General Outline. General Outline. Pathogenesis of Metabolic Dysfunction in Sleep Apnea: The Role of Sleep Fragmentation and Intermittent Hypoxemia
|
|
- Marilynn Sherman
- 5 years ago
- Views:
Transcription
1 Pathogenesis of Metabolic in Sleep Apnea: The Role of Sleep Fragmentation and Intermittent Hypoxemia Naresh M. Punjabi, MD, PhD Associate Professor of Medicine and Epidemiology Johns Hopkins University, School of Medicine Baltimore, Maryland (USA) General Outline Metabolic and Sleep Apnea Background: Sleep Apnea and Metabolic Effects of Intermittent Hypoxia on Glucose Effects of Sleep Fragmentation on Glucose General Outline Disease Definition: Metabolic Diabetes and Glucose Tolerance Metabolic and Sleep Apnea Diabetes Mellitus Diabetes Mellitus Background: Sleep Apnea and Metabolic 126 mg/dl 1 mg/dl Impaired Fasting Glucose 7. mmol/l 2 mg/dl 6.1 mmol/l 14 mg/dl Impaired Glucose Tolerance 11.1 mmol/l 7.8 mmol/l Effects of Intermittent Hypoxia on Glucose Effects of Sleep Fragmentation on Glucose Normal Fasting Plasma Glucose Normal 2-hour post-glucose on OGTT Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 24. Prevalence of Diabetes in the US Diagnosed and Undiagnosed Diabetes (US) Estimated Cases Among Adults, 1997 Percent of Population Percent Number U.S Year Number with diabetes (millions) Millions of Cases Diagnosed 5.4 Undiagnosed Center for Disease Control (Division of Diabetes, 23) Harris, et al. Diabetes Care. 1998;21:
2 Diabetes in the World: 2 (in millions) Diabetes in the World: 21 (in millions) India 17.7 China India 3.3 China 8.4 USA USA 8.9 Indonesia Japan Indonesia Japan Wild S et al. Diabetes Care. 24; 27(5): Wild S et al. Diabetes Care. 24; 27(5): Diabetes and Obesity: Two Epidemics in Tandem General Outline Metabolic and Sleep Apnea Background: Sleep Apnea and Metabolic Effects of Intermittent Hypoxia on Glucose Effects of Sleep Fragmentation on Glucose Definition of the Disorder: Sleep Apnea Terminology: Obstructive sleep apnea (OSA) Sleep apnea (SA) Sleep apnea-hypopnea syndrome (SAS) Sleep-disordered breathing (SDB) Pathophysiology of Sleep Apnea snores Normal Partial Collapse Complete Collapse Hypopneas Apneas 2
3 Tracing of Obstructive Apneas Definition of the Disorder Disease Defining Metric: Apnea-Hypopnea Index (AHI) = Number of apneas and hypopneas per hour of sleep Respiratory Disturbance Index (RDI) Normal : AHI or RDI < 5 events / hour General Outline Metabolic and Sleep Apnea Background: Sleep Apnea and Metabolic Effects of Intermittent Hypoxia on Glucose Effects of Sleep Fragmentation on Glucose Sleep Apnea and Glucose Tolerance Study Design Community-based cohort study 15 healthy but overweight men No history of diabetes (normal glucose) No cardiovascular or pulmonary disease Normal stress test (Bruce Protocol) Sleep Apnea and Glucose Tolerance Sleep Apnea and Insulin Resistance Glucose Levels (mg/dl) Fasting 2-hour HOMA HOMA = Go x Io AHI < 5 AHI: 5-19 AHI: 2-39 AHI > 4 AHI < 5 AHI: 5-19 AHI: 2-39 AHI > 4 Sleep Apnea Severity Sleep Apnea Severity Punjabi et al. AJRCCM. 22 Punjabi et al. AJRCCM. 22 3
4 The Sleep Heart Health Study: Field Sites Minneapolis (185) South Dakota (21) Sacramento (51) Framingham (1) New York (76) Pittsburgh (398) Hagerstown (1184) Phoenix (21) Tucson (911) Oklahoma (2) Ip et al. AJRCCM. 22 Are there population data? National Heart Lung and Blood Institute (NHLBI). The Sleep Heart Health Study: Manuals of Operation. Accessed July 18, 27. Sleep Apnea and Glucose Sleep Apnea and Glucose Percentage Impaired Diabetic Percentage Impaired Diabetic < RDI (events/h) < RDI (events/h) Punjabi et al. Am J Epidemiol. 24;16:521. Punjabi et al. Am J Epidemiol. 24;16:521. Sleep Apnea and Glucose Predictor Respiratory disturbance index (no. of events/hour) < Average oxyhemoglobin saturation during sleep (%) < Punjabi et al. Am J Epidemiol. 24;16:521. Fasting Glucose Level (n = 2,656) Odds Ratio 95% CI Sleep Apnea and HOMA levels HOMA = Go x Io HOMA Index (Units) P =.8 P =.2 < RDI Is insulin resistance enough for diabetes? Adjusted for age, gender, smoking status, BMI, waist circumference, and sleep duration HOMA = homeostasis Punjabi et al. Am J Epidemiol. 24;16:521. model assessment 4
