Sleep Apnea

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Contents 1 More Specific Terms 2 Classification 3 Epidemiology 4 Pathology 5 Clinical-manifestations 6 Laboratory 7 Complications 8 Management 9 More General Terms 10 Additional Terms 11 References

More Specific Terms

• central sleep apnea
• obstructive sleep apnea (OSA)

Classification

• central sleep apnea

• cessation of airflow accompanied by the absence of respiratory effort

• obstructive sleep apnea

• cessation of airflow with continued respiratory effort

• mixed sleep apnea (most common)

• cessation of airflow that generally begins with no respiratory effort, but ends with increasing respiratory effort
• obstructive sleep apnea is predominant pattern

Epidemiology

• 2% of women & 4% of men age 30-60 years meet diagnostic criteria for sleep apnea syndrome
• 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

• frequent episodes of apnea, hypopnea & symptoms of functional impairment
• frequent snoring
• frequent daytime sleepiness
• hypertension
• elevated body mass index ( obesity)
• some patients may be asymptomatic

Laboratory

• sleep study ( polysomnography)

• criterium:

• at least 30 episodes of apnea in a 7 hour sleep period

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

Management

• see obstructive sleep apnea
• central sleep apnea

• respiratory stimulants such as medroxyprogesterone

• mixed sleep apnea

• methylphenidate ( Ritalin)
• protriptyline
• clonidine
• fluoxetine

• cardiac ( atrial) pacing may reduce episodes of nocturnal apnea/ hypopnea [7] {both central & obstructive sleep apnea}

More General Terms

• sleep disordered breathing (SDB)
• apnea

Additional Terms

• clonidine (Catapres)
• fluoxetine (Prozac, Sarafem)
• medroxyprogesterone actetate; acetoxymethylprogesterone (Provera, Cycrin, Amen)
• methylphenidate (Ritalin, Concerta, Daytrana, Metadate CD, Centedrine)
• protriptyline (Vivactil, Concordin)
• sleep disordered breathing (SDB)

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 257
2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 749-50
3. Journal Watch vol 19 #22, pg 177, Nov 15, 1999
4. Netzer et al, Ann Intern Med 131:485, 1999
5. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
6. Journal Watch 21(13):107, 2001 Barbe et al Ann Intern Med 134:1015, 2001 Pack & Maislin Ann Intern Med 134:1065, 2001
7. 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
8. 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: [1]
9. Peppard PE et al, Longitudinal association of sleep-related breathing disorder and depression. Arch Intern Med 2006, 166:1709 PMID: [2]
10. 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: [3]
    - Canessa N and Ferini-Strambi L. Sleep-disordered breathing and cognitive decline in older adults. JAMA 2011 Aug 10; 306:654 PMID: [4]
11. NINDS Sleep Apnea Information Page [5]
12. What Is Sleep Apnea? [6]

sleep apnea