obstructive sleep apnea

what is OSA?

• episodes of complete or partial collapse of upper airway to decrease o2 sat or sleep arousal

• airway is blocked and air doesn’t move through

RFs

• obesity (>=30)

• age higher than 40

• DM

• male of post menopause women

• HTN

• alc/sedative use

associated disorders

cardio, neuro, endicrine, cancer

anatomical abnormaltities that may cause it

• nasopharynx - deviated septum, enlarged tonsils, uvula, or soft palate

• oropharynx - EtOH, benzos, baclofen

• larynx/trachea - obesity or fluid shifting (hf)

what happens when lung filling is decreasd?

alveolar hypoventilation —> poor gas exchange and hypoxia + hypercapnia

daytime s/sx

• dry mouth when woken

• slepiness

• difficulty concentrating

• waking headache

• fatigue and mood changes

nightime s/sx

• snoring

• apneic episode

• frequent awakeneings

• body spasms

• nocturia

what iss used to assess if OSA is moderate or severe

• we use STOP-BANG

• high risk is greater than or equal to 5

• low risk is less than 3

CVD complications

• HTN

• afib

• stroke

• pulmonary htn

• hf

• cad

how to manage it?

• primary airway pressure therapy

• obesity managementt

• trizepatide (zepbound)

trizepatide (zepbound)

• class: GLP1A

• INCREASES INSULIN SECRETION and decreases glucagon

• T2DM —> mounjaro

• this one though is used for OSA an chronic weight management

tirzepatide dosing

• 2.5 mg subq once a week

• goal maintenance is 10-15 mg wkly - max = 15 mg wkly

zepbound AE

• thyroid cancer

• pancreatitis

• GI sx which can be modified and managed - most common when starting or increasing dose

• diarrhea

• hypoglycemia

zepbound modification for AE

if increasing dose, return to the previous dose and extend dose to 2-4 wks

zepbound N/V, diarrhea, constipation management

• eat crackers, apples, mint, ginger 30 mins after dose

• hydrate!!!

• no sports drinks or high fiber or dairy if diarrhea

• constipation - enough fiber, increase physical activity and hydrate