Obstructive Sleep Apnea

What is obstructive sleep apnea?

OSA is a condition that is characterized by episodes of complete or partial upper airway obstruction during sleep, often resulting in gas exchange abnormalities and arousals.

What conditions increase the risk for OSA?

● Stroke

● Obesity

● Type 2 diabetes

● Atrial fibrillation

● Congestive heart failure

● Pulmonary hypertension

● Treatment-refractory hypertension

● High-risk driving populations (truck drivers)

What are symptoms of OSA?

● Loud snoring

● Morning headaches

● High blood pressure

● Excessive daytime sleepiness

● Trouble focusing during the day

● Waking during the night and gasping or choking

● Observed episodes of stopped breathing during sleep

● Awakening in the morning with a dry mouth or sore throat

● Mood changes, such as depression or being easily upset

What are some consequences of OSA?

● Hypoxemia - Below-normal level of oxygen in the blood

● Hypercapnia - Abnormally elevated carbon dioxide (CO2) levels in the blood

● Sleep fragmentation

● Increased sympathetic activity

● Marked swings in intrathoracic pressure

What does OSA increase the risk of?

● MI

● HTN

● Stroke

● Motor vehicle accidents

● Decreased daytime alertness

What are the three main management approaches for OSA?

● Mechanical

● Behavioral

● Surgical

What are the three types of positive airway pressure (PAP)?

● Continuous (CPAP)

● Bilevel (BiPAP)

● Autotitrating (APAP)

What is the preferred type of positive airway pressure (PAP)?

Continuous (CPAP)

CPAP Considerations

● Set at one single pressure

● Primarily used to treat OSA

● Least expensive of the PAP options

BiPAP Considerations

● Programmed with two distinct pressures (one for inhaling and one for exhaling; easier to breathe out)

● Used to treat different subsets of OSA or COPD

● More expensive than CPAP

APAP Considerations

● Adjusts pressure based on patient's breathing (easier to get used to)

● Used for more complex sleep apnea conditions or when CPAP is intolerable

● More expensive than CPAP

What are OSA behavioral management strategies?

● Weight loss to BMI ≤25 kg/m2

● Positional therapy - Avoid supine position (lying on back)

● Avoidance of alcohol and sedatives before bedtime

● Custom oral appliances (OA) and mandibular repositioning appliances (MRA)

True or False: There are effective medications specific for OSA.

False. There is no widely effective pharmacotherapy specific for OSA.

What medications can be used to treat residual excessive daytime sleepiness in OSA patients who have sleepiness despite effective PAP treatment and who are lacking any other identifiable cause for their sleepiness?

● Modafinil

● Armodafinil

● Solriamfeto

They should be used in addition to PAP therapy.