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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.
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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.
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