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Sleep-related breathing disorders

88 important questions on Sleep-related breathing disorders

What is the primary focus of the ICSD-3 regarding sleep-related breathing disorders (SRBDs)?

The ICSD-3 focuses on:

A comprehensive framework for the diagnosis of SRBDs
Five main clinical categories:

1. Obstructive sleep apnea (OSA)

Central sleep apnea (CSA)
Sleep-related hypoventilation disorders
Sleep-related hypoxaemia disorder
Isolated symptoms/normal variants

What are the minimal diagnostic criteria for the different categories of sleep-related breathing disorders?

Each SRBD category must meet specific diagnostic criteria which include:

Symptoms such as daytime sleepiness or breathing interruptions
PSG or OCST results demonstrating the required number of respiratory events

How does obstructive sleep apnea (OSA) differ from central sleep apnea (CSA)?

The differences between OSA and CSA are:

OSA involves upper airway obstruction due to anatomical issues or muscle control.
CSA involves disrupted ventilatory control from the central nervous system.

What is a key clinical feature of sleep-related hypoventilation disorders according to ICSD-3?

Key features of sleep-related hypoventilation disorders include:

Elevated partial pressure of carbon dioxide (PaCO2) >45 mmHg during sleep
Disproportionate increases in PaCO2 compared to wakefulness levels

What types of conditions fall under central sleep apnea (CSA)?

CSA includes various subgroups such as:

CSA with Cheyne-Stokes respiration
CSA due to high-altitude periodic breathing
Primary CSA
Treatment-emergent CSA
CSA from medical conditions

What symptoms are indicative of central hypoventilation syndrome in adults?

Symptoms of central hypoventilation syndrome primarily include:

Daytime sleepiness
Fatigue
Morning headaches

What diagnostic criteria must be met for adult obstructive sleep apnea (OSA)?

Criteria for diagnosing adult OSA include:

Patient reporting symptoms like non-restorative sleep or fatigue
PSG showing five or more obstructive respiratory events per hour

What characteristics define obstructive hypoventilation in pediatric patients?

Characteristics of obstructive hypoventilation in pediatrics include:

Snoring
Laboured, obstructed breathing
PSG showing obstructive apneas or hypoventilation with hypercapnia >50 mmHg

What is the challenge regarding sleep-related breathing disorders (SRBDs)?

Diagnosis is complicated due to:

Variety of disorders
Evolving understanding of pathophysiological mechanisms
Need for comprehensive classification
Clinical relevance for sleep professionals

What are the main clinical categories of sleep-related breathing disorders according to the ICSD-3?

The five main categories include:

Obstructive Sleep Apnea (OSA)
Central Sleep Apnea (CSA)
Sleep-Related Hypoventilation Disorders
Sleep-Related Hypoxaemia Disorder
Isolated Symptoms/Normal Variants

What is the difference between obstructive and central sleep apnea?

Key distinctions are:

OSA: upper airway obstruction
CSA: dysfunction of ventilatory control
OSA caused by abnormal anatomy/control of muscles
CSA involves central neural output issues

What defines an obstructive apnea/hypopnea event?

An event characterized by:

Lasts for >10 seconds
Reduced ventilation (hypopnea) or complete cessation (apnea)
AHI measures severity during sleep

What are the subgroups of central sleep apnea (CSA)?

CSA includes these subgroups:

CSA with Cheyne-Stokes respiration
CSA from medical condition without CSB
CSA due to high-altitude breathing
CSA from medication/substance
Primary CSA and its subtypes

What key feature of obstructive sleep apnea (OSA) contributes to comorbidities?

Intermittent hypoxia is crucial, leading to:

Oxidative stress
Sympathetic overactivity
Inflammation
Endothelial dysfunction

These factors cause progression and accumulation of comorbidities throughout life.

What does sleep-related hypoventilation signify according to the ICSD-3?

It indicates:

Elevated PaCO2 levels >45 mmHg during sleep
Possible imbalance in carbon dioxide levels
Associated conditions include OHS, congenital syndromes

What is the impact of continuous positive airway pressure (CPAP) on OSA-related comorbidities?

