Are you Screening? Your Obese Patients For Obstructive Sleep Apnea?

Your Patients May Have A Serious Sleep Disorder

 

What is Obstructive Sleep Apnea?

OSA is a common condition, in which the upper airway repeatedly collapses during sleep. If left untreated, this condition has been associated with an increased risk of high blood pressure, heart attack, depression, uncontrolled diabetes, and stroke.

 

What Causes the Airway to Collapse During Sleep?

  • Extra tissue in the back of the airway such as large tonsils
  • A decrease in the tone of the muscles holding the airway open
  • The tongue falling back and closing off the airway

 

Some of the Possible Signs and Symptoms of OSA:

  • Snoring, interrupted by pauses in breathing
  • Gasping or choking during sleep
  • Restless sleep
  • Excessive sleepiness or fatigue during the day
  • Large neck size (greater than 17" in men; greater than 16" in women)
  • Crowded airway
  • High blood pressure
  • Obesity

 

 

Screening For OSA Before Bariatric Surgery

In an article on best practices for anesthesia and pain management after weight loss surgery, the

authors identified that greater than 50% of patients undergoing surgery had OSA

 

The American Society of American society pre-operative guidelines indicates the need for screening patient’s pre-surgery for OSA.

 

Questions to Help Assess a Patient's Risk for OSA:

  1. Do you snore?
  2. Do you ever stop breathing during sleep?
  3. Has anyone identified that snort or pause your breathing while sleeping?
  4. Do you feel sleepy during the day?
  5. Do you have a history of high blood pressure?

 

If a patient answers yes to two or more of the "at risk" questions, follow-up with more detailed and objective testing performed in a sleep center or sleep lab.

 

 

 

Objective At-Home Pre-Screening and In-Lab Screening For OSA

The Respironics' RUSleeping RTS is an easy-to-use, easy-to-read at-home screening device. It provides continuous apneic/hypopneic event scoring which can help you tell if a patient is a likely candidate for undergoing an immediate sleep study at a sleep lab. The sleep study (known as a polysomnogram) will diagnose whether the patient has OSA and indicate the best treatment for it.

 

 

The Benefits of Treating OSA

Clinical studies have shown that treatment of OSA may:

  • lower blood pressure
  • reduce daytime sleepiness and increase daytime energy
  • reduce the potential risk for heart attack, stroke, and heart disease

 

Treatment of OSA

Positive Airway Pressure (PAP) is the gold standard treatment for OSA. Continuous Positive Airway Pressure (CPAP) is the most commonly used PAP therapy. CPAP therapy provides a continuous flow of air pressure through the nose to prevent airway collapse, allowing the patient to breathe freely while sleeping. CPAP therapy is noninvasive and can alleviate the symptoms of OSA when used as prescribed.

 

Prevalence Of OSA

  • As many as 5 to 10 percents of adults in the U.S. have
  • 9 percent of men and 4 percent of women have an Apnea Hypopnea Index (AHI) greater than
  • 15 (moderate OSA).

 

  • Prevalence of OSA is higher in the following ethnic groups
    • Asian
    • Hispanic Women
    • African-American

 

  • 85 to 90 percent of people within the U.S. who may have OSA have not been identified.

 

 

Many of the 20 million people in the U.S Suspected of having OSA may have an increased risk for other serious health conditions.

Young, T., et al., NEJM 1993;328:1230-12345

Young, T., et al., AJRCCM 2002;165:1217-1239

O’Connor, et al., Sleep 2003;26(1):74-79

Hiestand, D.M., et al.,  Chest 2006;130:780-786

 

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