Benjamas Intarapoka, MD
- Sleep apnea and chronic medical illness
Benjamas Intarapoka M.D.
Present: working at Bumrungrad International hospital Thailand
MD and Internal medicine: Khon Kaen University, Thailand
Sleep fellowship training: Rush Presbyterian St. Luke Medical center, Chicago. IL, USA.
Sleep apnea and chronic medical illness
Obstructive sleep apnea (OSA) is defined as repetitive pharyngeal collapse during sleep leading to increase effort to breath and arousals from sleep and end up with sleep fragmentation and poor sleep quality. There is no air entry due to completely collapse of pharynx (apnea) and reduce of air entry due to partially collapse of pharynx (hypopnea) lead to drop in oxygenation in arterial blood or hypoxemia. So the presenting symptoms of OSA patients are depending on airway narrowing and obstruction and consequences such as loud interruptive snoring, initial and maintenance insomnia, wake up to catch breath, wake up with palpitation or sense of panic attack, frequent nocturia, wake up un-refresh feeling, fatigue and tired, wake up with headache, increase blood pressure the morning, un-control hypertension, day time sleepiness, memory problem, learning ability, poor day time performances, emotional problem, impotence and interpersonal relationship.
OSA is more prevalence in middle age male, obese, older age and medical co-morbid diseases such as diabetes mellitus, hypertension, chronic kidney disease, hypothyroidism, stroke and heart disease.
OSA is increasing concerned due to epidemic obesity and increase in older world population. OSA is under estimate in diagnosis and treatment. It is happening during sleep which no one knows what was happening after she/ he sleep. Many patients do not have bed partner to observe what was happening while sleeping. There are so much knowledge about serious health consequences of left un-treated OSA not only day time sleepiness, drugs abuse and accident but more over OSA is independence risk factor of cardiovascular diseases, stroke and abnormal glucose metabolism.
Gold standard of diagnosis is overnight polysomnography. Both in-lab and home monitor are used to diagnose, determine severity of disease and treatment.
Continuous positive airway pressure (CPAP) is the treatment of choice and will be offered to every degree of severity to give back normal or near normal sleep. CPAP and its accessories are essential to start with in the beginning to reduce failure of treatment such as heated humidifier, chin strap and proper mask fit including program monitor and follow up session. Group therapy and peers support is important.