Obstructive Sleep Apnea

Flemons, W. Ward

doi:10.1056/nejmcp012849

Cited by 329 publications

(215 citation statements)

References 43 publications

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“…Frequent presenting symptoms of and risk factors for OSA are given in Table 1. 15,16,[18][19][20][21][22][23][24] A number of illnesses in addition to depression are comorbid with OSA, including hypertension and diabetes. PCPs commonly see patients with these conditions and are therefore ideally placed to assess these high-risk patients for symptoms associated with OSA.…”

Section: Recognitionmentioning

confidence: 99%

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Culpepper¹,

Roth²

2009

Prim. Care Companion J. Clin. Psychiatry

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Objective: This review aims to impart information regarding recognition of obstructive sleep apnea (OSA) and associated excessive sleepiness (ES) in the primary care setting in order to provide optimal care to patients with this common but serious condition. This review will also discuss the prevalence and treatment of depression in patients with OSA.Data Sources: A MEDLINE search of articles published between 1990 and 2008 was conducted using the search terms obstructive sleep apnea AND excessive sleepiness, obstructive sleep apnea AND depression, and obstructive sleep apnea AND primary care. Searches were limited to articles in English concerned with adult patients.Study Selection: In total, 239 articles were identified. Articles concerning other sleep disorders and forms of apnea were excluded. The reference lists of identified articles were searched manually to find additional articles of interest.Data Synthesis: Primary care physicians can aid in the diagnosis of OSA and associated ES by being vigilant for lifestyle and physical risk factors associated with this condition. In addition, primary care physicians should maintain a high level of clinical suspicion when presented with illnesses that are commonly comorbid with OSA, such as psychiatric disorders and depression, in particular. Conversely, assessment of patients with OSA for common comorbidities may also improve a patient's prognosis and quality of life.Conclusions: Primary care physicians play a vital role in recognizing OSA and ES. These clinicians are crucial in supporting their patients during treatment by ensuring that they have clear, concise information regarding available therapies and the correct application and maintenance of prescribed devices.

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Section: Recognitionmentioning

confidence: 99%

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Culpepper¹,

Roth²

2009

Prim. Care Companion J. Clin. Psychiatry

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“…Among the differential diagnoses to be considered is obstructive sleep apnea syndrome, which is common in obese patients. In this condition, the patient's muscle tone is incapable of maintaining upper airway patency during sleep, resulting in hypoventilation and hypoxemia, which leads to pulmonary hypertension, polycythemia and ultimately to heart failure, particularly right-sided heart failure, and impaired functional capacity 5 . A number of other conditions can also cause pulmonary hypertension, such as chronic obstructive pulmonary disease (COPD), chronic pulmonary thromboembolism, congenital heart diseases, and schistosomiasis, among others.…”

Section: Clinical Featuresmentioning

confidence: 99%

Caso 4: mulher de 78 Anos, obesa, com dispnéia súbita intensa

Ceotto¹,

Sousa²,

Benvenuti³

2008

Arq. Bras. Cardiol.

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A 78-year-old woman sought medical attention for severe dyspnea. She had morbid obesity, hypothyroidism, and long-standing hypertension, and was taking captopril 150 mg, furosemide 40 mg, digoxin 0.25 mg, and levothyroxine 75µg daily.For a long time she had dyspnea on heavy exertion, which became worse during the previous week, progressing to dyspnea at rest, orthopnea, nonproductive cough, and lower extremity edema. The patient had been diagnosed with heart failure at another medical institution. She was then medicated and discharged from hospital; nevertheless, her dyspnea worsened, and she sought emergency care at InCor.Physical examination (April 28, 2007) revealed tachypnea (36 breaths/min), heart rate of 120 bpm, blood pressure of 150/80 mm Hg, and body mass index of 46,9 kg/m². She weighted 275.5 pounds and was 5 feet and 3 inches tall. Chest auscultation revealed bilateral rales in the lower lung fields and occasional wheezing. Examinations of the heart and abdomen were unremarkable. Bilateral lower-extremity edema was noted, greater in the right leg. Oxygen saturation (measured percutaneously) was 88%.Laboratory data were as follows: urea 85 mg/dL, creatinine 1.8 mg/dL, blood glucose 116 mg/dL, hemoglobin 18 g/dL, hematocrit 57%, platelet count 228,000/mm³, troponin 2.8 ng/ml, CK-MB 10.8 g/L, fibrin D-dimer > 5000 g; and activated partial thromboplastin time (APTT) ratio 1.41.The electrocardiogram (ECG) showed sinus rhythm with a heart rate of 114 bpm, PR interval of 175 msec, QRS duration of 94 msec, QT interval of 282 msec, QRS axis +150 oriented posteriorly, S 1 Q 3 T 3 pattern, and right bundle branch block (Figure 1).The echocardiogram yielded the following measurements: aortic diameter of 32 mm, left atrial diameter of 32 mm, interventricular septal thickness of 10 mm and free wall thickness of 9 mm. The right atrium was markedly dilated, and the right ventricle was dilated and hypokinetic, with a systolic pressure of 85 mm Hg. The left ventricle was found to be normal.

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“…Of 65 diagnosed OSA patients, Gupta reported only 33 to use CPAP preoperatively [15]. Patient CPAP compliance is generally hindered by the obtrusive nature of the device [19].…”

Section: Patients Who Do Not Use Their Prescribed Cpapmentioning

confidence: 99%

“…It is clear from the medical literature that continuous positive airway pressure (CPAP) immediately reverses sleep *Address correspondence to this author at the Department of Anesthesiology, University of Rochester, Rochester, NY; Tel: 585-275-1384; Fax: 585-276-0122; E-mail: Suzanne_Karan@URMC.Rochester.edu related apnea and hypopnea by acting as a pneumatic splint [18,19]; though, the benefit of CPAP during the postoperative period, remains the subject of debate [20]. While some studies have suggested a role for CPAP for diagnosed and suspected OSA patients post-operatively, there is still a paucity of evidence on which to develop a protocol for its standardized utility.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Implementation of Continuous Positive Airway Pressure: A Review of the Considerations

Karan

Black²,

Mouton³

2011

TOATJ

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OSA patients present unique challenges in the peri-operative period. They routinely require more monitoring, oxygen therapy, unplanned ICU admissions, longer hospital stays, and have more adverse events than healthy counterparts. Some data suggest that perioperative CPAP use is associated with reduced morbidity and mortality of patients with OSA, and yet its application remains inconsistent. This review aims to summarize existing literature on the peri-operative use of CPAP, identify barriers to its implementation, and begin defining an algorithm for the practical application of peri-operative CPAP.

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Obstructive Sleep Apnea

Cited by 329 publications

References 43 publications

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Caso 4: mulher de 78 Anos, obesa, com dispnéia súbita intensa

Perioperative Implementation of Continuous Positive Airway Pressure: A Review of the Considerations

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