• Liam Doherty
• Consultant Respiratory Physician,
• Bon Secours Hospital, Cork

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Definition

• OSAHS is characterized by recurrent episodes
  of partial or complete upper airway obstruction
  during sleep

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Who cares?
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Kaplan-Meier survival curve for cardiovascular
death in CPAP treated and untreated patients.
Aaa
100
95
95
90
90
surviving
85
85
Untreated group
N61
N61
p0.009
CPAP group
80
80
N107
75
75
0
25
50
75
100
time (months)
Doherty et al - CHEST 2005
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Who?
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Who else?

• Children
• Cranio-facial abnormalities
• Micrognathia, macroglossia
• Neuro-muscular diesases
• Syndromes
• Downs, Prada-Willi, Treacher-Collins,
  Pierre-Rubin
• Miscellaneous
• Pregnancy, Renal failure, hypothyroid, CVA

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How common?
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• The Occurrence of Sleep-Disordered Breathing
  among Middle-Aged Adults
• Terry Young, Mari Palta, Jerome Dempsey, James
  Skatrud, Steven Weber, and Safwan Badr
• 19933281230-1235

n602
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symptoms
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Classical symptoms of OSAHS

• Excessive daytime sleepiness
• Heavy snoring
• Witnessed apnoeas/nocturnal choking
• Other symptoms
• Dyspepsia
• Nocturia, Enuresis
• Nightmares
• Insomnia
• Excess sweating

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Assessing sleepiness

• Epworth Sleepines Score (ESS)
• Stanford Sleepiness Scale
• Multiple Sleep Latency Test (MSLT)
• Maintenance of Wakefulness Test (MWT)
• Oxford Sleep Resistance test (OSLER)

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Epworth Sleepiness ScaleUse the following scale
to choose the most appropriate number for each
situation

• 0 would never doze or sleep
• 1 slight chance of dozing or sleeping
• 2 moderate chance of dozing or sleeping
• 3 high chance of dozing or sleeping
• Situation-Chance of Dozing or Sleeping
• Sitting and reading
  
• Watching TV
  
• Sitting inactive in a public place
  
• Being a passenger in a motor vehicle for an hour
  or more
• Lying down in the afternoon
  
• Sitting and talking to someone
  
• Sitting quietly after lunch (no alcohol)
  
• Stopped for a few minutes in traffic while
  driving
  

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Diagnostic tests

• Polysomnography (PSG)
• Limited sleep studies e.g. embletta
• Overnight oximetry

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PSG - Montage

• EEG C4/A1 or C3/A2
• EOG
• Chin and anterior tibialis EMG
• ECG
• Blood Pressure
• (optional)

• Airflow
• Saturations
• Sonogram
• Respitrace
• rib
• abdomen
• Sum

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Diagnosis of OSA

• Apnoea- cessation of airflow gt 10sec
• Hypopnea- gt 30 reduction in airflow accompanied
  by gt 4 drop in O2 saturations and/or an arousal.

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Obstructive Sleep Apnoea
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Diagnosis of OSA

• AHI gt5 mild
• AHI 15-30 moderate
• AHI gt30 severe
• This must only be interpreted with
  symptoms i.e. Epworth Score, and cardiovascular
  risk factors e.g. Hypertension, IHD, CVA,
  arrhythmias

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Treatment
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Conservative

• Lose weight
• Reduce alcohol
• Proper sleep hygiene
• Sleep on side

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Nasal CPAP therapy
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Oral appliances

• Tongue-retainers
• Anterior mandibular displacement

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Surgery

• Septoplasty
• Tonsillectomy
• Polypectomy
• Pharyngoplasty
• UPPP (uvulo-palato-pharyngo-plasty)
• Tracheostomy

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Take home messages

• Very common disorder (2-4 population)
• Substantial morbidity and ?mortality
• Diagnosis by sleep studies
• Very easy to treat
• On successful treatment, huge improvements in
  quality of life

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I want to die peacefully in my sleep like my
Grandfather, not screaming in terror like the
other passengers in his car
Anonymous