download - Malaysian Thoracic Society

More documents

Recommendations

Info

Annual Congress of Malaysian Thoracic Society Symposium 4A Sleep Disorders Obstructive sleep apnoea – How do we tackle this new pandemic disease? Zainudin Md Zin Damansara Specialist Hospital, Petaling Jaya, Selangor, Malaysia Obstructive sleep apnoea is a common disorder characterized by repetitive collapse of the pharyngeal airway during sleep. It affects at least 4% of adult men and 2% of adult women. Thus, it is a big problem affecting a large number of people with enormous medical, social and economic consequences. The medical consequences of obstructive sleep apnoea may be categorised into neurocognitive dysfunction which is a result of sleep fragmentation, and cardiovascular complications (hypertension, myaocardial infarction, stroke and congestive heart failure) possibly due to intermittent hypoxia. The condition is generally diagnosed in sleep laboratory through an overnight polysomnography, which is both labour-intensive and expensive. Alternative approaches to confirm the diagnosis are available and may be appropriate in many cases. A number of treatment options are also available. Continuous positive airway pressure remains the most effective treatment for most cases but dental/oral appliances and surgeries may also work for selected cases. Approach to the diagnosis of this condition and options of treatment will be discussed. 33
Annual Congress of Malaysian Thoracic Society Symposium 4A Sleep Disorders Initiating continuous positive airway pressure (CPAP) in obstructive sleep apnea Amanda Piper Australia Continuous positive airway pressure is well established therapy for the management of obstructive sleep apnea (OSA), and is associated with substantial improvement in daytime functioning and quality of life. However, the effectiveness of CPAP is frequently hindered by poor or nonadherence to therapy. A multitude of factors can influence whether an individual accepts and then uses CPAP consistently. While previous studies have evaluated physiological and patient characteristics as predictors of adherence (1), more recent studies have focused on the role of psychological factors and cognitive perceptions in influencing the decision about CPAP use (2). Several studies have found early experiences with CPAP impact on the individual’s decision to use CPAP (2,3), and this early pattern of use predicts long term adherence (4). Consequently, promoting a positive initial experience with CPAP is seen as crucial in encouraging patients to continue therapy long term. Three key aspects of initiating CPAP therapy will be discussed: a) the impact on adherence of how an effective pressure level is titrated, b) improvements in device technology to lessen side-effects commonly associated with CPAP use and c) education and support of the individual commencing CPAP. Evidence to date suggests that simplified approaches to the determination of effective pressures have not impacted negatively on CPAP adherence, at least in appropriately selected individuals (5). Considerable effort has been put into modification of CPAP devices to lessen side effects, and while these have been effective in reducing symptoms associated with therapy use, there is currently little evidence that these have had a clinically significant impact on adherence, at least in CPAP naïve individuals (6). More recent work has shown that educational support combined with behavioural strategies employed early in the CPAP experience is most likely to influence CPAP use (7). In general, studies evaluating device modifications and educational strategies on CPAP adherence have assessed CPAP naïve patients with moderate to severe apnea. More work is needed to determine the impact of these interventions in subjects with much milder disease, and those who are likely to be, or are already established, as poorly adherent to therapy. References 1. Weaver & Grunstein, Proc Am Thorac Soc 2008; 5:173-178 2. Sawyer et al, Qual Health Res 2010;20:873-892 3. Lewis et al, Sleep 2004;27:134-138 4. Drake et al, Sleep 2003;26:308-311 5. Collen et al, Sleep 2009;14:93-99 6. Smith & Lasserson, Cochrane Database Syst Rev 2009 7. Richards et al, Sleep 2007;30:635-40 34
Page 2 and 3: anniversary MALAYSIAN THORACIC SOCI
Page 4 and 5: AnnuAl Congress of MAlAysiAysi An T
Page 8 and 9: anniversary MALAYSIAN THORACIC SOCI
Page 18 and 19: Annual Congress of Malaysian Thorac
Page 84 and 85:
Annual Congress of Malaysian Thorac
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
show all

download - Malaysian Thoracic Society

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?