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8 - Sleep apnea (central and obstructive)

from SECTION 2 - SLEEP DISORDERS

Published online by Cambridge University Press:  08 August 2009

By
Kannan Ramar  and
Christian Guilleminault
Edited by
Harold R. Smith ,
Cynthia L. Comella  and
Birgit Högl
Kannan Ramar
Affiliation:
Stanford University Sleep Medicine Program, Stanford
Christian Guilleminault
Affiliation:
Stanford University Sleep Medicine Program, Stanford
Harold R. Smith
Affiliation:
University of California, Irvine
Cynthia L. Comella
Affiliation:
Rush University Medical Center, Chicago
Birgit Högl
Affiliation:
Inssbruck Medical University
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Summary

Introduction

Sleep-disordered breathing constitutes an important health problem with significant morbidity and mortality. There are two types of sleep apnea: obstructive and central, based on the presence or absence of respiratory effort.

The criteria for the classification of sleep-related breathing events have been established by the American Academy of Sleep Medicine (AASM). According to these criteria, an apnea is defined as cessation of airflow for at least 10 seconds. Hypopnea is defined as a 30% reduction or more in airflow associated with a drop in oxygen saturation of more than 3%. Central apnea is defined by the absence of respiratory effort, while obstructive apnea occurs despite persistent respiratory effort. There may be associated abdominal paradox with obstructive apnea, as illustrated in Fig. 8.1. Mixed apnea is usually a combination of both central and obstructive: an initial central part (lack of respiratory effort) followed by the terminal obstructive part (presence of respiratory effort), as illustrated in Fig. 8.2. Mixed apneas are usually grouped under obstructive apneas. The apnea/hypopnea index (AHI) is the number of apneas and hypopneas per hour of sleep. The respiratory disturbance index (RDI) is defined as the AHI plus the respiratory effort-related arousals (RERA). An illustration of RERA is shown in Fig. 8.3. This chapter will focus on the pathophysiology, clinical features, and management of obstructive and central sleep apnea.

Keywords

central sleep apneaCheyne-Stokes breathingcongestive heart failurehypercapnic CSAobstructive sleep apneaobesitysleep disorderidiopathic CSA
Type
Chapter
Information
Sleep Medicine , pp. 129 - 156
Publisher: Cambridge University Press
Print publication year: 2008

