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[[File:OSCAR daily screen.png|thumb|none|1000px|Oscar daily screenSymptom]] <br />----=== Left side-bar ==={||[[File:OSCAR Side-bar.png|thumb|none]1000px|Left side bar]]|The left part of the Daily screen is referred to as the ''left side-bar''. It contains details of your machine and its settingss may be present for years, your AHI and other sleep indicatorseven decades without identification, and the amount of during which time you were asleep.<br />Starting from the top, sufferer may become conditioned to the key parts of the left side-bar are# Program identification, menu, [[daytime sleepiness]] and tabs, as found on all screens within OSCAR# The current date. Click the small green arrows to move back & forth by one day. Click the Green arrow & bar >| to move to the latest date fatigue associated with data. Click the small black triangle to make the calendar appear or disappear.# Tabs to select details, events, notes, and bookmarks. These will be discussed in greater detail below.# AHI Summary. This is your '''apnea / hypopnea index''' for the sessions under review. It is the total number of apneas and hypopneas divided by the total hours significant levels of [[sleepdisturbance]]. Generally, this will be for the whole night, however, if you have turned any sessions on or off (See No 11 below) then the AHI is given only for the sessions turned on.# Machine type and settings summary. This gives the make and model of the CPAP machine. The PAP mode is the particular algorithm set on the machine (many machines can operate in more than one mode). It also shows the pressure settings. If you hover the mouse cursor over the machine name, the model number and serial number will appear in Persons who sleep alone without a poplong-up box. '''Note:''' The settings for PC, S, and S/T modes on Philips Respironics System One machines term human partner may be displayed as random garbage numbers - this is a known problem and will be fixed in a later release of Oscar.# Session starting, ending, and total times. Shows when the machine was turned on and off, and the total elapsed time. Note that although this is used to calculate the time asleep, the CPAP machine has no way of knowing if you were actually asleep or not.# Event rates per hour. A simplified view of the different types of events you have experienced. Note that some machines display more or fewer event types, and these can be selected in the Event flag selector on the Daily page.# Statistics for pressure, leaks, snores, and respiration. Detailed information told about your respiration throughout the night. The statistics panel gives details of your pressures, minute ventilation, respiration rate, and other important parameters. For each parameter (referred to as a 'channel') the panel shows the minimum recorded, the median, 95th percentile and the maximum. Also shown are the total time in apnea, and the time over the leak redline. For Resmed machines, this is 24 L/min. For all machines the redline number can be set in the menu File | Preferences | CPAP. # Machine Settings Details. A more complete set of machine settings giving you the pressure and other settings for your machine. The settings shown will vary according to the type of machine.# Session Information. Each time the machine is started then stopped is called a session. If you their [[sleep right through the night, that is a single session. If you stop the machine for a toilet break then start it again, then two sessions will be recorded.# Buttons (bars) to turn sessions on and off. Clicking on these buttons will include or exclude sessions from the display of the night's data. Clicking on the blue and yellow session buttons will include or exclude sessions from the display of the night's data. This can be useful if (for example) you had a very brief nap in the afternoon and want to exclude it from the night's results. Note that turning a session off will change the calculated AHI for the night. Note also that sessions can be turned on and off using the small green/black buttons in the section information panel. When a session is off the button changes to black / reddisorder]] symptoms.
Moderate 5-10<!--See also [[http:br //www.apneaboard.com/wiki/index.php?title=Bookmarks&action=edit&redlink=1 Bookmarks]] -->|}----=== The daily detailed graphs ===The main part of the daily page is given over to the detailed graphs. These allow you to inspect all the important things which happened during the night, right down to a breath-by-breath review.----====Common features of detailed graphs====Each daily graph chart has a number of features in common:
== Signs and symptoms ==
Common signs of OSA include unexplained daytime sleepiness, restless sleep, and loud snoring (with periods of silence followed by gasps). Less common symptoms are morning headaches; [[insomnia]]; trouble concentrating; mood changes such as irritability, anxiety and depression; forgetfulness; increased heart rate and/or blood pressure; decreased sex drive; unexplained weight gain; increased urination and/or [File:OSCAR event flags.PNG[nocturia]]; frequent heartburn or gastroesophageal reflux disease; and heavy night sweats.
