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What Is The Definition Of Sleep Apnea

Posted at January 8th, 2023 | Categorised in Blood Sugar

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What Is The Definition Of Sleep Apnea

What Is The Definition Of Sleep Apnea

Gokul Paidi, Anju Bisetti, Mary Jean, Farah P. Aziz Gray, Taha Siam and Maria F. Fleming, Joshua Neely, Lisa Cope and Ranbir Sandhu

Custom Mouthguards Help Sleep Apnea

, Anju Bisetti, Mary Jean and Farah P. Aziz Gray, Taha Siam and Maria F. Fleming, Joshua Neely, Lisa Cope and Ranbir Sandhu

Cite this article as: Paidi G, Beesetty A, Jean M, et al. (July 13, 2022) Primary care management of obstructive sleep apnea. 14(7): e26805. doi:10.7759/.26805

About 30 million Americans suffer from sleep disorders. The incidence and mortality associated with obstructive sleep apnea (OSA) has increased in recent years in the United States. OSA is associated with a variety of health problems, including depression and hypertension, which negatively impact occupational and academic performance. Therefore, OSA is a major public health problem. Sleep specialists can be consulted for evaluation and treatment of OSA. Continuous positive airway pressure (CPAP) is the mainstay of OSA treatment. The role of GPs is very important in such a situation, especially to choose the most appropriate approach for each patient, treat comorbidities and risk factors and refer to sleep specialists for further management if necessary. In addition to medical management, primary care physicians serve as primary patient educators about this specific health condition.

Obstructive sleep apnea (OSA) is a common condition, affecting more than 10% of the adult population, and its prevalence increases with age [1]. OSA is caused by frequent collapse of the upper airway during sleep; This leads to transient suffocation and thus to hypoxia. OSA remains a major public health problem and is associated with the onset or exacerbation of hypertension, other health problems, including cardiovascular disease and stroke, and poor overall quality of life [2]. OSA can affect work performance and contribute to traffic accidents [3]. It is important to note that 70% of patients with resistant hypertension have undiagnosed OSA. The use of continuous positive airway pressure (CPAP) can help control blood pressure [4]. In addition, higher quality sleep can improve memory, thinking, mood, alertness, energy levels and physical performance. However, only 10% of patients with OSA are identified. Inadequate diagnosis and treatment of OSA has direct implications for public health. Complications associated with OSA are shown in Figure 1.

Obstructive Sleep Apnoea Syndrome

An increased demand for specialized sleeping units for sleep services has been observed, along with waiting lists for consultations for these sleeping conditions. Chronic and chronic health problems, high prevalence and long-term consequences of this disease make the management of this disease necessary. As with other presenting chronic diseases, comprehensive management and care of OSA must include other clinical settings. In primary care, a new model for the treatment of OSA has been proposed [6]. Studies in patients with a high pre-test probability of OSA have shown that this treatment model is feasible in primary care centers. It shows similar efficacy to sleeping unit models [6]. Primary care is the most cost-effective and comprehensive setting for the treatment of individuals with suspected OSA. This may affect the use of diagnostic testing methods and different treatment plans that have yet to be explored. The purpose of this article is to explore the diagnosis, management, and complications of OSA in primary care.

During the diagnosis of OSA, it is essential to rule out other causative factors that may contribute to sleep disturbances [7]. An airway examination should be performed by determining patency and neck circumference measurements. Thyroid stimulating hormone levels are measured to determine if obstruction is due to thyroid enlargement [8]. GPs should ask about sleep hygiene, sleep quality and duration, illnesses, drug use, stressful life events, work, daily schedule, use of digital devices, bedroom layouts, alcohol and caffeine use, and other medical and mental health issues. disorders that disrupt sleep [7]. The diagnosis of OSA in elderly patients can be challenging for GPs, as age-related changes can lead to sleep cycle changes [7-8]. In addition, older individuals are often given medications that cause drowsiness or restlessness as side effects. Therefore, GPs should investigate whether excessive sleepiness is a symptom of other health problems or a side effect of prescription drugs [9].

The STOP-BANG questionnaire is used to determine the risk of sleep apnea (Table 1) and excessive sleepiness is assessed using the Epworth Sleepiness Scale (ESS; Table 2) [10].

