EWMA 2013 - Ep499 - Does Obstructive Sleep Apnea affect Lower extremities wound with Edema?


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Ahmed Heshmat
Chair of Family Medicine
Shady Grove Hospital
Maryland , USA

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EWMA 2013 - Ep499 - Does Obstructive Sleep Apnea affect Lower extremities wound with Edema?

  1. 1. Does Obstructive Sleep Apnea affect Lower extremities wound with Edema? Dr Ahmed Heshmat Chair of Family Medicine Shady Grove Hospital Maryland , USA
  2. 2. Evaluation of Lower extremities edema with wound 1.Causes of lower extremity edema. 2.Arterial Doppler/ABI to rule out PAD. 3.Venous Doppler to rule out venous reflex. 4.Nutritional status of the patient. 5.Ambulation status of the patient. 6.Side effects of medication .. 7.Early Signs of infection. 8.Chronic medical conditions .
  3. 3. Obstructive Sleep Apnea What is OSA? Pause of breathing while asleep for more than 9 sec. Frequent pause of breathing . Loud snoring. Shocking while asleep • US health authorities believe that approximately 1 in every 5 American adults has some degree of obstructive sleep apnea (OSA). • The National Health Service (NHS), UK reports that OSA is common, and affects 3.5% of men and 1.5% of women. People over the age of 40 are more likely to develop the condition; but individuals of all ages may be affected, even children.
  4. 4. Obstructive Sleep Apnea Complication of OSA • Chronic Fatigue • Cardiac arrhythmia • Increase incidence of stroke • Pulmonary Hypertension • Heart failure • depression
  5. 5. Complication Of Obstructive Sleep Apnea 1)Cardiac arrhythmia. 2)Congestive heart failure. 3)Pulmonary hypertension. 4)Chronic fatigue. 5)Depression. 6)Stroke. 7)Increase incident of MI.
  6. 6. Causes of Pulmonary Hypertension • Left Ventricular pump failure • Left Ventricular stiffness • Valve disease • COPD • Obstructive Sleep Apnea • Idiopathic • Drugs Scleroderma • Portal hypertension • Congenital heart disease • Pulmonary Embolism • Sickle cell anemia • Tumor emboli • Heritable BMPR2 or ALK-1 mutation • High altitude
  7. 7. Dose obstructive sleep apnea affect wound healing • AUTHOR Dr. Ahmed Heshmat M.D. -Chair of Family Practice at Shady Grove hospital • Research Method Observation of Twenty-five patients admitted to the hospital for wound debridement over a one-year span of time. • Tools Data gathered from medical records and direct patient observation. • Discussion Out of the twenty-five patients admitted, ten had an echocardiogram preformed .Nine of those ten had a diagnosis of pulmonary hypertension. Thirty-eight percent from total patient Eight out of nine were overweight by above 100 kilograms. Ninety percent of these patients had an echocardiogram. Of those eight patients, three had a confirmed diagnosis of OSA. Full investigation of lower extremity wound requires arterial Doppler, venous Doppler and nutritional status especially in those patients with lower extremity edema, as one of the signs of pulmonary hypertension is lower extremity edema. Severe OSA is one of the causes of pulmonary hypertension. In addition obesity contribute to OSA. • When the medical provider directly observes lower extremity edema in an obese patient it should merit further work up to include echocardiogram to investigate for pulmonary hypertension, if the diagnosis of pulmonary hypertension is confirmed then the medical provider must order a sleep study to evaluate OSA. • Conclusion • Thorough investigation of pulmonary hypertension is warranted in an obese patient that presents with lower extremity wounds. When Arterial and Venous Doppler studies are negative, the medical provider must order an echocardiogram to rule out Pulmonary Hypertension. If Pulmonary Hypertension is diagnosed then OSA is highly suggestive and must be treated for proper lower extremity wound healing.
  8. 8. The Connection In obese patient with lower extremities wound and edema suggest to evaluate for pulmonary hypertension since it is a factor for lower extremities edema. If tested positive for pulmnary hypertension above 30 by echocardiogram, it is recommend highly to evaluate for obstructive sleep apnea.