5 Sleep Apnea and Metabolic : HOMA and Oxygen Saturation HOMA = Go x Io HOMA Index (Units) ** Punjabi et al. Am J Epidemiol. 24;16:521. Worsening Hypoxemia * I II III IV Quartiles of Average Saturation During Sleep Quartiles I : < 93.32% II : 93.32% % III : 94.57% % IV : > 95.72% *P =.4 **P =.1 (for comparisons with the first quartile) Glucose Intolerance and Diabetes: Two Defects Insulin Secretion Genes Environment Glucose Intolerance Type 2 Diabetes Insulin Resistance Acute Insulin Response to IV Glucose: Normal Subjects 1 Glucose Acute Insulin Response to IV Glucose: Normal and Type 2 Diabetic Subjects 1 Glucose 1 Glucose Plasma Insulin (µu/ml) Plasma Insulin (µu/ml) Time (min) Time 3 (min) Normal 3 Time 3 (min) 3 Type 2 Diabetes Adapted from Robertson & Porte. J Clin Invest. 1973;52:87-876, with permission. Adapted from Robertson & Porte. J Clin Invest. 1973;52:87-876, with permission. Insulin Secretion: Modulation by Insulin Sensitivity Acute Insulin Response to Glucose (pm) Insulin Sensitivity Index ( 1 5 min 1 /pm) Adapted from Kahn, et al. Diabetes. 1993;42: , with permission Males Females 95th 5th 5th Insulin Sensitivity and Insulin Secretion: Relationship in Type 2 Diabetes and Groups at Risk Acute Insulin Response to Glucose (pm) IGT PCO women Former GDMs Older subjects Type 2 diabetes Insulin Sensitivity Index ( 1 Relatives, type 2 diabetes 5 min 1 /pm) 75th 5th 25th 5th 5
6 Changes in acute insulin response (AIR) relative to changes in Insulin Sensitivity Insulin Sensitivity and Insulin Secretion in Sleep Apnea subjects (no medical conditions) 4 AIR (µu/ml) NGT IGT DM NGT NGT NGT Men 71 and Women 47 Predominantly white (86.4%) Mean age was 45.7 years (range: 23 73) Insulin Sensitivity Weyer C et al. J Clin Invest 1999;14: Mean BMI was 29.4 kg/m 2 (range: ). Punjabi et al. ARJCCM. 28; In press Insulin and Glucose Profile: IVGTT Insulin and Glucose Profile: IVGTT 3 25 Normal Subject (AHI = 1.2/hr) Sleep Apnea Subject (AHI = 72/hr) 8 7 Glucose (mg /dl) Glucose Insulin Insulin (µu/ml) Glucose (mg /dl) Glucose Insulin Insulin (µu/ml) Time (minutes) Time (minutes) Insulin Sensitivity and Insulin Secretion Effects of Sleep Apnea Insulin Sensitivity and Oxygen Desaturation 1 8 S I ([mu/l] -1 [min] -1 ) Test for linear trend across groups: p <.7 < > 3. AIRG ([mu/l][min]) < > 3. S I ([mu/l] -1 [min] -1 ) Apnea-hypopnea index (events/hr) Apnea-hypopnea index (events/hr) Average SaO 2 (%) 6
7 General Outline Metabolic and Sleep Apnea Background: Sleep Apnea and Metabolic Effects of Intermittent Hypoxia on Glucose Effects of Sleep Fragmentation on Glucose General Outline Metabolic and Sleep Apnea Background: Sleep Apnea and Metabolic Effects of Intermittent Hypoxia on Glucose Effects of Sleep Fragmentation on Glucose Pathogenesis of Metabolic Animal Experiment Repetitive Intermittent Hypoxia Sleep Apnea 21 Day 1 Day 5 Hypoxia? Arousals Fi O 2 (%) Glucose Intolerance Insulin Resistance Type 2 Diabetes Light Cycle Fasting Blood Glucose/Insulin Dark Cycle 6 hrs Fasting Blood Glucose/Insulin IPGTT Human Experimental Approach Two distinct experimental paradigms Effects of acute intermittent hypoxia in normal subjects 5-hour exposure during wakefulness Intermittent hypoxia increases insulin levels Intermittent hypoxia worsens insulin sensitivity Effects of sleep fragmentation in normal subjects Two nights of sleep disruption with auditory and mechanical stimuli (~6/hr) 7
8 Human Experimental Approach Two distinct experimental paradigms Effects of acute intermittent hypoxia in normal subjects 5-hour exposure during wakefulness Acute Intermittent Hypoxia in Normal Subjects 21% Effects of sleep fragmentation in normal subjects Two nights of sleep disruption with auditory and mechanical stimuli (~6/hr) 5% Acute Intermittent Hypoxia in Normal Subjects Start Protocol (~8:3 am) 1 Start IVGTT (~1:3 pm) End Protocol (~4:3 pm) Study Protocol Hypoxia day 5% O 2 continued until O 2 saturation reaches 85% 21% O 2 continued until O 2 saturation reaches baseline level (95-97%) SaO 2 (%) FiO 2 (%) minutes Normoxia day 21% O 2 delivered throughout the 8-hour period Manual two-way valve used to alternate from one room air tank to another SaO 2 (%) EtCO 2 (%) EKG during one episode of desaturation S I ([mu/l] -1 [min] -1 ) Insulin Sensitivity and Insulin Secretion Effects of Hypoxia in Normal Subjects Normoxia p <.179 Intermittent Hypoxia AIRG ([mu/l][min]) Normoxia p =.85 Intermittent Hypoxia Intermittent Hypoxia is associated with decrease in insulin sensitivity but without an compensatory increase in insulin secretion Human Experimental Approach Two distinct experimental paradigms Effects of acute intermittent hypoxia in normal subjects 5-hour exposure during wakefulness Effects of sleep fragmentation in normal subjects Two nights of sleep disruption with auditory and mechanical stimuli (~6/hr) 8
