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Global OSA Institute UAE: Module 1 Integrating OSA into Cardiometabolic Risk Assessment

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Description

This activity is supported by an independent education grant from Lilly. This online education program has been designed for healthcare professionals globally, excluding the UK.

The content for this enduring activity has been designed to be specific to the UAE.

Join experts Dr. Reena Mehra and Dr. Jessica Schwartz Pumar to explore the critical intersection of Obstructive Sleep Apnea (OSA) and cardiometabolic health. This session equips healthcare providers with evidence-based strategies to integrate OSA screening into routine cardiometabolic risk assessments, utilizing validated tools to uncover undiagnosed patients and implement collaborative, multidisciplinary care pathways.

This is Module One of Three. Modules Two and Three can be found here.

Session Highlights

Targeting High-Risk Cardiometabolic Populations: Uncover the profound public health impact of obstructive sleep apnea, recognizing that up to 80% of moderate-to-severe cases remain undiagnosed. Learn to proactively identify high-risk patients, particularly those presenting with obesity, resistant hypertension, and established cardiovascular disease, to mitigate bidirectional health risks.
Implementing Validated Screening Protocols: Master the practical application of efficient, evidence-based screening instruments like the STOP-BANG and Berlin questionnaires during routine clinical visits. Overcome common diagnostic bottlenecks and recognize demographic-specific presentations, such as atypical sleepiness profiles in peri- and post-menopausal women.
Navigating Modern Diagnostic Pathways: Confidently transition patients from positive clinical screens to appropriate diagnostic testing. Evaluate the clinical utility of traditional, resource-intensive in-laboratory polysomnography versus highly accessible home sleep apnea testing (HSAT) to reduce care fragmentation and accelerate timely treatment initiation.
Fostering Interdisciplinary Care Models: Discover how to build collaborative, cross-discipline treatment pathways that unite primary care physicians, sleep medicine specialists, and cardiologists. Implement holistic management strategies that address both the respiratory and metabolic components of OSA to optimize long-term cardiovascular outcomes.

Who Should Watch

This program is designed for healthcare professionals globally involved in the frontline screening, diagnosis, and long-term clinical management of obstructive sleep apnea (OSA) including:

Primary Care Physicians (General Practitioners)
Sleep Specialists

Visual Learner? See our Infographic Here.

Faculty

Dr Reena Mehra, MD, MS is an Associate Professor of Medicine at Case Western Reserve University School of Medicine and a staff physician at the Cleveland Clinic, where she serves as the Director of Sleep Disorders Research within the Neurological Institute's Sleep Center. Her extensive research portfolio focuses on the intersection of sleep and cardiovascular health, specifically investigating the relationship between sleep-disordered breathing and abnormal cardiac electrophysiology. Through both epidemiological analyses and clinical trials, she explores how various sleep disorders contribute to cardiovascular disease, establishing her as a key contributor to the understanding of the hemodynamic and mechanistic links between sleep apnea and cardiac outcomes.

Dr Jessica Schwarts Pumar is a Specialist ENT and Sleep Surgeon at American Hospital Dubai and a highly regarded authority in advanced sleep medicine and surgical interventions. A Diplomate in Sleep Medicine and a board member of the Ibero-American Society of Sleep Surgery (SIBECS), Dr Pumar specializes in the comprehensive management of snoring and obstructive sleep apnea (OSA). She is recognized as a pioneer in the region, being one of only three physicians—and the first female specialist—in the UAE to perform hypoglossal nerve stimulation (HNS) therapy, an innovative upper airway implant procedure for patients with complex sleep apnea. Bringing a unique blend of surgical precision and cutting-edge clinical expertise to this online teaching session, Dr Pumar provides healthcare providers with practical, evidence-based insights into the latest diagnostic criteria and transformative therapeutic pathways for moderate-to-severe obstructive sleep apnea.

Disclosures

Partners for Advancing Clinical Education (Partners) requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All relevant financial relationships are mitigated according to Partners policies.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated according to Partners policies. Others involved in the planning of this activity have no relevant financial relationships.

Dr Reena Meehra has the following relevant financial relationships: Consultant, Advisory Board, Educational Media - Amgen, Apnimed, Centessa, Eli Lilly, Haymarket Media, and Mineralys.

Dr Jessica Schwartz Pumar has no relevant financial relationships to disclose.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Partners for Advancing Clinical Education (Partners) and MedAll. Partners is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Education

Partners designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Continuing Professional Development

The maximum number of hours awarded for this Nursing Continuing Professional Development activity is 0.25 ANCC contact hours.

PA Continuing Medical Education

Partners has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until July 27th 2027. PAs should only claim credit commensurate with the extent of their participation.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Fee Information

There is no fee for this educational activity.

This continuing education activity is active starting September 9th 2026, and will expire on July 27th 2027.

Estimated time to complete this activity: 15 Minutes

Learning objectives

Integrate OSA diagnosis into cardiometabolic risk assessment and management through screening of high-risk patients and coordinated cardiometabolic care.

Implement evidence-based, multimodal OSA treatment plans that integrate PAP therapy, cardiometabolic management, and emerging pharmacotherapy, applying a multidisciplinary, chronic-disease model.

