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Email this article Review of modern methods of diagnosis and treatment of obstructive sleep apnea
Abstract
Sleep apnea is a condition characterized by repetitive upper airway obstruction leading to nocturnal hypoxia and sleep fragmentation. It is estimated that between 2% and 4% of the middle-aged population suffer from sleep apnea, with more men than women. Risk factors for sleep apnea include obesity, gender, age, menopause, family factors, craniofacial anomalies, and alcohol. Sleep apnea is increasingly recognized as a serious health problem, linked to hypertension and an increased risk of cardiovascular disease and death. Increased airway collapse and impaired respiratory control are the main pathological features of this disorder. Polysomnography (PSG) is the gold standard for diagnosing sleep apnea and assessing the severity of sleep apnea; however, portable sleep monitoring has a diagnostic role in establishing a high pre-test probability of sleep apnea in the absence of significant comorbidities. Positive pressure therapy is the primary treatment for sleep apnea. Other treatments, such as upper airway surgery or mouth appliances, may be used to treat sleep apnea in selected cases. In this review, we will focus on describing the definition of sleep apnea, risk factor profile, underlying pathophysiological mechanisms, associated adverse effects, diagnostic methods, and treatment strategies.
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Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. TheReport of an American Academy of Sleep Medicine Task Force. Sleep.1999 Aug 1;22(5):667–689.
Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters forthe indications for polysomnography and related procedures: an updatefor 2005. Sleep. 2005;28(4):499–521.
Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepinessto respiratory disturbance index: the Sleep Heart Health Study. Am JRespir Crit Care Med. 1999;159(2):502–507.
Young T, Peppard P, Palta M, et al. Population-based study of sleepdisordered breathing as a risk factor for hypertension. Arch Intern Med.1997;157(15):1746–1752.
Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathingand cardiovascular disease: cross-sectional results of the Sleep HeartHealth Study. Am J Respir Crit Care Med. 2001;163(1):19–25.
Meisinger C, Heier M, Lowel H, Schneider A, Doring A. Sleep durationand sleep complaints and risk of myocardial infarction in middle-agedmen and women from the general population: the MONICA/KORA Augsburg cohort study. Sleep. 2007;30(9):1121–1127.
Lindberg E, Carter N, Gislason T, Janson C. Role of snoring and daytime sleepiness in occupational accidents. Am J Respir Crit Care Med.2001;164(11):2031–2035.
Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The associationbetween sleep apnea and the risk of traffic accidents. Cooperative GroupBurgos-Santander. N Engl J Med. 1999;340(11):847–851.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N EnglJ Med. 1993;328(17):1230–1235.
Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disorderedbreathing in women: effects of gender. Am J Respir Crit Care Med.2001;163(3 Pt 1):608–613.
Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A. Effects of ageon sleep apnea in men: I. Prevalence and severity. Am J Respir Crit CareMed. 1998;157(1):144–148.
Bearpark H, Elliott L, Grunstein R, et al. Snoring and sleep apnea.A population study in Australian men. Am J Respir Crit Care Med.1995;151(5):1459–1465.
Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apneahypopnea and related clinical features in a population-based sampleof subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163 (3 Pt 1):685–689.
Ip MS, Lam B, Tang LC, Lauder IJ, Ip TY, Lam WK. A communitystudy of sleep-disordered breathing in middle-aged Chinese womenin Hong Kong: prevalence and gender differences. Chest. 2004;125(1):127–134.
Ip MS, Lam B, Lauder IJ, et al. A community study of sleep-disorderedbreathing in middle-aged Chinese men in Hong Kong. Chest. 2001;119(1):62–69.
Kim J, In K, Kim J, et al. Prevalence of sleep-disordered breathing inmiddle-aged Korean men and women. Am J Respir Crit Care Med.2004;170(10):1108–1113.
Puvanendran K, Goh KL. From snoring to sleep apnea in a Singaporepopulation. Sleep Res Online. 1999;2(1):11–14.
Tami TA, Duncan HJ, Pfleger M. Identification of obstructive sleep apneain patients who snore. Laryngoscope. 1998;108(4 Pt 1): 508–513.
Vaidya AM, Petruzzelli GJ, Walker RP, McGee D, Gopalsami C. Identifying obstructive sleep apnea in patients presenting for laser-assisteduvulopalatoplasty. Laryngoscope. 1996;106(4):431–437.
Gottlieb DJ, Yao Q, Redline S, Ali T, Mahowald MW. Does snoringpredict sleepiness independently of apnea and hypopnea frequency?Am J Respir Crit Care Med. 2000;162(4 Pt 1):1512–1517.
