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epi chronic disease april 27 2010

sleep apnea, pulmonary htn, cor pulmonale

James Dolan

on 25 April 2010

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Transcript of epi chronic disease april 27 2010

Sleep apnea Abnormal breathing
during sleep sleepiness
poor concentration Daytime symptoms snoring
restlessness Serious cardiopulmonary problems
Motor vehicle accidents

Epidemiology if disease = ahi of 5 or more, prevalence is 20%.
if disease = ahi of 5 or more & at least one symptom, prevalence is 2-9%

the apnea/hypopnea index (AHI): the number of apneas & hypopneas per hour of sleep
The prevalence increases with age, starts to go up between 18 and 45, highest in those over 65.

African Americans higher risk under age 35.

Despite lower body weight, Asians do not have lower risk.

2 times more common in men than women. Risk Factors * obesity
* craniofacial & upper airway soft tissue abnormalities
* family history
* current smokers (3 x risk)
* nasal congestion(2 x risk)
* diabetes or insulin resistance (3 x risk) Pathophysiology complete or partial airway collapse due to:
reduced airway size due to increased amount of soft tissue
reduced neural activity during sleep Clinical Spectrum Mild - ahi 5-15

sedentary sleepiness, with little functional impairment
normal sleep stages are preserved
30% will tolerate and respond to treatment

Moderate - ahi 15-30

symptomatic daytime sleepiness
increased chance of motor vehicle accidents
some interruption in normal sleep stages
most pts respond to treatment with less daytime sleepiness, improved quality of life, and lower blood pressure
Severe - ahi > 30 & significant hypoxemia (O2 saturation)

disabling daytime sleepiness
3 to 6 times increase in all cause mortality
high motor vehicle risk
cardiopulmonary complications
Treatment positive airway pressure
oral appliances
surgery Pulmonary Hypertension Elevated pulmonary artery pressure and secondary right ventricular failure. Classfication idiopathic
drug and toxin induced
secondary to lung disease and/or hypoxia
secondary to other diseases
Symptoms dyspnea
exertional syncope
peripheral edema

symptomatic patients have median survival of 3 years

Rx: vasodilators &/or treatment of underlying illness
Natural history hypertension
propensity for night-time cardiac death nocturnal angina
cerebrovascular disease
cardiac arrythmias
cor pulmonale
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