Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Sleep Apnea


Medical Codes

ICD-9-CM:
780.50 - Sleep Disturbance, Unspecified
780.51 - Insomnia with Sleep Apnea, Unspecified
780.53 - Hypersomnia with Sleep Apnea, Unspecified
780.57 - Unspecified Sleep Apnea

Related Terms

  • Central Sleep Apnea
  • Mixed Sleep Apnea
  • Obstructive Sleep Apnea
  • Obstructive Sleep Apnea Syndrome
  • Obstructive Sleep Apnea-hypopnea Syndrome

Overview

Apnea means a pause in breathing. Sleep apnea is a term that describes a group of disorders where breathing stops for a brief time while the individual is asleep.

Everyone takes small pauses occasionally in breathing; however, it is abnormal to stop breathing during sleep for longer than 10 seconds. To qualify as pathologic sleep apnea, the breathing must stop for at least 10 seconds and the episodes must occur at least five times per hour. During the apneic period, the oxygen level in the blood falls dramatically (hypoxia).

The three types of sleep apnea are central, obstructive, and mixed. In central apnea, the airflow at the upper airway (e.g., pharynx and nose) and the effort by the diaphragm and other respiratory muscles cease. By contrast, during obstructive apnea, the airflow stops while the effort by the diaphragm and other respiratory muscles continues. In mixed apnea, an initial period of central apnea is followed by a period of obstructive apnea. The most common type of sleep apnea is obstructive sleep apnea (OSA). It occurs most often in moderately or severely obese individuals who tend to sleep on their backs (supine). Individuals with anatomically narrowed airways due to enlarged tonsils and adenoids are predisposed to sleep apnea syndrome. The ingestion of alcohol or sedatives before sleeping or nasal obstruction from any cause, such as a cold, can worsen the condition. Hypothyroidism and cigarette smoking are additional factors increasing the risk of obstructive sleep apnea. Individuals with high blood pressure (hypertension) are also prone to developing sleep apnea.

Incidence and Prevalence: Obstructive sleep apnea is common in the US and is thought to be underreported. Studies suggest that from 9% to 24% of men ages 30 to 60, and 4% to 9% of women ages 30 to 60 experience OSA (Rowley). Other estimates put the annual incidence of sleep apnea in the US at 1.3 million cases (Namen 1741). Few international studies have been done, but the incidence of sleep apnea in men has varied widely, from less than 1% in England to as high as 20% to 25% in Israel and Australia (Rowley).

Source: Medical Disability Advisor



Diagnosis

History: Individuals may complain of morning sluggishness, daytime fatigue, recent weight gain, and impotence. Bed partners may report that the individual has cycles of loud snoring, breath cessation, and restlessness. The apnea is interrupted with a loud snort and gasp before snoring returns to its regular pace. The individual may note personality changes, poor judgment, work-related problems, limited attention, memory impairment, or irritability. Other symptoms may include frequent night awakenings, waking unrested in the morning, abnormal daytime sleepiness, headaches, and lethargy.

Physical exam: The exam may be normal or reveal high blood pressure. The individual may appear sleepy during the exam. The back of the mouth and throat (oropharynx) is often narrowed with excessive soft tissue folds, large tonsils, or a prominent tongue. There may be evidence of a nasal obstruction or poor nasal airflow. The individual may have a short, thick neck (bull neck). On the other hand, it is possible that none of these physical symptoms are present.

Tests: When sleep apnea is suspected, a test that monitors brain activity, eye movement, heart rate, and other body functions during sleep (polysomnography) can help confirm the diagnosis and determine the severity and frequency of episodes. Other tests may be needed, such as monitoring the heart's electrical activity (electrocardiogram, or ECG), measuring blood oxygen levels (via oximetry or arterial blood gas), and measuring respiratory effort and airflow (pulmonary function tests).

Source: Medical Disability Advisor



Treatment

Multiple therapeutic approaches may be tried although no one treatment works for every individual. For obesity-related sleep apnea, weight reduction may reduce obstructive episodes, improve blood oxygenation, and reduce daytime drowsiness. Individuals are educated to avoid alcohol and hypnotic medications. Supplemental oxygen may help raise low blood oxygen levels.

Nasal continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) may be used in severe obstructive sleep apnea. Recent advances in CPAP machines allow automatic adjustment to apneas and airflow needs (Auto CPAP). Removable dental appliances may be used during sleep to prevent the upper airway from being obstructed by the tongue or other oral structures.

In the few individuals with severe symptoms that include heart or lung abnormalities and who fail to respond to the above measures, surgery may be recommended. Enlarged tonsils and/or adenoids should be removed. Several newer operations on the uvula are somewhat effective in the treatment of sleep apnea. Uvulopalatopharyngoplasty (UPPP) removes a portion of the uvula and the rim of the soft palate, and any excess tissue in the pharynx is excised. In other operations, the base of the tongue may be reduced in size or reshaped (lingualplasty). The muscles of the tongue may be pulled forward to prevent the throat from collapsing (genioglossus and hyoid advancement). In extreme cases, the upper or lower jaw may also be re-aligned (maxillary-mandibular advancement). Normally UPPP is attempted first before these more complex surgeries are performed.

