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Sleep and Obstructed Sleep Apnea

Sleep and Obstructed Sleep Apnea. Sathiyaraj George, MD Diplomate , American Board of Internal Medicine Diplomate , American Board of Sleep Medicine. Wake-Up! . “Some people talk in their sleep. Lecturers talk while other people sleep.” -Albert Camus. Coffee. Adenosine.

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Sleep and Obstructed Sleep Apnea

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  1. Sleep and Obstructed Sleep Apnea Sathiyaraj George, MD Diplomate, American Board of Internal Medicine Diplomate, American Board of Sleep Medicine

  2. Wake-Up! “Some people talk in their sleep. Lecturers talk while other people sleep.” -Albert Camus

  3. Coffee Adenosine

  4. What is sleep? Why do we need it? Why do we dream? • Reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment • Even though sleep is a very old evolutionary process, the functions of sleep remain elusive • Dream as memory consolidator

  5. Wakefulness/Sleep mechanisms

  6. EEG Tracings

  7. Normal Hypnogram

  8. Changes in sleep with age

  9. Common Sleep Disorders • Insomnias • Hypersomnias • Parasomnias • Circadian Rhythm Sleep Disorders • Sleep-Related Movement Disorders • Sleep-Related Breathing Disorders

  10. Obstructed Sleep Apnea (OSA) • Repetitive episodes of complete or partial upper airway during sleep obstruction during sleep • Usually occur in association with loud snoring and daytime sleepiness.

  11. Upper Airways

  12. Prevalence • OSA can occur in any ager group, but prevalence increases between middle and older age. • OSA with resulting daytime sleepiness occurs in at least four percent of men and two percent of women • About 24 percent of men and nine percent of women have the breathing symptoms of OSA with or without daytime sleepiness. • About 80 percent to 90 percent of adults with OSA remain undiagnosed. • OSA occurs in about two percent of children and is most common at preschool ages.

  13. Risk Groups • People who are overweight (Body Mass Index of 25 to 29.9) and obese (Body Mass Index of 30 and above) • Men and women with large neck sizes: 17 inches or more for men, 16 inches or more for women • Middle-aged and older men, and post-menopausal women • Ethnic minorities • People with abnormalities of the bony and soft tissue structure of the head and neck

  14. Risk Groups (cont…) • Adults and children with Down Syndrome • Children with large tonsils and adenoids • Anyone who has a family member with OSA • People with endocrine disorders such as Acromegaly and Hypothyroidism • Smokers • Those suffering from nocturnal nasal congestion due to abnormal morphology, rhinitis or both.

  15. Severity • Mild OSA: AHI of 5-15Involuntary sleepiness during activities that require little attention, such as watching TV or reading • Moderate OSA: AHI of 15-30Involuntary sleepiness during activities that require some attention, such as meetings or presentations • Severe OSA: AHI of more than 30Involuntary sleepiness during activities that require more active attention, such as talking or driving

  16. Mallampati score

  17. Polysomnogram

  18. Effects • Fluctuating oxygen levels • Increased heart rate • Chronic elevation in daytime blood pressure • Increased risk of stroke • Higher rate of death due to heart disease • Impaired glucose tolerance and insulin resistance • Impaired concentration • Mood changes • Increased risk of being involved in a deadly motor vehicle accident • Disturbed sleep of the bed partner

  19. Treatments • Continuous positive airway pressure (CPAP) • Oral Appliances • Surgery • Behavioral changes • Over-the-counter remedies • Position Therapy

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