Douglas NJ. Systematic review of the efficacy of nasal CPAP. Thorax.1998;53(5):414–415.
Beutler LE, Ware JC, Karacan I, Thornby JI. Differentiating psychological characteristics of patients with sleep apnea and narcolepsy. Sleep.1981;4(1):39–47.
Kribbs NB, Pack AI, Kline LR, et al. Effects of one night without nasalCPAP treatment on sleep and sleepiness in patients with obstructivesleep apnea. Am Rev Respir Dis. 1993;147(5):1162–1168.
Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea.The Epworth Sleepiness Scale. Chest. 1993;103(1):30–36.
Viner S, Szalai JP, Hoffstein V. Are history and physical examinationa good screening test for sleep apnea? Ann Intern Med. 1991;115(5):356–359.
Maislin G, Pack AI, Kribbs NB, et al. A survey screen for predictionof apnea. Sleep. 1995;18(3):158–166.
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the BerlinQuestionnaire to identify patients at risk for the sleep apnea syndrome.Ann Intern Med. 1999;131(7):485–491.
Kirby SD, Eng P, Danter W, et al. Neural network prediction ofobstructive sleep apnea from clinical criteria. Chest. 1999;116(2):409–415.
Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea andexcessive day sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123(4):1134–1141.
Kushida CA, Efron B, Guilleminault C. A predictive morphometricmodel for the obstructive sleep apnea syndrome. Ann Intern Med.1997;127(8 Pt 1):581–587.
Tsai WH, Remmers JE, Brant R, Flemons WW, Davies J, Macarthur C.A decision rule for diagnostic testing in obstructive sleep apnea. Am JRespir Crit Care Med. 2003;167(10):1427–1432.
Rowley JA, Aboussouan LS, Badr MS. The use of clinical predictionformulas in the evaluation of obstructive sleep apnea. Sleep. 2000;23(7):929–938
Young T, Shahar E, Nieto FJ, et al. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. ArchIntern Med. 2002;162(8):893–900.
Ancoli-Israel S, Klauber MR, Stepnowsky C, Estline E, Chinn A, FellR. Sleep-disordered breathing in African-American elderly. Am J RespirCrit Care Med. 1995;152(6 Pt 1):1946–1949.
Kapsimalis F, Kryger MH. Gender and obstructive sleep apneasyndrome, part 1: clinical features. Sleep. 15 2002;25(4):412–419.
Strohl KP, Saunders NA, Feldman NT, Hallett M. Obstructivesleep apnea in family members. N Engl J Med. 1978;299(18):969–973.
Redline S, Tishler PV, Tosteson TD, et al. The familial aggregationof obstructive sleep apnea. Am J Respir Crit Care Med. 1995;151(3 Pt 1):682–687.
Mathur R, Douglas NJ. Family studies in patients with thesleep apnea-hypopnea syndrome. Ann Intern Med. 1995;122(3):174–178.
Young T, Finn L, Austin D, Peterson A. Menopausal status andsleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am JRespir Crit Care Med. 2003;167(9):1181–1185.
Redline S, Tishler PV, Hans MG, Tosteson TD, Strohl KP, SpryK. Racial differences in sleep-disordered breathing in AfricanAmericans and Caucasians. Am J Respir Crit Care Med. 1997;155(1):186–192.
Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep.1986;9(4):469–477.
Lowe AA, Santamaria JD, Fleetham JA, Price C. Facial morphologyand obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 1986;90(6):484–491.
Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA.Cephalometric comparisons of craniofacial and upper airway structureby skeletal subtype and gender in patients with obstructive sleep apnea.Am J Orthod Dentofacial Orthop. 1996;110(6):653–664.
Maltais F, Carrier G, Cormier Y, Series F. Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea. Thorax.1991;46(6):419–423.
Zucconi M, Ferini-Strambi L, Palazzi S, Orena C, Zonta S, Smirne S.Habitual snoring with and without obstructive sleep apnoea: the importance of cephalometric variables. Thorax. 1992;47(3):157–161.
Wetter DW, Young TB. The relation between cigarette smoking andsleep disturbance. Prev Med. 1994;23(3):328–334.
108. Phillips BA, Danner FJ. Cigarette smoking and sleep disturbance. ArchIntern Med. 1995;155(7):734–737.
Yules RB, Lippman ME, Freedman DX. Alcohol administrationprior to sleep. The effect on EEG sleep stages. Arch Gen Psychiatry.
;16(1):94–97.
