Obstructive sleep apnea - Chronic
Rahul Soman, M. Pharm
Definition
According to The American Academy of Sleep Medicine, obstructive sleep apnea syndrome is defined as being characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation .
An apneic event is defined as the cessation of respiration for greater than 10 seconds . A practical, clinical definition of obstructive sleep apnea is based on what is considered a clinically important event by the apnea-hypopnea index .
Medical History
* Obese build
* Male
* Hypertension [Hypertension - Chronic]
* Alcohol Abuse
* Substance Abuse
* Smoking
* Hypothyroidism [Hypothyroidism - Chronic]
* Pediatric (0-12 years) , Hypertrophy of tonsils AND adenoids
Findings
* Increased blood pressure
* Dyssomnia
* Excessive somnolence
* Headache
* Impaired cognition
* Snoring
* Upper respiratory tract obstruction
Tests
Suspected obstructive sleep apnea
* Polysomnography: More than 5 apneic episodes per hour of sleep, or 15 episodes without other findings, is important if sleepiness or other cardiovascular comorbidities exist
Differential Diagnosis
* Gastroesophageal reflux disease - Chronic
* Parasomnia
* Depression - Chronic
* Congestive heart failure
* Chronic obstructive pulmonary disease - Chronic
* Seizure
* Narcolepsy
* Central sleep apnea syndrome
Treatment
Drug Therapy
To improve excessive sleepiness in obstructive sleep apnea; adjunct to standard treatment(s) for the underlying obstruction
MODAFINIL
Adults: 200 mg orally once daily each morning
ARMODAFINIL
Adults: 150 or 250 mg orally once daily each morning
Procedural Therapy
Obstructive sleep apnea
* Continuous positive airway pressure (CPAP): Studies have shown that the use of continuous positive airway pressure reduces daytime sleepiness . Nonadherence issues should be addressed.
Non-Procedural Therapy
Obstructive sleep apnea
* Weight Loss
* Avoidance of Depressant Drugs
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