Is Obstructive Sleep ApneaAffecting Your Daily Life?

• Doyoufeelsleepyduringthedaynomatterhowmuch sleepyouget?

• Canyoufallasleepeasilywhenyouareinadark, comfortableplacelikeamovietheater?

• Doyousnore?Isitloudenoughtodisturbyourbed partner?

• Haveyoubeentoldthatyouawakenduringthenight choking,snorting,orgaspingforair?

How You Feel When YouHave OSA

PeoplewithuntreatedOSAmay:

• Feelsleepyduringtheday;

• Beforgetfulandhavetroubleconcentrating;

• Wakeupwithdrymouthorsorethroat;

• Havemorningheadaches;

• Gotothebathroomfrequentlyatnight;and

• Haveinsomniaornighttimeawakenings.

OSAstartssograduallythatmanypeopledonotnoticeit.Theygetusedtofeelingdrowsyallday,andtheymaynotrealizethatthisisaproblemthatcanbetreated.However,untreatedOSAisaseriousprob-lem.Ifyoufeelsleepyduringtheday,youmaybeatriskofhavingaccidentsathome,atwork,andwhiledrivingontheroad.

Is Obstructive Sleep Apnea Affecting Your Daily Life?Thesearemajorsymptomsofobstructivesleepapnea(OSA),acommonsleep-relatedbreathingdisorder.WhenpeoplewithOSAfallasleep,theupperairwaymusclesrelaxandtendtocollapseandblocktheairways(Figure1).Breathingstops.SomepeoplewithOSAwakeupsud-denlygaspingforbreath.Moreoften,theywillexperiencepartialawakeningsfromsleepandresumebreathingwithoutrealizingthattheyhavebeenawake.Therepeat-edwakeningduringthenightkeepsthemfromgettingarefreshingsleep,causingthemtofeelsleepyallday.Often,theysnoreloudlyenoughtodisturbotherpeople.

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Figure 1

OSA and Your Health

UntreatedOSAcanaffectyourhealth.PeoplewithuntreatedOSAaremorelikelyto:

• Beobeseorgainweight;

• Developdiabetes;

• Havehighbloodpressure,heartdisease,and stroke;and

• Getdepressed,anxious,andirritable.

Talk to Your Doctor About OSA

IfyouthinkthatyoumighthaveOSA,askyourdoctoraboutit.Effectivetreatmentisusuallyavailable,anditmayhelpyouin1ormoreofthefollowingways:

• Youwillwakeupinthemorningfeelingrefreshed.

• Youwillnotfeelsleepyduringtheday.

• Youwillbemoreproductiveathomeandonthejob.

• Youwillthinkmoreclearlywhenyouarewellrested.

• Youwillnotbotherpeoplewithyoursnoring.

• Withpropersleep,youarelesslikelytohavecar accidents.

• Youwillbelesslikelytodevelopthemedicalconditions relatedtoOSA.

• Ifyouarealreadyoverweightorifyouhavehighblood pressure,heartdisease,ordepression,treatingyour OSAmayhelpwiththeseconditions.

• Youwillsavemoneyonhealthcare.

• Bestofall,treatingyourOSAcouldhelpyoulivelonger andbetter.

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What You Can Expect From Your Doctor

Yourdoctorwillprobablyaskyouquestionsaboutyoursleephabits.YourdoctormayaskyoutocompleteanEpworthSleepinessScale(Figure2)todeterminehowsleepyyouare,orhaveyoucompletetheSTOP-BANGQuestionnaire(Figure3)toseeifyouareathighorlowriskforOSA.

Yourdoctorwillalsoconsiderotherpossiblecausesofyoursleepiness.Forexample,youmightbetakingamedicationthatmakesyousleepy.IfyourdoctorthinksthatyoumayhaveOSA,youmaybereferredtoasleepspecialistorforanovernightstudyatasleeplaboratory.

Atthesleeplaboratory,technicianswillpasteelec-trodes(smallmetaldiscs)toyourbodysothattheycanmonitorwhathappenswhileyousleep.Theywillbeabletomonitoryourbrainwaveactivity,heartrate,oxygenlevels,andlegmovementsandseeifyoustopbreathingduringthenight.Allthatyoumustdoissleep.

Clinical Practice Tool

EPWORTH SLEEPINESS SCALE Name:

Date:

Age:

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual behavior in recent times. Even if you have not done some of these things recently, consider how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = would never doze 1 = slight chance of dozing

2 = moderate chance of dozing 3 = high chance of dozing

Chance of Situation Dozing

Sitting and reading __________

Watching television __________

Sitting inactive in a public place (eg, at a theater or meeting) __________

As a passenger in a car for an hour without a break __________

Lying down to rest in the afternoon when circumstances permit __________

Sitting and talking to someone __________

Sitting quietly after a lunch without alcohol consumption __________

In a car while stopped for a few minutes in traffic __________

TOTAL: __________

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540-545. Johns MW, Hocking B. Daytime sleepiness and sleep habits of Australian workers. Sleep. 1997;844-949.

Interpreting Results

0-10 Average score; normal population

11 and up Insufficient sleep; consider improving sleep hygiene; consultation with a sleep specialistrecommended

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Figure 2

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Screening for OSA: STOP-BANG Questionnaire

1.Snoring:Doyousnoreloudly(louderthantalkingor loudenoughtobeheardthroughcloseddoors)?□ hYes □h No

2.Tired:Doyouoftenfeeltired,fatigued,orsleepyduring thedaytime?

