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Rhinology and Facial Plastics
Published in Adnan Darr, Karan Jolly, Jameel Muzaffar, ENT Vivas, 2023
Adnan Darr, Karan Jolly, Shahzada Ahmed, Claire Hopkins
Background: Male > Female20% of population have mild OSA if BMI 25–30Collapse of airway secondary to Bernoulli principle: Flow of air through a narrow aperture must increase in velocity, resulting in a pressure dropTerminology: Apnoea: Cessation of flow for 10 secs with effort (pauses in breathing)Hypopnea: 50% flow reduction for 10 secs or reduction of sats by 4% with effort (shallow breathing)Obstructive sleep apnoea syndrome (OSAS) = OSA with symptomsUpper airway resistance syndrome (UARS) = Features of OSA with normal AHIIncreased risk of arrhythmias (sinus brady), CVA, IHD, hypertension, CCF (cor pulmonale), pulmonary artery hypertension, insulin resistance, GORD, intracranial hypertension
Extrapulmonary – Treatable traits
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
Unrecognised OSA in patients with asthma may lead to poor asthma control and a higher asthma score (ACQ, lower ACT) despite optimal therapy. Night-time awakenings, a common symptom of OSA, might lead to partly controlled or uncontrolled asthma. Increased anti-asthma therapy might not control asthma in patients suffering from comorbidity with OSA. However, treatment with continuous positive airway pressure (CPAP) clearly improves the ESS scale and the AHI score of patients with asthma and OSA, indicating that CPAP improves OSA in patients with comorbidity. Furthermore, CPAP improves asthmatics’ quality of life and general health (SF-36) on vital measures, but some studies have found that CPAP did not improve asthma control, whereas other studies have found that asthma control improved due to CPAP. Asthma might be out of control due to OSA, and inflammation due to OSA can push asthma from one inflammatory background, e.g. Th2 to another such as Th1, which is reducing the effectiveness of ICS.
Pulmonary Medicine
Published in James M. Rippe, Manual of Lifestyle Medicine, 2021
Nocturnal apneas are defined as a cessation of airflows during sleep. The term apnea specifically describes a cessation of airflow for ≥10 seconds. Hypopnea is a transient reduction in airflow that lasts ≥10 seconds and is associated with a ≥4% decrease in oxygen saturation. Frequent nocturnal apneas and hypopneas may result in hypoventilation. The diagnostic criteria for clinically significant obstructive sleep apnea is an average of greater than five apneas or hypopneas per hour of sleep. This is typically referred to as “Apnea-Hypopnea Index” (AHI). A sleep study must be performed to accurately measure AHI.
Comparison of STOP-Bang and STOP-Bag questionnaires in stratifying risk of obstructive sleep apnea
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Rida Waseem, Yasser Salama, Marcel Baltzan, Frances Chung
Patients were further invited to undergo lab-PSG. PSG recordings were scored by a technologist blinded to the STOP-Bang score. The recording included electroencephalography, bilateral electrooculograms, a chin electromyography, single-lead electrocardiography, thoracic and abdominal respiratory inductance plethysmography, airflow measured by thermocouple and nasal pressure cannula, finger pulse oximetry and bilateral limb movements. After PSG, patients were followed by a sleep specialist for further assessment. The polysomnographic records were scored by standard criteria. Apnea-hypopnea index (AHI) was used as the metric for diagnosis of obstructive sleep apnea. An AHI ≥ 5, AHI ≥ 15, and AHI ≥ 30 events per hour were classified as all OSA, moderate-to-severe OSA and severe OSA respectively.10
Continuous positive airway pressure affects mitochondrial function and exhaled PGC1-α levels in obstructive sleep apnea
Published in Experimental Lung Research, 2021
Ching-Chi Lin, Wei-Ji Chen, Yi-Kun Sun, Chung-Hsin Chiu, Mei-Wei Lin, I-Shiang Tzeng
According to the American Academy of Sleep Medicine (AASM) scoring rules, respiration and related events are manually scored to evaluate them.18 In short, apnea is defined when the amplitude of the airflow during the apnea period is less than 10% of the baseline amplitude during evaluation by an oronasal thermal sensor. The amplitude standard for apnea is an event that lasts more than 10 s and meets the amplitude standard for more than 9 s. Hypopnea is defined as a reduction of ≥50% in one of the following three respiratory parameters: airflow signal (detected by nasal pressure sensor), or abdominal or chest breathing signal (detected by induction plethysmography) over 10 s, and oxygen desaturation ≥3% or arousal from sleep.18 More than 90% of the duration of the event must meet the amplitude criterion. The AHI is defined as the mean of the sum of hypopnea and apnea per hour of sleep. The desaturation event frequency was defined as the average number of episodes of oxygen desaturation per hour of sleep. The arousal index was defined as the average number of arousals per hour of sleep, and sleep efficiency was calculated as a percentage of the total sleep time divided by the total bed time.18 Obstructive sleep apnea with an AHI score ≥5 and AHI score ≥ 20 was defined as moderate and severe OSA, respectively.
Canadian Sleep Society statement regarding Continuous Positive Airway Pressure coverage for patients with Obstructive Sleep Apnea and an Apnea Hypopnea Index between 5 and 15/hour
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Najib Ayas, Robert Skomro, Celyne Bastien, Jonatahan Charest, Thien Thanh Dang-Vu, Charles Samuels
It has become increasingly noted that the sole dependence on AHI, which represents the number of times the airway narrows or closes per hour of sleep to assess disease severity in OSA patients, is flawed.8 The AHI is merely one factor used to decide on therapy, and other factors such as symptoms (eg, sleepiness), comorbidities and other physiologic markers (eg, degree of hypoxemia) must be considered prior to deciding on therapy. The decision to treat OSA is nuanced and cannot be driven by a single metric such as AHI.9 There are certainly patients with an AHI considered in the “mild” range who are symptomatic, may have significant nocturnal desaturation or have significant comorbidities, which warrant CPAP therapy. Alternatively, there are patients with moderate disease who may not require therapy (eg, minimal desaturation, minimally symptomatic, few comorbidities).