Introduction to Sleep-Disordered Breathing and Treatment

2021 ◽  
pp. 509-528
Author(s):  
Joanne S. Martires ◽  
Reuben Ram ◽  
Jeanne Wallace
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Sleep Related Breathing Disorders ◽  
Adaptive Servo Ventilation ◽  
Breathing Disorders ◽  
Disordered Breathing

Sleep-related breathing disorders encompass a wide range of problems that occur during sleep. The most common sleep-related breathing disorder is obstructive sleep apnea syndrome (OSAS). OSAS is increasingly prevalent, underdiagnosed and can lead to significant daytime sleepiness and disability. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS but lack of adherence to CPAP is rampant. Supportive care, education, and motivational enhancement programs do show promise in improving compliance. Alternatives to CPAP such as oral appliances, hypoglossal nerve stimulation, and myofunctional therapy have not been proved as efficacious but may provide some benefit. In the future, personalized treatment may be the best way to approach this condition. Central sleep apnea and hypoventilation are other forms of sleep-related breathing disorders. Treatment largely depends on the underlying condition but may require the use of advanced modes of noninvasive ventilation such as adaptive servo-ventilation, bilevel positive airway pressure, and volume-assured pressure support. Treatment of sleep-related breathing disorders is complex and includes seeking patient input, understanding barriers to treatment, and reevaluating patients after treatment is initiated. Successful treatment of sleep-disordered breathing can lead to improvements in daytime function, quality of life, and overall health.

scholarly journals Canadian Thoracic Society 2011 Guideline Update: Diagnosis and Treatment of Sleep Disordered Breathing

2011 ◽  
Vol 18 (1) ◽  
pp. 25-47 ◽  
Author(s):  
John Fleetham ◽  
Najib Ayas ◽  
Douglas Bradley ◽  
Michael Fitzpatrick ◽  
Thomas K Oliver ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Diagnosis And Treatment ◽  
Obstructive Sleep ◽  
Disordered Breathing

The Canadian Thoracic Society (CTS) published an executive summary of guidelines for the diagnosis and treatment of sleep disordered breathing in 2006/2007. These guidelines were developed during several meetings by a group of experts with evidence grading based on committee consensus. These guidelines were well received and the majority of the recommendations remain unchanged. The CTS embarked on a more rigorous process for the 2011 guideline update, and addressed eight areas that were believed to be controversial or in which new data emerged. The CTS Sleep Disordered Breathing Committee posed specific questions for each area. The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the recommendations in the 2006/2007 guidelines. The recommendations on bariatric surgery, complex sleep apnea and optimum positive airway pressure technologies are new topics, which were not covered in the 2006/2007 guidelines.

scholarly journals Etiopathogenetic Mechanisms of Pulmonary Hypertension in Sleep-Related Breathing Disorders

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Ayodeji Adegunsoye ◽  
Siva Ramachandran
Keyword(s):  
Obstructive Sleep Apnea ◽  
Pulmonary Hypertension ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnea Syndrome ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Significant Health ◽  
Disordered Breathing

Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

Treatment of opioid-related central sleep apnea with positive airway pressure: A systematic review

2014 ◽  
Vol 10 (1) ◽  
pp. 57 ◽  
Author(s):  
Roopika Reddy, MD ◽  
David Adamo, RPSGT ◽  
Thomas Kufel, MD ◽  
Jahan Porhomayon, MD ◽  
Ali A. El-Solh, MD, MPH
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Poor Response ◽  
Supplemental Oxygen ◽  
Cochrane Library ◽  
Adaptive Servo Ventilation ◽  
Bilevel Positive Airway Pressure ◽  
Central Apneas

Objective: To systematically review the various modalities of positive airway pressure (PAP) in the treatment of opioid-related central sleep apnea (CSA).Design: Systematic review.Interventions: MEDLINE, the Cochrane Library, and EMBASE were screened through March 2013 to identify articles which investigated treatment of opioid-related CSA with PAP. Eligible articles were identified in a staged process and were assessed by two investigators independently. The methodological quality of the reporting of eligible articles was assessed using a set of questions addressing both general and statistical methodologies.Results: Five articles met the inclusion criteria for a total of 127 patients. All patients had been on opioids for at least 6 months. The dose ranged from 10 mg to 450 mg daily of morphine equivalent dose. Continuous positive airway pressure (CPAP) was proven mostly ineffective in reducing central apneic events. Bilevel positive airway pressure (BiPAP) with and without supplemental oxygen achieved elimination of central apneas in 62 percent of patients. Adaptive servo ventilation (ASV) yielded conflicting results with 58 percent of participants attaining a central apnea index <10 per hour. The presence of ataxic breathing predicted poor response to PAP.Conclusions: The available evidence on the efficacy of PAP in opioid-related CSA is inconclusive. With the increasing use of opioids, further studies are needed to assess optimal PAP therapy and predictors of success in this group of patients.

Positive airway pressure therapy

2017 ◽  
Author(s):  
Dirk Pevernagie
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Therapeutic Success ◽  
Pressure Therapy ◽  
Cardiovascular Comorbidity ◽  
Adaptive Servo Ventilation ◽  
Obstructive Sleep

This chapter describes positive airway pressure (PAP) therapy for sleep disordered breathing. Continuous PAP (CPAP) acts as a mechanical splint on the upper airway and is the treatment of choice for moderate to severe obstructive sleep apnea (OSA). Autotitrating CPAP may be used when the pressure demand for stabilizing the upper airway is quite variable. In other cases, fixed CPAP is sufficient. There is robust evidence that CPAP reduces the symptomatic burden and risk of cardiovascular comorbidity in patients with moderate to severe OSA. Bilevel PAP is indicated for treatment of respiratory diseases characterized by chronic alveolar hypoventilation, which typically deteriorates during sleep. Adaptive servo-ventilation is a mode of bilevel PAP used to treat Cheyne–Stokes respiration with central sleep apnea . It is crucial that caregivers help patients get used to and be compliant with PAP therapy. Education, support, and resolution of adverse effects are mandatory for therapeutic success.

Clinical Sleep-Related Breathing Disorders

2021 ◽  
pp. 1199-1202
Author(s):  
Vichaya Arunthari ◽  
Brynn K. Dredla
Keyword(s):  
Sleep Apnea ◽  
Respiratory Muscle ◽  
Sleep Apnea Syndrome ◽  
Central Sleep Apnea ◽  
Sleep Apnea Syndromes ◽  
Respiratory Drive ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Adults And Children

Sleep-related breathing disorders are categorized into obstructive sleep apnea syndromes, central sleep apnea syndrome, and sleep-related hypoventilation or hypoxic syndromes. These disorders can occur in adults and children. Clinical characteristics, diagnosis, and treatment are discussed in this chapter. Sleep apnea occurs when recurrent complete (apnea) or nearly complete (hypopnea) cessation of airflow develops, accompanied by preservation of the respiratory drive manifested as persistent respiratory muscle effort. Apnea is defined as the cessation of airflow for more than 10 seconds, using a valid measure of airflow. Hypopnea is an airflow reduction of at least 30% from baseline that lasts at least 10 seconds and is accompanied by an oxygen desaturation of 4% or more.

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