men
Prevalence of OSA is highest in _______.
during sleep, patient breathing repeatedly stops & starts intermittently; due to throat muscles relaxing and blocking upper airway
How does sleep apnea occur?
obesity (BMI >35), family history, type 2 dm, HF, afib, stroke, treatment-resistant HTN
Risk factors for OSA? (7)
high-risk driving occupation, daytime sleepiness, sleep dissatisfaction
Who should get screened for OSA? (3)
no significant CVD comorbidity
When can we conduct an in-home sleeping test?
undergoing bariatric surgery; treatment-resistant HTN
If a patient has no symptoms of OSA, we should still evaluate them if they __________ or ___________
loud snoring, nocturnal choking, gasping, daytime sleepiness, hx of drowsy driving
Symptoms of OSA? (5)
airflow cessation >= 10 sec
Apnea =
airflow reduction>=10 sec + 3-4% OxyHb desaturation; arousal from sleep
Hypopnea = (2)
epileptiform EEG, limb movement, nocturnal arrhythmia
What are other sleep measures we can try when diagnosing sleep apnea? (3)
AHI >= 5 & < 15/hr
Mild OSA =
AHI >=15 & 30/hr
Moderate OSA =
AHI>=30 hr
Severe OSA =
CPAP, weight reduction, surgery, sleep positions
Nonpharmacologic options for OSA? (4)
CNS depressants; weight gain
Patients who have OSA should avoid all _________ and drugs that promote __________.
alcohol, opioids, benzos
Which drugs should be avoided in OSA? (3)
ACEi; can cause inflammation/cough
Which drug should be monitored? Why?
patients with residual daytime sleepiness despite CPAP use
Who should receive wake-promoting medications?
Sunosi
Soliramefetol =
modafinil, armodafinil, soliramefetol, pitolisant
What are medications used to promote wakefulness? (4)
a
Which is a a DNRI?
a) Soliramefetol
b) Modafinil
c) Pitolisant
d) Armodafinil
c
Which is an H3 receptor antagonist?
a) Soliramefetol
b) Modafinil
c) Pitolisant
d) Armodafinil
a
Which requires titration?
a) Soliramefetol
b) Modafinil
c) Pitolisant
d) Armodafinil
75 mg OD; titrate every 3 days to max dose
Solriamfetol narcolepsy dosing?
37.5 mg OD
Solriamfetol OSA dosing?
37.5 mg OD; 75 mg OD after 7 days
Soliramfetol moderate renally impaired dosing?
37.5 mg OD; no titration
Soliramfetol severe renal impaired dosing?
f; not recommended
Soliramfetol can be used in ESRD; just at a much lower dose. T/F?
a
Which is contraindicated with MAOIs?
a) Soliramefetol
b) Modafinil
c) Pitolisant
d) Armodafinil
increased BP/HR, psychiatric symptoms
Warnings/Precautions in Soliramfetol use? (2)
HTN
OSA can lead to the development of ______.
underlying cause treatment; CPAP
What are the first-line treatments for OSA? (2)
Wakix
Pitolisant =