4/28/2017. Adult Obesity Rates

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2 Adult Obesity Rates

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4 Prevalence of Obstructive Sleep Apnea Rising prevalence of sleep apnea in U.S. threatens public health DARIEN, IL Sept. 29, 2014 Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea, which now afflicts at least 25 million adults in the U.S., according to the National Healthy Sleep Awareness Project. Several new studies highlight the destructive nature of obstructive sleep apnea, a chronic disease that increases the risk of high blood pressure, heart disease, Type 2 diabetes, stroke and depression. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013 May 1;177(9): Epub 2013 Apr 14.

5 Estimated Prevalence increasing? American Journal of Epidemiology Has increased substantially over the last two decades, most likely due to the obesity epidemic. It is now estimated that 26 percent of adults between the ages of 30 and 70 years have sleep apnea. Findings from new studies emphasize the negative effects of sleep apnea on brain and heart health; however, these health risks can be reduced through the effective treatment of sleep apnea with continuous positive airway pressure therapy: Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013 May 1;177(9): Epub 2013 Apr 14.

6 It is estimated that >75% of OSA patients are: Undiagnosed and Untreated

7 What is Obstructive Sleep Apnea? Characterized by repetitive episodes of complete (apnea) or partial (hypopnea) upper airway obstruction occurring during sleep. Often result in reduction in blood oxygen saturation and usually terminated by brief arousals from sleep

8 Definitions Apnea - Complete cessation of breathing for at least 10 seconds Hypopnea - Decrease in tidal volume associated with a fall in oxygen saturation (4%) or arousal response Arousal - Shift in EEG for at least 3 seconds (in REM sleep requires also increase in EMG or movement

9 Apnea Hypopnea Index (AHI) Normal: less than 5 events per hour Mild: 5-15 events per hour Moderate: events per hour Severe: over 30 events per hour

10 Oxygen Saturation Normally, the blood oxygen level should be above 90%. With obstructions, you can have varying degrees of desaturations. The severity of the problem depends on how much of a dropbelow 90%: Mild problem: 85-90% Moderate problem: 80-84% Severe problem: below 80%

11 Abbreviations Apnea Index AI Apnea Hypopnea Index AHI Oxygen Desaturation Index ODI Respiratory Effort Related Arousal RERA Respiratory Disturbance Index RDI (RDI = AHI + RERA)

12 Brain damage from OSA? A neuroimaging study in the September issue of the journal Sleep found that participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas, which was accompanied by impairments to cognition, mood and daytime alertness. One year of CPAP therapy led to an almost complete reversal of this brain damage. Castronovo V, Scifo P, Castellano A, et al. White matter integrity in obstructive sleep apnea before and after treatment. SLEEP 2014;37(9): This brain scan shows that the brain blood flow in a subject with obstructive sleep apnea (left) is markedly lower compared to a subject without the sleep disorder. Credit: Image courtesy of University of California - Los Angeles

13 Cardiac Arrhythmias? A Brazilian population study- nocturnal cardiac arrhythmias occurred in 92 percent of patients with severe sleep apnea compared with 53 percent of people without sleep apnea. The prevalence of rhythm disturbance also increased with sleep apnea severity. Cintra FD, Leite RP, Storti LJ, et al. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study. Arq Bras Cardiol 2014 Sep 23 [Epub ahead of print].

14 Preventable Cardiovascular Complications? Reversible Hypertension? Diagnosing sleep apnea and prescribing CPAP therapy prior to surgery significantly reduced postoperative cardiovascular complications - specifically cardiac arrest and shock - by more than half. Journal of Hypertension found a favorable reduction of blood pressure with CPAP treatment in patients with resistant hypertension and sleep apnea. Mutter TC, Chateau D, Moffatt M, et al. A matched cohort study of postoperative outcomes in obstructive sleep apnea: could preoperative diagnosis and treatment prevent complications? Anesthesiology Oct;121(4): Iftikhar IH, Valentine CW, Bittencourt LR, et al. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J Hypertens 2014 Sep 19 [Epub ahead of print].

15 There are four kinds of sleep studies. Diagnostic overnight PSG A general monitoring of sleep and a variety of body functions during sleep, including breathing patterns, oxygen levels in the blood, heart rhythms, and limb movements Diagnostic daytime multiple sleep latency test (MSLT) Is used to diagnose narcolepsy and to measure the degree of daytime sleepiness. It measures how quickly you fall asleep in quiet situations during the day. It also monitors how quickly and how often you enter REM sleep. To ensure accurate results, it's performed on the morning following a diagnostic overnight PSG.

16 Two-night evaluation PSG and CPAP titration. On the first night, you'll have general monitoring and diagnostic evaluation. If sleep apnea is discovered, you'll come back for a second night to determine the right air pressure for CPAP (continuous positive airway pressure) treatment. It delivers air into your airways through a specially designed nasal mask. Split-night PSG with CPAP titration is done when moderate or severe sleep apnea has been discovered or strongly suspected during the first part of the night's study. The second half of the night is used to determine the CPAP pressure needed to offset apnea.

17 HSAT methods do have a competitive advantage over PSG in that these studies are more convenient for some patients. In the end, the fundamental issue for sleep technologists should be not whether home sleep apnea testing studies are better or worse than PSG, but rather under what conditions use of HSAT is appropriate. Standards of practice indicate PSG is recommended to a patient if he or she has congestive heart failure, a pulmonary disease or a neuromuscular disease, or another suspected sleep disorder, such as narcolepsy, insomnia, periodic limb movement disorder or a less known variant of sleep apnea called upper airway resistance syndrome (UARS).

