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

1. Does Obstructive Sleep Apnea affect Lower
extremities wound with Edema?
Dr Ahmed Heshmat
Chair of Family Medicine
Shady Grove Hospital
Maryland , USA

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. 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. Obstructive Sleep
Apnea
Complication of OSA
• Chronic Fatigue
• Cardiac arrhythmia
• Increase incidence of stroke
• Pulmonary Hypertension
• Heart failure
• depression

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. 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. 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. 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.