Obstructive Sleep Apnea (OSA)

Pt > 50 y/o M with h/o obesity, HTN, CAD, cardiac arrhythmias, depression presents with partner complaints of loud snoring/gasping during sleep. Reports morning headache, daytime sleepiness. Currently being treated for HTN. BMI > 35 kg/m^2, neck circumference > 40 cm on exam.

  • STOP-BANG = 8

    • Refer for sleep study

    • Pt advised to lose weight with goal of reducing BMI to < 35 kg/m^2

  • Sleep study positive

    • Treatment with CPAP vs. oral appliance

    • Consider placing tennis ball in sock and pinning it to back of shirt to avoid supine sleeping position

  • Consider referral for surgery for refractory OSA

Notes

  • CPAP improves daytime sleepiness, but does not reduce risk of cardiovascular events

Snoring

DDX

Risk factors

  • increasing age

  • male gender

  • obesity (BMI >30)

  • craniofacial abnormalities

History

  • noisy breathing during sleep

  • apneas

  • choking or gasping

  • waking up tired

  • daytime somnolence

  • hyperactivity

  • behavioral problems

Initial work-up

  • nasal decongestant test

  • Epworth sleepiness score (ESS)

Also consider

  • snoring scale score

  • TFTs

  • growth hormone level

  • allergy tests

STOP-BANG for Sleep Apnea

[] Do you snore loudly?
[] Do you often feel tired, fatigued, or sleeping during the daytime?
[] Has anyone observed that you stop breathing, or choke or gasp during your sleep?
[] History of HTN
[] BMI > 35
[] Age > 50 years
[] Neck circumference > 40 cm
[] Male gender

Scoring

  • 0-2 (low risk)

  • 3-4 (intermediate risk)

  • >5 (high risk)