OSAHS
Obstructive Sleep Apnoea
Hypopnoea Syndrome
Liam Doherty
Consultant Respiratory Physician,
Bon Secours Hospital, Cork
Definition
OSAHS is characterized by recurrent
episodes of partial or complete upper airway
obstruction during sleep
Who cares?
Kaplan-Meier survival curve for
cardiovascular death in CPAP treated and
untreated patients.
Aaa
100
% surviving
95
90
85
Untreated group
N=61
p=0.009
CPAP group
80
N=107
75
0
25
50
75
100
time (months)
Doherty et al - CHEST 2005;
Who?
Who else?
Children
Cranio-facial
abnormalities
–Micrognathia, macroglossia
Neuro-muscular
diesases
Syndromes
–Downs, Prada-Willi, Treacher-Collins, Pierre-Rubin
Miscellaneous
–Pregnancy, Renal failure, hypothyroid, CVA
How common?
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Terry Young, Mari Palta, Jerome Dempsey, James Skatrud, Steven Weber, and Safwan Badr
1993;328:1230-1235
n=602
symptoms
Classical symptoms of
OSAHS

Excessive daytime sleepiness
 Heavy snoring
 Witnessed apnoeas/nocturnal choking
Other symptoms
 Dyspepsia
 Nocturia, Enuresis
 Nightmares
 Insomnia
 Excess sweating
Assessing sleepiness
Epworth
Stanford
Sleepines Score (ESS)
Sleepiness Scale
Multiple Sleep Latency Test (MSLT)
Maintenance of Wakefulness Test (MWT)
Oxford Sleep Resistance test (OSLER)
Epworth Sleepiness Scale
Use the following scale to choose the most appropriate number for
each situation:
0 = would never doze or sleep
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping
Situation-Chance of Dozing or Sleeping
1. Sitting and reading
2. Watching TV
3. Sitting inactive in a public place
4. Being a passenger in a motor vehicle for an hour or more
5. Lying down in the afternoon
6. Sitting and talking to someone
7. Sitting quietly after lunch (no alcohol)
8.
Stopped for a few minutes in traffic while driving
Diagnostic tests
Polysomnography
Limited
(PSG)
sleep studies e.g. embletta
Overnight oximetry
PSG :- Montage





EEG C4/A1 or
C3/A2
EOG
Chin and anterior
tibialis EMG
ECG
Blood Pressure
(optional)

Airflow
 Saturations
 Sonogram
 Respitrace
– rib
– abdomen
– Sum
Diagnosis of OSA

Apnoea:- cessation of airflow > 10sec

Hypopnea:- > 30% reduction in airflow
accompanied by > 4% drop in O2
saturations and/or an arousal.
Obstructive Sleep Apnoea
Diagnosis of OSA

AHI >5
 AHI 15-30
 AHI >30
mild
moderate
severe
This must only be interpreted with
symptoms i.e. Epworth Score, and
cardiovascular risk factors e.g.
Hypertension, IHD, CVA, arrhythmias
Treatment
Conservative
– Lose weight
– Reduce alcohol
– Proper sleep hygiene
– Sleep on side
Nasal CPAP therapy
Oral appliances
– Tongue-retainers
– Anterior mandibular displacement
Surgery
– Septoplasty
– Tonsillectomy
– Polypectomy
– Pharyngoplasty
– UPPP (uvulo-palato-pharyngo-plasty)
– Tracheostomy
Take home messages





Very common disorder (2-4% population)
Substantial morbidity and ?mortality
Diagnosis by sleep studies
Very easy to treat
On successful treatment, huge
improvements in quality of life
“I want to die peacefully in my
sleep like my Grandfather, not
screaming in terror like the
other passengers in his car”
Anonymous