Obstructive Sleep Apnea Medical Slides

Present each component: Snoring (loud), Tired (daytime sleepiness), Observed apneas, Pressure (treated hypertension), BMI >35, Age >50, Neck circumference >40 cm, Gender (male). Scoring: 0-2 low risk, 3-4 intermediate, 5-8 high risk for moderate-to-severe OSA. Sensitivity for moderate-severe OSA at score ≥3 is 93%. Emphasize use as a pre-operative screening tool — AASM recommends evaluation before elective surgery when score ≥3.

Present the adherence challenge: only 50-60% of patients meet the CMS adherence definition (≥4 hours/night on ≥70% of nights in 30-day period). Reference interventions that improve adherence: motivational enhancement therapy, cognitive behavioral therapy for CPAP, telemonitoring with early intervention (per Fox 2012), heated humidification, and proper mask fitting. Discuss the dose-response relationship — benefits for blood pressure reduction require ≥4 hours/night (Barbé 2012, SAVE trial).

Present the STAR trial (Strollo 2014): Inspire device in moderate-severe OSA patients who failed CPAP showed 68% reduction in AHI at 12 months. Eligibility criteria: AHI 15-65, BMI <32, no complete concentric collapse on DISE (drug-induced sleep endoscopy), failed CPAP. Five-year follow-up data sustained efficacy. Include comparison with traditional UPPP (variable success rates, 33-50% at 5 years) and MMA advancement (>85% success but higher morbidity).