-
Lancet (London, England) Feb 2014Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features... (Review)
Review
Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss.
Topics: Accidents, Traffic; Adenoids; Adult; Age Factors; Continuous Positive Airway Pressure; Female; Humans; Hypertension; Hypertrophy; Male; Menopause; Obesity; Palatine Tonsil; Polysomnography; Risk Assessment; Risk Factors; Sex Factors; Sleep Apnea, Obstructive; Sleep Stages; Smoking; Water-Electrolyte Imbalance; Weight Loss
PubMed: 23910433
DOI: 10.1016/S0140-6736(13)60734-5 -
F1000Research 2019Central sleep apnea is prevalent in patients with heart failure, healthy individuals at high altitudes, and chronic opiate users and in the initiation of "mixed" (that... (Review)
Review
Central sleep apnea is prevalent in patients with heart failure, healthy individuals at high altitudes, and chronic opiate users and in the initiation of "mixed" (that is, central plus obstructive apneas). This brief review focuses on (a) the causes of repetitive, cyclical central apneas as mediated primarily through enhanced sensitivities in the respiratory control system and (b) treatment of central sleep apnea through modification of key components of neurochemical control as opposed to the current universal use of positive airway pressure.
Topics: Altitude; Analgesics, Opioid; Heart Failure; Humans; Prevalence; Respiratory System; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 31297185
DOI: 10.12688/f1000research.18358.1 -
Journal of Perinatology : Official... Sep 2021This narrative review provides a broad perspective on immature control of breathing, which is universal in infants born premature. The degree of immaturity and severity... (Review)
Review
This narrative review provides a broad perspective on immature control of breathing, which is universal in infants born premature. The degree of immaturity and severity of clinical symptoms are inversely correlated with gestational age. This immaturity presents as prolonged apneas with associated bradycardia or desaturation, or brief respiratory pauses, periodic breathing, and intermittent hypoxia. These manifestations are encompassed within the clinical diagnosis of apnea of prematurity, but there is no consensus on minimum criteria required for diagnosis. Common treatment strategies include caffeine and noninvasive respiratory support, but other therapies have also been advocated with varying effectiveness. There is considerable variability in when and how to initiate and discontinue treatment. There are significant knowledge gaps regarding effective strategies to quantify the severity of clinical manifestations of immature breathing, which prevent us from better understanding the long-term potential adverse outcomes, including neurodevelopment and sudden unexpected infant death.
Topics: Apnea; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Respiration
PubMed: 33712716
DOI: 10.1038/s41372-021-01010-z -
European Respiratory Review : An... Dec 2019Obstructive sleep apnoea (OSA) and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) have long been considered predominantly male-related conditions. The clinical... (Review)
Review
Obstructive sleep apnoea (OSA) and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) have long been considered predominantly male-related conditions. The clinical presentation of sleep disordered breathing in females differs from males and can vary with age and physiological status, menopause and pregnancy. Overall, females appear to be more symptomatic, with lower apnoea-hypopnoea index scores compared to males. Furthermore, they appear to have more prolonged partial upper airway obstruction, and may report insomnia as a symptom of OSAHS more frequently. As a consequence of these differences in clinical presentation, females with sleep disordered breathing are often underdiagnosed and undertreated compared to males. This review is aimed at discussing the epidemiology, clinical presentation, pathophysiology and hormonal and metabolic differences in females who present with OSA/OSAHS in comparison to males.
Topics: Female; Humans; Male; Risk Factors; Sex Factors; Sleep Apnea, Obstructive
PubMed: 31694839
DOI: 10.1183/16000617.0030-2019 -
The Pan African Medical Journal 2018Obstructive sleep apnoea (OSA) affects approximately 4% of men and 2% of women in the middle ages but many of these patients are not diagnosed or treated. Cardiovascular... (Review)
Review
Obstructive sleep apnoea (OSA) affects approximately 4% of men and 2% of women in the middle ages but many of these patients are not diagnosed or treated. Cardiovascular and cerebrovascular morbidity and mortality are associated with sleep apnoea. This causal link has been confirmed in recent years on the basis of epidemiological, experimental and therapeutic data. The prevalence in the general population and the impact on the genesis and evolution of systemic and pulmonary arterial hypertension, of cardiac rhythm disorders, of coronary artery disease, of heart failure and of strokes should encourage clinicians to early diagnose and treat sleep disordered breathing and, if possible, to prevent them.