9 Sleep Fragmentation in Normal Subjects Sleep Fragmentation in Normal Subjects Baseline IVGTT Follow-up IVGTT Sleep Fragmentation Day 1 Habituation Night Day 2 Fragmentation Night Day 3 Fragmentation Night Day 4 N = 11 Baseline IVGTT Control Group Follow-up IVGTT Day 1 Habituation Night Day 2 Normal Night Day 3 Normal Night Day 4 N = 7 Sleep Fragmentation in Normal Subjects Insulin Sensitivity with Fragmented Sleep 7. Pre-Intervention Post-Intervention Insulin sensitivity (mu/l -1 min -1 ) p <.1. Fragmented Sleep Intervention Non-Fragmented Sleep Insulin Secretion with Fragmented Sleep Tasali E. et.al. PNAS 28;15: p = NS AIRG (mu/l -1 min -1 ) p = NS. Fragmented Sleep Intervention Non-Fragmented Sleep 9
10 Mechanistic Links: Sleep Apnea and Metabolic Sleep Fragmentation Is CPAP is Effective in Reversing the Metabolic Disturbance Sleep Apnea Sympathetic Activation HPA dysregulation Systemic Inflammation Insulin Resistance Type 2 Diabetes Intermittent Hypoxemia Susceptibility Genes β-cell Effects of CPAP on Insulin Sensitivity Insulin Sensitivity Index (ISI) assessed with the hyperinsulinemic clamp at baseline, after 2 d, and after 3 m of CPAP therapy Baseline After 2 days CPAP therapy Improvement compared to baseline After 3 months CPAP therapy Improvement compared to baseline ISI (Whole group, n = 4) (After 3 months, n = 31) (µmol/kg min) P = P =.1 Harsch et al. Am J Respir Crit Care Med. 24;169:156. A man in love with his CPAP won t leave home without it Conclusions and Summary Independent of obesity, sleep apnea is associated with insulin resistance, glucose intolerance, and type 2 diabetes Intermittent hypoxemia and recurrent arousals may mediate the metabolic abnormalities in sleep apnea CPAP appears to mitigate the metabolic disturbance? (more research is still needed) 1
Sleep Apnea: Vascular and Metabolic Complications
Sleep Apnea: Vascular and Metabolic Complications Vahid Mohsenin, M.D. Professor of Medicine Yale University School of Medicine Director, Yale Center for Sleep Medicine Definitions Apnea: Cessation of
More informationLipolysis and Metabolic Impairment in Community-Based Sample with Obstructive Sleep Apnea
Lipolysis and Metabolic Impairment in Community-Based Sample with Obstructive Sleep Apnea R. Nisha Aurora, MD Assistant Professor of Medicine Division of Pulmonary & Critical Care Medicine Group 4 Obstructive
More informationDiabetes & Obstructive Sleep Apnoea risk. Jaynie Pateraki MSc RGN
Diabetes & Obstructive Sleep Apnoea risk Jaynie Pateraki MSc RGN Non-REM - REM - Both - Unrelated - Common disorders of Sleep Sleep Walking Night terrors Periodic leg movements Sleep automatism Nightmares
More informationHeart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows
Question Heart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows 1 ResMed 2012 07 2 ResMed 2012 07 Open Airway 3 ResMed 2012 07 Flow Limitation Snore 4 ResMed 2012 07 Apnoea 5 ResMed 2012
More informationCircadian Variations Influential in Circulatory & Vascular Phenomena
SLEEP & STROKE 1 Circadian Variations Influential in Circulatory & Vascular Phenomena Endocrine secretions Thermo regulations Renal Functions Respiratory control Heart Rhythm Hematologic parameters Immune
More informationPolycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners. M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017
Polycystic Ovarian Syndrome and Obstructive Sleep Apnea: Poor Bedpartners M. Begay, MD UNM Sleep Medicine Fellow 01/31/2017 Case of S.R. S.R. is a 39 year old female referred for suspected obstructive
More informationOSA and Hypertension Scope of the Problem
OSA and Hypertension Scope of the Problem Dr Ahmad Izuanuddin Ismail Senior Lecturer & Respiratory Physician Faculty of Medicine, Universiti Teknologi MARA izuanuddin@salam.uitm.edu.my http://respiratoryuitm.com
More informationThe most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome
The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome Natsios Georgios University Hospital of Larissa, Greece Definitions Obstructive Sleep Apnea (OSA)
More informationSleep and the Heart. Physiologic Changes in Cardiovascular Parameters during Sleep
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationSleep and the Heart. Rami N. Khayat, MD
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationIs CPAP helpful in severe Asthma?
