RECOGNITION AND CONSEQUENCES OF OBSTRUCTIVE SLEEP APNEA HYPOPNEA SYNDROME
Section snippets
DEFINING THE DISORDER
The International Classification of Sleep Disorders manual35 describes obstructive sleep apnea syndrome as “.… characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation….” with associated features of daytime sleepiness and snoring.35 Unfortunately, that definition does not include specific criteria for identifying: (1) the occurrence of upper airway obstruction, (2) the number of obstructive episodes
MONITORING APPROACHES
The standard approach for assessing SDB is with in-laboratory polysomnography. That approach has been used for approximately 25 years. Typically, sleep architecture and arousals are assessed by EEG (from central and sometimes occipital leads), right and left electroculograms, and chin electromyogram (EMG). Breathing is assessed qualitatively, with a measure of airflow, measured with thermocouples or thermistors positioned near the external nares or nares and mouth, or a pressure transducer at
PREVALENCE
The preceding discussion emphasizes that SAHS is characterized by, but not easily defined by, the occurrence of episodes of obstructed breathing that occur during sleep and are associated with oxygen desaturation, sleep fragmentation, and symptoms of disruptive snoring and daytime sleepiness. Variability in measuring and quantifying those parameters limits comparison and interpretation of data from various centers and locales. Furthermore, the prevalence estimates that have been calculated for
SYMPTOMS OF SLEEP APNEA HYPOPNEA SYNDROME
The symptoms used most commonly to characterize, and sometimes to screen for, SAHS can be grouped broadly into the following areas: breathing disturbances occurring during sleep (snoring frequency and intensity, choking or gasping, apneas or pauses); difficulties maintaining sleep (frequent awakenings, restless sleep); daytime sleepiness; fatigue; mood effects (depression and irritability); and general impairment of daily function and quality of life (e.g., problems with performance of daily
RISK FACTORS
Factors that reduce upper airway size or predispose to upper airway collapsibility increase susceptibility to SAHS. The strongest risk factors are obesity and male gender. Obesity, particularly central obesity, may precipitate or exacerbate SAHS by influences related to upper airway fat deposition, which may affect airway patency or compliance, and abdominal mass loading, which may influence breathing pattern (predisposing to hypoventilation) or reduce oxygen stores (predisposing to
CONSEQUENCES OF SLEEP APNEA HYPOPNEA SYNDROME
Patients with SAHS may experience a number of potentially adverse physiologic exposures during sleep, including gas exchange abnormalities and increased sympathetic nervous system activity.128 The latter is probably a response to intermittent hypoxemia and hypercapnia, chemoreflex activation, and the increased central nervous system arousal that occurs with obstructed breathing.9, 43, 67, 97, 128, 130 In addition, large fluctuations in intrathoracic pressure that occur with obstructed breathing
CLINICAL RECOGNITION OF SLEEP DISORDERED BREATHING
Although prevalence estimates vary with differences in the age and underlying morbidity levels of samples studied, and in the specific criteria used for measuring associated attributes and defining disease, it may be estimated that approximately 2% to 5% of the population meet minimal criteria for clinical illness. There are groups with higher prevalences of SDB and groups who may be especially susceptible to adverse health effects associated with SDB.
Despite increasing numbers of epidemiologic
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Address reprint requests to Susan Redline, MD, MPH VAMC 111 G (W) 10701 Wade Park Oval Cleveland, OH 44106
Supported in part by the National Heart, Lung and Blood Institute (HL-46380) and a SCOR in Cardiopulmonary Disorders of Sleep (HL-42215), and by the Cleveland Veterans Affairs Medical Center.