Topics: Cardiovascular Diseases; Early Diagnosis; Female; Humans; Male; Middle Aged; Prevalence; Risk Factors; Sleep Apnea, Obstructive
PubMed: 29875929
DOI: 10.11604/pamj.2018.29.47.11267 -
Sleep & Breathing = Schlaf & Atmung Jun 2022Obstructive sleep apnea syndrome (OSAS) is characterized by symptoms and signs of more than 5 apneas per hour (AHI) at polysomnography or 15 or more apneas per hour... (Review)
Review
Obstructive sleep apnea syndrome (OSAS) is characterized by symptoms and signs of more than 5 apneas per hour (AHI) at polysomnography or 15 or more apneas per hour without symptoms. In this review, the focus will be a subgroup of patients: adult non-obese subjects with OSA and their specific features. In non-obese OSA patients (patients with BMI < 30 kg/m), there are specific polysomnographic features which reflect specific pathophysiological traits. Previous authors identified an anatomical factor (cranial anatomical factors, retrognatia, etc.) in OSA non-obese. We have hypothesized that in this subgroup of patients, there could be a non-anatomical pathological prevalent trait. Little evidence exists regarding the role of low arousal threshold. This factor could explain the difficulty in treating OSA in non-obese patients and emphasizes the importance of a specific therapeutic approach for each patient.
Topics: Adult; Arousal; Body Mass Index; Humans; Polysomnography; Sleep Apnea, Obstructive
PubMed: 34324126
DOI: 10.1007/s11325-021-02412-1 -
European Respiratory Review : An... Sep 2019Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive... (Review)
Review
Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive airway pressure. The most commonly used oral appliance advances the lower jaw during sleep, the so-called mandibular advancement device (MAD). Patients seek treatment because of disturbing snoring, daytime symptoms, apnoeas that disturb sleep and the longer term consequences with regard to cardiovascular risks. MADs reduce the apnoea-hypopnoea index, although to various degrees among patients. Effects on daytime sleepiness have been observed mainly among the more severe OSA patients. Blood pressure may be reduced in MAD-treated OSA patients. There is, however, uncertainty about which patients will respond to this therapy in terms of apnoea reductions, decreased sleepiness and other symptoms, and reduced risk for future impaired health. The occurrence of side-effects also remains difficult to predict at present. The majority of sleep apnoea patients suffer from various comorbidities in terms of cardiovascular diseases, type 2 diabetes and depression. The most recent findings indicate that phenotyping of patients, considering various aspects of this multifaceted disease, will shed more light on the indications for MADs in patients with nightly sleep breathing disturbances. This review summarises the most recent knowledge about MAD treatment.
Topics: Comorbidity; Equipment Design; Humans; Lung; Mandibular Advancement; Occlusal Splints; Respiration; Risk Factors; Sleep; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 31554705
DOI: 10.1183/16000617.0083-2019 -
European Respiratory Review : An... Jun 2021Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in... (Review)
Review
INTRODUCTION
Obstructive sleep apnoea (OSA) is a common sleep disorder with a high social and economic burden. Thus, early prediction and diagnosis of OSA are important. Changes in metabolism and the microbiome may serve as biomarkers for OSA. Herein, we review the literature on the metabolomic and microbiome changes associated with OSA, and identify the metabolites and microorganisms involved.
METHODS
We searched the PUBMED and EMBASE electronic databases using the following terms: "obstructive sleep apnea", "OSA", "sleep disordered breathing", "SDB", "intermittent hypoxia", "sleep fragmentation", and either "metabolomics" or "microbiome". In total, 273 papers were identified, of which 28 were included in our study.
RESULTS
Changes in the levels of certain metabolites related to fatty acid, carbohydrate and amino acid metabolism were associated with the incidence of OSA. The diversity and abundance of microflora, particularly Firmicutes and Bacteroidetes, were altered in humans and rodents with OSA.
CONCLUSIONS
Certain changes in metabolism and the microbiota play an integral role in the pathophysiology of OSA and OSA-induced cardiovascular complications. Metabolomic and microbiome biomarkers shed light on the pathogenesis of OSA, and facilitate early diagnosis and treatment.
Topics: Biomarkers; Humans; Metabolomics; Microbiota; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33980666
DOI: 10.1183/16000617.0220-2020 -
Acta Otorhinolaryngologica Italica :... Oct 2019
Review
Topics: Child; Databases, Factual; Endoscopy; Humans; Needs Assessment; Polysomnography; Risk Factors; Sleep Apnea, Obstructive
PubMed: 31708576
DOI: 10.14639/0392-100X-N0262 -
Paediatric Anaesthesia Feb 2022Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher... (Review)
Review
Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis-à-vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications.
Topics: Anesthesia; Apnea; Child; Child, Preschool; Humans; Infant; Oxygen; Respiration; Sleep Apnea, Central
PubMed: 34877744
DOI: 10.1111/pan.14362