What Is The Definition Of Sleep Apnea

Interpretation: 0-10: normal sleep in healthy adults, 11-14: light sleep, 15-17: moderate sleep, 18-24: heavy sleep

Obstructive Sleep Apnea And Cardiovascular Disease: A Scientific Statement From The American Heart Association

Patients with suspected OSA should be referred to a sleep specialist for polysomnography (PSG). By intervening early in the diagnosis of sleep apnea by a sleep specialist, the use of PSG can be tailored to the needs of the patient. This allows accurate interpretation of the results and allows general practitioners and sleep specialists to collaborate for treatment planning, implementation and follow-up [10]. A polysomnogram performed in a sleep lab is the gold standard for diagnosing sleep disorders. This test helps to obtain comprehensive signals from brain waves, breathing patterns, heart rate, oxygen saturation and exercise. Sleep-center PSG can be used to diagnose all three types of apnea, as well as rapid eye movement sleep disorders, sleep-related seizures (nocturnal seizures), sleep-related movement disorders (periodic limb movement sleep disorder, parasomnias, restless legs). syndrome) and narcolepsy [13]. .

Home sleep testing (HRT) was initially used in most patients due to cost constraints and patient preference. Technical issues associated with home sleep studies include poor lead placement, nightly maintenance during sleep, and lack of health education. Because the HRT does not measure brain wave activity and body movements, it cannot be used to diagnose sleep-related seizures and movement disorders. In addition, HRT is not effective in patients with severe heart or lung disease, early severe sleep problems, neuromuscular disease, history of stroke and persistent opioid use [10, 13]. The difference between a laboratory sleep study and a home sleep study is explained in Table 3.

A threshold of ≥5 scoreable respiratory events within an hour is used to diagnose OSA. These events can include any combination of obstructive apnea, excitement, or hypopnea [15]. Information about the following terms (Table 4) is essential for reading a sleep study report.

A decrease in airflow of at least 30% for 10 seconds or more and resulting in a desaturation of at least 4%

The Deadly Health Consequences Of Sleep Apnea

Apnea-Hypopnea Index (AHI) is the most important and widely used parameter to diagnose OSA. Assessment of OSA based on AHI is shown in Table 5.

AHI varies with body position; A person sleeps in the supine position when the tongue is more prone to fall back and become obstructed. In addition, the duration of sleep in the supine, left and right position should be determined and the correlation with SPO.

CPAP is the gold standard for the treatment of OSA [17]. CPAP creates a predetermined pressure that keeps the airway open during sleep. The pressure setting is from 4 to 30 cm

What Is The Definition Of Sleep Apnea

O. Individuals’ blood pressure is determined by a pulmonologist based on their AHI, sleeping position, and respiratory disturbance index (RDI). New patients should use a low pressure setting at first to help them get used to the use and pressure of the mask. CPAP can significantly improve patients’ quality of life and reduce blood pressure in hypertensive patients [17]. In addition, CPAP improves lung mechanics by attracting microalecstasis and increasing diffusion capacity. The use of CPAP in patients with lung and heart failure improves hemodynamics by reducing preload, afterload, and left ventricular transmural pressure. In addition, CPAP has been reported to reduce the need for intubation [18]. A dry nose and throat is the most common side effect of CPAP. However, adjusting the humidifier level can fix this problem. Dry eyes and pain are other side effects caused by air leakage from the mask. Using a suitable mask can help solve this problem. Aerophagia, a condition in which air enters the stomach, is usually caused by high or low pressure. Aerophagia can be prevented by adjusting the pressure relief setting on CPAP, which allows individuals to adjust air pressure during inhalation, use full face masks to avoid mouth breathing, and sleep at a 30-40° upward angle [13, 15, 17, 18 , 19].

Breathing Related Sleep Disorders In The Elderly

Another option for CPAP management is the use of automatic self-adjusting positive airway pressure (APAP). APAP delivers the lowest air pressure possible to maintain a patent airway [20]. This strategy may be helpful for individuals who have difficulty adjusting to the constant pressure of the CPAP device [21]. Bilevel positive airway pressure is another device used to simulate normal breathing and involves the application of low

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