Shyamala  Pradeepan  Staff  Specialist-­‐  Department  of  Respiratory  and  Sleep  Medicine.  John  

Hunter  Hospital.  Conjoint  lecturer  –University  of  New  Castle.  

What  is  sleep  apnoea??  � Repetitive  upper  airway  narrowing  and  closure,  leading  to  increased  number  of  brain  arousals  and  oxygen  desaturations.  

Types  � Obstructive-­‐  Common  � Central-­‐  many  causes-­‐  Hear  failure,  drugs,  high  altitude,  brain  stem  lesions  and  ventilatory  instability  

Obstructive Sleep Apnea

l  Airway narrowing/obstruction l  Decreased air flow l  Increased effort l  Oxygen saturation swings

and hypoxia l  Increased BP and HR l  Disrupted sleep

Burden  of  the  disease  �  1.5  million  Australian  suffer  from  sleep  disoders.  �  9%  population.  �  20  million  Americans  have  sleep  apnoea.  �  1990  data-­‐  4%  men  and  2%  women  have  sleep  apnoea  syndrome.  

Effects of sleep apnoea

u  Due to increased arousals-Excessive day time somnolence.

u  Due to repetitive de oxygenation and re oxygenation-CVS morbidity and mortality

Symptoms of sleep apnoea

u  Snoring

u  Restless sleep

Irritability

Lack of concentration

Depression

SLEEP, Vol. 30, No. 3, 2007

Sleep  Heart  health  study Ø 1927  men  and  2495  women  ≥40  years  of  age  and  free  of  coronary  heart  disease  and  heart  failure  at  the  Ame  of  baseline  had  polysomnography.  

Ø   Followed  up  for  a  median  of  8.7  Yrs  Ø   ProspecAve  longitudinal  epidemiological  study.    Ø   obstrucAve  sleep  apnoea  was  a  significant  was  a  significant  predictor  of      incident  coronary  heart  Ø   Among  men  AHI  ≥30  were  68%  more  likely  to  develop  coronary  heart  disease  than  those  with  AHI  <5.    Ø   ObstrucAve  sleep  apnoea  predicted  incident  heart  failure  in  men(adjusted  hazard  raAo  1.13  [95%  confidence  interval  1.02  to  1.26]  per  10-­‐unit  increase  in  AHI).  Ø   Men  with  AHI  ≥30  were  58%  more  likely  to  develop  heart  failure  than  those  with  AHI  <5.    

Sleep heart health( survival probability)

Risk factors

l  Age l  Male sex l  Obesity l  Oro facial anatomical abnormality. l  Family history of sleep apnoea l  Drugs and alcohol.

Screening for sleep apnoea

l  OSA 50 l  Berlin Questionnaire l  Stop Bang l  Epworth Sleepiness

scale(ESS)

OSA50 screening questionnaire.

Chai-Coetzer C L et al. Thorax doi:10.1136/thx.2010.152801

Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.

Diagnosis  

•  Types  of  studies  •  Level  1-­‐  in  lab  Polysomnography  •  Level2  –Home  based  Polysomnography  •  Level  3-­‐  Limited  channel  home  sleep  study.  •  Level  4  –  Home  Oxymetry.  

History  

Treatment  � Weight  loss.  � CPAP-­‐Continuous  positive  airway  pressure.  � Mandibular  advancement  splints  � ENT  surgical  procedure  � Positional  devices  

�   264  healthy  men,  377  simple  snorers,  403  with  untreated  mild-­‐moderate  obstructive  sleep  apnoea-­‐hypopnoea,  235  with  untreated  severe  disease,  and  372  with  the  disease  and  treated  with  CPAP  were  included  in  the  analysis.  

�  Patients  with  untreated  severe  disease  -­‐fatal  cardiovascular  events  (1.06  per  100  person-­‐years)  -­‐non-­‐fatal  cardiovascular  events  (2.13  per  100  person-­‐years)    

�  Untreated  patients  with  mild-­‐moderate  disease  (0.55,  p=0.02  and  0.89,  p<0.0001),  

�  Simple  snorers  (0.34,  p=0.0006  and  0.58,  p<0.0001),    �  patients  treated  with  CPAP  (0.35,  p=0.0008  and  0.64,  p<0.0001),    �  healthy  participants  (0.3,  p=0.0012  and  0.45,  p<0.0001).    �  Multivariate  analysis,  adjusted  for  potential  confounders,  showed  that  

untreated  severe  obstructive  sleep  apnoea-­‐hypopnoea  significantly  increased  the  risk  of  fatal  (odds  ratio  2.87,  95%CI  1.17-­‐7.51)  and  non-­‐fatal  (3.17,  1.12-­‐7.51)  cardiovascular  events  compared  with  healthy  participants.  

SLEEP, Vol. 30, No. 3, 2007

Effects  of  CPAP  on  ESS  

Quality  of  life  

Problems  with  CPAP  � Costly  � Poor  uptake  � Poor  adherence  

Mandibular  advancement  splints  

ENT  surgical  opAons  �  28  Yr  old  male,  BMI  30,  had  significant  tonsillar  enlargement.  Was  found  to  have  large  adenoids.  

� Had  surgery  to  remove  both  with  some  weight  loss  options.  

Inadequate  control  of  symptoms  

•  Modafinil-­‐  as  an  adjunct  therapy.  

Summary  

•  Sleep  apnoea  is  a  significant  problem  in  our  populaAon.  

•  RecogniAon,  invesAgaAon  ,  treatment  and  follow  up  is  rewarding  to  the  paAent  and  to  the  community    

•  More  than  anything  else….  gives  lot  of  saAsfacAon  to  me.  

Thank  you  

•  Shyamala  Pradeepan  contact  details  •  Email  shyamala.pradeepan@hnehealth.nsw.gov.au  

•  Numbers    •  4942  2457-­‐  Private  •  49223150-­‐Public