Sleep Apnea and Obesity Hypoventilation Syndrome

Sleep Apnea

a sleep disorder characterized by repeated episodes of airway obstruction, leading to intermittent hypoxia and sleep disruption

Obstructive

most common type of sleep apnea, where the upper airway collapses

Central

a type of sleep apnea characterized by reduced respiratory effort due to brainstem dysfunction

Mixed

a type of sleep apnea that is a combination of OSA and CSA

men, obesity, neck, alcohol, family, 60

Risk Factors of Sleep Apnea

-Common in middle-aged and older adults

-___ > women

-________, large ____ circumference, craniofacial abnormalities, smoking, _______ use, sedative medications, ______ history, and age > __ years old

upper, decreases, collapse, breathing, hypoxia, daytime, cardiovascular

Sleep Apnea Pathophysiology

-During sleep, muscle tone of the ____ airway _________. This causes airway ________ and transient cessation of _________, which can lead to:

→_______ and hypercapnia → increased sympathetic activity

→ Arousals from sleep → fragmented sleep and _________ fatigue

→Increased risk of hypertension, _________ disease, and metabolic syndrome

snoring, apneas, frequent, sleepiness, headaches, mood

Nighttime Symptoms of Sleep Apnea

→Loud ______, witnessed ______, gasping/choking, and _________ awakenings

Daytime Symptoms

→Excessive daytime _________ (EDS), morning __________, difficulty concentrating, irritability, and ____ changes

STOP BANG

What questionnaire is used to identify high risk individuals for sleep apnea?

Epworth Sleepiness Scale (ESS)

What sleep apnea screening tool is used to assess daytime sleepiness?

Polysomnography (PSG)

What is the gold standard test for diagnosing sleep apnea? It measures the AHI, which is the apnea-hypoxia index

Home Sleep Apnea Test (HSAT)

What is an alternative for individuals with potentially moderate-to-severe OSA cases?

mild, 15-30, >

Apnea-Hypopnea Index (AHI)

-_____: 5-15 events/hour

-Moderate: __-__ events/hour

-Severe: _ 30 events/hour

weight, supine, CPAP, MADs, refractory

Treatment of Sleep Apnea

-Lifestyle Modifications: ____ loss (if obese), avoid alcohol and sedatives, positional therapy (avoiding ______ position)

-First-Line Treatment: continuous positive airway pressure (____), which is the gold standard for moderate to severe cases

-Alternative therapies: mandibular advancement devices (_____) for mild-moderate cases or upper airway surgery for _________ cases

-Central: adaptive servo-ventilation (ASV)

underdiagnosed, obstructive, PSG, CPAP, cardiovascular

Sleep Apnea Pearls

-Sleep apnea is __________ but highly prevalent

-________ sleep apnea (OSA) is the most common form

-Polysomnography (___) is the gold standard for diagnosis

-_____ is the first-line treatment for moderate-severe OSA

-Untreated OSA increases ___________ and metabolic risks

daytime, obese, cause, 90

Obesity Hypoventilation Syndrome (OHS)

-A disorder characterized by chronic _______ hypoventilation in ______ individuals without an alternative _____. __% of OHS patients also have OSA.

-10-20% of obese individuals have OHS

obesity, 50, neck, hypoxia

Risk Factors of OHS

-________

-Male sex

-Age > __ years

-____ circumference > 17 inches

-Chronic _______-related conditions like asthma or COPD

work, restriction, CO2, hypercapnia, leptin

Pathophysiology of OHS

-Increased ____ of breathing due to chest wall ________ → impaired central respiratory drive (blunted response to ___) → nocturnal hypoventilation leading to daytime _______ → increased ____ resistance, impairing ventilatory drive

sleepiness, headaches, cognitive, snoring, obesity, hypoxia

Symptoms and Exam Findings of OHS

-Excessive daytime _______, morning _______ (due to CO2 retention overnight), fatigue, depression, and ________ impairment

-Loud ______, witnessed apneas, choking/gasping episodes, restless sleep

-______ (BMI > 30) and signs of chronic _______, like cyanosis, polycythemia, lower extremity edema

clinical, 45, 70, PSG, CO2, restrictive, failure

OHS Diagnosis

-_______ suspicion in obese patients with hypercapnia and hypoxia

-Arterial Blood Gas: PaCO2 > __ mmHg, PaO2 < __ mmHg

-___: evaluates OSA, nocturnal hypoxia

-Serum Bicarbonate: suggests chronic ___ retention

-PFTs: ________ pattern

-CXR and ECG: assess for right heart _______

PAP

The first-line therapy for OHS is ___ therapy, which includes CPAP and BiPAP