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When Was Sleep Apnea First Discovered

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Obstructive Sleep Apnea: From Simple Upper Airway Obstruction To Systemic Inflammation

moc.liamg@2mammahsa

The pathogenesis of cardiovascular diseases in OSA patients is not fully understood; however, recent data suggest that the intermittent hypoxia that results from frequent upper airway closure in OSA patients may play a major role in the pathophysiology of cardiovascular complications in OSA. Intermittent hypoxia is different from the sustained hypoxia seen in patients with chronic lung diseases, and OSA is a unique model for intermittent hypoxia. The short repetitive cycles of hypoxia and re-oxygenation activate different inflammatory processes and release pro-inflammatory cytokines, chemokines and adhesion molecules, which may result in endothelial injury and dysfunction, leading to atherosclerosis.,

Complex Sleep Apnea Syndrome Is A Combination Of Osa And Central Sleep Apnea

Doctors have recently identified a third type of sleep apnea called complex sleep apnea, which is a combination of obstructive sleep apnea and central sleep apnea.  Patients with this type of sleep apnea may at first seem to have obstructive sleep apnea, but unlike typical patients with obstructive sleep apnea, these patients’ symptoms are not fully addressed with the use of CPAP.

In patients with complex sleep apnea syndrome, breathing problems persist even after the airway obstruction is addressed and treated, which means something besides the collapsing throat muscles are also contributing to the apnea.

The problem is that there is still a lot of debate among sleep medicine specialists about whatexactly is going on in complex sleep apnea, or what the key characteristics that define it are. 

In a study published in March 2014 in the journal Sleep Medicine Clinics, doctors conducted a review of 223 patients referred to the Mayo Clinic Sleep Disorders Center over one month, as well as 20 patients diagnosed with central sleep apnea. 00122-7/abstract” rel=”nofollow”>11) They found that 15 percent of all sleep apnea patients had complex sleep apnea. As many as 84 percent were found to have obstructive sleep apnea, and 0.4 percent had central sleep apnea.

Link Between Alzheimer’s Disease And Sleep Apnea Discovered In Brain Tissue

Decades before symptoms of Alzheimer’s disease are detected, molecular changes are afoot in the brain. Clumps of amyloid-beta and tangles of another protein called tau start to accumulate in places, becoming stark hallmarks of a gradual decline in brain health.

Alzheimer-like amyloid plaques have also been found in brain tissue samples of people diagnosed with obstructive sleep apnea, a sleep disorder where a person’s breathing repeatedly stops and starts. Now, a study has revealed a correlation in the locations of these clumpy proteins.

While scientists already knew the two conditions are related, this first-of-its-kind study provides the gritty details of brain involvement.

“We know that if you have sleep apnea in mid-life, you’re more likely to develop Alzheimer’s when you’re older, and if you have Alzheimer’s you are more likely to have sleep apnea than other people your age,” said one of the research team, Stephen Robinson, a neuroscientist researching sleep disorders at RMIT University in Australia.

People with obstructive sleep apnea, the most common form of sleep apnea, can also experience shortfalls in memory, a classic feature of Alzheimer’s disease, and have a higher risk of developing dementia.

“The connection is there but untangling the causes and biological mechanisms remains a huge challenge,” Robinson said.

Amyloid plaques stained brown in brain tissue .

As with all good research, the findings prompt more questions and future studies.

After Recalling Millions Of Sleep Apnea Machines Philips Sued By Consumers

Sean P. Murphy

Medical equipment maker Philips is facing a raft of lawsuits following the announcement last month that it was recalling about 2 million machines used by obstructive sleep apnea patients in the US.

In its recall announcement, Philips said the foam used in its machines for noise reduction can break down and be ingested by users, causing serious and even life-threatening injury, though no deaths have been reported.

Among the most serious allegations made in the lawsuits, which include 10 filed in US District Court in Boston since June 17, is that Philips failed to disclose the defect as soon as it knew about it.

