Dr. Ketan C. Patel to talk about sleep apnea at Thursday's walk


Dr. Ketan C. Patel will lead Thursday's Walk With a Doc program. He is scheduled to talk about sleep apnea.

Patel is board-certified in internal medicine, pulmonary disease medicine, critical care medicine and sleep medicine and completed fellowship training in sleep medicine.

Walk With a Doc, a project of the Smith County Medical Society, begins at 6 p.m. Thursday at the Rose Rudman Recreational Trail's Copeland Road trailhead, followed by walking.

Q: What is obstructive sleep apnea?

A: Obstructive sleep apnea (OSA)is a common chronic disorder that often requires lifelong care. Cardinal features in adults include: obstructive apneas, hypopneas or respiratory effort related arousals. Daytime symptoms attributable to disrupted sleep, such as sleepiness, fatigue or poor concentration. Signs of disturbed sleep, such as snoring, restlessness or resuscitative snorts.

Q: Who is at risk of developing sleep apnea?

A: The estimated prevalence in North America is approximately 20 to 30 percent in males and 10 to 15 percent in females when OSA is defined broadly as and apnea-hyponea index (AHI) greater than five events per hours as measured by a polysomnogram.

1. Age: The prevalence of OSA increases from young adulthood through the sixth to seventh decade.

2. Gender: OSA is approximately two to three times more common in males than females, although the gap narrows at the age of menopause in women.

3. Obesity: 10 percent increase in weight was associated with a sixfold increase in risk of incident OSA.

4. Craniofacial and upper airway abnormalities: Examples include an abnormal maxillary or short mandibular size, a wide craniofacial base, tonsillar hypertrophy and adenoid hypertrophy.

5. Other risk factors: Nasal congestion confers an approximately twofold increase in prevalence of OSA. Smoking leads to nearly three times more likely to have a OSA. Menopausal women appear to have an increased risk. Family history of snoring or OSA.

Q: What are the health risks of untreated sleep apnea?

A: The prevalence of OSA is increased in patients with a variety of medical conditions, including the following: pregnancy; congestive heart failure; end-stage renal disease; chronic lung disease, including asthma, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis; stroke and transient ischemic attacks; acromegaly; hypothyroidism; polycystic ovary syndrome; post-traumatic stress disorder.

OSA is important disorder because patients are at increase risk for poor neurocognitive performance and adverse medical outcomes, due to repeated arousals and/or hypoxemia during sleep over months to years. Severe untreated OSA is associated with increased all-cause and cardiovascular mortality.

Patients with OSA are at increased risk for adverse clinical outcomes ranging from decreased daytime alertness and quality of life to cardiovascular morbidities and mortality to increase risk for hospitalization. Motor vehicle crashes are two to three times more common among patients with OSA. Patients with moderate to severe untreated OSA, are at increased risk for a broad range of cardiovascular morbidities, including systemic hypertension, pulmonary arterial hypertension, coronary artery disease, cardiac arrhythmias, heart failure and stroke.

Patients with OSA have an increased prevalence of insulin resistance and Type 2 diabetes. Patient with OSA may be a greater risk for perioperative complications such as postoperative oxygen desaturation, acute respiratory failure, postoperative cardiac events and intensive care unit transfers. Patient with untreated severe OSA (AHI > 30) have two-to threefold increased risk of all-cause mortality compared with individuals without OSA.

Q: What can you do to treat sleep apnea?

A: The goals of therapy are to reduce or eliminate apneas, hypopneas and oxyhemoglobin desaturation during sleep and thereby improve sleep quality and daytime function. Potential benefits of successful treatment of OSA include improved quality of life, improved systemic blood pressure control, reduced motor vehicle crashes, reduced health care utilization and costs and possibly decreased cardiovascular morbidity and mortality.

Gold standard therapy for OSA is weight loss and continuous positive airway pressure (CPAP) therapy. Alternative therapies include oral appliance, upper airway surgery and hypoglossal nerve stimulation.

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