CPAP, the first-line therapy, has:

Little effect on cardiometabolic risk
Highlights the need for integrated approaches
Necessitates a combination of therapies for effective management

How can obstructive sleep apnea be diagnosed in adults?

Diagnostic criteria include:

Patient reports sleepiness, snoring, or gasping
PSG shows obstructive events
AHI measurement indicates >5 or >15 events per hour

What characterizes obstructive sleep apnea (OSA)?

OSA is defined by:

Repeated episodes of apnea and hypopnea
Causes intermittent hypoxia and sleep fragmentation
Results in symptoms like daytime sleepiness and impaired cognition

What does this chapter cover regarding therapeutic approaches for sleep-disordered breathing?

The chapter discusses various therapeutic methods for managing sleep-disordered breathing, including:

General recommendations
Conservative measures
Pharmacological agents
Oral devices
Positive airway pressure (PAP)
Surgical interventions

What symptoms are associated with central hypoventilation in adults?

They typically include:

Fatigue
Daytime sleepiness
Morning headaches
Rare manifestations linked to genetic factors

How does obstructive sleep apnea affect cardiometabolic risk?

The combination of OSA and comorbidities can increase:

Cardiometabolic risk
Rates of cardiovascular events and mortality
Necessitates tailored therapies and follow-up

What role do pharmacological agents play in treating sleep apnea?

Pharmacological agents have minimal importance in obstructive sleep apnea treatment, but some may assist in treating:

Central sleep apnea (CSA)
Patients with heart failure

What is the significance of the AASM guidelines for CSA?

Importance includes:

Recommended sensor for respiratory effort is esophageal pressure
Calibrated inductive belts are valid
Helps in classifying respiratory events reliably

What are the primary health risks associated with obstructive sleep apnea?

OSA significantly correlates with:

Hypertension
Arrhythmias
Stroke and coronary heart disease
Increased cardiovascular mortality

What is the primary treatment method for moderate to severe obstructive sleep apnea?

Continuous positive airway pressure (CPAP) is essential for treating:

Moderate to severe obstructive sleep apnea (OSA)
Monitoring treatment efficacy

What diagnostic criteria are established for pediatric obstructive sleep apnea (OSA)?

Criteria require:

Snoring and labored breathing
PSG shows obstructive apnea/hypopneas
Associated behavioral or learning problems

Describe the comorbidities commonly linked with obstructive sleep apnea.

Common comorbidities include:

Hypertension
Metabolic syndrome components (visceral obesity, insulin resistance)
Type 2 diabetes
Chronic kidney disease

In which situation is surgical intervention indicated for obstructive sleep apnea patients?

Surgical intervention may be suitable for selected patients with:

Pharyngeal anomalies
Retrognathia
Obesity

How is sleep-related hypoventilation categorized in the ICSD-3?

It includes conditions like:

OHS
Congenital central alveolar hypoventilation syndrome
Central hypoventilation due to medications or disorders

What role does sympathetic nervous system activation play in OSA-related comorbidities?

It causes:

Oxidative stress
Systemic inflammation
May lead to metabolic and endothelial dysfunction

These effects are key in developing cardiometabolic comorbidities.

What is the importance of lifestyle and dietary interventions in managing sleep apnea?

Initial management of obstructive sleep apnea focuses on:

Addressing lifestyle factors
Reducing obesity
Improving apnea-hypopnea index (AHI)

What are the clinical symptoms of obstructive sleep apnea (OSA) and how do they vary among individuals?

Various symptoms are present:

Asymptomatic individuals vs. multisymptomatic patients
Symptoms include:
- Snoring
- Reported apneas
- Nocturnal choking
- Frequent nocturia
- Excessive daytime sleepiness
Cardiovascular comorbidities are also common.

How do environmental factors contribute to comorbidities in OSA patients?

High-risk-profile OSA often clusters with:

Tobacco smoking
Physical inactivity
Pollution
Unhealthy diet, resulting in obesity

Why is patient education crucial in managing sleep-disordered breathing?