This problem can also be caused by excessive weight in children. In this case, the symptoms are more like the symptoms adults feel: restlessness, exhaustion, etc.
OSA is more frequent than [[File:OSCAR flow rate detail.pngcentral sleep apnea]]and is the most common category of sleep-disordered breathing. It is a common condition in many parts of the world.
Most cases of OSA are believed to be caused by:
* old age (natural or premature),
* brain injury (temporary or permanent),
* decreased muscle tone,
* increased soft tissue around the airway (sometimes due to obesity), and
* structural features that give rise to a narrowed airway.
'''Craniofacial syndromes'''
'''Post-operative complication'''
OSA is a also serious post-operative complication that seems to be most frequently associated with pharyngeal flap surgery, compared to other procedures for treatment of velopharyngeal inadequacy (VPI). In OSA, recurrent interruptions of respiration during sleep are associated with temporary airway obstruction. Following pharyngeal flap surgery, depending on size and position, the flap itself may have an "obturator" or obstructive effect within the pharynx during sleep, blocking ports of airflow and hindering effective respiration. There have been documented instances of severe airway obstruction, and reports of post-operative OSA continue to increase as healthcare professionals (i.e. physicians, speech language pathologists) become more educated about this possible dangerous condition. Subsequently, in clinical practice, concerns of OSA have matched or exceeded interest in speech outcomes following pharyngeal flap surgery.
The normal [[sleep cycle|sleep/wake cycle]] in adults is divided into [[REM]] (rapid eye movement) sleep, [[non-REM]] (NREM) sleep, and consciousness. NREM sleep is further divided into Stages 1, 2 and 3 NREM sleep. The deepest stage (stage 3 of NREM) is required for the physically restorative effects of sleep, and in pre-adolescents this is the period of release of human growth hormone. NREM stage 2 and REM, which combined are 70% of an average person's total sleep time, are more associated with mental recovery and maintenance. During REM sleep in particular, muscle tone of the throat and neck, as well as the vast majority of all skeletal muscles, is almost completely attenuated, allowing the tongue and soft palate/oropharynx to relax, and in the case of sleep apnea, to impede the flow of air to a degree ranging from light snoring to complete collapse. In the cases where airflow is reduced to a degree where blood oxygen levels fall, or the physical exertion to breathe is too great, neurological mechanisms trigger a sudden interruption of sleep, called a neurological arousal. These arousals rarely result in complete awakening, but can have a significant negative effect on the restorative quality of sleep. In significant cases of OSA, one consequence is sleep deprivation due to the repetitive disruption and recovery of sleep activity. This sleep interruption in stage 3 (also called [[slow-wave sleep]]), and in REM sleep, can interfere with normal growth patterns, healing, and immune response, especially in children and young adults.
Diagnosis of OSA is often based on a combination of patient history and tests (lab- or home-based). These tests range, in decreasing order of cost, complexity and tethering of the patient (number and type of channels of data recorded), from lab-attended full polysomnography ("sleep study") down to single-channel home recording. In the USA, these categories are associated with insurance classification from Type I down to Type IV. Reimbursement rules vary among European countries.
