Shyamala Pradeepan. Staff Specialist- Department of Respiratory and Sleep Medicine. John Hunter Hospital. Conjoint lecturer University of New Castle.

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1 Shyamala Pradeepan Staff Specialist- Department of Respiratory and Sleep Medicine. John Hunter Hospital. Conjoint lecturer University of New Castle.

2 What is sleep apnoea?? Repetitive upper airway narrowing and closure, leading to increased number of brain arousals and oxygen desaturations.

3 Types Obstructive- Common Central- many causes- Hear failure, drugs, high altitude, brain stem lesions and ventilatory instability

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6 Obstructive Sleep Apnea

7 l Airway narrowing/obstruction l Decreased air flow l Increased effort l Oxygen saturation swings and hypoxia l Increased BP and HR l Disrupted sleep

8 Burden of the disease 1.5 million Australian suffer from sleep disoders. 9% population. 20 million Americans have sleep apnoea data- 4% men and 2% women have sleep apnoea syndrome.

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10 Effects of sleep apnoea u Due to increased arousals-excessive day time somnolence. u Due to repetitive de oxygenation and re oxygenation-cvs morbidity and mortality

11 Symptoms of sleep apnoea u u Snoring Restless sleep

12 Irritability

13 Lack of concentration

14 Depression

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17 SLEEP, Vol. 30, No. 3, 2007

18 Sleep Heart health study Ø 1927 men and 2495 women 40 years of age and free of coronary heart disease and heart failure at the Ame of baseline had polysomnography. Ø Followed up for a median of 8.7 Yrs Ø ProspecAve longitudinal epidemiological study. Ø obstrucave sleep apnoea was a significant was a significant predictor of incident coronary heart Ø Among men AHI 30 were 68% more likely to develop coronary heart disease than those with AHI <5. Ø ObstrucAve sleep apnoea predicted incident heart failure in men(adjusted hazard raao 1.13 [95% confidence interval 1.02 to 1.26] per 10- unit increase in AHI). Ø Men with AHI 30 were 58% more likely to develop heart failure than those with AHI <5.

19 Sleep heart health( survival probability)

20 Risk factors l Age l Male sex l Obesity l Oro facial anatomical abnormality. l Family history of sleep apnoea l Drugs and alcohol.

21 Screening for sleep apnoea l OSA 50 l Berlin Questionnaire l Stop Bang l Epworth Sleepiness scale(ess)

22 OSA50 screening questionnaire. Chai-Coetzer C L et al. Thorax doi: /thx Copyright BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.

23 Diagnosis Types of studies Level 1- in lab Polysomnography Level2 Home based Polysomnography Level 3- Limited channel home sleep study. Level 4 Home Oxymetry.

24 History

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26 Treatment Weight loss. CPAP- Continuous positive airway pressure. Mandibular advancement splints ENT surgical procedure Positional devices

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30 264 healthy men, 377 simple snorers, 403 with untreated mild- moderate obstructive sleep apnoea- hypopnoea, 235 with untreated severe disease, and 372 with the disease and treated with CPAP were included in the analysis. Patients with untreated severe disease - fatal cardiovascular events (1.06 per 100 person- years) - non- fatal cardiovascular events (2.13 per 100 person- years) Untreated patients with mild- moderate disease (0.55, p=0.02 and 0.89, p<0.0001), Simple snorers (0.34, p= and 0.58, p<0.0001), patients treated with CPAP (0.35, p= and 0.64, p<0.0001), healthy participants (0.3, p= and 0.45, p<0.0001). Multivariate analysis, adjusted for potential confounders, showed that untreated severe obstructive sleep apnoea- hypopnoea significantly increased the risk of fatal (odds ratio 2.87, 95%CI ) and non- fatal (3.17, ) cardiovascular events compared with healthy participants.

31 SLEEP, Vol. 30, No. 3, 2007

32 Effects of CPAP on ESS

33 Quality of life

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36 Problems with CPAP Costly Poor uptake Poor adherence

37 Mandibular advancement splints

38 ENT surgical opaons 28 Yr old male, BMI 30, had significant tonsillar enlargement. Was found to have large adenoids. Had surgery to remove both with some weight loss options.

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41 Inadequate control of symptoms Modafinil- as an adjunct therapy.

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46 Summary Sleep apnoea is a significant problem in our populaaon. RecogniAon, invesagaaon, treatment and follow up is rewarding to the paaent and to the community More than anything else. gives lot of saasfacaon to me.

47 Thank you Shyamala Pradeepan contact details Numbers Private Public