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References

American Thoracic Society. Idiopathic congenital central hypoventilation syndrome: diagnosis and management. Am J Resp Crit Care Med 1999; 160: 368–73.CrossRef
Atwood, CW Jr, McCrory, D, Garcia, JG, Abman, SH, Ahearn, GS. American College of Chest Physicians. Pulmonary artery hypertension and sleep-disordered breathing: ACCP evidence-based clinical practice guidelines. Chest 2004; 126 (1 Suppl): 72S–77S.CrossRefGoogle ScholarPubMed
Bady, E, Achkar, A, Pascal, S, Orvoen-Frija, E, Laaban, JP. Pulmonary arterial hypertension in patients with sleep apnoea syndrome. Thorax 2000; 55:934–9.CrossRefGoogle ScholarPubMed
Bassetti, C, Aldrich, MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999; 22:217–23.CrossRefGoogle ScholarPubMed
Berry, RB, Parish, JM, Hartse, KM. The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea: an American Academy of Sleep Medicine review. Sleep 2002; 25:148–73.Google ScholarPubMed
Black, JE, Hirshkowitz, M. Modafinil for treatment of residual excessive sleepiness in nasal continuous positive airway pressure-treated obstructive sleep apnea/hypopnea syndrome. Sleep 2005; 28:464–71.CrossRefGoogle ScholarPubMed
Bonnet, MH, Dexter, JR, Arand, DL. The effect of triazolam on arousal and respiration in central sleep apnea patients. Sleep 1990; 13:31–41.CrossRefGoogle ScholarPubMed
Bradley, TD, Logan, AG, Kimoff, RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005; 353:2025–33.CrossRefGoogle ScholarPubMed
Franklin, KA, Eriksoon, P, Sahlin, C, et al. Reversal of central sleep apnea with oxygen. Chest 1997; 111:163–9.CrossRefGoogle ScholarPubMed
Friberg, D, Gazelius, B, Hokfelt, T, Nordlander, B. Abnormal afferent nerve endings in the soft palatal mucosa of sleep apnoics and habitual snorers. Regul Pept 1997; 71:29–36.CrossRefGoogle ScholarPubMed
Gonzalez, MA, Selwyn, AP. Endothelial function, inflammation, and prognosis in cardiovascular disease. Am J Med 2003; 115 (Suppl 8A): 99S–106S.CrossRefGoogle ScholarPubMed
Guilleminault C, Motta J. Sleep apnea syndrome as a long-term sequela of poliomyelitis. In: Guilleminault, C, Dement, W, eds. Sleep Apnea Syndromes. New York, NY: Liss, 1978: 309–15.Google Scholar
Guilleminault, C, Connolly, SJ, Winkle, RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52:490–4.CrossRefGoogle ScholarPubMed
Guilleminault, C, Motta, J, Mihm, F, Melvin, K. Obstructive sleep apnea and cardiac index. Chest 1986; 89:331.CrossRefGoogle ScholarPubMed
Guilleminault, C, Partinen, M, Hollman, K, et al. Familial aggregates in obstructive sleep apnea syndrome. Chest 1995; 107:1545–51.CrossRefGoogle ScholarPubMed
Guilleminault, C, Li, K, Chen, NH, Poyares, D. Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects. Chest 2002; 122:866–70.CrossRefGoogle ScholarPubMed
Guilleminault, C, Kirisoglu, C, Ohayon, MM. C-reactive protein and sleep-disordered breathing. Sleep 2004; 27:1507–11.CrossRefGoogle ScholarPubMed
Guilleminault, C, Lee, JH, Chan, A. Pediatric obstructive sleep apnea syndrome. Arch Pediatr Adolesc Med 2005; 159:775–85.CrossRefGoogle ScholarPubMed
Hanly, PJ, Millar, TW, Steljes, DG, et al. The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med 1989; 111:777–82.CrossRefGoogle ScholarPubMed
Horner, RR, Mohiaddin, D, Lowell, S, et al. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnea and weight matched controls. Eur Respir J 1989; 2:613–22.Google ScholarPubMed
Hyland, RH, Hutcheon, MA, Perl, A, et al. Upper airway occlusion induced by diaphragmatic pacing for primary alveolar hypoventilation: implications for the pathogenesis of obstructive sleep apnea. Am Rev Respir Dis 1981; 124:180–5.Google ScholarPubMed
Issa, FG, Sullivan, CE. Reversal of central sleep apnea using nasal CPAP. Chest 1986; 90:165–71.CrossRefGoogle ScholarPubMed
Javaheri, S.Acetazolamide improves central sleep apnea in heart failure: a double-blind, prospective study. Am J Respir Crit Care Med 2006; 173:234–7.CrossRefGoogle ScholarPubMed
