Adult Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA) is a highly prevalent disease characterized by recurrent episodes of upper airway obstruction that result in recurrent arousals and episodic oxyhemoglobin desaturations during sleep. Significant clinical consequences of the disorder cover a wide spectrum, including daytime hypersomnolence, neurocognitive dysfunction, cardiovascular disease, metabolic dysfunction, and cor pulmonale. The major risk factors for the disorder include obesity, male gender, and age. Current understanding of the pathophysiologic basis of the disorder suggests that a balance of anatomically imposed mechanical loads and compensatory neuromuscular responses are important in maintaining upper airway patency during sleep. OSA develops in the presence of both elevated mechanical loads on the upper airway and defects in compensatory neuromuscular responses. A sleep history and physical examination is important in identification of patients and appropriate referral for polysomnography. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic approaches. Knowledge of common patterns of OSA may help to identify patients and guide therapy.Keywords critical pressure; diagnosis; obstructive sleep apnea; pathophysiology Obstructive sleep apnea (OSA) is a highly prevalent disease, affecting 4% of men and 2% of women, 1 and strongly linked to the current obesity epidemic. The disorder is characterized by recurrent episodes of upper airway obstruction, and is associated with reductions in ventilation, resulting in recurrent arousals and episodic oxyhemoglobin desaturations during sleep.2 Significant clinical consequences of the disorder cover a wide spectrum including daytime hypersomnolence,3 , 4 neurocognitive dysfunction, 5 cardiovascular disease (hypertension, stroke, myocardial infarction, heart failure), 6, 7 metabolic dysfunction,8 -10 respiratory failure, and cor pulmonale. 11 The major risk factors for the disorder include obesity, male gender, postmeno-pausal status, and age, and are discussed in detail elsewhere. [12][13][14] The rising prevalence of obesity in the United States suggests that OSA will represent an escalating public health burden. 15 Therefore, knowledge and understanding of the pathogenic basis, clinical presentation, and diagnosis of OSA are essential for the development of preventive, screening, and therapeutic strategies to reduce the public health burden of the disorder. In this review, we * The manuscript was supported by grants HL50381, HL37379, and HL77137 from the National Heart, Lung, Blood Institute, National NIH Public Access Author ManuscriptChest. Author manuscript; available in PMC 2010 January 29. Published in final edited form as:Chest. Pathophysiology of Upper Airway Obstruction in OSAThe pharynx is a complex structure that serves several purposes including speech, swallowing, and respiration. The human pharynx is composed of > 20 muscles and divided into four sections that include the nas...

Obstructive Sleep Apnea and Incidence of Postoperative Delirium After Elective Knee Replacement in the Nondemented Elderly

“…[52][53][54] The mechanism by which OSA increases the risk for POD remains unknown, though there is reason to believe that the reduced oxygen metabolism that occurs with OSA might be playing a role. OSA is a sleep disorder characterized by the recurrent collapse of the pharynx, causing upper airway obstruction and leading to recurrent arousals during sleep and episodes of oxygen desaturation, 31,55 and hypoxia is a known cause of delirium. 56 Consistent with this etiology, a previous study reported that all of its enrolled patients who became delirious after thoracotomy for pulmonary malignancy had inadequate arterial oxygen saturation; delirium in these patients was resolved by administration of supplemental oxygen.…”

“…This review included the diagnostic criterion of the presence of 5 or more apneic events per hour as determined by PSG. 30,31 For two of the three patients without PSG reports, the use of home continuous positive airway pressure (CPAP) was employed as a surrogate confirmation of OSA diagnosis. The third patient who did not have PSG records had undergone uvulopalatoplasty surgery 10 years earlier but had returned to his pre-surgical OSA symptoms at the time of his participation in our study, and the medical team ordered CPAP during his hospital stay.…”

Nordic consensus statement on the systematic assessment and management of possible severe asthma in adults

“…Screening of patients for OSAS can be performed with validated questionnaires such as the, STOP-BANG or the Berlin Questionaire [81,82]. If OSAS is suspected, patients should be referred for polysomnography [83]. …”

Utility of AdaBoost to Detect Sleep Apnea-Hypopnea Syndrome From Single-Channel Airflow

“…lead to cessation or significant reduction of airflow (AF) [3]. These apneic events cause oxygen desaturations and arousals [3], preventing patients from resting while sleeping [2].…”