18 Snoring indicates that there is some resistance to the normal path of air from the outside to the lungs, and snoring is associated with disrupted sleep, daytime fatigue and sleepiness, and decreases in oxygen levels in the body. Snoring can also be extremely disruptive to the sleep of the bedpartner and can stress interpersonal relationships of couples. In addition to disturbed sleep patterns and sleep deprivation, other serious health problems may result. Snoring may also be a symptom of other medical conditions such as obstructive sleep apnea (OSA). Not everybody who snores has OSA, and not everybody who has OSA has snoring. It is estimated that 45 percent of all adults snore occasionally, and 25 percent habitually snore. Snoring is more common in males and people who are overweight.

19 What causes snoring? Snoring may be caused by many factors, including: Poor muscle tone Excessively bulky throat tissue Long soft palate Long uvula Stuffed or blocked nasal passages Deformities of the nose Deformities of the nasal septum Can snoring be prevented? Mild or occasional snoring may be helped by: A healthy lifestyle that includes exercise and proper diet Losing weight Avoiding tranquilizers, sleeping pills, and antihistamines before bedtime Avoiding alcohol at least four hours before bedtime Avoiding heavy meals at least three hours before bedtime Establishing regular sleeping patterns Sleeping on your side Tilting the head of the bed up about 4 inches

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21 Mallampati score In anesthesia, the Mallampati score, also Mallampati classification, named after Seshagiri Mallampati, is used to predict the ease of intubation. A high Mallampati score (class 3 or 4) is associated with more difficult intubation as well as a higher incidence of sleep apnea. The score is assessed by asking the patient, in a sitting posture, to open his or her mouth and to protrude the tongue as much as possible. The anatomy of the oral cavity is visualized; specifically, the assessor notes whether the base of the uvula, faucial pillars and soft palate are visible. Scoring may be done with or without phonation. Depending on whether the tongue is maximally protruded and/or the patient asked to phonate, the scoring may vary

22 Mallampati score. Class 1: Faucial/tonsillar pillars, uvula and soft palate are all visible Class 2: Partial visibility of the faucial/tonsillar pillars, uvula and soft palate. Class 3: Base of the uvula, soft and hard palate visible. Class 4: Only hard palate is visible.

23 Tonsillar size. Grade 0: No tonsil tissue present. Grade 1: Tonsils hidden within the faucial/tonsillar pillars. Grade 2: Tonsils extending to the pillars but not beyond them. Grade 3: Tonsils extending beyond the faucial/tonsillar pillars but not to the midline. Grade 4: Tonsils extending to the midline and may be touching...

24 Mallampati Score and Pediatric Obstructive Sleep Apnea Harsha Vardhan Madan Kumar, M.D. Division of Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL Measurements and Main Results A significant correlation was found between Mallampati score, tonsillar size, and AHI. For every point increase in the Mallampati score, the odds ratio of having OSA increased by more than 6-fold. For every point increase in tonsillar size, the odds ratio of having OSA increased by more than 2-fold. Conclusions: Mallampati score and tonsillar size are independent predictors of OSA. Oral examination including Mallampati score and tonsillar size should be considered when evaluating a patient for OSA. They can be used to prioritize children who may need PSG.

25 Craniofacial development issues associate with SDB

26 Dental arch dimensional changes after adenotonsillectomy in prepubertal children Anna Cristina Petraccone Caixeta,a Ildeu Andrade, Jr,b Tatiana Bahia Junqueira Pereira,a Let!ıcia Paiva Franco,c Helena Maria Gonc alves Becker,c and Bernardo Quiroga Soukib Belo Horizonte, Minas Gerais, Brazil After airway clearance, the adenotonsillectomy group showed a significant maxillary transverse width gain compared with the control subgroup. The control subgroup showed a significant deepening of the palatal height when compared withthe adenotonsillectomy subgroup after 1 year. Conclusions: The adenotonsillectomy subgroup had a significantly different pattern of arch development compared with the untreated controls. After adenotonsillectomy, the mouth-breathing children showed greater maxillary transverse development than did the controls. The palatal vault deepened in the untreated children. The mouth-breathing children showed a deeper palata vault, a larger mandibular width, and a larger mandibular arch length in comparison with the nasal-breathing children. (Am J Orthod Dentofacial Orthop 2014;145:461-8)

27 What is Central Sleep Apnea? Central sleep apnea is a sleep disorder in which you briefly stop breathing during sleep. A problem with your brain's signaling. Your brain momentarily "forgets" to tell your muscles to breath Usually associated with serious illness, especially an illness in which the lower brainstem -- which controls breathing -- is affected. Only treatment for CSA is CPAP or BiPAP

28 Central sleep apnea Being older. Middle-aged and older people have a higher risk of central sleep apnea. Heart disorders. People with congestive heart failure are more at risk of central sleep apnea. Using narcotic pain medications. Opioid medications, especially long-acting ones such as methadone, increase the risk of central sleep apnea. Stroke. People who've had a stroke are more at risk of central sleep apnea or treatment-emergent central sleep apnea.

29 Conditions associated with central sleep apnea include the following: Congestive heart failure Hypothyroid Disease Kidney failure Neurological diseases Parkinson's disease Alzheimer's disease amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) Damage to the brainstem caused by Encephalitis Stroke Traumatic brain injury, or other factors