Is CPAP helpful in severe Asthma? P RAP UN KI TTIVORAVITKUL, M.D. PULMONARY AND CRITICAL CARE DIVISION DEPARTMENT OF MEDICINE, PHRAMONGKUTKLAO HOSPITAL Outlines o Obstructive sleep apnea syndrome (OSAS)
More informationSleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease
1 Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease Rami Khayat, MD Professor of Internal Medicine Director, OSU Sleep Heart Program Medical Director, Department of
More informationCo-Morbidities Associated with OSA
Co-Morbidities Associated with OSA Dr VK Vijayan MD (Med), PhD (Med), DSc, FCCP, FICC, FAPSR, FAMS Advisor to Director General, ICMR Bhopal Memorial Hospital and Research Centre & National Institute for
More informationMario Kinsella MD FAASM 10/5/2016
Mario Kinsella MD FAASM 10/5/2016 Repetitive episodes of apnea or reduced airflow Due to upper airway obstruction during sleep Patients often obese Often have hypertension or DM 1 Obstructive apneas, hypopneas,
More informationPVDOMICS. Sleep Core. Cleveland Clinic Cleveland, Ohio
PVDOMICS Sleep Core Rawan Nawabit, Research Coordinator and Polysomnologist Joan Aylor, Research Coordinator Dr. Reena Mehra, Co-Investigator, Sleep Core Lead Cleveland Clinic Cleveland, Ohio 1 Obstructive
More informationYear in Review. Outline of Lecture
Year in Review Allan I. Pack, M.B.Ch.B., Ph.D. John Miclot Professor of Medicine Director, Center for Sleep and Circadian Neurobiology University of Pennsylvania Perelman School of Medicine Philadelphia,
More informationEdoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica
Convegno Pneumologia 2016 Milano 16-18 giugno 2016 Centro Congressi Palazzo delle Stelline Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica Central apnea 10 second
More informationHigh Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah
High Flow Nasal Cannula in Children During Sleep Brian McGinley M.D. Associate Professor of Pediatrics University of Utah Disclosures Conflicts of Interest: None Will discuss a product that is commercially
More informationSleep Apnea in Women: How Is It Different?
Sleep Apnea in Women: How Is It Different? Grace Pien, MD, MSCE Division of Pulmonary and Critical Care Department of Medicine Johns Hopkins School of Medicine 16 February 2018 Outline Prevalence Clinical
More informationZia H Shah MD FCCP. Director of Sleep Lab Our Lady Of Lourdes Hospital, Binghamton
Zia H Shah MD FCCP Director of Sleep Lab Our Lady Of Lourdes Hospital, Binghamton Obesity 70-80% of cases Alcohol use Hypognathism Marfan s syndrome Smoking ENT problems OSA and DM epidemics have
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea Definition: Repetitive episodes of upper airway obstruction (complete or partial) that occur during sleep and are associated with arousals or desaturations +/or daytime sleepiness.
More informationSleep and the Heart. Sleep Stages. Sleep and the Heart: non REM 8/31/2016
Sleep and the Heart Overview of sleep Hypertension Arrhythmias Ischemic events CHF Pulmonary Hypertension Cardiac Meds and Sleep Sleep Stages Non-REM sleep(75-80%) Stage 1(5%) Stage 2(50%) Stage 3-4*(15-20%)
More informationSleep Apnea and CardioMetabolic Syndrome in women
Sleep Apnea and CardioMetabolic Syndrome in women 신원철 강동경희대병원신경과, 수면센터 1 Today s Talks 폐쇄성수면무호흡증의정의와발생기전 수면무호흡증의합병증 : 고혈압, 관상동맥질환, 부정맥, 뇌졸중, 돌연사, 당뇨, 대사증후군 여성에서의폐쇄성수면무호흡증 폐쇄성수면무호흡증 (Obstructive Sleep Apnea:
More informationSleep Diordered Breathing (Part 1)
Sleep Diordered Breathing (Part 1) History (for more topics & presentations, visit ) Obstructive sleep apnea - first described by Charles Dickens in 1836 in Papers of the Pickwick Club, Dickens depicted
More informationSleep Apnea: Diagnosis & Treatment
Disclosure Sleep Apnea: Diagnosis & Treatment Lawrence J. Epstein, MD Sleep HealthCenters Harvard Medical School Chief Medical Officer for Sleep HealthCenters Sleep medicine specialty practice group Consultant
More informationObstructive sleep apnea (OSA) is the periodic reduction
Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis 1 Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto,
More informationEight Hours of Nightly CPAP Treatment of Obstructive Sleep Apnea Improves. Glucose Metabolism in Prediabetes: A Randomized Controlled Trial
Eight Hours of Nightly CPAP Treatment of Obstructive Sleep Apnea Improves Glucose Metabolism in Prediabetes: A Randomized Controlled Trial Sushmita Pamidi, MD 1, Kristen Wroblewski, MSc 2, Magdalena Stepien
More informationQuestions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?
Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part
More informationHow We Breathe During Sleep Affects Health, Wellness and Longevity
How We Breathe During Sleep Affects Health, Wellness and Longevity Susan Redline, MD, MPH Peter C. Farrell Professor of Sleep Medicine Program Director- Sleep Medicine Epidemiology Harvard Medical School
More informationSurgical Options for the Successful Treatment of Obstructive Sleep Apnea
Surgical Options for the Successful Treatment of Obstructive Sleep Apnea Benjamin J. Teitelbaum, MD, FACS Otolaryngology Head and Neck Surgery Saint Agnes Medical Center Fresno, California Terms Apnea
More informationSleep Disorders and the Metabolic Syndrome
Sleep Disorders and the Metabolic Syndrome Tom V. Cloward, M.D. Intermountain Sleep Disorders Center LDS Hospital Objectives Describe how sleep disorders impact your daily medical practice Don Don t do
More informationStudy of Prevalence of Obstructive Sleep Apnea in Patients With Metabolic Syndrome
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 01 Ver. VI January. (2018), PP 51-55 www.iosrjournals.org Study of Prevalence of Obstructive
More informationIn-Patient Sleep Testing/Management Boaz Markewitz, MD
In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when
More informationUCSD Pulmonary and Critical Care
Sleep Apnea Phenotyping Atul Malhotra, MD amalhotra@ucsd.edu UCSD Pulmonary and Critical Care Director of Sleep Medicine NAMDRC 2014 Dr. Malhotra has declared no conflicts of interest related to the content
More informationObesity, Weight Loss and Obstructive Sleep Apnea
Obesity, Weight Loss and Obstructive Sleep Apnea Gary D. Foster, Ph.D. Center for Obesity Research and Education Temple University School of Medicine Overview Sociocultural context Obesity: Prevalence
More informationOSA and cardiovascular disease what is the evidence? Mohan Edupuganti, MD, FACC. Baptist Health Cardiology. Disclosures: None
OSA and cardiovascular disease what is the evidence? Mohan Edupuganti, MD, FACC. Baptist Health Cardiology. Disclosures: None 1 OSA basics Affects 20-30% of males and 10-15% of females in North America
More informationSimple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease
Cardiovascular diseases remain the number one cause of death worldwide Simple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease Shaoguang Huang MD Department
More information6/5/2017. Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA
Mellar P Davis MD FCCP FAAHPM Geisinger Medical Center Danville, PA Opioids adversely influence respiration in five distinct ways Opioids cause complex sleep disordered breathing consisting of central
More informationAn update on childhood sleep-disordered breathing
An update on childhood sleep-disordered breathing แพทย หญ งวนพร อน นตเสร ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร มหาว ทยาล ยสงขลานคร นทร Sleep-disordered breathing Primary snoring Upper airway resistance syndrome
More informationInteractions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes
Ann. N.Y. Acad. Sci. ISSN 0077-8923 ANNALS OF THE NEW YORK ACADEMY OF SCIENCES Issue: The Year in Diabetes and Obesity Interactions between sleep, circadian function, and glucose metabolism: implications
More informationSleep Apnoea : its impact outside the chest. Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh
Sleep Apnoea : its impact outside the chest Dr Tom Mackay Consultant Respiratory Physician Royal Infirmary Edinburgh Body Mass Index < 20 kg/m 2 20-25 kg/m 2 25-30 kg/m 2 > 30 kg/m 2 underweight normal
More informationPOLICY All patients will be assessed for risk factors associated with OSA prior to any surgical procedures.
Revised Date: Page: 1 of 7 SCOPE All Pre-Admission Testing (PAT) and Same Day Surgery (SDS) nurses at HRMC. PURPOSE The purpose of this policy is to provide guidelines for identifying surgical patients
More informationUP TO 25% SLEEP DISORDERED BREATHING AND STROKE OSA. Prevalence 11/12/2015. Young et al. NEJM 1993
SLEEP DISORDERED BREATHING AND STROKE Daniel Shade, Jr., MD FCCP, ABSM, D Medical Director, AHN Sleep Medicine OSA Prevalence Young et al. NEJM 1993 Middle aged cohort (30-60years) Diagnosed by PSG, in
More informationObstructive sleep apnoea How to identify?
Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential conflict of interest None Obstructive
More informationSweet Dreams: The Relationship between Sleep Health and Your Weight
Sweet Dreams: The Relationship between Sleep Health and Your Weight Jason C. Ong, PhD Associate Professor Department of Neurology Center for Circadian and Sleep Medicine Northwestern University Feinberg
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential
More informationOverview of epidemiology of sleep and obesity risk
Overview of epidemiology of sleep and obesity risk Sanjay R. Patel MD, MS Director, Center for Sleep and Cardiovascular Outcomes Research Visiting Professor of Medicine University of Pittsburgh What is
More informationA Deadly Combination: Central Sleep Apnea & Heart Failure
A Deadly Combination: Central Sleep Apnea & Heart Failure Sanjaya Gupta, MD FACC FHRS Ohio State University Symposium May 10 th, 2018 Disclosures Boston Scientific: fellowship support, speaking honoraria
More informationGOALS. Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) FINANCIAL DISCLOSURE 2/1/2017
Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) 19th Annual Topics in Cardiovascular Care Steven Khov, DO, FAAP Pulmonary Associates of Lancaster, Ltd February 3, 2017 skhov2@lghealth.org
More informationSleep and Weight Control
A Wake-up Call Charles H. Samuels, MD, CCFP, DABSM As presented at the Sleep and Respiration Rounds held at the Lung Association Sleep Centre at Foothills Medical Centre, Calgary, Alberta (May 2005) Jill
More informationAHA Sleep Apnea and Cardiovascular Disease. Slide Set
AHA 2008 Sleep Apnea and Cardiovascular Disease Slide Set Based on the AHA 2008 Scientific Statement Sleep Apnea and Cardiovascular Disease Virend K. Somers, MD, DPhil, FAHA, FACC Mayo Clinic and Mayo
More informationIntroducing the WatchPAT 200 # 1 Home Sleep Study Device
Introducing the WatchPAT 200 # 1 Home Sleep Study Device Top 10 Medical Innovation for 2010 Cleveland Clinic Fidelis Diagnostics & Itamar Medical Fidelis Diagnostics founded in 2004, is a privately-held
More informationΥΠΝΟΣ ΚΑΙ ΠΑΧΥΣΑΡΚΙΑ: ΜΙΑ ΑΜΦΙΔΡΟΜΗ ΣΧΕΣΗ?
ΥΠΝΟΣ ΚΑΙ ΠΑΧΥΣΑΡΚΙΑ: ΜΙΑ ΑΜΦΙΔΡΟΜΗ ΣΧΕΣΗ? ΜΑΡΙΑ ΜΠΑΣΤΑ, ΕΠΙΚΟΥΡΗ ΚΑΘ. ΨΥΧΙΑΤΡΙΚΗΣ ΤΜΗΜΑ ΙΑΤΡΙΚΗΣ, ΠΑΝ/ΜΙΟ ΚΡΗΤΗΣ POST DOC FELLOSHIP SLEEP RESEARCH AND TREATMENT CENTRER, HERSHEY, PA EUROPEAN SOMNOLOGIST
More informationThe Sleep-Stroke Connection: An Under-recognized Entity. Simin Khavandgar MD UPMC Neurology Department
The Sleep-Stroke Connection: An Under-recognized Entity Simin Khavandgar MD UPMC Neurology Department Sleep Disordered Breathing (SDB) Obstructive Sleep Apnea (OSA): -Transient cessation of airflow, duration
More informationOSA and COPD: What happens when the two OVERLAP?
2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine
More informationPediatric Sleep-Disordered Breathing
Pediatric Sleep-Disordered Breathing OSA in infants and young children is generally characterized by partial, persistent obstruction of the upper airway Continuum Benign primary snoring Upper-airway resistance
More informationSLEEP DISORDERED BREATHING The Clinical Conditions
SLEEP DISORDERED BREATHING The Clinical Conditions Robert G. Hooper, M.D. In the previous portion of this paper, the definitions of the respiratory events that are the hallmarks of problems with breathing
More informationAssociation between Depression and Severity of Obstructive Sleep Apnea Syndrome
Original Article Association between Depression and Severity of Obstructive Sleep Apnea Syndrome Mojahede Salmani Nodoushan 1,2 and Farzaneh Chavoshi 3 1. Department of Occupational Medicine, Medical School,
More informationMetabolic Disregulation in Obese Adolescents with Sleep-Disordered Breathing Before and After Weight Loss
Metabolic Disregulation in Obese Adolescents with Sleep-Disordered Breathing Before and After Weight Loss K. Van Hoorenbeeck 1, H. Franckx 2, P. Debode 2, P. Aerts 1, J. Ramet 1,3, L.F. Van Gaal 1,4, K.N.
More informationSleep Apnea and Heart Failure
Sleep Apnea and Heart Failure Micha T. Maeder, MD Cardiology Division Kantonsspital St. Gallen Switzerland micha.maeder@kssg.ch Sleep Disordered Breathing (SDB) in HFrEF 700 HFrEF patients (LVEF
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea by Barbara Phillips MD MSPH and Matthew T Naughton MD FRACP Epidemiology and risk factors 7 Clinical presentation 13 Medical complications 22 Diagnosis 40 Medical management 50
More informationSleep-disordered breathing in the elderly: is it distinct from that in the younger or middle-aged populations?
Editorial Sleep-disordered breathing in the elderly: is it distinct from that in the younger or middle-aged populations? Hiroki Kitakata, Takashi Kohno, Keiichi Fukuda Division of Cardiology, Department
More informationManagement of OSA in the Acute Care Environment. Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018
Management of OSA in the Acute Care Environment Robert S. Campbell, RRT FAARC HRC, Philips Healthcare May, 2018 1 Learning Objectives Upon completion, the participant should be able to: Understand pathology
More informationApnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing. Alan S Maisel MD
Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing Alan S Maisel MD Triumvirate of Health-public awareness 1.8% Sleep Physical Fitness Nutrition 91.3% 99.9% Sleep is important to
More informationNational Sleep Disorders Research Plan
Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING
More informationUse of Technology in the Assessment of Type 2 Diabetes and Sleep Apnea
Use of Technology in the Assessment of Type 2 Diabetes and Sleep Apnea Eileen R. Chasens, PhD Associate Professor University of Pittsburgh September 3, 2014 Disclosure I do not own a Smart Phone, I have
More informationPolysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Polysomnography for Obstructive Sleep Apnea Should Include Arousal-Based Scoring: An American Academy of Sleep Medicine Position Statement Raman K. Malhotra,
More informationShyamala Pradeepan. Staff Specialist- Department of Respiratory and Sleep Medicine. John Hunter Hospital. Conjoint lecturer University of New Castle.
