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Cardio Diabetes Medicine 2017 215

Obstructive Sleep Apnoea Syndrome and

Cardio Metabolic Risk

Dr. Solaiman Juman, FRCS
Lecturer in Otolaryngology,
University of the West Indies

Abstract ruptive to sleep and there are no apnoeas (cessation
In Obstructive sleep Apnoea Syndrome (OSAS) the of airflow for greater than 10 seconds or more).
upper airway is obstructed many times during sleep Some authors believe that as the obstructive process
leading to a cascade of neurological, hormonal and worsens, Upper Airway Resistance Syndrome (UARS)
haematological changes that affect the cardio-met- occurs which is thought to be due to further narrow-
abolic status which in turn result in significant mor- ing of the airway but with no closures [1] . Because
bidity and mortality. of the work of breathing, the patient may have symp-

There is an increasing prevalence of OSAS interna- toms similar to Obstructive Sleep Apnoea Syndrome
tionally and the phenotypes of patients can differ (OSAS), fatigue, daytime sleepiness, unrefreshing
greatly, so medical personnel must be aware of the sleep- but there are no or minimal apnoeic episodes.
different types of presentations and treatment mo- As the obstruction progresses, OSAS (Apnoea – Hy-
dalities to provide optimal care. popnea Index (AHI) of greater than 5 on polysom-
nography) is precipitated.. Apart from obesity, there
Advances in concepts and approaches dealing with
all aspects of OSAS will be discussed in this chapter. are many other factors that cause obstruction in the
airway, such as old age, neuromuscular disorders,
Introduction structural abnormalities and adenotonsillar hypertro-
phy.
Obstructive Sleep Apnoea Syndrome (OSAS) is char-
acterized by disrupted fragmented sleep associated Incidence
with airflow obstruction which can lead to serious
life threatening consequences if not managed ad- OSAS occurs in about 4% of middle-aged men and
equately. 2% of women [2] and over the past two decades there
has been an increase in prevalence of OSAS [3] and
Along with the related international epidemic of obe- a subsequent explosion in research about the ep-
sity, idemiology, aetiology, diagnosis, management and

OSAS has become increasingly relevant to the health prognosis of patients with OSAS.
and well being of adults and children worldwide. Despite the increasing incidence of OSAS, Sia et.al.
Benign Snoring, Upper Airway Resistance Syndrome has shown that awareness and knowledge of OSA
(UARS) and Obstructive Sleep Apnoea Syndrome among the general population in Singapore is poor
(OSAS) [4]. Therefore ongoing health education should have
OSAS issues included in the campaigns.
Definition There is a paucity of Indian studies in OSAS preva-
Noisy breathing due to obstruction of the upper air- lence, but Singh et al [5] looked at 1512 subjects in
way develops in a progressive stepwise manner. As Lucknow and found and that 6.2% were found to be
the obstruction starts to develop (e.g. due to deposi- high risk of OSAS and 12.2% were obese.
tion of fat in the pharynx) the individual may manifest
benign primary snoring which is noisy but is not dis- Screening

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