“The central allegation is that Philips had knowledge of the defect but failed to alert the public of the serious dangers it presented,” said Shanon J. Carson, of the firm Berger Montague, who is a lawyer in one of the suits filed in Boston.

Patients who have used the Philips machines “have complained about black particles in their machines for years,” the complaint says, apparently referring to a visible byproduct of the breakdown of the foam.

Carson said he expected lawyers to try to determine what Philips knew and when it knew it as part of the early stages of litigation.

Carson also called the timing of the recall “highly suspicious.”

“Philips timed its recall … to coincide with the launch of its next generation of products,” which apparently do not include the foam Philips now regards as dangerous, the complaint says.

Link Between Alzheimers Disease And Sleep Apnea Discovered In Brain Tissue

Sleep Apnea Raises The Risk Of Glaucoma

showrunner

Decades before symptoms of Alzheimer’s disease are detected, molecular changes are afoot in the brain. Clumps of amyloid-beta and tangles of another protein called tau start to accumulate in places, becoming stark hallmarks of a gradual decline in brain health.

Alzheimer-like amyloid plaques have also been found in brain tissue samples of people diagnosed with obstructive sleep apnea, a sleep disorder where a person’s breathing repeatedly stops and starts. Now, a study has revealed a correlation in the locations of these clumpy proteins.

While scientists already knew the two conditions are related, this first-of-its-kind study provides the gritty details of brain involvement.

“We know that if you have sleep apnea in mid-life, you’re more likely to develop Alzheimer’s when you’re older, and if you have Alzheimer’s you are more likely to have sleep apnea than other people your age,”said one of the research team, Stephen Robinson, a neuroscientist researching sleep disorders at RMIT University in Australia.

People with obstructive sleep apnea, the most common form of sleep apnea, can also experience shortfalls in memory, a classic feature of Alzheimer’s disease, and have a higher risk of developing dementia.

“The connection is there but untangling the causes and biological mechanisms remains a huge challenge,” Robinson said.

Amyloid plaques stained brown in brain tissue .

As with all good research, the findings prompt more questions and future studies.

What It Is Its Risk Factors Its Health Impacts And How It Can Be Treated

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Sleep apnea is a condition marked by abnormal breathing during sleep. People with sleep apnea have multiple extended pauses in breath when they sleep. These temporary breathing lapses cause lower-quality sleep and affect the body’s supply of oxygen, leading to potentially serious health consequences.

Sleep apnea is one of the most common sleep disorders in the United States. It can affect children and adults and people of both sexes, although it is more common in men.

Because of sleep apnea’s prevalence and potential health impact, it is important for people to be aware of what sleep apnea is and to know its types, symptoms, causes, and treatments.

Fda Clears First Daytime Treatment Device For Obstructive Sleep Apnea

Matthew Gavidia

The FDA approved a prescription tongue muscle stimulation device that claims to reduce mild sleep apnea and snoring in patients with obstructive sleep apnea.

The FDA recently announced the approval of a prescription tongue muscle stimulation device that claims to reduce mild obstructive sleep apnea and snoring. The device, called eXciteOSA, is approved through the de novo regulatory pathway for people 18 years and older.

Compared with prior devices used at nighttime for the treatment of OSA, such as continuous positive airway pressure therapy, eXciteOSA would be the first device to improve tongue muscle function while awake, which over time can prevent the tongue from collapsing backward and obstructing the airway during sleep.

The approval comes after the FDA assessed the safety and effectiveness of the device in 115 patients with snoring, including 48 patients with comorbid snoring and mild sleep apnea. Each participant underwent eXciteOSA therapy for 20 minutes once a day for 6 weeks.

After being reassessed 2 weeks following therapy discontinuation, the percent of time spent snoring at levels louder than 40dB, the noise level at which snoring begins to impact sleep, was found to be reduced by more than 20% in three-fourths of the patient cohort . Moreover, among patients with comorbid snoring and mild sleep apnea, average levels of the Apnea Hypopnea Index fell by 48%, from 10.21 to 5.27, in 41 of the 48 patients.

