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

EAMA Core Curriculum Sleep Apnea 13 th EUGMS Congress Developing Preventive Actions in Geriatrics 20/22 September 2017 Thomas Münzer, MD, EAMA Board Member St. Gallen, Switzerland

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

Sleep Disordered Breathing • Wide spectrum of sleep-related breathing abnormalities • increased upper airway resistance • snoring, upper airway resistance syndrome (UARS), • obstructive sleep apnea-hypopnea syndrome (OSAHS) • Central sleep apnea • Combinations

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

Definition of OSAS Apnea-hypopnea index (AHI) • Number of apneas (>80% reduction of Desaturation >3% or the flow signal) a respiratory-induced EEG • Number of hypopneas (>50% reduction arousal of the flow signal) • Oxygen desaturation index (ODI) number of desaturations >3% of a stable baseline

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

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

Apnea 38 sec duration Journal of Clinical Sleep Medicine, Vol. 8, No. 5, 2012

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

Many open questions

OSAS Affects Functional Outcome J Am Geriatr Soc. 2014; 62(11): 2040 – 2046

BMI and SDB in Women and Men Age 50-70 90 80 70 60 Prevalence 50 40 30 20 10 0 <25 25-29.9 30-39.9 >40 BMI Am J Epidemiol. 2013;177(9):1006 – 1014

CSB and CAI Predict Heart Failure in Older Men Am J Respir Crit Care Med Vol193, 561 – 568, 2016

CSB and CAI Predict Heart Failure in Older Men Am J Respir Crit Care Med Vol193, 561 – 568, 2016

Sleep Apnea and Stroke Risk in Older Men SLEEP 2016;39(3):531 – 540

Sleep Stage Predicts Changes in Cognition SLEEP 2015;38(3):411 – 421

Progression of Cognitive Decline Depends on OSAS MCI Age at onset 83y without SDB Age at onset 72y with SDB Neurology 2015;84:1964 – 1971

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 1 st trial in 5 patients • Upper Airway Stimulation

Effects of CPAP on total/lean BM and IGF- 1 5 p=0.007 4 p=0.017 3 p=0.02 p=0.06 kg 2 p=0.002 p=0.002 1 0 -1 30 p=0.35 25 20 IGF-1 (ng/ml) p=0.0027 15 p=0.04 10 5 0 -5 <=40 (N=11) >40-60 (N=42) >60 (N=20) European Journal of Endocrinology 161 1 – 11

CPAP Effects on VO 2 max and Heart Rate Recovery Int J Cardiol. 2009 Feb 6;132(1):75-83.

18 Mo Follow Up Upper Airway Stimulation SLEEP, Vol. 38, No. 10, 2015

Effects of CPAP ventilation in Older Persons

Take Home Messages • Risk Factors or OSAS include • Many open questions in Age, BMI, sex • OSAS is associated with older persons • 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

An Other Way of Treating OSAS BMJ,doi:10.1136/bmj.38705.470590.55, 2005