Sleep Apnea 13 th EUGMS Congress Developing Preventive Actions in - - PowerPoint PPT Presentation

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Sleep Apnea 13 th EUGMS Congress Developing Preventive Actions in - - PowerPoint PPT Presentation

Sep 17, 2022 372 likes •628 views

EAMA Core Curriculum Sleep Apnea 13 th EUGMS Congress Developing Preventive Actions in Geriatrics 20/22 September 2017 Thomas Mnzer, MD, EAMA Board Member St. Gallen, Switzerland CONFLICT OF IN INTEREST DIS ISCLOSURE I have the following

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SLIDE 1

EAMA Core Curriculum

Sleep Apnea

13th EUGMS Congress Developing Preventive Actions in Geriatrics 20/22 September 2017

Thomas Münzer, MD, EAMA Board Member

  • St. Gallen, Switzerland
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SLIDE 2

CONFLICT OF IN INTEREST DIS ISCLOSURE

I have the following potential conflict(s) of interest to report

  • Invited speaker (indirect sponsoring)
  • Medica, IBSA, Menarini
  • Böhringer Ingelheim, Mepha
  • Lundbeck, MSR, Mylan, Vifor
  • I snore sometimes
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SLIDE 3

Sleep Disordered Breathing

  • Wide spectrum of sleep-related breathing abnormalities
  • increased upper airway resistance
  • snoring, upper airway resistance syndrome (UARS),
  • bstructive sleep apnea-hypopnea syndrome (OSAHS)
  • Central sleep apnea
  • Combinations
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SLIDE 4

Obstructive Sleep Apnea

  • Cessation of airflow
  • desaturation
  • Day time sleepiness
  •  Prevalence with age
  •  Cardiovascular risk
  •  Quality of life
  • Metabolic consequences
  • Endocrine consequences
  • Treatment: CPAP
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SLIDE 5

Definition of OSAS

Apnea-hypopnea index (AHI)

  • Number of apneas (>80% reduction of

the flow signal)

  • Number of hypopneas (>50% reduction
  • f the flow signal)
  • Oxygen desaturation index (ODI)

number of desaturations >3% of a stable baseline Desaturation >3% or a respiratory-induced EEG arousal

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SLIDE 6

Diagnosis and Classification of OSAS

  • History of
  • snoring
  • Daytime sleepiness
  • Positive screening (questionnaires)
  • Diagnosis
  • Nocturnal desaturations
  • Polysomnography (sleep lab)
  • Classification
  • Mild

5-15 AH events /hour sleep

  • Intermediate

16-30 AH events /hour sleep

  • Severe

>31 AH events /hour sleep

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SLIDE 7

Obstructive Hypopnea

Journal of Clinical Sleep Medicine, Vol. 8, No. 5, 2012

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SLIDE 8

Apnea 38 sec duration

Journal of Clinical Sleep Medicine, Vol. 8, No. 5, 2012

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SLIDE 9

Prevalance of OSAS

Lancet Respir Med. 2015 April ; 3(4): 310–318

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SLIDE 10

Many open questions

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SLIDE 11

OSAS Affects Functional Outcome

J Am Geriatr Soc. 2014; 62(11): 2040–2046

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SLIDE 12

Am J Epidemiol. 2013;177(9):1006–1014

BMI and SDB in Women and Men Age 50-70

10 20 30 40 50 60 70 80 90 <25 25-29.9 30-39.9 >40 BMI Prevalence

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SLIDE 13

CSB and CAI Predict Heart Failure in Older Men

Am J Respir Crit Care Med Vol193, 561–568, 2016

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SLIDE 14

CSB and CAI Predict Heart Failure in Older Men

Am J Respir Crit Care Med Vol193, 561–568, 2016

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SLIDE 15

Sleep Apnea and Stroke Risk in Older Men

SLEEP 2016;39(3):531–540

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SLIDE 16

Sleep Stage Predicts Changes in Cognition

SLEEP 2015;38(3):411–421

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SLIDE 17

Progression of Cognitive Decline Depends on OSAS

Neurology 2015;84:1964–1971

MCI Age at onset 83y without SDB Age at onset 72y with SDB

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SLIDE 18

OSAS Treatment

  • Weight reduction
  • Evening walk
  • CPAP
  • 1920 first observation of sleep/wake cycles in EEC
  • 1958 discovery of REM sleep
  • 1978 discovery of obstruction (OSAS)
  • 1980 Sullivan invented CPAP machine
  • 1981 1st trial in 5 patients
  • Upper Airway Stimulation
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SLIDE 19

Effects of CPAP on total/lean BM and IGF- 1

  • 1

1 2 3 4 5

kg

<=40 (N=11) >40-60 (N=42) >60 (N=20)

  • 5

5 10 15 20 25 30

IGF-1 (ng/ml)

p=0.06 p=0.35 p=0.0027 p=0.04 p=0.002 p=0.007 p=0.017 p=0.002 p=0.02

European Journal of Endocrinology 161 1–11

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SLIDE 20

CPAP Effects on VO2max and Heart Rate Recovery

Int J Cardiol. 2009 Feb 6;132(1):75-83.

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SLIDE 21

18 Mo Follow Up Upper Airway Stimulation

SLEEP, Vol. 38, No. 10, 2015

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SLIDE 22

Effects of CPAP ventilation in Older Persons

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SLIDE 23

Take Home Messages

  • Risk Factors or OSAS include
  • Age, BMI, sex
  • OSAS is associated with
  • Functional and cognitive decline and strole while
  • Cheyne-Stokes breathing and desaturations predict HF
  • CPAP improves
  • body composition, IGF-1 and cardiac indurance
  • New option: UAS

Many open questions in

  • lder persons
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SLIDE 24

An Other Way of Treating OSAS

BMJ,doi:10.1136/bmj.38705.470590.55, 2005