Understanding The Relationship Between Sleep Apnea And Brain Damage

Many don’t immediately recognize the potential dangers of untreated sleep apnea. Some only have mild symptoms, such as snoring or a headache, and simply learn to live with their condition. However, we have seen that leaving Obstructive Sleep Apnea or Central Sleep Apnea unaddressed can lead to severe health problems further down the road. The disruption in oxygen flow to the brain may cause various brain damage symptoms, including headaches, confusion, tremors, and fatigue. Fortunately, through regular CPAP therapy, those living with any form of sleep apnea can find relief from their condition and begin to sleep soundly again.

Obstructive Sleep Apnea Is The Most Common Subtype Of The Condition

The most common type of sleep apnea is obstructive sleep apnea, sometimes referred to as OSA. With OSA, the throat muscles in the back of your throat, which naturally become more relaxed during sleep, collapse too much to allow for normal breathing.

The throat muscles support the soft tissues in the back of the throat — such as the soft palate, the uvula, the tonsils, and tongue — so when those muscles collapse too much, those tissues can fall back into the throat, partially or completely blocking the normal flow of air in your airway. When the airway is blocked partially the person may start to snore, which is why this symptom is common in OSA.

When your brain senses that you aren’t getting enough oxygen, it signals your body to wake up enough so that you can reopen your airway, and you may gasp for air during the night. Simply put, having obstructive sleep apnea means that not enough air can get into lungs at night, and your brain wakes you up to breathe, says Robson Capasso, MD, chief of sleep surgery and associate professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California.

Doctors diagnose OSA using a sleep test that measures your body and brain activity during sleep, which is conducted either at home or at a sleep lab. 

Your doctor may also advise you to lose weight and to avoid sleeping on your back, to prevent gravity from further pushing your tongue, tonsils, and other soft tissues in your throat into your airway.

Table 1 Causes Of Upper Airway Narrowing In Obstructive Sleep Apnea

• Infiltration of pharyngeal tissue

– Shy-Drager syndrome – Dysautonomias

Narrowing and closure of the upper airway, specifically the pharynx, during sleep is the basis of snoring and obstructive sleep apnea syndrome. Other portions of the upper airway are less compliant, whereas the pharynx is more collapsible because it has additional functions related to swallowing and phonation. Anatomic studies indicate that during wakefulness, persons with obstructive sleep apnea tend to have narrow upper airways, increased inspiratory resistance, and increased pharyngeal compliance compared to persons without apnea. Snoring is produced by vibration of the soft tissues of the upper airway. The intensity is determined by the amount of floppy tissue that can vibrate and the velocity of airflow, which is, in turn, a function of the negative intrathoracic pressure and the diameter of the airway.

High resistance to airflow is associated with compensatory increased respiratory effort that minimizes changes in ventilation and oxygenation but still leads to arousals and sleep fragmentation. This condition has been described as the upper airway resistance syndrome .

The airway opens only after an arousal, a brief awakening, or a change in the sleep stage that leads to increased activity of pharyngeal dilators. The patient then takes a few deep breaths and returns to sleep, wherein the cycle repeats itself .

How Is Central Sleep Apnea Different From Obstructive Sleep Apnea

In obstructive sleep apnea, a person makes a notable effort to breathe, but the airway in the back of the throat is blocked. The blockage in the back of the throat causes an obstruction to our windpipe, which leads to sleep fragmentation and a disturbed oxygen balance in the body.

In central sleep apnea, the problem isn’t a blocked airway. Instead, pauses in breathing occur because the brain and the muscles that control breathing aren’t functioning properly. As a result, there is no normal respiratory effort, which is in clear contrast to OSA.

While OSA and CSA are separate conditions, they can arise at the same time in what is known as mixed sleep apnea. In addition, treatment of OSA with continuous positive airway pressure , can induce central sleep apnea, and this is called treatment-emergent central sleep apnea.

