Who should have a sleep study?! Michael Newnam MD! Medical Director Oklahoma Heart Sleep Care!
Learning Objectives! Understand who should be referred for a sleep evaluation! Understand what a sleep evaluation will entail! Understand what CPAP entails!
Who should be referred for a sleep evaluation?!
Prevalence of Sleep Apnea!
Overall Prevalence of Sleep Apnea! 26% of people between 30-70 years old have OSA! 80-90% of those with sleep apnea are UNDIAGNOSED! Estimated that about 25-30% of patients in a primary care practice have sleep apnea! Approximately 50% have sleep apnea in a cardiology practice!
Prevalence of OSA in associated comorbidities! Drug-Resistant Hypertension- 83%! Obesity- 77%! CHF- 76%! Atrial fibrillation- 49%! Diabetes- 48%! All Hypertension- 37%! Coronary artery disease- 30%! Stroke- 50-70%!
Signs and Symptoms of Sleep Apnea! Lack of Energy! Excessive sleepiness- Epworth score >9! Morning Headaches! Frequent nighttime awakenings and nocturia! Depression! Obesity!
Signs and Symptoms of Sleep Apnea! Snoring! Gasping or choking episodes! Witnessed pauses in breathing! Large neck size! GERD! Waking up unrefreshed! Comorbidities- HTN, Diabetes, AFIB, Stroke, CHF!
Sleep Evaluation!
Sleep Evaluation! Sleep consultation! Home testing vs. polysomnogram! Education about sleep disorders, treatment and patient buy in to treatment plan!
Overnight Polysomnogram! Indications- suspected OSA, CSA, suspected periodic limb movement disorder, parasomnias, suspected narcolepsy! Monitors sleep stages by EEG, monitors heart rhythm, pulse oximetry, air flow, respiratory effort and anterior tibialis emg! Split night study will treat sleep apnea, if present, in the second half of the night!
Advantages of Polysomnograms! Very accurate, comprehensive and reproducible- Gold Standard! Comprehensive evaluation of multiple disorders of sleep including both OSA and CSA, parasomnias, PLMD, nocturnal seizures! Can evaluate complicated patients such as those with heart failure, neuromuscular disorders, and pulmonary disease!
Disadvantages of Polysomnograms! Cost- more expensive initially than home testing! Less convenient- must spend a night in the sleep center!
Home Sleep Study! Suspected moderate to severe OSA without significant comorbid conditions such as systolic heart failure or moderate to severe COPD or neuromuscular disorders!
Home Testing is not appropriate for:! Evaluation of Insomnia! parasomnias! RLS/PLMD! Class III or IV Heart Failure! mod/severe COPD! patients on narcotics! Morbidly obese patients!
Understand the limitations of HST! HST s don t know when you are asleep! Underestimate severity of OSA! If an HST is borderline or normal but there is a high suspicion for OSA proceed with a polysomnogram!
Sleep Apnea Treatment! PAP therapy (CPAP/BiPAP)- Gold Standard! Custom oral appliance- acceptable treatment for mild to moderate OSA! Surgery- 2nd or 3rd line treatment except for children where adenotonsillectomy is often curative!
CPAP!
Myths about CPAP! It s loud! It s bulky! Can t sleep on your side! Mask covers your whole face! You ll get dependent on it! You can t travel with it!
CPAP mask is the KEY!
How people imagine a CPAP mask!
The reality!
What s new with CPAP?! Downloadable for efficacy and compliance! Modems built in for remote access to data and settings! Auto-titrating technology! Expiratory pressure relief!
What to expect with CPAP?! What you can feel! 4-6 week acclimation period! Snoring should stop (bed partner can now sleep)! Dreaming again! Waking up more refreshed! Not waking up to pee! Less daytime napping and more energy! Better focus and concentration!
What to expect with CPAP?! What you can t feel! Decreased Blood Pressure! Weight loss (improved metabolism)! Improved glycemic control! Improved cardiac function! Decreased arrythmias!
Oral Appliance!
Summary! OSA is very common and under recognized! It is highly associated with HTN, heart disease, DM2 and obesity! Snoring, tiredness and disrupted sleep are hallmark symptoms! Polysomnograms are the gold standard of testing for OSA but home testing is also useful in select patients!
Summary! CPAP is the gold standard of OSA treatment but oral appliances are an acceptable alternative in mild to moderate OSA! CPAP and mask technology has made many advancements- improving comfort and tolerability of CPAP therapy!
SEND ME YOUR TIRED! Michael Newnam MD! Michael.Newnam@oklahomaheart.com! 918-592-0999!