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
More informationBrian Palmer, D.D.S, Kansas City, Missouri, USA. April, 2001
Brian Palmer, D.D.S, Kansas City, Missouri, USA A1 April, 2001 Disclaimer The information in this presentation is for basic information only and is not to be construed as a diagnosis or treatment for any
More informationOBSTRUCTIVE SLEEP APNEA and WORK Treatment Update
OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update David Claman, MD Professor of Medicine Director, UCSF Sleep Disorders Center 415-885-7886 Disclosures: None Chronic Sleep Deprivation (0 v 4 v 6 v 8 hrs)
More informationPolysomnography (PSG) (Sleep Studies), Sleep Center
Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)
More informationRisk of Obstructive Sleep Apnea Assessment Among Patients With Type 2 Diabetes in Taif, Saudi Arabia
Original Article J Clin Med Res. 2017;9(12):1002-1006 Risk of Obstructive Sleep Apnea Assessment Among Patients With Type 2 Diabetes in Taif, Saudi Arabia Reem Mohammed Noor Kalakattawi a, Afnan Mohammed
More informationOutline of Lecture 2/13/2018
Allan I. Pack, M.B.Ch.B., Ph.D., FRCP John Miclot Professor of Medicine Director, Center for sleep and Circadian Neurobiology University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
More informationΣύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών;
Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών; E.N. Σημανηηράκης MD, FESC Επίκ. Καθηγηηής Καρδιολογίας Πανεπιζηημιακό Νοζοκομείο Ηρακλείοσ Epidemiology 4% 2% 24%
More informationSleep Medicine. Paul Fredrickson, MD Director. Mayo Sleep Center Jacksonville, Florida.
Sleep Medicine Paul Fredrickson, MD Director Mayo Sleep Center Jacksonville, Florida Fredrickson.Paul@mayo.edu DISCLOSURES No relevant conflicts to report. Obstructive Sleep Apnea The most common sleep
More informationWRHA Surgery Program. Obstructive Sleep Apnea (OSA)
WRHA Surgery Program Obstructive Sleep Apnea (OSA) March 2010 Prepared by WRHA Surgery & Anesthesiology Programs Objectives 1. Define obstructive sleep apnea (OSA). 2. Purpose of the guidelines. 3. Identify
More informationAre We Sure That Obstructive Sleep Apnea Is Not a Risk factor for Atrial Fibrillation in the Elderly Population?
ISPUB.COM The Internet Journal of Geriatrics and Gerontology Volume 6 Number 1 Are We Sure That Obstructive Sleep Apnea Is Not a Risk factor for Atrial Fibrillation in the Elderly H Ganga, Y Thangaraj,
More informationUpdate on Sleep Apnea Diagnosis and Treatment
Update on Sleep Apnea Diagnosis and Treatment Damien Stevens MD Pulmonary/Critical Care/Sleep Medicine Medical Director KU Medical Center Sleep Laboratory Objectives Discuss physiology of sleep and obstructive
More informationProf. Samir Morcos Rafla Alexandria Univ. Cardiology Dept.
Obesity as a risk factor for Atrial Fibrillation Prof. Samir Morcos Rafla Alexandria Univ. Cardiology Dept. CardioAlex 2010 smrafla@hotmail.com 1 Obesity has reached epidemic proportions in the United
More informationClinical Trials in OSA
24th ANNUAL ADVANCES IN SLEEP APNEA AND SNORING February 16-17, 2018 Grand Hyatt on Union Square San Francisco, California Clinical Trials in OSA Samuel T. Kuna, MD Department of Medicine Center for Sleep
More informationSelecting the Right Patients for Oral Appliance Therapy
Selecting the Right Patients for Oral Appliance Therapy AN OVERVIEW OF THE IN-LAB MATRx TITRATION SYSTEM Oral Appliance Titration Made Simple Confidently Prescribe Oral Appliance Therapy The ONLY validated
More informationInsomnia and Health- Related Quality of Life in Adults with Type 2 Diabetes
Insomnia and Health- Related Quality of Life in Adults with Type 2 Diabetes Eileen R. Chasens, PhD, RN, FAAN Letitia Y. Graves, MSN Susan M. Sereika, PhD University of Pittsburgh Conflicts of interest
More informationSleep and Neurocognitive aging in Population based studies
Sleep and Neurocognitive aging in Population based studies Alberto Ramos, MD,MSPH, FAASM Associate Professor of Neurology University of Miami Health System Miller School of Medicine aramos@med.miami.edu
More informationYoung Seok Song 1, You-Cheol Hwang 2, Hong-Yup Ahn 3, Cheol-Young Park 1
Comparison of the Usefulness of the Updated Homeostasis Model Assessment (HOMA2) with the Original HOMA1 in the Prediction of Type 2 Diabetes Mellitus in Koreans Young Seok Song 1, You-Cheol Hwang 2, Hong-Yup
More informationOutcome Measures in OSA Defining Our Treatment Goal. Defining common outcome metrics in OSA Al-Shawwa Sleep Med Rev 2008
Outcome Measures in OSA Defining Our Treatment Goal Disclosures Apnicure Minor stock holder sleep apnea device Siesta Medical Minor stock holder sleep apnea device Patent Pending 61/624,105 Sinus diagnostics
More informationFabrice Czarnecki, M.D., M.A., M.P.H., FACOEM I have no disclosures to make.