The History Of Sleep Apnea: Why Am I Just Hearing About It Now

is one of the most common sleeping disorders in the entire world, but most people have only heard of it within the past couple of years. Does this mean that it’s strictly a problem for the 21st century? That couldn’t be farther from the truth! Historical records show that symptoms that sound like obstructive sleep apnea have actually been observed for nearly 2,000 years. Fortunately, since then, the understanding of what sleep apnea is and how to treat it has dramatically improved, enabling sufferers to rest easy and safeguard their health.

Central Sleep Apnea Due To A Medical Disorder Without Cheyne

Link Between Alzheimer’s Disease And Sleep Apnea ...

CSA that is attributed to a medical disorder, but does not have the characteristic periodic breathing pattern of CSB, is classified as CSA due to a medical disorder without Cheyne-Stokes breathing . Here the term medical disorder is used as an all-inclusive nomenclature that includes cardiovascular, respiratory, and neurologic conditions; however, most of these patients have brainstem lesions of developmental, vascular, neoplastic, degenerative, demyelinating, or traumatic origin. Examples of such neurologic conditions that are typically associated with CSA without CSB include prior cerebrovascular accident ,14-16 Chiari malformation,20 brainstem neoplasms, and multiple system atrophy.21 A predominance of OSA versus CSA is more common after a CVA.15 However, many post-CVA patients have a mixture of OSA and CSA; CSA following CVA can be present with and without a pattern of CSB.

Patients classified in the diagnostic category of CSA without CSB may have awake or sleep-related hypoventilation, or both. Further, in such patients, if diagnostic criteria for CSA and sleep-related hypoventilation are met , both diagnoses are made .

Andrey V. Zinchuk, Robert Joseph Thomas, in, 2017

Diagnosis And Treatment Of Obstructive Sleep Apnea In Adults

MICHAEL SEMELKA, DO; JONATHAN WILSON, MD; and RYAN FLOYD, MD, Excela Health Latrobe Hospital, Latrobe, Pennsylvania

Am Fam Physician. 2016 Sep 1;94:355-360.

 Patient information: See related handout on obstructive sleep apnea, written by the authors of this article.

Obstructive sleep apnea is a common, chronic disorder that disrupts breathing during sleep. It affects persons of all ages but especially those middle-aged and older.1 Patients with OSA temporarily stop or decrease their breathing repeatedly during sleep.25 This cessation or decrease in breathing is the result of repetitive partial or complete obstruction of the airway caused by narrowing of the respiratory passages.4,68 These breathing disruptions can awaken a person or prevent deep, restful sleep. The effects of fragmented sleep on daytime fatigue and sleepiness are widely recognized.3,6

WHAT IS NEW ON THIS TOPIC: OBSTRUCTIVE SLEEP APNEA

In patients with obstructive sleep apnea, continuous positive airway pressure lowers blood pressure and rates of arrhythmia and stroke, improves left ventricular ejection fraction in patients with heart failure, and reduces fatal and nonfatal cardiovascular events.

A recent meta-analysis demonstrated similar rates of blood pressure lowering between continuous positive airway pressure and mandibular advancement devices.

BEST PRACTICES IN SLEEP MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Understanding The Link Between Sleep Apnea And Brain Damage

    According to the American Academy of Sleep Medicine, about 26 percent of U.S. adults are living with sleep apnea. Many with sleep apnea do not receive the proper treatment. Untreated sleep apnea is often associated with a number of serious health problems, such as Type 2 diabetes, heart disease, and stroke. However, a lesser-known risk of this sleep apnea is brain damage. If you’re wondering, “can you get brain damage from sleep apnea,” here is everything you need to know.

