Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

Obstructive Sleep Apnea 1077

■Diseases that may interefere w/ sleep & cause sleep-related sym-

ptoms:

➣COPD/emphysema/asthma

➣Sinusitis & postnasal drip

➣GERD

➣CHF

➣Anxiety & panic attacks

management

What to Do First

■Weight loss (only 10–20% of obese pts can maintain significant

weight loss)

■Avoid alcohol & sedatives for 4 h before bedtime

■Sleep in the lateral position (sew 1–2 tennis balls in back of T-shirt

to prevent lying on back)

■Treat nasal allergies or obstruction

specific therapy

Treatment Options

■After confirmatory sleep study:

➣CPAP:

Most consistently effective medical therapy if pt adherent

BiPAP (BiLevel) may be superior to CPAP in 10–20% of pts

Proper fit & settings can improve adherence

➣Oral appliances can be used during sleep to pull jaw forward (fit

by dentist)

➣Surgery:

Surgical treatment not always curative; need good follow-up

Tracheotomy most effective, but a morbid procedure

➣Antidepressants: protriptyline or SSRIs options if other therapies

ineffective

➣Oxygen: may be used if other therapies not tolerated, but does

not open obstructed airway

follow-up

■Clinical follow-up to see if symptoms improve

■For CPAP, follow-up in first 2–4 wk improves adherence

■For surgery or oral appliances, follow-up sleep study to document

effectiveness

■If pt has significant change in weight or symptoms, repeat sleep study

often recommended