Obstructive Sleep Apnea (OSA)

2-4%

What % of the population is affected by Obstructive Sleep Apnea (OSA)?

males

Is OSA more prevalent in males or females?

AfAM and Hispanic

What ethnic groups is OSA more prevalent in?

obese range BMI

What is the typical BMI of someone with OSA?

older ppl

Does OSA occur more in older people or younger?

etiology of OSA

-pharyngeal narrowing and closure

-anatomical factors: neck circumference, excess soft tissue, tonsillar hypertrophy, inferior displacement of the hyoid

-concomitant disease: endocrine disorders, neurological disorders

increased risk: motor vehicle accidents, depression, cancer/stroke/CVD

Why do we care about OSA?

central sleep apnea (CSA)

impairment of the respiratory drive

Obstructive sleep apnea (OSA)

upper airway collapse and obstruction

Mixed sleep apnea

characteristics of both CSA and OSA

OSA

is defined by the occurrence of daytime sleepiness, loud snoring, witnessed breathing interruptions, or awakenings due to gasping or choking in the presence of at least 5 obstructive respiratory events (apneas, hypopneas, or respiratory effort related arousals) per hour of sleep

apnea

complete cessation of breathing

hypopnea

partial airway closure with blood oxygen desaturation

s/s of OSA

-snoring

-coughing/gasping for air in sleep

-feeling tired during the day

-having poor memory or being forgetful

-experiencing multiple night time bathroom trips

-having HA in the morning

epworth sleepiness scale (ESS)

used to evaluate severity of sleepiness

STOP BANG Questionnaire

used to evaluate probability of moderate to severe OSA

differential dx

-asthma

-COPD

-depression

-GERD

-hypothyroidism

-narcolepsy

dx of OSA

-clinical suspicion, based on symptoms

-GOLD standard= sleep study in the lab

Sleep study

-polysomnography (PSG)

-can do in home sleep testing for qualifying pts

helps identify the type of severity of sleep apnea

What does sleep study help you do?

Respiratory Disturbance Index (RDI) /Apnea Hypopnea Index (AHI)

-classifies severity of sleep apnea

-number of apnea and hypopnea episodes documented by PSG

mild OSA

5-15 events/hour

moderate OSA

16-30 events/hour

severe OSA

> 30 events/hour

non-pharm options for OSA

-weight loss

-side sleeping

-mandibular advancement devices (MAD)

-surgery

continuous positive airway pressure (CPAP)

What is the best nonpharmacologic option for OSA?

meds that may exacerbate OSA

-Benzodiazepines

-Opiates

-Antidepressants

Pharm tx options for OSA

-Solriamfetol (Sunosi)

-Pitolisant (Wakix)

-Modafinil (Provigil)

-Armodafinil (Nuvigil)

Sunosi (solriamfetol)

to improve wakefulness in adult pts with excessive daytime sleepiness associated with narcolepsy or OSA

Nuvigil (armodafinil)

to improve wakefulness in pts with excessive sleepiness associated with OSA

Provigil (modafinil)

to improve wakefulness in adult patients with OSA

Wakix (pitolisant)

-OFF LABEL for OSA

-obstructive sleep apnea related excessive daytime sleepiness

Pitolisant (Wakix) MOA

histamine-3 receptor antagonist/inverse agonist

CI Pitolisant (Wakix)

-once daily in the morning

-severe hepatic impairment

QT prolongation

What is the warning for Pitolisant (Wakix)?

AEs of Pitolisant (Wakix)

-insomnia

-N

-anxiety

-HA

Solriamfetol (Sunosi) MOA

dopamine and norepinephrine reuptake inhibitor

Solriamfetol (Sunosi)

-C-IV substance

-once daily in the morning

-contraindicated in concomitant use with MAO inhibitors or within 14 days of discontinuation

increased HR, BP, psych symptoms

What are the warnings for Solriamfetol (Sunosi)?

SE of Solriamfetol (Sunosi)

-insomnia

-HA

-N

-reduced appetite

-anxiety

Modafinil (Provigil) and Armodafinil (Nuvigil)

-Armodafinil is the R isomer of modafinil

-C IV substances

-once daily in the morning

stimulants

What is the MOA of Modafinil and Armodafinil?

use with caution in pre-existing cardiac, hepatic, renal, or psychiatric conditions; potential life-threatening rash (Stevens-Johnson syndrome)

What is the warning with Modafinil and Armodafinil?

AEs of modafinil and armodafinil

-HA

-anxiety

-N