Management of sleep apnea in the neurology patient

Abstract

SummaryRecognizing and treating sleep-disordered breathing (SDB) is essential in delivering neurologic care due to its association with a growing list of neurologic conditions (e.g., stroke, neurodegenerative disorders). Thus, increased proficiency in the recognition and management of SDB is likely to result in better outcomes, care, and utilization of health care resources. To date, continuous positive airway pressure remains the gold standard for patients with moderate to severe obstructive sleep apnea and has been shown to be effective in treating variations of SDB. Appropriate application of new methods and technology such as home sleep testing can help bridge the gap between the need and supply for sleep health care and delivery. Increased focus on efficacious strategies to further awareness and education for patients, caretakers, and providers is paramount to long-term adherence to treatment. S leep-disordered breathing (SDB) is one spectrum of sleep disorders that all physicians, particularly neurologists, should have ongoing educational exposure to in order to maintain a baseline level of knowledge proficiency. Mounting evidence suggests that untreated SDB has the potential to negatively affect both patient mortality and morbidity. Untreated sleep apnea, a type of SDB, is a primary risk factor for the development of several medical conditions particularly relevant to neurologists, including hypertension, coronary heart disease, and stroke.1 SDB is not only common in neurologic patients but also may directly affect the manifestation and management of neurologic disorders.2 Thus, it is imperative that neurologists are familiar with SDB and the effect it can have on clinical practice.

Sleep Disturbances among Older Adults in the United States, 2002–2012: Nationwide Inpatient Rates, Predictors, and Outcomes

“…Over the last decade men tended to have higher rates for OSA, while women tend to have higher rates for insomnia. These gender differences in OSA and insomnia rates have been supported in previous studies (Ohayon et al, 2004; Wolkove et al, 2007; Salas et al, 2014). In terms of hospitalization outcomes, women with any type of sleep disturbance tended to have lower MR and lower TC than men.…”

“…Given Blacks are less likely than Whites to utilize health care services and/or more likely to utilize health care resources with severe symptomology (Weech-Maldonado et al, 2014), our study may be underestimating the rates of sleep disturbances and the MR associated with sleep disturbances within older Blacks. However, our finding may further provides support that sleep disturbances, particularly in Blacks, may be underdiagnosed in the health care setting (Kapur et al, 2002; Benca, 2014; Salas et al, 2014). This is corroborated with findings on income differentials in the rates of sleep disturbance, whereby for both insomnia and OSA, higher income individuals had a higher rate, suggesting higher access to health care, particularly for OSA which requires a sleep study as opposed to insomnia which is only assessed through a clinical diagnosis and patient history.…”

“…The current study uses clinical diagnostic codes, such as ICD-9-CM, given by a health provider to estimate sleep disturbance; however, it is unclear what diagnostic tests were given to assess the symptoms/signs common to each sleep disturbance. Many of the previous studies have estimated sleep disturbance, particularly OSA, after participants have completed clinical evaluation, standardized questionnaires, an in-lab overnight sleep study, and/or in-home sleep testing (HST; Salas et al, 2014). Furthermore, many of the previous studies have actively recruited participants within the community, while this study is accounting for individuals in the community that sought medical care.…”

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 1 Definitions and Diagnosis

“…The impacts on the quality of life of untreated OSA patients are numerous and include excessive daytime sleepiness, impaired work performance, cognitive dysfunction, and various impaired health parameters. Observational and experimental evidence also suggests that untreated OSA contributes to the development of systemic hypertension, cardiovascular disease, abnormalities in glucose metabolism, and stroke [10][11][12][13][14][15][16][17]. Early recognition and adequate treatment can diminish the neurocognitive consequences and improve cardiovascular health [18].…”

Obstructive sleep apnea induced bilateral tonic- clonic seizure of unknown origin: A case series of a novel association

“…4 Fluctuations in blood oxygen supply and pressure may lead to hypoperfusion, hypoxia, or ischemia of major brain areas, potentially representing a major etiopathology for obstructive sleep apnea-induced neurological disorders. 5 Interestingly, obstructive sleep apnea is an important comorbid condition in late-onset epilepsy 6 and cerebrovascular disease, 7 establishing a 2-way relationship between obstructive sleep apnea and neurological health. Neuro-inflammatory predisposition might be an additional contributing factor toward obstructive sleep apnea-induced neurological and neurocognitive impairments.…”