□ h Yes □h No

3.Observed:Hasanyoneobservedyoustopbreathing duringyoursleep?

□ h Yes □h No

4.Bloodpressure:Doyouhaveorareyoubeingtreated forhighbloodpressure?□ h Yes □h No

5.BMI:BMImorethan35kg/m2?□ h Yes □h No

6.Age:Ageover50yearsold?□ h Yes □h No

7.Neckcircumference:Neckcircumferencegreaterthan 40cm?□ h Yes □h No

8.Gender:Gendermale?□ h Yes □h No

High risk for OSA:answeringyesto3ormoreitems

Low risk for OSA:answeringyestofewerthan3items

FromChungF,etal.Anesthesiology.2008;108:812-821.

If You Do Have OSA

PeoplewithOSAcanbetreatedinavarietyofways,butusuallythefirstapproachistotryatypeoftherapycalled“continuouspositiveairwaypressure”orCPAP.Youwillgetasmallappliance—aspecializedaircompressor—thatyouputbesideyourbed.Itblowsairthroughahosethatisattachedtoamaskthatgoesoveryournoseorfullfaceandistightlyfittedtoavoidleaks.Thepressurewillbecarefullyadjustedtomeetyourneed.

Itwillprobablyfeelstrangetosleepwithamaskoveryournose,anditmaytakeawhiletogetusedtoit.Tryflippingthehosesothatitgoesoveryourheadtowardthetopofyourbedsothatyoudonotgettangledupinitwhileyousleep.Youmayneedtoadjustthestrapsslightlyiftheyaretootight.Tryforaweekortwotogetusedtosleepingwiththemask.

Stick With It

MostpeoplegetusedtousingtheCPAPappliance,butsomepeoplerunintoproblems.Theairflowmaymakeyournosefeeltoodry,orthemaskmightmakeyoufeelclaustrophobic.Itmaybetemptingtoquit,butpleasedonotdothat.Ifyouhaveaproblemwiththeapplianceoryoujustcannotgetusedtoit,gobacktoyourdoctor.Taketheappliancewithyousothatyoucanpointouttheproblemorshowhowyouuseit.Thereareseveralkindsofappliancesandmasks,andadifferentonemightworkbetterforyou.Asmallerorsoftermaskmightnotfeelsoconfining,orperhapsyoucanuseanappliancewithanattachedhumidifiersothatyournosedoesnotfeelsodry.Therearemanyalternatives.Noonesizefitsall.Therearemanyvaria-tionsintheavailableequipment.Youwillneedtobepatienttofindtheidealcombinationforyou.

Justkeeptrying,andtalktoyourdoctororasleepspecialistifyouneedmorehelp.Remember,ifyoucangetusedtosleepingwiththeCPAPappliance,youwillfeelmuchbetterandmorealert,everysingleday.

Figure 3

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Resources

AmericanAcademyofSleepMedicine.Availableat:www.aasm.orgAccessedJuly20,2011.

AmericanSleepApneaAssociation.Availableat:www.sleepapnea.orgAccessedJuly20,2011.

NationalSleepFoundation.Availableat:www.sleepfoundation.orgAccessedJuly20,2011.

DoghramjiPP.Recognitionofobstructivesleepapneaandassociatedexcessivesleepinessinprimarycare.JFamPract.2008;57(suppl):S17-S23.

EpsteinLJ,KristoD,StrolloPJJr,etal;AdultObstructiveSleepApneaTaskForceoftheAmericanAcademyofSleepMedicine.Clinicalguidelinefortheevaluation,managementandlong-termcareofobstructivesleepapneainadults.JClinSleepMed.2009;5:263-276.

GroverM,MookadamM,ArmasD,etal.Identifyingpa-tientsatriskforobstructivesleepapneainaprimarycarepractice.JAmBoardFamMed.2011;24:152-160.

HirshkowitzM.Theclinicalconsequencesofobstructivesleepapneaandassociatedexcessivesleepiness.JFamPract.2008;57(suppl):S9-16.

KushidaCA,LittnerMR,HirshkowitzM,etal;AmericanAcademyofSleepMedicine.Practiceparametersfortheuseofcontinuousandbilevelpositiveairwaypressuredevicestotreatadultpatientswithsleep-relatedbreath-ingdisorders.Sleep.2006;29:375-380.

LiebermanJA3rd.Obstructivesleepapnea(OSA)andexcessivesleepinessassociatedwithOSA:recognitionintheprimarycaresetting.PostgradMed.2009;121:33-41.

McDaidC,DuréeKH,GriffinSC,etal.Asystematicreviewofcontinuouspositiveairwaypressureforobstructivesleepapnoea-hypopnoeasyndrome.SleepMedRev.2009;13:427-436.

MoldJW,QuattlebaumC,SchinnererE,BoeckmanL,OrrW,HollabaughK.Identificationbyprimarycarecliniciansofpatientswithobstructivesleepapnea:apractice-basedresearchnetwork(PBRN)study.JAmBoardFamMed.2011;24:138-145.

PagelJF.Theburdenofobstructivesleepapneaandassociatedexcessivesleepiness.JFamPract.2008;57(suppl):S3-8.

RosenbergR,DoghramjiP.Optimaltreatmentofobstruc-tivesleepapneaandexcessivesleepiness.AdvTher.2009;26:295-312.Epub2009Apr3.