Maryland College of Occupational and Environmental Medicine April 2014 Fabrice Czarnecki, M.D., M.A., M.P.H., FACOEM fczarnecki@gablesgroup.com I have no disclosures to make. Guidelines 2006: Joint Task
More informationTired of being tired?
Tired of being tired? Narval CC MRD ResMed.com/Narval Sleepiness and snoring are possible symptoms of sleep apnea. Did you know that one in every four adults has some form of sleep disordered-breathing
More informationBiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides
More informationTreatment-related changes in sleep apnea syndrome in patients with acromegaly: a prospective study
Treatment-related changes in sleep apnea syndrome in patients with acromegaly: a prospective study Thalijn Wolters 1 *, Sean Roerink 1 *, Linda Drenthen 1, Jolanda van Haren- Willems 2, Guido van den Broek
More information11/20/2015. Eighth Bi-Annual Pediatric Sleep Medicine Conference. November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida
Eighth Bi-Annual Pediatric Sleep Medicine Conference November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida Carol L. Rosen, MD Case Western Reserve University School of Medicine
More informationKey words: hypoxemia; obesity; obstructive sleep apnea-hypopnea syndrome; subcutaneous fat accumulation; visceral fat accumulation
Sleep Oxygen Desaturation and Circulating Leptin in Obstructive Sleep Apnea-Hypopnea Syndrome* Koichiro Tatsumi, MD, FCCP; Yasunori Kasahara, MD; Katsushi Kurosu, MD; Nobuhiro Tanabe, MD, FCCP; Yuichi
More informationObesity, Diabetes and Obstructive Sleep Apnea Syndrome (OSAS ) Jaakko Tuomilehto. Prof. MD, MA, PhD, FRCP (Edin)
Obesity, Diabetes and Obstructive Sleep Apnea Syndrome (OSAS ) Jaakko Tuomilehto Prof. MD, MA, PhD, FRCP (Edin) Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki,
More informationSleep Disorders in Spinal Cord Injury: Challenges and Opportunities
Sleep Disorders in Spinal Cord Injury: Challenges and Opportunities JENNIFER L. MARTIN, PHD RESEARCH SCIENTIST AND PSYCHOLOGIST VA GREATER LOS ANGELES HEALTHCARE SYSTEM ASSOCIATE PROFESSOR DAVID GEFFEN
More informationImpaired glucose-insulin metabolism in males with obstructive sleep apnoea syndrome
Eur Respir J 2003; 22: 156 160 DOI: 10.1183/09031936.03.00089902 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2003 European Respiratory Journal ISSN 0903-1936 Impaired glucose-insulin
More informationSleep Apnea and ifficulty in Extubation. Jean Louis BOURGAIN May 15, 2016
Sleep Apnea and ifficulty in Extubation Jean Louis BOURGAIN May 15, 2016 Introduction Repetitive collapse of the upper airway > sleep fragmentation, > hypoxemia, hypercapnia, > marked variations in intrathoracic
More informationObstructive Sleep Apnea in Truck Drivers
Rocky Mountain Academy of Occupational and Environmental Medicine Denver, Colorado February 6, 2010 Obstructive Sleep Apnea in Truck Drivers Philip D. Parks, MD, MPH, MOccH Medical Director, Lifespan Health
More informationSleep and Stroke. M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi ABSTRACT
Ann Natl Acad Med Sci (India), 49(3&4): 169-176, 2013 Sleep and Stroke M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi Circadian variations in conjunction
More informationOutline. Major variables contributing to airway patency/collapse. OSA- Definition
Outline Alicia Gruber Kalamas, MD Associate Clinical Professor of Anesthesia & Perioperative Care University of California, San Francisco September 2011 Definition Pathophysiology Patient Risk Factors
More informationObstructive Sleep Apnoea. Dr William Man Thoracic and Sleep Medicine, Harefield Hospital
Obstructive Sleep Apnoea Dr William Man Thoracic and Sleep Medicine, Harefield Hospital Obstructive Sleep Apnoea Common Condition (Syndrome) 3 7% of adult males, 2 5% females Prevalence expected to rise
More information18/06/2009 NZ Respiratory & Sleep Institute
Sleep Disorders in Primary Care - a personal view 18/06/2009 Andrew G Veale NZ Respiratory & Sleep Institute Abnormal Sleep Disorders of the initiation & maintenance of sleep (DIMS) Insomnia 1 o or 2 o
More information