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Sleep Breathing Disorders
Last edited |
10/22/2008
Sleep disordered breathing encompasses
a spectrum of conditions whose common feature is intermittent loss of upper
airway patency associated with sleep
This results in sleep disruption,
daytime symptoms and other physiological consequences.
These syndromes, which
range from snoring to frank obstructive sleep apnea, have gained increasing
recognition in the past 20 years.
There has been evolution from a clinical focus on the most severe cases to a
much wider spectrum of sleep disordered breathing.
The most common sleep
disordered breathing disorders are:
Obstructive Sleep Apnea Syndrome (OSAS)
The primary complaint is excessive daytime sleepiness or insomnia.
The sleep is characterized by several episodes of sleep
apnea (episode of cessation of breathing during the sleep that lasts up to
10 seconds) caused by upper airway obstruction.
Patients with this syndrome have usually a long history of
loud snoring. Upon wake up, they often feel the sleep was not refreshing.
Morning headaches and dry mouth upon awakening are also frequently reported.
A growing body of the literature has shown that Obstructive Sleep
Apnea Syndrome has serious consequences:
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excessive daytime sleepiness,
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increased risk of
mortality,
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long term
cardiovascular complications including increased risk of hypertension and
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high economical
costs.
Central Sleep Apnea Syndrome (CSAS)
Like for OSAS, the primary complaint is excessive daytime sleepiness or
insomnia.
The sleep is characterized by several episodes of sleep
apnea caused by a cessation or decrease in the ventilatory effort during
sleep.
Patients with this syndrome often complain of an inability
to maintain sleep. It is not uncommon, these patients wake up during the
night gasping for air or with a sensation of choking. During the daytime,
they frequently report being tired, fatigued or sleepy.
Upper Airway Resistance Syndrome
(UARS)
This disorder results from repeated increases in resistance to airflow within
the upper airway that lead to brief arousals.
It is often accompanied of daytime somnolence that motives
the subject to consult a physician.
Currently, a diagnosis of UARS is appropriate for patients
who:
1) complain of daytime tiredness and/or daytime sleepiness
2) have a classical thermistor-defined Apnea/Hypopnea Index <
5 events per hour and
3) display an abnormal increased respiratory effort as
measured by esophageal pressure monitoring during sleep which leads to
repetitive arousals from EEG sleep.
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