Professional Documents
Culture Documents
Dr J.M. Joshi Professor and Head Department of Pulmonary Medicine T.N. Medical College B.Y.L. Nair Hospital Mumbai
SAS
Sleep apnoea syndromes (SAS) represent a
group of conditions with abnormal respiration during sleep 3 forms of sleep apnea: OSA, CompSAS and CSA constitute 84% 15% and 0.4%, of cases respectively Obstructive sleep apnea syndrome-OSAS (objective sleeping respiratory disturbance with daytime sleepiness) Nasal continuous positive airway pressure (CPAP) is the most effective treatment for patients with moderate to severe OSAS
Obstructive Apnoea
Obstructive Apnoea when complete
closure of the upper airway
Central Apnoea
Central Apnoea complete cessation of effort to
breathe Airway still open but no respiratory drive, hence no respiratory muscle activity
CLINICAL FEATURES
Snoring is the cardinal symptom, cyclical with periods of loud snoring exceeding 100 decibels or snoring alternating with quieter intervals of apnoeas
Diagnosis of OSA
A) EDS B) 2 of the following Snoring Witnessed apnoeas Unrefreshing sleep Daytime fatigue Poor concentration And c) Sleep Study showing AHI > 5 Ref: PSG Task Force, ASDA. Sleep 1997;20:406-22.
Polysomnography (PSG)
Neurological EEG EOG EMG Cardio-Respiratory Snoring Thoraco-abdominal movements Airflow Type 4 Oximetry
Type 3
Type 1,2
Ref: Clinical guidelines for unattended PM in the diagnosis of OSA in adult patients. J Clin Sleep Med 2007; 3:737747
until most of the apnoeas and arousals are abolished, as monitored by PSG
Sleepy snorer by Epworth Sleepiness Score Sleep Apnea Clinical Score (SACS) based on
snoring, witnessed episodes of apnea, neck circumference, and systemic hypertension
Ref: Likelihood ratios for a sleep apnea clinical prediction rule. AJRCCM 1994;150:1279-85.
Summary
Magnitude of OSA and paucity of sleep labs needs
simplified approaches for physicians Enough evidence now exists that simple ambulatory diagnostictherapeutic strategies have equivalent clinical outcome in cases with high pretest probability Patients who have a low probability, have comorbidities or have difficulties during ambulatory management should be referred to a sleep centre for detailed evaluation/in-laboratory attended full PSG and further management