Understanding sleep apnea enhances treatment acceptance and involves:

Clarifying the disorder
Discussing treatment options and side effects
Committing to a treatment plan

Why is the classification of sleep disorders clinically important?

It aids in:

Understanding prevalence in the population
Assisting clinical diagnosis
Bridging gaps between clinicians and researchers

How does the clinical picture differ between obstructive sleep apnea (OSA) and central sleep apnea (CSA)?

Central sleep apnea (CSA) shows:

Symptoms from associated diseases (e.g., heart failure, stroke)
Less pronounced daytime sleepiness compared to OSA
Side effects of medication (e.g., opiates) may be present.

What are the main effects of intermittent hypoxia in obstructive sleep apnea (OSA)?

Intermittent hypoxia leads to:

Oxidative stress
Increased sympathetic overactivity
Inflammation
Endothelial dysfunction
Progression of comorbidities throughout life.

What are essential sleep hygiene practices for patients with sleep-disordered breathing?

Good sleep hygiene consists of:

Avoiding sleep-disturbing habits
Optimizing the bedroom environment
Maintaining proper sleep timings

What are the different types of sleep-related breathing disorders?

The main categories of sleep-related breathing disorders include:

Obstructive sleep apnea (OSA)
Central sleep apnea (CSA)
Hypoventilation syndromes

What are common symptoms of hypoventilation syndromes?

Symptoms of hypoventilation syndromes include:

Nocturnal dyspnea
Peripheral oedema
Morning headache
Symptoms dominated by the underlying disease.

How can the management of obstructive sleep apnea be improved?

The management of OSA can be enhanced by:

Integrated care beyond CPAP
Combining various therapies
Individualized follow-up procedures
Addressing multiple clinical scenarios.

How does alcohol consumption affect sleep apnea?

Alcohol impacts sleep apnea by:

Suppressing REM sleep
Increasing obstructive events
Advising avoidance for patients

What distinguishes obstructive sleep apnea (OSA) from central sleep apnea (CSA)?

Key differences include:

OSA involves upper airway obstructions.
CSA relates to respiratory drive.
OSA affected by extraluminal pressure, while CSA associated with respiratory drive changes.

What symptoms do children with obstructive sleep apnea (OSA) exhibit?

Children with OSA may present:

Adenotonsillar hypertrophy
Obesity
Snoring
Observed breathing difficulties
Behavioral issues (hyperactivity, aggression)
Poor school performance.

What has research shown about CPAP therapy's effectiveness on comorbidities?

Research indicates that:

CPAP therapy has little to no effect on cardiometabolic comorbidities.
There is a need for a combination of treatment strategies.

What is the effect of hypnotics on patients with obstructive sleep apnea?

Hypnotics may lead to:

Increased upper airway collapsibility
Conflicting evidence regarding their effects
Short-term use allowed during CPAP initiation

What is critical closing pressure (Pcrit) and its significance?

Pcrit quantifies upper airway collapsibility:

It represents the nasal pressure at which collapse occurs.
A negative Pcrit means low collapsibility.
A positive Pcrit indicates high collapsibility, influencing airflow.

What is the diagnostic process for obstructive sleep apnea (OSA)?

The diagnostic process includes three steps:

Clinical interview with standardized questionnaires
Physical examination and functional tests
Sleep diagnostic evaluation (polysomnography considered the “gold standard”).

What common comorbidities are frequently associated with OSA?

OSA is commonly linked with:

Hypertension
Arrhythmias
Stroke
Coronary heart disease
Increased cardiovascular mortality.

How does obesity relate to sleep-disordered breathing?

Obesity is a significant contributor to sleep-disordered breathing, particularly in:

70% of obstructive sleep apnea patients
Encouraging weight loss is critical

How do anatomical factors contribute to obstructive sleep apnea (OSA)?

Anatomical predispositions include:

Skeletal malformations affecting airway width.
Fat deposition increasing tissue pressure.
Size of tongue or tonsils contributing to obstruction.

What are some special clinical conditions associated with obstructive sleep apnea (OSA)?