Develop multidisciplinary OSA management plans that systematically address obesity co-management, PAP alternatives, and cardiometabolic comorbidities within specialist-led and hospital-centric care environments.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

So let's move on now to our second objective, implementing multimodal evidence-based obstructive sleep apnea treatment. So we have now our pulling question 3. In a patient with obstructive sleep apnea on positive airway pressure, who has persistent symptoms and worsening metabolic risk, what do you usually prioritize first? A. Review positive airway pressure use and side effects. B. Intensify BP diabetes management as relevant. C. Start structured weight management. Consider anti-obesity pharmacotherapy. Or E, coordinate a multidisciplinary care plan. So leave some time to answer. So patient case 2. It's a 50 8 year old male with severe obstructive sleep apnea, obesity, type 2 diabetes, hypertension, dyslipidemia. So he has already undergone a sleep study that has shown a severe degree of sleep apnea based on an apnea hypopnea index of 38 events per hour, nadir oxygen saturation is 79%. So accordingly, treatment for sleep apnea was initiated, so he started continuous positive airway pressure six months ago. Uh, and has persistent sleepiness and fatigue despite starting CPAP. So his upper sleepiness scale score is 14. His download of his CPAP device shows that his average usage is approximately 3 hours per night. He is struggling with some mask leak and dry mouth, and a residual apnea hypopnea index of 9 events per hour. His body mass index is 38, identical to his AHI. Uh, his BP is elevated despite antihypertensive therapy with an angiotensin receptor blockade agent and a calcium channel blocker. And his hemoglobin A1C remains elevated at 8. His LDL is 124. So positive airway pressure support is focused on um device supply and and there's no weight loss or cardio metabolic care plan. So let's delve into therapy for obstructive sleep apnea a little bit more. So what are the options for first line therapy for sleep apnea according to severity, history, and comorbidities. So as we think about treatment for sleep apnea, it should be approached as a chronic disease. Management requiring long-term multidisciplinary management. And most patients with symptomatic moderate to severe sleep apnea will require treatment with continuous positive airway pressure. Selection of the ideal therapy is really based upon the interpretation of the diagnostic sleep study results in terms of the severity of sleep apnea, as well as the degree of oxygen desaturation. Um, also taking into consideration the symptoms that the patient is presenting with, for example, sleepiness, motor motor vehicle accidents, uh, risk, and the presence of comorbid sleep diagnosis, for example, insomnia, comorbid, um, insomnia with sleep apnea, um, and, uh, insufficient sleep, restless leg syndrome, for example, and also the presence of related Uh, relevant medical comorbidities, for example, cardiovascular disease, respiratory diseases such as, uh, COPD, pulmonary hypertension. So the approach to first line, uh, treatment really involves taking all of this into consideration, and lifestyle modification and advice really should be part of what we are discussing with our patients overall. Um, and then getting into more of the details as far as, again, continuous positive airway pressure has long been considered the um the treatment for uh sleep apnea, and now we are Having more options in our armamentarium to treat sleep apnea, positional therapy, uh, mandibular advancement devices, obesity pharmacotherapy. Uh, but for the most part, again, CPAP is considered first line. Uh, with symptomatic moderate to severe sleep apnea or mild sleep apnea with significant hypoxemia or symptoms such as daytime sleepiness. In anti-obesity therapy, uh, with incret therapy such as trazepatide can also mitigate cardio metabolic risk in those with moderate to severe sleep apnea and obesity, per the surmount OSA trial results. And CPAP therapy, while it is foundational, adherence must be something that we pay attention to as we have patients follow up, uh, after starting their CPAP therapy, and this really, um, is incredibly important. Um, so what is positive airway pressure? It is basically, um, a bedside, a pump. A device that uses a positive airway pressure to serve as a pneumatic splint for the upper airway to prevent the repetitive upper airway collapse inherent to obstructive sleep apnea. This device is connected to a hose, which is connected to a mask, and uh there are a variety of masks that are available, and that mask fitting at the upfront is very important. In terms of size and comfort. And ideally, um, you know, in terms of the goals of optimal therapy, we want people to feel better after using CPAP, so tracking their symptoms such as sleepiness and, you know, considering targeting an upper sleepiness skill score of less than 10, for example, can be helpful. Um, there's no consistent benefit for hard cardiovascular outcomes. Improvement for BP, yes, in systemic hypertension, resistant hypertension, but Trials such as SAVE have not really shown consistent benefit in mitigating cardiovascular outcomes, although there's associations, uh, and biologic possibility for a relationship and association of sleep apnea and cardiovascular outcomes. So, um, and the benefits can be somewhat dose dependent in terms of the usage of CPAP. So the more it is used, the more likely you are to derive benefits, including, um, cardiovascular outcomes. So it can improve the degree of sleep apnea defined by the apnea hypothia index can improve. Sleepiness symptoms, quality of life measures, um, mood in terms of anxiety, depression. Uh, there are data to support improvement in atrial fibrillation recurrence after ablation or cardioversion. And again, BP control has consistently been shown in many randomized control trials. Sleep apnea adherence we do recognize is a major barrier to long term um sleep apnea outcomes and and those beneficial outcomes, achieving those beneficial outcomes. And approximately 60% of those with cardiovascular disease and moderate to severe sleep apnea do do not maintain usage for more than 4. per night at 12 months as you can see in the graph on your right. Um, and the risk for non-adherence can be associated with those who have, um, more socioeconomic disadvantage and perhaps more limited access to care, low educational background, comorbid insomnia, um, uh. Again, mood disorders, uh, and those who have less in the way of symptoms, and evidence-based interventions that improve CPAP that we can really use to help us, um, augment PAP adherence include providing education, motivational enhancement or interview. in cognitive behavioral therapy. So this is really important for us to be aware of because I don't know that many um primary care physicians or even sub-specialists are aware that these are strategies that can really um help improve path optimization. Now common side effects of positive airway pressure also include escape of the pressure resulting in dry eyes, dry mouth, uh, those who have claustrophobia can have difficulty tolerating CPAP, uh, nasal congestion, uh, noise from the device. So paying attention to the specific issues that the patient is bringing forward, uh, in terms