We’ve now completed our pleural effusions,
let us now go into a very important topic, sleep apnea.
Many of you that will be going into your respective private practices
are then going to either join a group that has a sleep clinic, right,
or maybe you yourself with your friends and residency are going to develop a group that has sleep studies.
It’s fishy in our society, why? Let’s take a look.
First, definition overall of sleep apnea – overall, of sleep apnea, overall must know –
repeated stoppage, cessation of breathing for how long? Ten whole seconds?
I mean, trust me, that’s a lot. If you’re doing it on purpose that’s one thing
but if you can’t even help it and it’s just occurring automatically during sleep, this is kind of scary.
Now, if that’s the case and your breathing is not proper and you have this absence of breathing,
what does this mean to you?
Well the resulting disruption of asleep sure
and then obviously you don’t feel rested, you wake up and during the day you just feel sleepy, don’t you?
Okay, fine. Is that gonna kill you?
No, but the day time PO2 is within normal limits
because here even though the ten seconds seems like a long time,
it’s not going to kill you and you don’t have severe hypoxemia but at some point in time,
let’s say that there's nocturnal hypoxia, well, this is a problem.
At some in time if your sleep apnea is not correctly addressed which happens quite a bit,
now, what happened – oh, my husband or whatever –
my wife, my spouse they snore, they snore and snore and why do they do it?
They separate, right? They sleep alone or whatever so it has to be addressed
and if it’s not, if it’s nocturnal hypoxia, whenever that you have hypoxia what do your primary blood vessels do?
Now you get this and you tell me, we need to be detailed here, so if nocturnal hypoxia
you will tell me correctly that we have pulmonary vasoconstriction, good.
If that’s the case then we definitely have some type of pulmonary hypertension – good.
Is this class I? No, cuz it could be familial mostly, and drugs, no such thing here. Is it class 2?
The origin of pulmonary hypertension, the heart,
I told you to think of the heart as being left and right, if that helps you, class 2?
Nope. Class 3? Hypoxia resulting in hypoxic vasoconstriction resulting in secondary hypertension
and in addition if there’s nocturnal hypoxia what is then going to happen?
A kidney response and releases epo, erythropoietin.
What is this called? Secondary polycythemia isn’t it?
Number 3, at some point in time, maybe, you might undergo right ventricular hypotrophy
due to primary hypertension and so therefore it is arrythmogenic and whenever arrhythmia
ends up being the cause or development of whatever –
oh, boy, what are you worried about ladies and gentlemen? Yeah, sudden death.
Remember that patient with the hypertrophic obstructive cardiomyopathy,
could the patient die of arrhythmic sudden death? Sure.
What’s the most common cause of sudden death in a post myocardial infarction patient?
Sure, ones again arrhythmia, that’s no joke.
Okay, so, sleep apnea.
Definition when it becomes really dangerous is doing the nocturnal hypoxic events.