Special clinical conditions include:

Cardiovascular diseases (hypertension, stroke, heart failure)
Endocrine disorders (hypothyroidism, acromegaly, diabetes)
Prevalent in sleepy drivers and during pregnancy.

How does OSA relate to diabetes and metabolic syndrome?

OSA is associated with:

Visceral obesity
Hypertension
Insulin resistance
Abnormal lipid metabolism
Type 2 diabetes and even type 1 diabetes.

What are the general recommendations for managing sleep-disordered breathing (SDB)?

Initial management involves:

Addressing lifestyle factors
Considering dietary interventions
Avoiding drugs that exacerbate symptoms
Tailoring treatment based on individual needs
Treating underlying medical conditions

What role does fluid accumulation play in sleep apnea?

Fluid accumulation contributes by:

Causing narrowing of the upper airways.
Shifting from lower to upper body compartments at night.
Influencing neck circumference and apnea-hypopnea index (AHI).

How prevalent is disruptive snoring among patients with obstructive sleep apnea (OSA)?

Disruptive snoring occurs in up to:

95% of OSA patients
Recognized as a hallmark symptom
The absence of snoring reduces the likelihood of an OSA diagnosis.

What role does OSA play in chronic kidney disease (CKD)?

The relationship between OSA and CKD includes:

Shared common risk factors
Bidirectional influence
Worsening kidney function from OSA
Improved OSA severity through ultrafiltration.

What is the role of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA)?

CPAP is essential for treating:

Moderate to severe OSA
It helps maintain open airways during sleep
Improves overall quality of life

How does the functionality of upper airway muscles affect obstructive sleep apnea (OSA)?

Upper airway muscle function is crucial:

Genioglossus activity stabilizes airway width.
Muscle relaxation during sleep can narrow airways.
Phasic activity responds to breathing demands.

What defines sleep apneas in the context of obstructive sleep apnea (OSA)?

Sleep apneas are defined as:

>90% reduction of airflow for >10 seconds
Witnessed apneas considered a good diagnostic predictor
Accompanied by body movement, gasping, deep breaths, or snoring.

What are the factors contributing to hypertension in OSA patients?

Contributors to hypertension in OSA:

Chronic intermittent hypoxia
Oxidative stress
Increased sympathetic outflow
Activation of the renin-angiotensin system.

How do oral appliances (OAs) assist in OSA treatment?

OAs are beneficial for:

Patients with mild to moderate OSA
They advance the mandible to keep the airway open
May help select severe cases

What are the learning objectives in understanding sleep-related breathing disorders?

Key learning objectives include:

Discrimination of OSA and CSA.
Understanding OSA pathophysiology: morphology, muscle function, drive.
Differentiation of hypercapnic/non-hypercapnic CSA.
Comprehension of CSA features: drive, chemoresponsiveness, apnea threshold.

What are the symptoms of obstructive sleep apnea (OSA)?

Clinical symptoms may include:

Snoring
Reported apneas
Nocturnal choking
Frequent nocturia
Excessive daytime sleepiness
Cardiovascular comorbidities

Describe the impact of obesity on OSA and its comorbidities.

Obesity influences OSA by:

Acting as a significant risk factor
Clustering with other high-risk comorbidities
Contributing to increased cardiovascular risk and mortality.

What lifestyle management strategies can reduce the severity of OSA?

Key strategies include:

Weight management
Regular exercise
Healthy diet
Avoidance of alcohol and sedatives
Proper sleep posture

What are the main types of sleep-related breathing disorders discussed?

The primary sleep-related breathing disorders include:

Obstructive sleep apnea (OSA)
Central sleep apnea (CSA)
Hypoventilation syndromes

How is obstructive sleep apnea diagnosed?

Diagnostic management includes:

Clinical interview using standardized questionnaires
Physical examination followed by functional tests
Sleep diagnostic evaluation via polysomnography or polygraphy

Why should patients with sleep-disordered breathing avoid alcohol?

Alcohol can:

Suppress REM sleep
Increase obstructive apneas and hypopneas
Worsen overall sleep quality

How do obstructive sleep apnea (OSA) and central sleep apnea (CSA) differ?