Javaheri, S, Parker, TJ, Wexler, L, et al. Effect of theophylline on sleep-disordered breathing in heart failure. N Engl J Med 1996; 335:562–7.CrossRefGoogle ScholarPubMed
Kaneko, Y, Floras, JS, Usui, K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003; 348:1233–41.CrossRefGoogle ScholarPubMed
Kapsimalis, F, Kryger, MH. Gender and obstructive sleep apnea syndrome, part 1: clinical features. Sleep 2002; 25:412–19.Google ScholarPubMed
Kapsimalis, F, Kryger, MH. Gender and obstructive sleep apnea syndrome, part 2: mechanisms. Sleep 2002; 25:499–506.Google ScholarPubMed
Khoo, MC, Kronauer, RE, Strohl, KP, Slutsky, AS. Factors inducing periodic breathing in humans: a general model. J Appl Physiol 1982; 53:644–59.CrossRefGoogle ScholarPubMed
Kushida, CA, Morgenthaler, TI, Littner, MR, et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 2006; 29:240–3.CrossRefGoogle ScholarPubMed
Lattimore, JD, Celermajer, DS, Wilcox, I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 2003; 41:1429–37.CrossRefGoogle ScholarPubMed
Lavie, L, Hefetz, A, Luboshitzky, R, Lavie, P. Plasma levels of nitric oxide and L-arginine in sleep apnea patients: effects of nCPAP treatment. J Mol Neurosci 2003; 21:57–63.CrossRefGoogle ScholarPubMed
Li, KK, Powell, NB, Riley, RW, Guilleminault, C. Temperature-controlled radiofrequency tongue base eduction for sleep-disordered breathing: long-term outcomes. Otolaryngol Head Neck Surg 2002; 127:230–4.CrossRefGoogle Scholar
Linder-Aronson, S. Adenoids: their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition. Acta Otolaryngol Suppl 1970; 265:1–132.Google Scholar
Marrone, O, Bongsignore, MR. Pulmonary hemodynamics in obstructive sleep apnea. Sleep Med Rev 2002; 6:175–93.CrossRefGoogle Scholar
Martinez-Garcia, MA, Galiano-Blancart, R, Roman-Sanchez, P, et al. Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest 2005; 128:2123–9.CrossRefGoogle ScholarPubMed
Mayer, J, Becker, H, Brandenberg, U, et al. Blood pressure and sleep apnea: results of long term nasal continuous positive airway pressure therapy. Cardiology 1991; 79:84–92.CrossRefGoogle ScholarPubMed
Meoli, AL, Casey, KR, Clark, RW, et al. Clinical practice review committee: hypopnea in sleep disordered breathing in adults. Sleep 2001; 24:469–70.Google ScholarPubMed
Mezzanotte, WS, Tangel, DJ, White, DP. Influence of sleep onset on upper-airway muscle activity in apnea patients versus normal controls. Am J Respir Crit Care Med 1996; 153:1880–87.CrossRefGoogle ScholarPubMed
Miller, WP. Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Am J Med 1982; 73:317–21.CrossRefGoogle ScholarPubMed
Møller, DS, Lind, P, Strunge, B, Pedersen, EB. Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens 2003; 16:274–80.CrossRefGoogle ScholarPubMed
Naimark, A, Cherniack, RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol 1960; 15:377–82.CrossRefGoogle ScholarPubMed
Narkiewicz, K, Somers, VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand 2003; 177:385–90.CrossRefGoogle ScholarPubMed
Naughton, M, Benard, D, Tam, A, et al. The role of hyperventilation in the pathogenesis of central sleep apnea in patients with congestive heart failure. Am Rev Respir Dis 1993; 148:330–8.CrossRefGoogle ScholarPubMed
Palomaki, H, Partinen, M, Juvela, S, Kaste, M. Snoring as a risk factor for sleep-related brain infarction. Stroke 1989; 20:1311–15.CrossRefGoogle ScholarPubMed
Partinen, M, Guilleminault, C, Quera-Salva, MA, Jamieson, A. Obstructive sleep apnea and cephalometric roentgenograms: the role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 1988; 93:1199–205.CrossRefGoogle ScholarPubMed
Peppard, PE, Young, T, Palta, M, Skatrud, J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342:1378–84.CrossRefGoogle ScholarPubMed
