#22 Obstructive Sleep Apnea

What do you do when you notice that your patient has obstructive sleep apnea (OSA)? Hospitalist James Thomas MD PhD, discusses what OSA is, risk factors, its relationship with heart disease, and how to navigate management of OSA in the hospital setting.

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What is Obstructive Sleep Apnea (OSA)?

Obstructive sleep apnea (OSA) is a disorder caused by the repetitive collapse of the upper airway during sleep.

“OSA is essentially an increased resistance to inspiration that your body can’t overcome through a normal sleep mechanism.”

Dr. James Thomas

Diagnosis

The American Academy of Sleep Medicine (AASM) lists the following criteria. At least 1 of the following criteria must apply for OSA to be diagnosed:

  • The patient reports daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and/or unintentional sleep episodes during wakefulness. The patient awakens with breath holding, gasping, or choking. The patient’s bed partner reports loud snoring, breathing interruptions, or both during the patient’s sleep.
  • Five or more respiratory events (eg, apneas, hypopneas) per hour of sleep and/or evidence of respiratory effort during all or a portion of each respiratory event.

Diagnosis cannot happen in an inpatient setting. Diagnosis requires an outpatient referral for a sleep study. Sleep studies can be performed during an overnight observation in a sleep lab or with a home sleep test. Diagnosis depends on the number of apneic episodes experienced per hour.

Risk factors for OSA

  • Advanced age
  • Obesity
  • Being male
  • Hypertension
  • Large neck circumference

Complications

  • Increased BP
  • Mood disorders
  • Daytime sleepiness
  • Morning headaches
  • Heart disease
  • Diabetes
  • Stroke

OSA v. OHS

Obesity Hypoventilation Syndrome (OHS): Diagnostic criteria for this is simple: awake CO2 > 45 and BMI > 30.

In OHS, obese individuals breath shallowly due to resistance in the airway that cannot be fully overcome due to musculature weakness.

Summing It Up

  • OHS: think shallow breaths, high CO2
  • OSA: think periods of no breaths, low O2, mildly elevated CO2

what do you know when your patient becomes hypoxic due to OSA?

Apply oxygen. Does your patient become delirious due to hypercapnia? Call RT and use CPAP or BiPAP.