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sleep apnea
Epidemiology:
1) 2% of women & 4% of men age 30-60 years meet diagnostic criteria for sleep apnea syndrome
2) 1/4-1/2 of patients have positional sleep apnea
- apnea episodes occur more frequently in supine position than lateral or prone position [8]
Pathology:
- associated with adverse health effects & increased mortality
Clinical manifestations:
1) frequent episodes of apnea, hypopnea & symptoms of functional impairment
2) frequent snoring
3) frequent daytime sleepiness
4) hypertension
5) elevated body mass index (obesity)
6) sleep apnea headache
7) some patients may be asymptomatic
Special laboratory:
- sleep study (polysomnography)
- criterium:
- at least 30 episodes of apnea in a 7 hour sleep period
- out-of-center sleep study (home apnea monitoring)
- selected patients without cardiopulmonary disease
- see obstructive sleep apnea
Classification:
1) central sleep apnea
- cessation of airflow accompanied by the absence of respiratory effort
2) obstructive sleep apnea
- cessation of airflow with continued respiratory effort
3) mixed sleep apnea (most common)
a) cessation of airflow that generally begins with no respiratory effort, but ends with increasing respiratory effort
b) obstructive sleep apnea is predominant pattern
Complications:
- depression [9]
- increased risk of cognitive decline in older women [10]
- automobile accidents are 5-10 times more common in patients with sleep apnea
- increased risk of sudden cardiac death [11]
- increased nocturnal coagulability [11]
Management:
1) see obstructive sleep apnea
2) central sleep apnea
- respiratory stimulants such as medroxyprogesterone
3) mixed sleep apnea
a) methylphenidate (Ritalin)
b) protriptyline
c) clonidine
d) fluoxetine
4) cardiac (atrial) pacing may reduce episodes of nocturnal apnea/hypopnea [7] {both central & obstructive sleep apnea}
Interactions
disease interactions
Related
home apnea monitoring
polysomnography (PSG)
sleep test
Specific
central sleep apnea
obstructive sleep apnea (OSA)
General
sleep disordered breathing (SDB)
apnea
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 257
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 749-50
- Journal Watch vol 19 #22, pg 177, Nov 15, 1999
- Netzer et al, Ann Intern Med 131:485, 1999
- Medical Knowledge Self Assessment Program (MKSAP) 11, 17
American College of Physicians, Philadelphia 1998, 2015
- Journal Watch 21(13):107, 2001
Barbe et al Ann Intern Med 134:1015, 2001
Pack & Maislin Ann Intern Med 134:1065, 2001
- Journal Watch 22(6):47, 2002
Garrigue S et al, N Engl J Med 346:404, 2002
Gottlieb DJ, N Engl J Med 346:444, 2002
- Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ.
Prevalence of positional sleep apnea in patients undergoing
polysomnography.
Chest. 2005 Oct;128(4):2130-7.
PMID: 16236865
- Peppard PE et al,
Longitudinal association of sleep-related breathing disorder
and depression.
Arch Intern Med 2006, 166:1709
PMID: 16983048
- Yaffe K et al.
Sleep-disordered breathing, hypoxia, and risk of mild
cognitive impairment and dementia in older women.
JAMA 2011 Aug 10; 306:613.
PMID: 21828324
- Canessa N and Ferini-Strambi L.
Sleep-disordered breathing and cognitive decline in older
adults.
JAMA 2011 Aug 10; 306:654
PMID: 21828331
- Shah BR et al
Use of Stress Testing and Diagnostic Catheterization after
Coronary Stenting: Association of Site-level Patterns with
Patient Characteristics and Outcomes in 247,052 Medicare
Beneficiaries.
J Am Coll Cardiol. Published online June 5, 2013.
PMID: 23727207
http://content.onlinejacc.org/Onlinefirst.aspx
- NINDS Sleep Apnea Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Sleep-Apnea-Information-Page
- What Is Sleep Apnea?
http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html