Sleep Related Breathing Disorders 2012 April Part One (1)
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Sleep related breathingdisorders
Mahmoud Ibrahim MahmoudProfessor of Chest Diseases
Faculty of Medicine
Alexandria University
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Age- and
sex-specific
prevalence
rates of the
AHI based
on polysomnog
raphic
sample of
352 males
and 250
femalesfrom
Wisconsin
USA
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Conclusion: 93% of women and 82% of men with
moderate to severe sleep apnea (AHI > 15) “undiagnosed”
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Estimated clinical values of
specific symptoms in the
diagnosis of OSAHSChervin RD,
2000
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Estimated clinical values of
specific symptoms in the
diagnosis of OSAHSChervin RD,
2000
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Clinical Features: Overbite
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Clinical Features: Retronagthia
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Mallampati Airway Classification
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Clinical Features: Body Fat Distribution
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Clinical Features: Body Fat Distribution
Apple shape is riskier than Pear shape
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Hypersomnolence
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Hypersomnolence
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Obese Hypersomnolent
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Obesity
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Pillar G, Shehadeh N. The chicken or the egg ?
Diabetes Care 2008;31 Suppl 2:S303-9.
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Theories linking OSA and the metabolic
syndrome
Bonsignore MR, Eckel J. Eur Respir Rev 2009; 18(12):113
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Obesity, retrognathia, mouth
breathing, hypersomnolent
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Snoring
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Snoring reported by bed partner
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Witnessed
apnea, chocking
and restlesssleep
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Tregear S, et al. J Clin Sleep Med 2009;5(6):573
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Tregear S, et al. J Clin Sleep Med 2009;5(6):573
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•Annual recertification is required for an individual with untreated OSA and an
AHI ≤ 20, who is not sleepy or who is effectively treated;
•Dis ualification for drivers who re ort slee iness while drivin , have
Tregear S, et al. J Clin Sleep Med 2009;5(6):573
experienced a crash with falling asleep, or have an AHI > 20 until CPAP is
instituted, or have had surgery for OSA but not had repeat PSG, or have a BMI
> 33 kg/m2 (until evaluated).
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"The Posthumous Papers of the
Pickwick Club” Charles Dickens'
“Damn That Boy” Said the
old men, “He’s gone tosleep again”.
Joe, "wonderfully fat boy ……… with his eyes closed“
Joe was edematous, and a very loud snorer
“Very Extraordinary boy”,said Mr. Pickwick. Does he
always sleep in this way?
f
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"The Posthumous Papers of the
Pickwick Club” Charles Dickens'
“Sleep” said the old
gentleman, “he’s alwaysasleep”. “Goes on errands
Joe, "wonderfully fat boy ……… with his eyes closed“
Joe was edematous, and a very loud snorer
waits at table”
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Estimated clinical values of specific symptoms in
the diagnosis of OSAHS
Chervin RD,2000
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Retrognathia
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Kissing tonsils, crowded upper
airway
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Obstructive apnea
Coleman J. Sleep studies. Otolaryngol Clin North
Am 1999;32(2):195
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Central Apnea
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Central Apnea
Coleman J. Sleep studies. Otolaryngol Clin North Am 1999;32(2):195
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Pathophysiology Obstruction
Increased respiratory effort Fragmentedsleep
Intermittent hypoxemia