Obstructive Sleep Apnea: Epidemiology, Causes, and Consequences

2020 ◽  
Author(s):  
Diane C Lim ◽  
Richard J Schwab
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cushing Syndrome ◽  
Upper Airway ◽  
Fat Distribution ◽  
Epidemiologic Studies ◽  
Obstructive Sleep ◽  
Upper Airway Muscles ◽  
Underlying Diseases

As part one of the three chapters on sleep-disordered breathing, this chapter reviews obstructive sleep apnea (OSA) epidemiology, causes, and consequences. When comparing OSA prevalence between 1988 to 1994 and 2007 to 2010, we observe that OSA is rapidly on the rise, paralleling increasing rates in obesity. Global epidemiologic studies indicate that there are differences specific to ethnicity with Asians presenting with OSA at a lower body mass index than Caucasians. We have learned that structural and physiologic factors increase the risk of OSA and both can be influenced by genetics. Structural risk factors include craniofacial bony restriction, changes in fat distribution, and the size of the upper airway muscles. Physiologic risk factors include airway collapsibility, loop gain, pharyngeal muscle responsiveness, and arousal threshold. The consequences of OSA include daytime sleepiness and exacerbation of many underlying diseases. OSA has been associated with cardiovascular diseases including hypertension, coronary heart disease, stroke, atrial fibrillation, and other cardiac arrhythmias; pulmonary hypertension; metabolic disorders such as type 2 diabetes, hypothyroidism, acromegaly, Cushing syndrome, and polycystic ovarian syndrome; mild cognitive impairment or dementia; and cancer. This review contains 4 figures, 1 table and 48 references. Key Words: cardiac consequences, craniofacial bony restriction, epidemiology, fat distribution, metabolic disease, neurodegeneration, obesity, obstructive sleep apnea

Arousal and ventilatory responses during sleep in children with obstructive sleep apnea

1998 ◽  
Vol 84 (6) ◽  
pp. 1926-1936 ◽  
Author(s):  
Carole L. Marcus ◽  
Janita Lutz ◽  
John L. Carroll ◽  
Owen Bamford
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Upper Airway ◽  
Respiratory Drive ◽  
Ventilatory Control ◽  
Arousal Threshold ◽  
Ventilatory Responses ◽  
Obstructive Sleep ◽  
Upper Airway Muscles

Abnormal central regulation of upper airway muscles may contribute to the pathophysiology of the childhood obstructive sleep apnea syndrome (OSAS). We hypothesized that this was secondary to global abnormalities of ventilatory control during sleep. We therefore compared the response to chemical stimuli during sleep between prepubertal children with OSAS and controls. Patients with OSAS aroused at a higher[Formula: see text] (58 ± 2 vs. 60 ± 5 Torr, P < 0.05); those with the highest apnea index had the highest arousal threshold ( r = 0.52, P < 0.05). The hypercapnic arousal threshold decreased after treatment. For all subjects, hypoxia was a poor stimulus to arousal, whereas hypercapnia and, particularly, hypoxic hypercapnia were potent stimuli to arousal. Hypercapnia resulted in decreased airway obstruction in OSAS. Ventilatory responses were similar between patients with OSAS and controls; however, the sample size was small. We conclude that children with OSAS have slightly blunted arousal responses to hypercapnia. However, the overall ventilatory and arousal responses are normal in children with OSAS, indicating that a global deficit in respiratory drive is not a major factor in the etiology of childhood OSAS. Nevertheless, subtle abnormalities in ventilatory control may exist.

scholarly journals Children with Upper Airway Dysfunction: At Risk of Obstructive Sleep Apnea

2019 ◽  
Vol 09 (01) ◽  
pp. e59-e67
Author(s):  
Carlos Sisniega ◽  
Umakanth Katwa
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Adverse Outcomes ◽  
Upper Airway Obstruction ◽  
Lymphoid Tissues ◽  
Obstructive Sleep ◽  
Potential Risk Factors

AbstractObstructive sleep apnea is characterized by prolonged partial upper airway obstruction or intermittent complete obstruction that disrupts normal ventilation during sleep and alters normal sleep patterns. Patients with obstructive sleep apnea tend to develop neurocognitive, cardiovascular, behavioral, attention issues, and poor academic performance. Therefore, it is essential to diagnose and treat obstructive sleep apnea early and avoid significant and long-lasting adverse outcomes. Most commonly, upper airway obstruction is caused by enlarged lymphoid tissues within the upper airway, and therefore adenotonsillectomy is considered as the first-line treatment of obstructive sleep apnea in children. Fifty to 70% of patients who have obstructive sleep apnea and treated by surgery are not entirely cured on follow-up polysomnography. In light of this, it is recommended that patients with suspected obstructive sleep apnea undergo a thorough evaluation, and all potential risk factors are identified and treated. The purpose of this review is to familiarize pediatricians with developmental, anatomical, and physiological risk factors involved in the development of obstructive sleep apnea. Additionally, we will present an array of evaluation techniques that can offer adequate assessment of the patient's upper airway anatomy and physiology.

