1. Analysis of demographic and pathophysiological data among sleepy and non- sleepy adult OSA patients in Parami General Hospital in Parami General Hospital Dr. Zay Ya Aye, Dr. Khine Nwe Win, Prof; Yadanar Kyaw, Prof; Thiwa Tin, Prof; Seinn Mya Mya Aye,Aung Aung Oo, Swe Swe Aung Presented By Dr.Khin Thiri Kyaw

2. Research Objective To explore differences of demographic and physiological parameters (by sleep test)between sleepy and non sleepy adult OSA patients. To aware factors governing disease severity and prognosis of adult OSA patients.

3. Introduction OSA and sleepiness, what and why? “Disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts normal ventilation during sleep and normal sleep pattern accompanied by symptoms and signs”. + Commonest symptom= Abnormal day time sleepiness due to EEG arousals and sleep fragmentation due to chronic intermittent hypoxia to brain. + Prevalence of sleepiness in OSA patients = 22.6% of male and 15.5% of female * + Some OSA patients with severe degree of AHI** do not have daytime sleepiness and usually do not aware OSA symptoms (non sleepy phenotype?). *= Wisconsin sleep study ** AHI = Apnea-Hypopnea Index (diagnosis= AHI ≥ 5 + signs &symptoms) Severity criteria; AHI =0-5= Normal, 5-15= Mild, 15-30= Moderate, >30=Severe

4. Polysomnogram (PSG or Sleep Test) + Sleep test device with AASM* compliance software. + Sensor for-- EEG,EOG,EMG, inductive movement of chest and abdomen, SPO2, tidal volume, NREM-REM sleep stages and body positions. + Reproduce– AHI, SPO2 desaturation index, sleep stages, sleep efficiency %, EEG arousal pattern, limb movement index, Heart rate and Respiratory effort ect--- + Sensitivity = 95.2% & Specificity= 40.1% + Uses International diagnostic manual( ICSD3 2014)**. * AASM= American Academy of Sleep Medicine ** ICSD= International Classification of Sleep Disorder and Diagnostic Manual, 3rd edition, 2014.

5. Material and Method Total patients = 293 (>18yr) with suspected OSAS from 2013 - 2017. Confirmed cases of OSA by polysomnogram = 253 ( AHI ≥ 5 with ICSD criteria B). Sleepiness screening by ESS or Epworth Sleepiness Scale (sensitivity= 80.0% and specificity= 76.0% ). ESS= > 10 as sleepy and 10 or < as non sleepy. Group 1; Sleepy OSA patients; n= 155(59.8%) Group 2; Non-sleepy OSA patients; n= 104(40.2%) Cross sectional study of demographic and PSG (physiology) data between 2 groups. Data analysis by SPSS (ver.13), independent t test and X² test

6. ICSD3* diagnostic criteria of OSA in adult Criteria A and B or C must be met. A-The presence of 1 or > of the followings - 1- patient; sleepiness, non restorative sleep, fatigue or insomnia 2- Patients awaken with breathing holding, gasping or chocking 3- Bed partner observed ; snoring, breathing interruption during p/t sleep. 4- patients diagnosed with ; hypertension, mood disorder, cognitive dysfunction, CAD, CCF, AF or NIDDM B-PSG or OCS demonstrates 1- 5 or more predominately obstructive respiratory event, mixed apnea or hypopneas or RERA per hour of sleep in PSG or OCST. C- PSG or OCST demonstrates ; 15 or > obstructive respiratory event per hour of sleep during PSG or OCST ICSD3*= International Classification of Sleep Disorder 3 rd edition

7. Complications of OSAS -Neurocognitive, cardiopulmonary, metabolic complications and road traffic accidents.

8. Findings

13. Summary results 1-Age ; did not effect on severity of sleepy and non-sleepy OSA group, but OSA was common finding of middle age group in this hospital based study. 2- Gender; did not effect on severity of sleepy and non-sleepy OSA group in this study. 3- BMI; positively associated with AHI in both sleepy and non sleepy OSA groups. 4- Sleepiness scale measured by ESS( Epworth Sleepiness Scale); ESS was found significantly higher with OSA severity in all groups (p=<0.001). 5- EEG arousal Index (AI); positive correlation between over all AHI and AI in both groups. 6- Sleep efficiency and number of awakening; no significant difference in between two groups. 7- AHI ( Apnea Hypopnea Index); Sleepy OSA group had greater AHI than non- sleepy OSA group.

14. Conclusion 1-OSA is predominant finding in middle age group with no gender differences in this hospital based study. 2-Sleepy OSA group had higher AHI than non- sleepy OSA patients. 3- Obesity and severe AHI found to have significant prognostic factors for excessive daytime sleepiness measured by ESS. 4-To get greater awareness and suspicion of OSA in general public, community health education is needed.

15. Conflict of interest There was no funding and conflict of interest during making of this research article.

16. References

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