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Sleep apnea

1. Signs, Symptoms, and Complications: – Screening involves asking about symptoms like snoring and pauses in breathing – Wide range of symptoms from asymptomatic to […]

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1. Signs, Symptoms, and Complications:
– Screening involves asking about symptoms like snoring and pauses in breathing
– Wide range of symptoms from asymptomatic to falling asleep while driving
– Some individuals are unaware of having sleep apnea
– OSA may increase the risk for accidents due to sleep fragmentation
– Untreated OSA increases mortality risk from cardiovascular disease
– Complications include hypertension, congestive heart failure, atrial fibrillation, coronary artery disease, stroke, and type 2 diabetes
– Daytime fatigue and sleepiness are public health concerns leading to transportation crashes
– OSA may be a risk factor for severe COVID-19 complications
– Alzheimer’s disease and severe OSA are connected through beta-amyloid increase and white-matter damage

2. Risk Factors and Frequency:
– OSA can affect anyone regardless of sex, race, or age
– Typical risk factors include narrow pharyngeal anatomy and craniofacial structure
– Severity of OSA increases with multiple risk factors present
– Aging and obesity increase the risk of sleep apnea
– Other risk factors include family history, allergies, and enlarged tonsils
– Approximately 1 in 10 people globally have OSA
– OSA affects up to 30% of the elderly
– Sleep apnea is more common in men than women (2:1 ratio)

3. Diagnostic Methods and Criteria:
– In-lab sleep study is preferred for diagnosing sleep apnea
– Apnea-hypopnea index (AHI) determines disease severity in OSA
– Respiratory effort measurement distinguishes between OSA and CSA
– Diagnosis criteria include recurrent upper airway collapse during sleep
– Severity measured by AHI or Respiratory Disturbance Index (RDI)
– International Classification of Sleep Disorders includes 4 types of criteria
– Symptoms include excessive sleepiness, fatigue, insomnia, and breathing interruptions
– Medical issues such as hypertension, stroke, heart failure, and diabetes are considered

4. Treatment Options and Effectiveness:
– Lifestyle changes, mouthpieces, breathing devices, and surgery are treatment options
– Effective lifestyle changes include weight loss and avoiding alcohol
– CPAP machines are commonly used breathing devices
– CPAP can improve insulin sensitivity and blood pressure
– Long-term compliance with CPAP is a challenge for many patients
– Continuous Positive Airway Pressure (CPAP) is a common treatment for OSA
– CPAP helps reduce amyloid proteins and cognitive impairment
– CPAP restores brain structure and improves sleep efficiency
– Proper treatment of OSA can help decrease the risk of developing Alzheimer’s disease

5. Statistics and Classification:
– OSA accounts for 84% of sleep apnea cases
– CSA represents 0.9% while mixed sleep apnea accounts for 15%
– Diagnosis based on recurrent upper airway collapse during sleep
– AHI measures mean apneas and hypopneas per hour of sleep
– RDI includes respiratory effort-related arousals
– OSA diagnosed with AHI ≥ 5 episodes per hour or RDI ≥ 15

Sleep apnea (Wikipedia)

Sleep apnea is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night. A choking or snorting sound may occur as breathing resumes. Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition.

Sleep apnea
Other namesSleep apnoea, sleep apnea syndrome
Obstructive sleep apnea
SpecialtyOtorhinolaryngology, sleep medicine
SymptomsPauses breathing or periods of shallow breathing during sleep, snoring, tired during the day
ComplicationsHeart attack, Cardiac arrest, stroke, diabetes, heart failure, irregular heartbeat, obesity, motor vehicle collisions, Alzheimer's disease, and premature death
Usual onsetVaries; up to 50% of women age 20–70
TypesObstructive sleep apnea (OSA), central sleep apnea (CSA), mixed sleep apnea
Risk factorsOverweight, family history, allergies, enlarged tonsils, asthma
Diagnostic methodOvernight sleep study
TreatmentLifestyle changes, mouthpieces, breathing devices, surgery
Frequency~ 1 in every 10 people, 2:1 ratio of men to women, aging and obesity higher risk

Sleep apnea may be categorized as obstructive sleep apnea (OSA), in which breathing is interrupted by a blockage of air flow, central sleep apnea (CSA), in which regular unconscious breath simply stops, or a combination of the two. OSA is the most common form. OSA has four key contributors; these include a narrow, crowded, or collapsible upper airway, an ineffective pharyngeal dilator muscle function during sleep, airway narrowing during sleep, and unstable control of breathing (high loop gain). In CSA, the basic neurological controls for breathing rate malfunction and fail to give the signal to inhale, causing the individual to miss one or more cycles of breathing. If the pause in breathing is long enough, the percentage of oxygen in the circulation can drop to a lower than normal level (hypoxaemia) and the concentration of carbon dioxide can build to a higher than normal level (hypercapnia). In turn, these conditions of hypoxia and hypercapnia will trigger additional effects on the body such as Cheyne-Stokes Respiration.

Some people with sleep apnea are unaware they have the condition. In many cases it is first observed by a family member. An in-lab sleep study overnight is the preferred method for diagnosing sleep apnea. In the case of OSA, the outcome that determines disease severity and guides the treatment plan is the apnea-hypopnea index (AHI). This measurement is calculated from totaling all pauses in breathing and periods of shallow breathing lasting greater than 10 seconds and dividing the sum by total hours of recorded sleep. In contrast, for CSA the degree of respiratory effort, measured by esophageal pressure or displacement of the thoracic or abdominal cavity, is an important distinguishing factor between OSA and CSA.

A systemic disorder, sleep apnea is associated with a wide array of effects, including increased risk of car accidents, hypertension, cardiovascular disease, myocardial infarction, stroke, atrial fibrillation, insulin resistance, higher incidence of cancer, and neurodegeneration. Further research is being conducted on the potential of using biomarkers to understand which chronic diseases are associated with sleep apnea on an individual basis.

Treatment may include lifestyle changes, mouthpieces, breathing devices, and surgery. Effective lifestyle changes may include avoiding alcohol, losing weight, smoking cessation, and sleeping on one's side. Breathing devices include the use of a CPAP machine. With proper use, CPAP improves outcomes. Evidence suggests that CPAP may improve sensitivity to insulin, blood pressure, and sleepiness. Long term compliance, however, is an issue with more than half of people not appropriately using the device. In 2017, only 15% of potential patients in developed countries used CPAP machines, while in developing countries well under 1% of potential patients used CPAP. Without treatment, sleep apnea may increase the risk of heart attack, stroke, diabetes, heart failure, irregular heartbeat, obesity, and motor vehicle collisions.

OSA is a common sleep disorder. A large analysis in 2019 of the estimated prevalence of OSA found that OSA affects 936 million—1 billion people between the ages of 30–69 globally, or roughly every 1 in 10 people, and up to 30% of the elderly. Sleep apnea is somewhat more common in men than women, roughly a 2:1 ratio of men to women, and in general more people are likely to have it with older age and obesity. Other risk factors include being overweight, a family history of the condition, allergies, and enlarged tonsils.

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