scholarly journals Obstructive Sleep Apnea in Women: Specific Issues and Interventions

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Alison Wimms ◽  
Holger Woehrle ◽  
Sahisha Ketheeswaran ◽  
Dinesh Ramanan ◽  
Jeffery Armitstead
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Correct Diagnosis ◽  
Upper Airway ◽  
Fat Distribution ◽  
Apnea Hypopnea Index ◽  
Optimal Care ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Degrees Of Severity

Obstructive sleep apnea (OSA) has traditionally been seen as a male disease. However, the importance of OSA in women is increasingly being recognized, along with a number of significant gender-related differences in the symptoms, diagnosis, consequences, and treatment of OSA. Women tend to have less severe OSA than males, with a lower apnea-hypopnea index (AHI) and shorter apneas and hypopneas. Episodes of upper airway resistance that do not meet the criteria for apneas are more common in women. Prevalence rates are lower in women, and proportionally fewer women receive a correct diagnosis. Research has also documented sex differences in the upper airway, fat distribution, and respiratory stability in OSA. Hormones are implicated in some gender-related variations, with differences between men and women in the prevalence of OSA decreasing as age increases. The limited data available suggest that although the prevalence and severity of OSA may be lower in women than in men, the consequences of the disease are at least the same, if not worse for comparable degrees of severity. Few studies have investigated gender differences in the effects of OSA treatment. However, given the differences in physiology and presentation, it is possible that personalized therapy may provide more optimal care.

scholarly journals Risk factors and clinical prediction formula for the evaluation of obstructive sleep apnea in Asian adults

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246399
Author(s):  
Do-Yang Park ◽  
Ji-Su Kim ◽  
Bumhee Park ◽  
Hyun Jun Kim
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Goodness Of Fit ◽  
Upper Airway ◽  
Physical Exam ◽  
Berlin Questionnaire ◽  
Clinical Prediction ◽  
Obstructive Sleep ◽  
Tongue Position

Obstructive sleep apnea is a highly prevalent cyclic repetitive hypoxia-normoxia respiratory sleep disorder characterized by intermittent upper-airway collapse. It is mainly diagnosed using in-laboratory polysomnography. However, the time-spatial constraints of this procedure limit its application. To overcome these limitations, there have been studies aiming to develop clinical prediction formulas for screening of obstructive sleep apnea using the risk factors for this disorder. However, the applicability of the formula is restricted by the group specific factors included in it. Therefore, we aimed to assess the risk factors for obstructive sleep apnea and develop clinical prediction formulas, which can be used in different situations, for screening and assessing this disorder. We enrolled 3,432 Asian adult participants with suspected obstructive sleep apnea who had successfully undergone in-laboratory polysomnography. All parameters were evaluated using correlation analysis and logistic regression. Among them, age, sex, hypertension, diabetes mellitus, anthropometric factors, Berlin questionnaire and Epworth Sleepiness Scale scores, and anatomical tonsil and tongue position were significantly associated with obstructive sleep apnea. To develop the clinical formulas for obstructive sleep apnea, the participants were divided into the development (n = 2,516) and validation cohorts (n = 916) based on the sleep laboratory visiting date. We developed and selected 13 formulas and divided them into those with and without physical examination based on the ease of application; subsequently, we selected suitable formulas based on the statistical analysis and clinical applicability (formula including physical exam: sensitivity, 0.776; specificity, 0.757; and AUC, 0.835; formula without physical exam: sensitivity, 0.749; specificity, 0.770; and AUC, 0.839). Analysis of the validation cohort with developed formulas showed that these models and formula had sufficient performance and goodness of fit of model. These tools can effectively utilize medical resources for obstructive sleep apnea screening in various situations.

scholarly journals Physiology in Medicine: Obstructive sleep apnea pathogenesis and treatment—considerations beyond airway anatomy

2014 ◽  
Vol 116 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Jerome A. Dempsey ◽  
Ailiang Xie ◽  
David S. Patz ◽  
David Wang
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Muscle Activation ◽  
Upper Airway ◽  
Airway Anatomy ◽  
Output Stability ◽  
Dilator Muscle ◽  
Obstructive Sleep ◽  
Treatment Considerations

