Obstructive Sleep Apnea

Question 1

What are the treatment indications for patients with OSA (3)?

Answer 1

(1) Patients w/symptoms of excessive sleepiness or impaired sleep-related QOL.
(2) Comorbid HTN
(3) Asymptomatic patients with severe OSA or critical occupation.

Question 2

What is the definition of OSA?

Answer 2

(1) Symptoms (sleepiness, choking, awakenings) AND

2) Objective testing with a sleep study (at least 5 apnea/hyponea events during sleep monitoring

Question 3

What are the degrees of sleep apnea?

Answer 3

(A) Mild 5-15
(B) Moderate 15-30
(C) Severe > 30 API

Question 4

What is the most suggestive finding on history of sleep apnea?

Answer 4

Nocturnal Choking/Gasping

LR 3.3

Question 5

What physical exam finding is most suggestive of OSA?

Answer 5

There are NO good physical exam findings to rule in or out OSA - sleep study required!

Question 6

What is CPAP compliance defined as?

Answer 6

Compliance is defined as > or = 4 hours > 70% of nights in the past 30 days.

Question 7

What are the CMA driver’s guide recommendations for sleep apnea?

Answer 7

Drivers should be disqualified immediately or denied certification if any of the following conditions are met:

(1) The driver admits to experiencing sleepiness during the major wake period while driving OR
(2) The driver experienced a crack associated with falling asleep in the past 5 years if effective therapy has not be instituted in the interim.
(3) The driver has been found to be non-compliant with treatment.