Ballard RD, Irvin CG, Martin RJ, Pak J, Pandey R, White DP. Influenceof sleep on lung volume in asthmatic patients and normal subjects.J Appl Physiol. 1990;68(5):2034–2041.
Younes M, Ostrowski M, Thompson W, Leslie C, Shewchuk W.Chemical control stability in patients with obstructive sleep apnea.Am J Respir Crit Care Med. 2001;163(5):1181–1190.
Wheatley JR, White DP. The influence of sleep on pharyngeal reflexes.Sleep. 1993;16 Suppl 8:S87–S89.
Stanchina ML, Malhotra A, Fogel RB, et al. Genioglossus muscleresponsiveness to chemical and mechanical stimuli during non-rapid eyemovement sleep. Am J Respir Crit Care Med. 2002;165(7): 945–949.
Malhotra A, Trinder J, Fogel R, et al. Postural effects on pharyngealprotective reflex mechanisms. Sleep. 2004;27(6):1105–1112.
Younes M. Contributions of upper airway mechanics and controlmechanisms to severity of obstructive apnea. Am J Respir Crit CareMed. 2003;168(6):645–658.
Ryan CM, Bradley TD. Pathogenesis of obstructive sleep apnea.J Appl Physiol. 2005;99(6):2440–2450.
Kimoff RJ, Sforza E, Champagne V, Ofiara L, Gendron D. Upperairway sensation in snoring and obstructive sleep apnea. Am J RespirCrit Care Med. 2001;164(2):250–255.
Svanborg E. Upper airway nerve lesions in obstructive sleep apnea.Am J Respir Crit Care Med. 2001;164(2):187–189.
Friberg D, Gazelius B, Hokfelt T, Nordlander B. Abnormal afferentnerve endings in the soft palatal mucosa of sleep apnoics and habitualsnorers. Regul Pept. 1997;71(1):29–36.
Boyd JH, Petrof BJ, Hamid Q, Fraser R, Kimoff RJ. Upper airwaymuscle inflammation and denervation changes in obstructive sleepapnea. Am J Respir Crit Care Med. 2004;170(5):541–546.
Ibrahim LH, Patel SR, Modarres M, et al. A measure of ventilatoryvariability at wake-sleep transition predicts sleep apnea severity. Chest.2008;134(1):73–78.
Friedman JM, Halaas JL. Leptin and the regulation of body weight inmammals. Nature. 1998;395(6704):763–770.
O’Donnell CP, Schaub CD, Haines AS, et al. Leptin prevents respiratory depression in obesity. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1477–1484.
Practice parameters for the indications for polysomnography andrelated procedures. Polysomnography Task Force, American SleepDisorders Association Standards of Practice Committee. Sleep.1997;20(6):406–422.
Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines forthe use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Forceof the American Academy of Sleep Medicine. J Clin Sleep Med.2007;3(7):737–747.
Iber C, Redline S, Kaplan Gilpin AM, et al. Polysomnographyperformed in the unattended home versus the attended laboratorysetting – Sleep Heart Health Study methodology. Sleep. 2004;27(3):536–540.
Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169(6):668–672
Faccenda JF, Mackay TW, Boon NA, Douglas NJ. Randomizedplacebo-controlled trial of continuous positive airway pressure onblood pressure in the sleep apnea-hypopnea syndrome. Am J RespirCrit Care Med. 2001;163(2):344–348.
Engleman HM, Kingshott RN, Wraith PK, Mackay TW, DearyIJ, Douglas NJ. Randomized placebo-controlled crossover trial ofcontinuous positive airway pressure for mild sleep Apnea/Hypopneasyndrome. Am J Respir Crit Care Med. 1999;159(2):461–467.
Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick MF.Positional treatment vs continuous positive airway pressure in patientswith positional obstructive sleep apnea syndrome. Chest. 1999;
(3):771–781.
Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructivesleep apnoea by continuous positive airway pressure applied throughthe nares. Lancet. 1981;1(8225):862–865.
Ballester E, Badia JR, Hernandez L, et al. Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleepapnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159(2):495–501.
Barbe F, Mayoralas LR, Duran J, et al. Treatment with continuouspositive airway pressure is not effective in patients with sleep apneabut no daytime sleepiness: a randomized, controlled trial. Ann InternMed. 2001;134(11):1015–1023.
Barnes M, Houston D, Worsnop CJ, et al. A randomized controlledtrial of continuous positive airway pressure in mild obstructive sleepapnea. Am J Respir Crit Care Med. 2002;165(6):773–780.