Pepperell, JC, Davies, RJ, Stradling, JR. Systemic hypertension and obstructive sleep apnoea. Sleep Med Rev 2002; 6:157–73.CrossRefGoogle ScholarPubMed
Powell, N, Riley, R, Guilleminault, C, Troell, R.A reversible uvulopalatal flap for snoring and sleep apnea syndrome. Sleep 1996; 19:593–9.CrossRefGoogle ScholarPubMed
Redline, S, Kump, K, Tishler, PV, et al. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994; 149:722–6.CrossRefGoogle Scholar
Riley, RW, Powell, NB, Guilleminault, C. Maxillofacial surgery and nasal CPAP: a comparison of treatment for obstructive sleep apnea syndrome. Chest 1990; 98:1421–5.CrossRefGoogle ScholarPubMed
Shahar, E, Whitney, CW, Redline, S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163:19–25.CrossRefGoogle ScholarPubMed
Shiomi, T, Guilleminault, C, Stoohs, R, Schnittger, I. Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. Chest 1991; 100:894–902.CrossRefGoogle ScholarPubMed
Sin, DD, Fitzgerald, F, Parker, JD, et al. Relationship of systolic BP to obstructive sleep apnea in patients with heart failure. Chest 2003; 123:1536–43.CrossRefGoogle ScholarPubMed
Solow, B, Siersbaek-Nielsen, S, Greve, E. Airway adequacy, head posture, and craniofacial morphology. Am J Orthod 1984; 86:214–23.CrossRefGoogle ScholarPubMed
Somers, VK, Dyken, ME, Clary, MP, Abboud, FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995; 96:1897–904.CrossRefGoogle ScholarPubMed
Spiegel, K, Tasali, E, Penev, P, Cauter, E. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004; 141:846–50.CrossRefGoogle ScholarPubMed
Stein, I, Colapinto, N, Rotstein, , et al. Improvement in upper airway function after weight loss in patients with obstructive sleep apnea. Am Rev Respir Dis 1988; 138:1192–5.Google Scholar
Stoohs, R, Guilleminault, C. Snoring during NREM sleep: respiratory timing, esophageal pressure behavior and EEG arousal. Respir Physiol 1991; 85:151–67.CrossRefGoogle Scholar
Sullivan, CE, Issa, FG, Berthon-Jones, M, Eves, L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225):862–5.CrossRefGoogle ScholarPubMed
Teschler, H, Dohring, J, Wang, Y, et al. Adaptive pressure support servo-ventilation: a novel treatment for Cheyne–Stokes respiration in heart failure. Am J Resp Crit Care Med 2001; 164:614–19.CrossRefGoogle ScholarPubMed
Tilkian AG, Motta J, Guilleminault C. Cardiac arrhythmias in sleep apnea. In: Guilleminault, C, Dement, W, eds. Sleep Apnea Syndromes. New York, NY: Liss, 1978: 197–210.Google Scholar
Valencia-Flores, M, Orea, A, Herrera, M, et al. Effect of bariatric surgery on obstructive sleep apnea and hypopnea syndrome, electrocardiogram, and pulmonary arterial pressure. Obes Surg 2004; 14:755–62.CrossRefGoogle ScholarPubMed
Vargervik, K, Miller, AJ, Chierici, G, Harrold, E, Tomer, BS. Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod 1984; 85:115–24.CrossRefGoogle Scholar
Whittle, AT, Marshall, I, Mortimore, IL, et al. Neck soft tissue and fat distribution: comparison between normal men and women by magnetic resonance imaging. Thorax 1999; 54:323–8.CrossRefGoogle ScholarPubMed
Xie, A, Rankin, F, Rutherford, R, Bradley, TD. Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol 1997; 82:918–26.CrossRefGoogle ScholarPubMed
Xie, A, Skatrud, J, Puleo, D, Rahko, PS, Dempsey, JA. Apnea-hypopnea threshold for CO2 in patients with congestive heart failure. Am J Respir Crit Care Med 2002; 165:1245–50.CrossRefGoogle ScholarPubMed
Yaggi, HK, Concato, J, Kernan, WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005; 353:2030–41.CrossRefGoogle ScholarPubMed
Young, T, Palta, M, Dempsey, J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328:1230–35.CrossRefGoogle ScholarPubMed
Young, T, Peppard, PE, Gottlieb, DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165:1217–39.CrossRefGoogle ScholarPubMed
Young, T, Shahar, E, Nieto, FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002; 162:893–900.CrossRefGoogle ScholarPubMed

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