\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{RoseCher}
\pdfinfo{
  /Title (sleep-apnea.pdf)
  /Creator (Cheatography)
  /Author (RoseCher)
  /Subject (Sleep Apnea Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{145BA3}
\definecolor{LightBackground}{HTML}{F0F4F9}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Sleep Apnea Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{RoseCher} via \textcolor{DarkBackground}{\uline{cheatography.com/87410/cs/20185/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}RoseCher \\
  \uline{cheatography.com/rosecher} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 3rd August, 2019.\\
   Updated 3rd August, 2019.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pathophysiology}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Breathing Disruption during sleep the lasts at least 10 seconds and occurs a minimum of five times in an hour.} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Most common airway obstruction by soft palate or tongue.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
Obesity (Modifiable) & A large Uvula (Non-modifiable) \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Short neck (Non-modifiable) & Smoking (Modifiable) \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
enlarged tonsils or adenoids (Both) & oropharyngeal edema (Non-Modifiable) \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
Male gender (non-modifiable) & High Blood Pressure (Both) \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Long term effects of chronic OSA includes increase risk for HTN, Stroke, Cognitive deficits, weight gain, Diabetes, and Pulmonary and Cardiovascular disease}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Signs and Symptoms}}  \tn
% Row 0
\SetRowColor{LightBackground}
Snoring heavily & Transient Apnea \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Excessive daytime sleepiness & Morning headache \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Insomnia & Restless Sleep (waking up tired) \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
Nightmares & Memory loss \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Performance deficiencies & GERD \tn 
% Row Count 8 (+ 2)
% Row 5
\SetRowColor{white}
Depression & Moody (personality changes) \tn 
% Row Count 10 (+ 2)
% Row 6
\SetRowColor{LightBackground}
Nocturia & Impotence \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Usually verified by family members who observe the problem when the adult sleeps.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Interventions}}  \tn
% Row 0
\SetRowColor{LightBackground}
Positional Therapy & Mild sleep apnea can be treated by changing the patient's sleeping position. Sleeping on one's side, or with the head of the bed elevated can help to reduce or eliminate episodes of apnea. \tn 
% Row Count 10 (+ 10)
% Row 1
\SetRowColor{white}
Oral Appliance & Use of an oral appliance, such as a mouth guard, may help to prevent obstruction of the patient's airway by shifting the jaw and tongue forward. \tn 
% Row Count 18 (+ 8)
% Row 2
\SetRowColor{LightBackground}
Continuous Positive Airway Pressure (CPAP) & CPAP therapy is used in patients w/ severe OSA who experience 15 or more episodes of apnea in one hour. CPAP provides positive pressure upon both inspiration and expiration, to maintain an open airway. An Alternative intervention called believe positive airway pressure (BiPAP) can also be used to treat OSA. This type of therapy may be better tolerated by patients due to higher inspiratory pressure, and lower mean presets during expiration. \tn 
% Row Count 41 (+ 23)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Interventions (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
Surgery & Surgey may be indicated to treat OSA if the other non-surgical interventions are ineffective. A \seqsplit{uvulopalatopharyngoplasty} (UPPP) can be preformed to remove tissues in the throat, such as tonsils, uvula, and soft palate, that are causing airway obstruction. \tn 
% Row Count 13 (+ 13)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Patients should be educated about what to expect after surgery, including sore throat, halitosis (bad breath), and snoring.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Assessment : Nursing}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The most accurate test for Sleep Apnea is an overnight sleep study. The patient is directly observed while wearing a variety of monitoring equipment to evaluate depth of sleep, type of sleep. respiratory effort, oxygen saturation, and muscle movement.Monitoring devices include an electroencephalogram (EEG), and electrocardiograph (ECG), a pulse oximeter, and electromyograph (EMG).} \tn 
% Row Count 8 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Patient are often unaware that they suffer from sleep apnea. A beginning assessment includes having the patient complete the STOP-Bang Sleep Apnea Questionnaire}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pharmalogical TX}}  \tn
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{One drug that has been approved to help manage the daytime sleepiness associated with OSA (modafinil {[}Attence, Provigil{]}) and may help patients who suffer from {\emph{narcolepsy}} (uncontrolled daytime sleep) by promoting daytime wakefulness. This drug does not treat the cause of OSA.  Sleep-Inducing sedatives also are not considered first-line therapy.% Row Count 7 (+ 7)
} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}