OSA without Daytime Somnolence
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Respiratory medicine
OSA without Daytime Somnolence
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There's a discussion in the Cardiology forum about screening heart failure patients for Central Sleep Apnoea, which has moved onto discussions regarding OSAin heart failure.
Once question which com
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Cat:OpenClinicalForum:8114d353-b41b-4a03-b052-dc009589d5cf
Cat:OpenClinicalForum:8114d353-b41b-4a03-b052-dc009589d5cfDiscussion:eb744499-9834-4937-9078-143e8bceba4a
Forums » Open clinical » Respiratory medicine » OSA without Daytime Somnolence
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Re: OSA without Daytime Somnolence
posted at 29/1/2012 7:11 PM GMT
on bmj.com
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Posts: 1593
First: 24/12/2008 Last: 14/5/2013 |
This is great discussion. There is sleep questionnaire and sleep monitoring i.e AHI for the diagnosis of OSA (discussed here). What you all think about respiratory disturbance index (RDI)? I would love to read about opinions about it especially in relation to much established AHI. Thanks.
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Re: OSA without Daytime Somnolence
posted at 29/1/2012 10:02 PM GMT
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
RDI is the same as the AHI. Respiratory Disturbance Index = Apnoeas + Hypopnoeas/hr = AHI which is normal if equal to or less than 5/hr as the overall AHI. However one needs to know the AHI in REM, NREM, supine REM, supine NREM, supine (all) and non-supine to give the whole picture.
The Arousal Index is normal if < 20 Arousals can be due to resp events, PLMD, other. It is just another colour on the portrait. Arousals make one sleepy, not hypoxic events and many very sleepy (high ESS) don't desaturate. |
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Re: OSA without Daytime Somnolence
posted at 31/1/2012 6:34 AM GMT
on bmj.com
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Posts: 16
First: 18/7/2011 Last: 27/10/2012 |
As far I know RDI= no. of apneas+ hypopneas+ RERAs/hr of sleep. In contrast AHI excludes RERAs. In that sense RDI is not synonimous to AHI. The forum is open to share other views. I would like to know more. In regard to asymptomatic OSA I would like to know that whether or not SDB esp. apnea invariably causes O2 desaturation? If it does there is no point for omission of CPAP rx if OSA is established by polysomnography. As far I know, American Academy of Sleep Medicine recommends to treat OSA if AHI /> 15/hr irrespective of daytime symptoms for the risk it poses on cardiovascular health. Hoping to hear from others. |
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Re: OSA without Daytime Somnolence
posted at 31/1/2012 11:56 AM GMT
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
Atom = neutrons and protons (and neutrinos, etc). RERAs = neutrinos etc. They were not on the radar until recently. They rarely figure as more than neutrinos or quarks. In 1940 during the Battle of Britain, Fighter Command layed down a doctrine that squadrons should fly in V-formation with a scout (usually the most inexperienced at the back on top). The Germans flew in groups of two (Ace and wingman) in loose formation. The result takes no tactical genius to work out. They called the British formation by a well earned pejorative. The Britishers lost more than was necessary for want of bad tactics. I fly in loose formation. I attack the enemy of sleep disordered breathing according to prevailing conditions and the tactical situation; not by numbers or according to the dictates of the Grand Order of Sleep Water Buffaloes. I tug the forelock to no water buffaloes as we have many in my country. Some will have an overall AHI of 5 but have a supine REM AHI of 55. Rules are for dummkopfs. it takes imagination and intelligence to practice medicine by anything than "numbers" or established dogma. That is why we now treat cardiac failure with beta blockers and stomach ulcers with antibiotics. Rules are for fools; dogma for committees and the anally retentive. Most rules in medicine will soon be found to be wanting. Recommended reading: A most dangerous enemy by Stephen Bungay. |
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Re: OSA without Daytime Somnolence
posted at 8/2/2012 4:31 PM GMT
on bmj.com
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Posts: 2
First: 8/2/2012 Last: 24/12/2012 |
I am working on a study based in this exact theme. It's my Doctorate, hoping to finish it this year. Any theories o why do some people with OSA do not have sleep apnea and under what justification should we treat them? |
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Re: OSA without Daytime Somnolence
posted at 8/2/2012 8:23 PM GMT
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
I am not sure I understand your Irish comment, Spanish critic. However, I do not think we know enough about arousal thresholds, the neuroanatomy of the upper airways and the influence of obesity-related hormones and cytokines. The upper airway tube is a complicated little part of the cosmos. There is an interesting article on "Obesity and obstructive sleep apnoea: Mechanisms for increasing collapsibility of the passive pharyngeal airway" by Shiroh ISONO in the latest Respirology 2012:17;32-42. The posterior third of the normal tongue is 30% fat (extramyocellular fat). It is an unsually interesting tree in the monotonous plantation forest of medical publications. The more I know, the more I wonder. With knowledge, doubt increases. Goethe. PS. Patient seen this week. High ESS (18/24), presenting with insomnia and depression not responding to antidepressants. AHI 40/hr overall, 55 in REM and 80 in NREM, no snoring, oxygen down to 78%. This shows that insomnia (waking after 1-4 hrs) was caused by OSA. No snoring in a thin woman with siblings and father tired. She had a Malampatti 4 throat. This is the corollary to the above topic. Tired OSA with no snoring presenting as insomnia. Her family needs screening.
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Re: OSA without Daytime Somnolence
posted at 10/2/2012 3:02 PM GMT
on bmj.com
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Posts: 1178
First: 19/4/2010 Last: 21/5/2013 |
Welcome to Doc2Doc, Spanish critic. Can you clarify your question - you've said why do some people with OSA not have sleep apnoea. OSA *is* sleep apnoea to us. Do you mean why do some people with Sleep Disordered Breathing, not have the full syndrome of Sleep Apnoea, that is they lack daytime somnolence? This was my original query, and I don't think we really know. The presentation of sleepiness is sometimes, but not always OSA. The presentation of snoring is sometimes, but not always OSA. The presentation of witnessed apnoeas during sleep is sometimes, but not always, OSA. Here's another questions - in a completely asymptomatic patient with a positive sleep study (using whatever parameters you choose), but with a wife who has daytime somnolence because the patient's snoring/apnoeas keep her awake, and they only have one bedroom, would you give the patient CPAP?
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Re: OSA without Daytime Somnolence
posted at 10/2/2012 10:50 PM GMT
on bmj.com
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Posts: 2947
First: 10/3/2009 Last: 29/4/2013 |
No I would have the patient pay for it. I once had a man who had such bad OSA the neighbours bought his CPAP pump. Another presented to me from an orthopod as he had a bad back. The reason was his wife kneed him in the back all night when he snored. I had a pug dog next door to us which snored terribly. I tell patients that H,sapiens have foreshortened faces unlike a dog (Scottish deer hound which I once had) and we are like pug dogs and not Alsatians. Look at a photo of Churchill. Everything in the mouth has been crammed back. It is why we snore and have OSA.
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Sorry I meant excessive daytime sleepiness (EDS) not sleep apnea
posted at 24/12/2012 12:54 PM GMT
on bmj.com
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Posts: 2
First: 8/2/2012 Last: 24/12/2012 |
Thank you for your comments, indeed I meant EDS. Great article in Respirology, brings out a new theory but there is much to know about sleep apnea with no EDS, it seems that patients with severe OSAS and no EDS present higher cardiovascular morbidity and maybe these are the ones that we shoud treat, not te mild ones. |
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