Sleep Related Breathing Disorders 2012 April Part One (1)

8/2/2019 Sleep Related Breathing Disorders 2012 April Part One (1)

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Sleep related breathingdisorders

Mahmoud Ibrahim MahmoudProfessor of Chest Diseases

Faculty of Medicine

Alexandria University

[email protected]









Age- and

sex-specific

prevalence

rates of the

AHI based

on polysomnog

raphic

sample of

352 males

and 250

femalesfrom

Wisconsin

USA



Conclusion: 93% of women and 82% of men with

moderate to severe sleep apnea (AHI > 15) “undiagnosed”











Estimated clinical values of

specific symptoms in the

diagnosis of OSAHSChervin RD,

2000



Estimated clinical values of

specific symptoms in the

diagnosis of OSAHSChervin RD,

2000





Clinical Features: Overbite



Clinical Features: Retronagthia



Mallampati Airway Classification







Clinical Features: Body Fat Distribution



Clinical Features: Body Fat Distribution

Apple shape is riskier than Pear shape



Hypersomnolence



Hypersomnolence



Obese Hypersomnolent



Obesity



Pillar G, Shehadeh N. The chicken or the egg ?

Diabetes Care 2008;31 Suppl 2:S303-9.



Theories linking OSA and the metabolic

syndrome

Bonsignore MR, Eckel J. Eur Respir Rev 2009; 18(12):113





Obesity, retrognathia, mouth

breathing, hypersomnolent





Snoring





Snoring reported by bed partner



Witnessed

apnea, chocking

and restlesssleep



Tregear S, et al. J Clin Sleep Med 2009;5(6):573






•Annual recertification is required for an individual with untreated OSA and an

AHI ≤ 20, who is not sleepy or who is effectively treated;

•Dis ualification for drivers who re ort slee iness while drivin , have


experienced a crash with falling asleep, or have an AHI > 20 until CPAP is

instituted, or have had surgery for OSA but not had repeat PSG, or have a BMI

> 33 kg/m2 (until evaluated).





"The Posthumous Papers of the

Pickwick Club” Charles Dickens'

“Damn That Boy” Said the

old men, “He’s gone tosleep again”.

Joe, "wonderfully fat boy ……… with his eyes closed“

Joe was edematous, and a very loud snorer

“Very Extraordinary boy”,said Mr. Pickwick. Does he

always sleep in this way?

f



"The Posthumous Papers of the

Pickwick Club” Charles Dickens'

“Sleep” said the old

gentleman, “he’s alwaysasleep”. “Goes on errands

Joe, "wonderfully fat boy ……… with his eyes closed“

Joe was edematous, and a very loud snorer

waits at table”



Estimated clinical values of specific symptoms in

the diagnosis of OSAHS

Chervin RD,2000





Retrognathia



Kissing tonsils, crowded upper

airway



Obstructive apnea

Coleman J. Sleep studies. Otolaryngol Clin North

Am 1999;32(2):195



Central Apnea



Central Apnea

Coleman J. Sleep studies. Otolaryngol Clin North Am 1999;32(2):195



Pathophysiology Obstruction

Increased respiratory effort Fragmentedsleep

Intermittent hypoxemia

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Sleep Related Breathing Disorders 2012 April Part One (1)