Sleep Apnea and OHS

Sleep Apnea

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

Obstructive, Central, Mixed

Types of sleep apnea

• __________ sleep apnea: most common, caused by upper airway collapse

• _______ sleep apnea: Reduced respiratory effort d/t brainstem dysfunction

• ______ sleep apnea: combination of OSA and CSA

middle, >, 30, neck, abnormalities, sedative, 60

Sleep Apnea

• Common in _______-aged and older adults

• Men _ Women (until post-menopause)

• Risk Factors

  • Obesity (BMI >__)

  • Large ____ circumference (>17” in men, >16” in women)

  • Craniofacial ______________

  • Smoking, alcohol use, ________ medications

  • Family history

  • Age >__ years

tone, decreases, cessation, sympathetic, fatigue, hypertension

Sleep Apnea Pathophysiology

• During sleep, muscle ____ of the upper airway _________ → airway collapse → transient _________ of breathing

• Leads to

  • Hypoxia and Hypercapnia → increased ___________ activity

  • Arousal from sleep → fragmented sleep and daytime _________

  • Increased risk of _____________, cardiovascular disease, metabolic syndrome

snoring, choking, awakenings, sleepiness, headaches, irritability

Sleep Apnea Clinical Presentation

• Nighttime Symptoms

  • Loud ________

  • Witnessed apneas, gasping/________ episodes

  • Frequent ____________

• Daytime Symptoms

  • Excessive daytime __________ (EDS)

  • Morning __________

  • difficulty concentrating, memory issues

  • ____________, mood changes

STOP-BANG, Epworth, polysomnography, home

Sleep Apnea Diagnosis

• Screening Tools

  • ____-_____ Questionnaire: identifies high-risk individuals

  • ________ Sleepiness Scale (ESS): Assesses daytime sleepiness

• Definitive Diagnosis

  • _______________ (PSG) (Gold Standard): measures sleep apnea-hypopnea index (AHI)

  • ____ Sleep Apnea Test: alternative for moderate-to-severe OSA cases

weight loss, sedatives, positional, positive, mandibular, surgery

Sleep Apnea Treatment and Management

• Lifestyle Modifications

  • ______ ____

  • Avoid alcohol, __________

  • __________ therapy (avoid supine position)

• First line treatment

  • Continuous ________ airway pressure: gold standard for moderate-severe OSA

• Alternative Therapies

  • __________ advancement devices (MADs) for mild-moderate cases

  • Upper airway ________ for refractory cases

• Treatment of Central Sleep Apnea

  • Adaptive servo-ventilation, oxygen therapy

hypertension, stroke, insulin, dementia

Sleep Apnea Complications

• Cardiovascular Risks

  • ____________

  • Atrial Fibrillation

  • Myocardial infarction, ______

• Metabolic Effects

  • _______ resistance, type 2 diabetes

• Neurocognitive Impairment

  • Increased risk of _________, depression

• Increased accident risk

  • higher likelihood of motor vehicle accidents

Obesity Hypoventilation Syndrome (OHS)

a disorder characterized by chronic daytime hypoventilation (PaCO2 >45 mmHg) in obese individuals (BMI > 30 kg/m²) without an alternative cause of hypoventilation

90

What percentage of individuals with OHS also have obstructive sleep apnea?

50, male, 50, 17, hypoxia

OHS Major Risk Factors

• Obesity (BMI > 30 kg/m², especially >__ kg/m²)

• ____ sex

• Age > __ years

• Neck circumference > __ inches

• Chronic ________-related conditions

restriction, central, hypercapnia, leptin

OHS Pathophysiology

Obesity leads to:

• Increased work of breathing d/t chest wall __________

• Impaired _______ respiratory drive (blunted response to CO2)

• Nocturnal hypoventilation → daytime ___________

• Increased _______ resistance, impairing ventilatory drive

daytime, headaches, cognitive, snoring, restless, hypoxia

OHS Clinical Presentation

• Daytime Symptoms

  • Excessive ________ sleepiness

  • Morning _________ (d/t CO2 retention overnight)

  • Fatigue, depression, _________ impairment

• Nocturnal Symptoms

  • Loud _______, witnessed apneas

  • Choking/gasping episodes

  • ________ sleep

• Physical Exam Findings

  • Obesity

  • Signs of chronic _______: cyanosis, polycythemia, lower extremity edema

obese, 45, 70, hypoxia, bicarbonate, restrictive, right

OHS Diagnosis

• Clinical suspicion in ______ patients with hypercapnia and hypoxia

• Key Diagnostic Tests

  • ABG: PaCO2 > __ mmHg + PaO2 < __ mmHg

  • Polysomnography: Evaluates OSA, nocturnal _______

  • Serum ___________ (>27 mEq/L): suggests chronic CO2 retention

  • PFTs: _________ pattern

  • CXR & Echocardiography: To assess for _____ heart failure (cor pulmonale)

positive, CPAP, BiPAP, diet, alcohol, sedatives, diuretics

OHS Treatment and Management

• First Line Therapy:

  • ________ Airway Pressure (PAP) Therapy:

    • ____ (if OSA present)

    • _____ (if persistent hypercapnia despite CPAP)

• Lifestyle Modifications

  • Weight loss

  • Physical Activity and _____ changes

  • Smoking/_______ cessation

  • Avoid use of _________

• Medical Therapy for Symptom Management

  • O2 therapy if hypoxemia persists despite PAP therapy

  • _________ for fluid overload in cor pulmonale

early, hypertension, failure, stroke

OHS

• Prognosis: Improved with_____ PAP therapy and weight loss

• Potential Complications

  • Pulmonary ___________ → right heart failure (cor pulmonale)

  • Severe hypoxemia and hypercapnic respiratory _______

  • Increased risk of cardiovascular disease (_____, MI)