Elsevier

Disease-a-Month

Volume 40, Issue 4, April 1994, Pages 202-252
Disease-a-Month

Obstructive sleep apnea

https://doi.org/10.1016/0011-5029(94)90013-2Get rights and content

Abstract

The high prevalence of obstructive sleep apnea (OSA) has only recently been appreciated, in part because the symptoms and signs of chronic sleep disruption are often overlooked in spite of their debilitating consequences. They typically develop insidiously during a period of years. We now know that the lives of millions of peopel each year are significantly impaired by the sequelae of OSA. Many of these patients go unrecognized, with tremendous medical and economic consequences for individual patients and for society. Evidence indicates that chronic, heavy snoring may be associated with increased long-term cardiovascular and neurophysiologic morbidity. Therefore considerable interest lies in the study of the epidemiology and the natural history of these related disorders.

The fundamental problem in OSA is the periodic collapse of the pharyngeal airway during sleep. The pathophysiology of this phenomenon is reviewed in some detail. During apneas caused by obstruction, airflow is impeded by the collapsed pharynx in spite of continued effort to breathe. This causes progressive asphyxia, which increasingly stimulates breathing efforts against the collapsed airway, typically until the person is awakened. Hypopneas predominate in some patients and are caused by partial pharyngeal collapse. The clinical sequelae of OSA relate to the cumulative effects of exposure to periodic asphyxia and to sleep fragmentation caused by apneas and hypopneas. Some patients with frequent, brief apneas and hypopneas and normal underlying cardiopulmonary function may have considerable sleep disruption without much exposure to nocturnal hypoxia.

Patients with sleep apnea often have excessive daytime sleepiness. As the disorder progresses, sleepiness becomes increasingly irresistible and dangerous, and patients develop cognitive dysfunction, inability to concentrate, memory and judgment impairment, irritability, and depression. These problems may lead to family and social problems and job loss. Cardiac and vascular morbidity in OSA may include systemic hypertension, cardiac arrhythmias, pulmonary hypertension, cor pulmonale, left ventricular dysfunction, stroke, and sudden death. The challenge for the clinician is to routinely consider the diagnosis and to incorporate several basic questions in the historical review of systems regarding daytime or inappropriate sleepiness. The diagnosis of OSA is made with polysomnography, and the decision to treat is based on an overall assessment of the severity of sleep-disordered breathing, sleep fragmentation, and associated clinical sequelae. The therapeutic options for the management of OSA are reviewed. Recognition and appropriate treatment of OSA and related disorders will often significantly enhance the patient's quality of life, overall health, productivity, and safety on the highways.

References (139)

  • JW Shepard

    Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea

    Clin Chest Med

    (1992)
  • J He et al.

    Mortality and apnea index in obstructive sleep apnea

    Chest

    (1988)
  • C George et al.

    Sleep apnoea patients have more automobile accidents

    Lancet

    (1987)
  • LJ Findley et al.

    Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia

    Chest

    (1986)
  • RP Millman et al.

    Daytime hypertension in obstructive sleep apnea: prevalence and contributing risk ractors

    Chest

    (1991)
  • J Hung et al.

    Association of sleep apnoea with myocardial infarction in men

    Lancet

    (1990)
  • M Partinen et al.

    Snoring and cerebral infarction

    Lancet

    (1985)
  • J Krieger et al.

    Left ventricular ejection fraction in obstructive sleep apnea: effects of long-term treatment with nasal continuous positive airway pressure

    Chest

    (1991)
  • PC Waller et al.

    Is snoring a cause of vascular disease?

  • C Guilleminault et al.

    A cause of excessive daytime sleepiness

  • C Guilleminault et al.

    Snoring: daytime sleepiness in regular heavy snorers

    Chest

    (1991)
  • S Redline et al.

    Measurement of sleep-related breathing disturbances in epidemiologic studies

  • FR Dolly et al.

    Effect of flurazepam on sleep-disordered breathing and nocturnal oxygen desaturation in asymptomatic subjects

    Am J Med

    (1982)
  • PM Suratt et al.

    Changes in breathing and the pharynx after weight loss in obstructive sleep apnea

    Chest

    (1987)
  • J Krieger

    Breathing during sleep in normal subjects

    Clin Chest Med

    (1985)
  • DW Hudgel et al.

    Mechanics of the respiratory system and breathing during sleep in normal humans

    J Appl Physiol

    (1984)
  • L Wiegand et al.

    Collapsibility of the human upper airway during normal sleep

    J Appl Physiol

    (1989)
  • DW Hudgel et al.

    Palate and hypopharynx: sites of inspiratory narrowing of the upper airway during sleep

    Am Rev Respir Dis

    (1988)
  • R Lydic et al.

    Sleep-dependent changes in upper airway muscle function

  • L Wiegand et al.

    Pathogenesis of obstructive sleep apnea: role of the pharynx

    Semin Respir Med

    (1988)
  • DJ Tangel et al.

    Influence of sleep on tensor palatini EMG and upper airway resistance in normal men

    J Appl Physiol

    (1991)
  • DA Wiegand et al.

    Geniohyoid muscle activity in normal men during wakefulness and sleep

    J Appl Physiol

    (1990)
  • JM Lopes et al.

    Total airway resistance and respiratory muscle activity during sleep

    J Appl Physiol

    (1983)
  • C Iber et al.

    Ventilatory adaptations to resistive loading during wakefulness and non-REM sleep

    J Appl Physiol

    (1982)
  • L Wiegand et al.

    Sleep and the ventilatory response to resistive loading in normal men

    J Appl Physiol

    (1988)
  • L Wiegand

    Sleep and resistive loading influences on human upper airway collapsibility

    Prog Clin Biol Res

    (1990)
  • K Gleeson et al.

    The influence of increasing ventilatory effort on arousal from sleep

    Am Rev Respir Dis

    (1990)
  • W Vincken et al.

    Inspiratory muscle activity as a trigger causing the airways to open in obstructive sleep apnea

    Am Rev Respir Dis

    (1987)
  • GA Gould et al.

    The sleep hypopnea syndrome

    Am Rev Respir Dis

    (1988)
  • S Ancoli-Israel et al.

    Sleep-disordered breathing in community-dwelling elderly

    Sleep

    (1991)
  • P Lavie

    Incidence of sleep apnea in a presumably healthy working population: a significant relationship with excessive daytime sleepiness

    Sleep

    (1983)
  • JR Stradling et al.

    Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men

    Thorax

    (1991)
  • T Young et al.

    The occurrence of sleep-disordered breathing among middle-aged adults

    N Engl J Med

    (1993)
  • AJ Block et al.

    Sleep apnea, hypopnea and oxygen desaturation in normal subjects

    N Engl J Med

    (1979)
  • C Guilleminault et al.

    A review of 50 children with obstructive sleep apnea syndrome

    Lung

    (1981)
  • CL Rosen et al.

    Adult criteria for obstructive sleep apnea do not identify children with serious obstruction

    Am Rev Respir Dis

    (1992)
  • CP Browman et al.

    Obstructive sleep apnea and body weight

    Chest

    (1984)
  • E Garpestad et al.

    Stroke volume and cardiac output decrease at termination of obstructive apneas

    J Appl Physiol

    (1992)
  • FA Tolle et al.

    Reduced stroke volume related to pleural pressure in obstructive sleep apnea

    J Appl Physiol

    (1983)
  • CW Zwillich et al.

    Bradycardia during sleep apnea: characteristics and mechanisms

    J Clin Invest

    (1982)
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