In our prescriptions for bilevelpatients who are at high likelihood of having OSA, I would venture a randomized controlled trial found that the '''average gap is in the 5 home [[oximetry]] (a non-invasive method of monitoring blood oxygenation) may be adequate and easier to 6''' range with tremendous variation, including some with obtain than formal polysomnography. High probability patients were identified by an [[Epworth Sleepiness Scale (ESS)]] score of 10 or greater and a '''gap [[Sleep apnea clinical score (SACS)]] of only 2 15 or 3'''greater. Those with a lower gap requirement would likely do as well on FLEX or APAPHome oximetry, but to repeathowever, the large majority of our patients have a gap of 4 does not measure [[apneic event]]s or greaterrespiratory event-related arousals and thus does not produce an AHI value."''<br />
Some treatments involve lifestyle changes, such as avoiding alcohol and medications that relax the central nervous system (for example, sedatives and muscle relaxants), losing weight, and quitting smoking. Some people are helped by special pillows or devices that keep them from sleeping on their backs, or oral appliances to keep the airway open during sleep. For those cases where these conservative methods are inadequate, doctors can recommend continuous positive airway pressure (CPAP), in which a face mask is attached to a tube and a machine that blows pressurized air into the mask and through the airway to keep it open. There are also surgical procedures intended to remove and tighten tissue and widen the airway, but none has been reproducibly successful. Some individuals may need a combination of therapies to successfully treat their condition.
[[File:OSCAR pressure.pngOral appliance]]therapy is less effective than CPAP, but is more 'user friendly'. Side-effects are common, but rarely is the patient aware of them.
A known algorithm that number of different surgeries are available to improve the size or tone of a patient's airway. For decades, [[tracheostomy]] was the only effective treatment for sleep apnea. It is used today only in rare, intractable cases that have withstood other attempts at treatment. Modern operations employ one or more of several options, tailored to automatically set each patient pressure in APAP machines is called ResMed AutoSet's needs. All Success rates are directly proportional to the accuracy in all, the AutoSet device, and its algorithm, is excellent for treating OSA patientsinitial diagnosis of the site of obstruction.
The ResMed AutoSet algorithm monitors patient flow and raises pressure when it detects flow limitation or snore. Because apnoeas are normally preceded by periods role of surgery in the treatment of sleep apnea has been questioned repeatedly as the long term success rate of flow limitation (also called partial obstruction) or snoring, apnoeas are rarely encounteredthe procedures has come into question. As a backup measurePatient selection in the past was oftentimes quite poor, pressure is also raised if an apnoea is detectedresulting in poor overall results. In Potential surgical candidates should now be extensively examined to assure the absence site of any measured flow disturbance, the pressure obstruction is allowed clearly evident prior to decay slowly and hopefully an equilibrium pressure will be achieved that allows the patient to sleep arousal-freeany surgical intervention. The AutoSet algorithm responds proportionally patient's age, weight and so other factors may make them a metric is used bad candidate for each condition to which surgery. When a patient can tolerate it responds, positive air pressure treatment is the gold standard. The metrics used are: However, surgical intervention is a flattening index viable option for flow-limitationthose patients who cannot, a calibrated RMS measure of sound averaged over an inspiration for snore and the length of any apnoea detectedor refuse, to utilize CPAP.
Many people benefit from sleeping at a 30 degree elevation of the upper body or higher, as if in a recliner. Doing so helps prevent the gravitational collapse of the airway. Lateral positions (sleeping on a side), as opposed to [[File:OSCAR Leak graph Resmed.png | 1200 px | Leak graph from Resmed machine showing excessive leakagesupine position]]<br>'''Leak graph from Resmed machine showing excessive leakage'''s (sleeping on the back), are also recommended as a treatment for sleep apnea, largely because the gravitational component is smaller than in the lateral position. A 30 degree elevation of the upper body can be achieved by sleeping in a recliner, an adjustable bed, or a bed wedge placed under the mattress. This approach can easily be used in combination with other treatments and may be particularly effective in very obese people.
The most serious consequence of untreated OSA is to the heart. Sleep apnea sufferers have a 30% higher risk of heart attack or death than those unaffected. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure known as cor pulmonale. One prospective study showed that patients with OSA, compared with healthy controls, initially had statistically significant increases in vascular endothelial growth factor (P=.003) and significantly lower levels of nitrite-nitrate (P=.008), which might be pathogenic factors in the cardiovascular complications of OSA. These factors reversed to normal levels after 12 weeks of treatment by CPAP, but further long---term trials are needed to assess the impact of this therapy.
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