1. Obstructive Sleep Apnea
Julia Buchfuhrer, PGY-II
Updated March 2018

2. Objectives Define OSA Recognize Risk Factors for OSA
Know when to refer for PSG
Know the available treatments for OSA

3. Case
52y/o obese gentleman comes into clinic complaining of being tired everyday. He often falls asleep at work or while driving home. He gets about 8 hours of sleep most nights and falls asleep right away.
Vitals signs normal except BP 145/90
Physical exam BMI 40, enlarged neck
All other labs normal including EKG

4. Case
We’ll get back to him later…

5. What is OSA?
Collapse of the oropharynx during sleep causing decreased airflow
Includes spectrum from apneas to hypopneas to breathing related arousals
Hypopnea defined as <88% oxygen saturation

6. More Pathophys
Increased work of breathing against closed airway leads to arousals during sleep
Patients often don’t remember these arousals
Sleep arousals  poor quality sleep  daytime sleepiness

7. Chief Complaint
Most often the patient’s complaint is excessive daytime sleepiness
In the setting of 7+ hours of sleep at night
If the patient is getting less than 7 hours of sleep at night, daytime sleepiness is likely due to this

8. When does OSA occur? REM SUPINE SLEEP most commonly, why?
Pharyngeal airway muscles relaxed during REM sleep
Neck habitus while supine physically collapses pharynx

9. Epidemiology 20-30% of male Americans 10-15% of female Americans
THAT’S A LOT OF PEOPLE!

10. Risk Factors Age Gender: M>F Obesity, especially BMI >40
Small airway
Large neck size

11. When to screen?
Patient with concerning RFs and complaint of excessive daytime sleepiness
How to screen? STOP-BANG Questionnaire
RFs – risk factors Questionnaire on next slide

12. STOP-BANG Scoring
<3 is low risk, 3-5 medium, 5+ high risk

13. Back to our patient
52y/o obese gentleman comes into clinic complaining of being tired everyday. He often falls asleep at work or while driving home. He gets about 8 hours of sleep most nights and falls asleep right away.
Vitals signs normal except BP 145/90
Physical exam BMI 40, enlarged neck

14. What’s his STOP-BANG? Tired, BP, BMI, Age, Neck, Gender = 6
This is the key slide here, go through this thoroughly
Tired, BP, BMI, Age, Neck, Gender = 6

15. So now what? Send for “sleep testing”, what is that?
PSG = Polysomnographic study
No need to go over this picture, just here for reference

16. Treatment - CPAP CPAP - the mainstay of OSA treatment
Uses PEEP to open posterior oropharynx

17. Treatment
WEIGHT LOSS!
Decreases BMI, neck size, BP – 3 of the STOP-BANG
A 2009 Randomized control trial showed 10kg weight loss lead to decrease in AHI by approx 10 (A LOT). P<.001

18. Summary
Sleep apnea is collapse of the oropharynx during sleep causing reduced airflow
Rougly ¼ of Americans have sleep apnea
STOP BANG Questionairre > 3 = PSG
Treatment = CPAP + weight loss

19. THE END!
UpToDate.com. Accessed 3/5/
Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. Dixon et. Al. JAMA Sep;308(11):  
A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Foster et. Al. Arch Intern Med Sep;169(17):  
Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Araghi et al. Sleep. 2013;36(10):1553. Epub 2013 Oct 1. 
Continuous positive airways pressure for obstructive sleep apnoea in adults. Giles et al. Cochrane Database Syst Rev