Barnes M, McEvoy RD, Banks S, et al. Efficacy of positive airwaypressure and oral appliance in mild to moderate obstructive sleepapnea. Am J Respir Crit Care Med. 2004;170(6):656–664.
Chakravorty I, Cayton RM, Szczepura A. Health utilities in evaluatingintervention in the sleep apnoea/hypopnoea syndrome. Eur Respir J.2002;20(5):1233–1238.
Engleman HM, McDonald JP, Graham D, et al. Randomized crossovertrial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am
J Respir Crit Care Med. 2002;166(6):855–859.
Henke KG, Grady JJ, Kuna ST. Effect of nasal continuouspositive airway pressure on neuropsychological function in sleepapnea-hypopnea syndrome. A randomized, placebo-controlled trial.Am J Respir Crit Care Med. 2001;163(4):911–917.
Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison oftherapeutic and subtherapeutic nasal continuous positive airwaypressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet. 1999;353(9170):2100–2105.
Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P,Naughton MT. Controlled trial of continuous positive airway pressurein obstructive sleep apnea and heart failure. Am J Respir Crit CareMed. 2004;169(3):361–366.
Marshall NS, Neill AM, Campbell AJ, Sheppard DS. Randomised controlled crossover trial of humidified continuous positive airway pressurein mild obstructive sleep apnoea. Thorax. 2005;60(5): 427–432.
McArdle N, Devereux G, Heidarnejad H, Engleman HM, MackayTW, Douglas NJ. Long-term use of CPAP therapy for sleepapnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159(4 Pt 1):1108–1114.
Engleman HM, Martin SE, Deary IJ, Douglas NJ. Effect of continuous positive airway pressure treatment on daytime function in sleepapnoea/hypopnoea syndrome. Lancet. 1994;343(8897):572–575.
Ryan CF, Love LL, Peat D, Fleetham JA, Lowe AA. Mandibularadvancement oral appliance therapy for obstructive sleep apnoea: effecton awake calibre of the velopharynx. Thorax. 1999;54(11):972–977.
Ng AT, Gotsopoulos H, Qian J, Cistulli PA. Effect of oral appliancetherapy on upper airway collapsibility in obstructive sleep apnea. AmJ Respir Crit Care Med. 2003;168(2):238–241.
Fujita S, Conway W, Zorick F, Roth T. Surgical correction of anatomic azbnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg. 1981;89(6):923–934.
Sher AE, Schechtman KB, Piccirillo JF. The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apneasyndrome. Sleep. 1996;19(2):156–177.
Ferguson KA, Heighway K, Ruby RR. A randomized trial of laserassisted uvulopalatoplasty in the treatment of mild obstructive sleepapnea. Am J Respir Crit Care Med. 2003;167(1):15–19.
Larrosa F, Hernandez L, Morello A, Ballester E, Quinto L, Montserrat JM. Laser-assisted uvulopalatoplasty for snoring: does it meet theexpectations? Eur Respir J. 2004;24(1):66–70.
Woodson BT, Steward DL, Weaver EM, Javaheri S. A randomizedtrial of temperature-controlled radiofrequency, continuous positiveairway pressure, and placebo for obstructive sleep apnea syndrome.
Otolaryngol Head Neck Surg. 2003;128(6):848–861.
Stuck BA, Sauter A, Hormann K, Verse T, Maurer JT. Radiofrequencysurgery of the soft palate in the treatment of snoring. A placebocontrolled trial. Sleep. 2005;28(7):847–850.
Ceylan K, Emir H, Kizilkaya Z, et al. First-choice treatment inmild to moderate obstructive sleep apnea: single-stage, multilevel,temperature-controlled radiofrequency tissue volume reduction ornasal continuous positive airway pressure. Arch Otolaryngol HeadNeck Surg. 2009;135(9):915–919.
Back LJ, Liukko T, Rantanen I, et al. Radiofrequency surgery ofthe soft palate in the treatment of mild obstructive sleep apnea isnot effective as a single-stage procedure: a randomized singleblinded placebo-controlled trial. Laryngoscope. 2009;119(8):1621–1627.
Li HY, Wang PC, Lee LA, Chen NH, Fang TJ. Prediction of uvulopalatopharyngoplasty outcome: anatomy-based staging system versusseverity-based staging system. Sleep. 2006;29(12):1537–1541.
National Commission on Sleep Disorders Research. Wake up America:a national sleep alert. Bethesda, MD: 1995;2.
Punjabi NM. The epidemiology of adult obstructive sleep apnea. ProcAm Thorac Soc. 2008;5(2):136–143.
Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men andwomen. Sleep. 1997;20(9):705–706.
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