We review evidence in support of significant contributions to the pathogenesis of obstructive sleep apnea (OSA) from pathophysiological factors beyond the well-accepted importance of airway anatomy. Emphasis is placed on contributions from neurochemical control of central respiratory motor output through its effects on output stability, upper airway dilator muscle activation, and arousability. In turn, we consider the evidence demonstrating effective treatment of OSA via approaches that address each of these pathophysiologic risk factors. Finally, a case is made for combining treatments aimed at both anatomical and ventilatory control system deficiencies and for individualizing treatment to address a patient 's own specific risk factors.

scholarly journals Risk factors and fraction of exhaled nitric oxide in obstructive sleep apnea in adults

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052092601
Author(s):  
Xiaokai Feng ◽  
Xiheng Guo ◽  
Junling Lin ◽  
Zhiling Zhao ◽  
Zhaohui Tong
Keyword(s):  
Nitric Oxide ◽  
Risk Factors ◽  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Soft Palate ◽  
Upper Airway ◽  
Transverse Diameter ◽  
Obstructive Sleep ◽  
Male Sex

Objective This study aimed to evaluate the relationship between obstructive sleep apnea (OSA) and the fraction of exhaled nitric oxide (FENO), and to assess the effect of risk factors of airway inflammation on OSA. Methods Medical records of patients in the Respiratory Sleep Center at Chao-Yang Hospital in Beijing between January 2015 and June 2017 were analyzed. All patients were diagnosed with OSA. Data of the medical history, clinical examinations, FENO, and upper airway computed tomographic findings were collected. Logistic regression was used to evaluate risk factors of OSA. Results A total of 181 patients were admitted to the Respiratory Sleep Center during the study and 170 had a diagnosis of OSA and were included in the study. Single factor analysis showed that male sex, age, body mass index, smoking index, alcohol consumption, FENO, soft palate thickness, soft palate length, the narrowest transverse diameter of the upper airway, tonsil size, and nasal sinusitis were risk factors for sleep-disordered breathing and disease severity. Conclusions Male sex, age, body mass index, FENO, the narrowest transverse diameter of the upper airway, and normal tonsil size are associated with OSA and disease severity. The severity of OSA is associated with FENO levels.

scholarly journals Characteristics and risk factors of snoring and the prevalence of suspected obstructive sleep apnea in children

2016 ◽  
Vol 45 (1) ◽  
pp. 40
Author(s):  
Bambang Supriyatno ◽  
Rusmala Deviani ◽  
Alan R Tumbelaka ◽  
Evita KB Ifran ◽  
Nastiti N Rahajoe
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Physical Examination ◽  
Upper Airway ◽  
Cross Sectional Study ◽  
Adenoid Hypertrophy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Obstructive Sleep

Background Snoring as a consequence of upper airway obstruc-tion is common in children. Snoring can be considered as normal,but might also reflect a disease such as obstructive sleep apnea(OSA), which is associated with serious morbidities. In Indonesia,data on the characteristics and risk factors of snoring and obstruc-tive sleep apnea is limitedObjectives The aims of this study were to find out the character-istics and risk factors of snoring in children and to determine theprevalence of suspected OSA in snoring children.Methods A cross-sectional study was carried out on children aged5-13 years using parental questionnaires scored according to theBrouilette formula. All children underwent physical examination forweight, height and tonsil size. Adenoid radiology was performedon part of the samples.Results Of the 917 questionnaires distributed, only 658 were com-pleted. The ratio of boys to girls was equal. Obesity was detectedin 18.3% of children, among whom 54.2% snored. Obese childrenwere 2.1 times more likely to snore. Besides obesity, rhinitis andatopy were found to be associated with snoring (PR= , 95%CI ;and PR= , 95%CI ; respectively). Asthma and tonsil hypertrophywere shown not to be predisposing factors of snoring. Childrenwith adenoid hypertrophy were 1.8 times more likely to snore ha-bitually. The prevalence of snoring and suspected OSA in childrenaged 5-13 years were 31.6% and 5.9%, respectively.Conclusion Risk factors of snoring were obesity, adenoid hyper-trophy, atopy and rhinitis. Prevalence of snoring in children age 5-13 years was 31.6% and that of suspected OSA cases was 5.9%.

Body Fat Distribution, Serum Leptin, and Cardiovascular Risk Factors in Men With Obstructive Sleep Apnea

CHEST Journal ◽  
2002 ◽  
Vol 122 (3) ◽  
pp. 829-839 ◽  
Author(s):  
Harald Scha¨fer ◽  
Dirk Pauleit ◽  
Thomas Sudhop ◽  
Ioanna Gouni-Berthold ◽  
Santiago Ewig ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Cardiovascular Risk ◽  
Sleep Apnea ◽  
Cardiovascular Risk Factors ◽  
Body Fat ◽  
Fat Distribution ◽  
Body Fat Distribution ◽  
Serum Leptin ◽  
Obstructive Sleep
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