If nasal deformities are contributory, they are repaired surgically with a nasal septoplasty to realign a deviated septum, or a rhinoplasty to decrease the size of enlarged nasal bones. In severe, life-threatening cases, an airway opening can be created in the neck (tracheostomy). This procedure bypasses obstructions in the mouth and upper throat (oropharynx).

Source: Medical Disability Advisor



Prognosis

Most individuals respond to nonsurgical treatment. The success rate for UPPP ranges from 40% to 60% (Downey; Herpel 1017; Strohl 465). Individuals who are no more than 25% over their ideal body weight are the most likely to experience long-term benefits from the surgery (Morgan). The success rate of UPPP varies substantially among individual physicians and facilities.

Tracheostomy is effective as a radical procedure for severe cases, but has numerous adverse effects including scar tissue, possible infection, and possible speech disturbances.

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Internal Medicine Physician
  • Otolaryngologist
  • Pulmonologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Heart disease
  • Lung disease
  • Obesity

Source: Medical Disability Advisor



Complications

The repeated periods of apnea or decreased breathing (hypopnea) result in insufficient oxygenation of blood. The low blood oxygen levels decrease the amount of oxygen that the brain, heart, and other organs receive. This puts stress on these organs and may predispose individuals with sleep apnea to strokes, heart attacks, and arterial pulmonary hypertension. Other possible complications include cardiac rhythm abnormalities (e. g. sinus arrhythmias, extreme bradycardia, atrial flutter, ventricular tachycardia), high blood pressure (hypertension), stroke, and morning headache. If the condition is severe enough, pulmonary hypertension may occur and the individual may develop right-sided heart failure (cor pulmonale) or myocarditis.

In addition, low oxygen levels continually wake the individuals, causing them to be sleep deprived and exhibit slowed thought processing. This sleep deprivation can have serious adverse consequences on daily life activities, including driving and job performance.

Source: Medical Disability Advisor



Factors Influencing Duration

The severity of the disorder, treatment, response to treatment, and job requirements are factors that can influence disability. Length of disability for individuals having UPPP depends on the extent of surgery. It is common for individuals having UPPP to need several small, repeated procedures, extending the period of disability.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Associated daytime drowsiness and thought and memory problems may create safety concerns. Individuals with these conditions should not have job responsibilities that require operating heavy machinery or driving a vehicle until the condition is corrected.

Those who require surgery may need extended leave from work. UPPP is a painful treatment. Individuals may need pain medication that may interfere with their ability to drive or operate machinery upon their return to work. Individuals whose work involves a great deal of speaking may need to be reassigned temporarily to jobs where they do not need to use their voice as much.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Do factors such as obesity, sleeping on the back, brain disturbance, alcohol, sedative, or cigarette use place individual at greater risk for sleep apnea?
  • Does individual have associated symptoms such as lethargy, daytime fatigue, or concentration problems?
  • Does the bed partner report cycles of loud snoring, breath cessation, and restlessness?
  • Did the physical exam reveal associated conditions of hypertension, oral, nasal, or pharyngeal obstructions?
  • Was a sleep study done to confirm the diagnosis?
  • Were additional diagnostic tests done to rule out other conditions with similar symptoms (i.e., seizure disorder, other sleep disorders, psychiatric disturbances)?

Regarding treatment:

  • Did individual receive instructions regarding weight loss, avoidance of alcohol and sedatives and alternative sleeping positions? Were these measures successful in relieving symptoms?
  • If not were other more aggressive measures considered (i.e., CPAP, BiPAP, surgical interventions)?

Regarding prognosis:

  • Does individual have comorbid conditions such as obesity, psychiatric depression, lung or heart disorders that may affect recovery and prognosis?
  • Did any complications arise such as cardiac rhythm abnormalities (e.g., sinus arrhythmias, extreme bradycardia, atrial flutter, and ventricular tachycardia), hypertension, heart attack, stroke, morning headache, or slowed thought processing that could lengthen recovery time?

Source: Medical Disability Advisor



References

Cited

Downey, Ralph, and Himanshu Wickramasinghe. "Apnea, Sleep." eMedicine. Eds. Sat Sharma, et al. 4 Jun. 2004. Medscape. 29 Dec. 2004 <http//emedicine.com/med/topic163.htm>.

Herpel, Laura B., and Carolyn Wong Simkins. "Sleep-Disordered Breathing." The Osler Medical Handbook. Eds. Alan Cheng and Aimee Zaas. 1st ed. Baltimore: Johns Hopkins University Press, 2003. 1011-1019.

Morgan, Charles E., and Jonathan P. Lindman. "Snoring and Obstructive Sleep Apnea, Surgery." eMedicine. Eds. Hassan H. Ramadan, et al. 2 Aug. 2004. Medscape. 29 Dec. 2004 <http//emedicine.com/ent/topic370.htm>.

Namen, Andrew M., et al. "Increased Physician-Reported Sleep Apnea." Chest 121 (2002): 1741-1747.

Rowley, James. "Sleep Apnea." eMedicine. Eds. Gregory Tino, et al. Medscape. 29 Oct. 2004 <http://emedicine.com/med/topic2697.htm>.

Strohl, Kingman P. "Obstructive Sleep Apnea-Hypopnea Syndrome." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 462-466.

Source: Medical Disability Advisor