Key differences are:

OSA involves upper airway obstructions.
CSA is related to respiratory drive.
OSA's pathophysiology focuses on airway morphology, CSA on drive and brainstem response.

What characterizes central sleep apnea (CSA) compared to OSA?

Conditions of CSA include:

Fewer symptoms of excessive sleepiness
Associated with diseases like heart failure or neurodegenerative diseases
Diagnostic challenges in distinguishing from OSA

What is the impact of hypnotics on patients with obstructive sleep apnea?

Hypnotics can:

Enhance airway collapsibility
Possibly worsen hypoxia
Be contraindicated unless using CPAP

What is critical closing pressure (Pcrit) in OSA?

Pcrit is defined as:

The nasal pressure level when the upper airway collapses.
Indicates airway collapsibility.
A negative Pcrit means low collapsibility; a positive Pcrit indicates high collapsibility.

What are common characteristics of obstructive sleep apnea in children?

In children, OSA may present as:

Adenotonsillar hypertrophy
Obesity
Snoring
Breathing difficulties observed by parents
Daytime hyperactivity and behavioural problems

How does the pathophysiology affect treatment for central sleep apnea (CSA)?

CSA treatment requires:

Identification of underlying diseases
Symptomatic treatments like medication
Use of oxygen supplementation or CPAP

Which anatomical factors contribute to OSA?

Contributing anatomical factors include:

Skeletal malformations
Fat deposition
Fluid accumulation
Size of the tongue and pharyngeal walls

What role does snoring play in the diagnosis of OSA?

Snoring is a key symptom:

Up to 95% prevalence in OSA patients
Heavy and habitual snoring particularly noted when supine
Its absence makes OSA diagnosis less likely but not impossible

What surgical options exist for obstructive sleep apnea?

Surgery may involve:

Pharyngeal anomaly correction
Retrognathia or obesity treatment
Tailored to specific patient needs

How does obesity impact upper airway obstruction in OSA?

Obesity influences OSA by:

Causing fat accumulation in upper airway tissues.
Reducing the width of the airways.
Being the most significant risk factor for OSA.

What factors should be addressed in patient education regarding sleep apnea?

Essential factors include:

Nature of the disorder
Treatment options and side effects
Potential risks of insufficient treatment
Importance of commitment to therapy

How do fluid shifts affect the upper airways during sleep?

Fluid shifts lead to:

Increased neck circumference at night.
Potential narrowing of the upper airways.
Variation in airway resistance during sleep.

How prevalent is obesity among patients with obstructive sleep apnea?

Obesity is common, with:

Approximately 70% of OSA patients being obese
Weight loss can significantly improve symptoms

What role do upper airway muscles play in obstructive sleep apnea?

Their role includes:

Stabilizing airway width during breathing.
Tonic activity decreases during sleep.
Mechanical irritations influence muscle tone.

What are typical findings in patients with hyperventilatory CSA?

Typical findings comprise:

Increased minute ventilation.
Elevated chemoresponsiveness.
Reactivity to internal and external stimuli.

What mechanisms can reduce respiratory drive in CSA?

Mechanisms include:

Use of central depressant drugs.
Impaired transmission of drive to thoracic muscles via motor neurons.

How does sleep apnea relate to oxygen desaturations?

Sleep apnea causes:

Repetitive cessations or reductions in airflow.
Associated oxygen desaturations.
Activation of the central nervous system (arousals).

What factors impact the effectiveness of dilating muscles in OSA?

Factors affecting effectiveness include:

Timely muscle activation before thoracic muscles.
Integrity of muscle fibers.
Sensitivity of mucosal nerves for reflex activation.

What did recent research reveal about arousability in sleep apnea?

Research emphasizes:

Arousal's critical role in CSA, hypoventilation, and OSA.
Understanding functional aspects rather than purely mechanical concepts.

The question on the page originate from the summary of the following study material:

Sleep Medicine Textbook | 9781119789017 | Claudio Basseti, et al

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