OSA in elderly

Sophie Tatishvili
Case 1
• Male 68 years old.
• Spouse attends to loud disturbing snoring at night
• Is known to stop breathing for short periods of time while
sleeping
• Has not been diagnosed with sleep apnea
• Frequently tired during the day
• Weight 230 lbs. Height 5’10”
• Neck girth 17”
• Hypertensive 145/93. Taking antihypertensive medication.
• No history of illness recently. Coming in for scheduled
screening colonoscopy due to family history of Bowel CA.
What are this patient’s
risk factors for OSA
• Age
•Gender
•Hypertension
•Weight – neck girth
•Snoring
•Chronically tired even after sleep
•Stops breathing for short periods of time
while sleeping
 What Increases Your Risk
Risk Factors for AF in the U.S. include:
1. Age
2. Diabetes
3. Hypertension
4. Heart failure
5. Coronary artery disease

• Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA 2004;292:2471–7.
• Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health
Study. Am J Med 2005;118:489 –95.
 Sleep Apnea in Obese Patients Predicts AF

• Obesity is an
independent risk
factor for AF
• Obstructive sleep
apnea strongly
predicts the
incidence of AF
within about
5 years of its
diagnosis
Severity of OSA
Gami AS et al. Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation. J Am Coll Cardiol 2007;49:565–
71.
Signs and Symptoms
• Loud snoring
• Pauses in breathing while sleeping
• Restless sleep
• Waking up frequently at night
• Being very tired or falling asleep during the day
What Causes Sleep Apnea?

High risk

If you have obstructive sleep apnea, excess

soft tissue can obstruct your airway.
Stop Bang Questionnaire
(given for all surgical patients in SDC)
We are hoping this would be filled out by the surgeon’s office prior to booking the patient for Endoscopy.

Section A

Screening for Sleep Apnea:

• Have you been diagnosed with sleep apnea? (stop breathing while
you are asleep?)
• Do you use a CPAP, bi-level machine or dental device to help you
breathe while
sleeping?
What is Sleep Study?
Section B
• Do you snore loudly (louder than talking or loud enough to be heard
through closed
doors)?
• Do you often feel tired, fatigued, or sleepy during daytime?
• Has anyone observed you stop breathing during your sleep?
• Do you have or are you being treated for high blood pressure?
Section C
• BMI: more than 35 kg/m ? – (patient significantly overweight.)
• Age: over 50 years old?
• Neck circumference: Male: > 43 cm (17 in.) Female: > 40 cm (15 in.)?
• Gender: male?

YES to 3 or 4 Items
Request Aesthetic Chart Review

Diagnosed OSA or YES to > 5 Items

Request Aesthetic Consult
 How are AF and Sleep Apnea Linked?

• Half of the patients with AF also

have obstructive sleep apnea
• Patients with obstructive sleep
apnea have 4 times the risk of AF

Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation

and obstructive sleep apnea. Circulation 2004;110:364 –7.
 How are AF and Sleep Apnea Linked?

• Obstructive sleep apnea is

an independent risk factor
for AF even after adjusting
for obesity, diabetes and
hypertension

Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation

and obstructive sleep apnea. Circulation 2004;110:364 –7.
Questions to consider before discharge of an OSA
patient
• Patients are not suitable for discharge if any of the
following events have occurred in the last 30 minutes.
• Oxygen desaturation of less than 90 % (3 episodes)
• Bradypneas – less than 8 breaths per minute. (3 episodes)
• Apnea greater than 10 seconds (1 episode)
• Not taking narcotics for pain

• *(events observed in a quiet environment)

In-patient
• When giving report to the ward notify patient OSA and risks involved.
• Consider holding patient longer in recovery
• Suggest pt be on Oxymetry post-op.
How is Sleep Apnea Treated?

1. Weight loss
2. Avoidance of alcohol and sedatives
3. Address underlying cause
4. Continuous Positive Pressure Ventilation
5. Surgery
6. Dental appliances
 Treatment (CPAP)
Continuous Positive Airway Pressure (CPAP) therapy

Hypopharyngeal Retropalatal
Retroglossal
Treatment (CPAP)
CPAP and AF treatment
• Patients with obstructive sleep apnea can have 25% to 31%
increased risk for AF recurrence after catheter ablation compared
with patients who did not have OSA
• Use of CPAP is associated with a significant reduction in AF
recurrence
• CPAP use reduces AF recurrence across patient groups; it does
not matter whether they are managed medically or with ablation

Shukla A, et al. Effect of Obstructive Sleep Apnea Treatment on Atrial Fibrillation Recurrence A Meta-Analysis. J Am Coll
Cardiol EP 2015;1-2:41–51.