    Central Sleep Apnea Associated With Cerebrovascular Disease

    Nonhypercapnic CSA has been observed in 10% to 15% of patients with cerebrovascular accidents.143,144,144a Its pathogenesis and clinical features have not been well described. However, several studies have found no relationship between the presence of CSA and the location, size, or type of stroke.143,144 In some patients, CSA appears in a CSR-CSA pattern. In such cases, CSR-CSA was invariably associated with asymptomatic left ventricular systolic dysfunction.145 This observation strongly suggests that CSR-CSA in patients with stroke is related to underlying occult cardiac dysfunction and therefore probably shares the same pathogenesis as CSR-CSA in patients with heart failure. However, neither the clinical significance of this finding in patients with stroke nor the therapeutic approach have been studied in any depth. Nevertheless, the implications of finding CSR-CSA in patients following stroke is that one should investigate for evidence of left ventricular systolic dysfunction.

    Richard B. Berry MD, Mary H. Wagner MD, in, 2015

    A Short History And Timeline Of The Cpap Machine And Sleep

    1965: Research in to sleep disorders begins In 1965 a team of European Doctors, The study deduced that people with gout have a 42% higher risk of developing gout.When was sleep apnea first discovered?“Sleep apnea is a serious, Researchers for the Mayo Clinic discovered Complex Sleep Apnea in 2006 5.Development and discovery of sleep apnea in humans The first reports in the medical literature of what is now called obstructive sleep apnea date only from 1965, or cutting a hole in the neck exposing the airway, the most advanced medical technique at the time was to perform a tracheotomy, Success,Association between sleep apnea and diabetes, it comes as no surprise that sleep apnea

    What Are The Symptoms Of Sleep Apnea Induced Brain Damage

    Those who suffer from brain damage caused by sleep apnea may experience a wide range of symptoms. These symptoms can target many different areas of the body, including the bones, digestive system, and nervous system. In addition, some people find that they suffer a number of cognitive symptoms after experiencing sleep apnea induced brain damage.

    Some of the most common sleep apnea and brain damage symptoms include the following:

    • Temporary Loss of Consciousness
    • Difficulties With Balance
    • Blurred Vision

    If you recognize any of these symptoms in yourself, it’s crucial to seek out the help you need as soon as possible.

    Differences Between The 3 Types Of Sleep Apnea Explained

      Unless you are brand new to sleep apnea, you likely know by now that there are three types of sleep apnea: Obstructive, Central, and Complex Sleep Apnea. If you are new to sleep apnea treatment, then you’ve come to the right place to further understand it and how you can find the help you need to manage yours. 

      Quality is often just as important as quantity when it comes to sleeping. For instance, if you doze off for the majority of an eight-hour flight between New York and London, you’ll still find yourself tired because it’s unlikely your body reached the stages of sleep it needed to deliver you the sufficient rest to arrive refreshed.

      But what does dozing off on a transatlantic flight have to do with sleep apnea? Living with any of the three types of sleep apnea is a similar problem: you are not only not getting quality sleep but you are also not getting enough of that quality sleep. With sleep apnea, your body is never staying in a single stage of sleep long enough for it to do what it needs to do at that stage.

      Each type of sleep apnea is manifested in your body differently, but they all have one thing in common: they disrupt your ability to get quality sleep. Understanding the differences between each type is key to promoting healthy sleep and helping you achieve the amount of rest you need nightly to be alert and productive the next day.

      Central Sleep Apnea Happens When The Brain Is Involved

      Central sleep apnea is less common than obstructive sleep apnea. It can also be trickier to diagnose and treat. Unlike obstructive sleep apnea, which is caused by a mechanical problem that blocks the airway, central sleep apnea occurs because the brain is not sending the proper messages to the muscles that control breathing. “Central sleep apnea is caused by a neurological reason,” explains Dr. Capasso.

      While central and obstructive sleep apneas share many symptoms — such as episodes of pauses in breathing, constant awakenings during the night, and extreme sleepiness during the day — central sleep apnea often affects people who have underlying illnesses, too, such as a brain infection or other conditions that affect the brainstem. Common diseases associated with central sleep apnea include: severe obesity, Parkinson’s disease, stroke, and chronic . Certain drugs, such as or , can also play a role in central sleep apnea. “In patients who use opioids on a chronic basis, the breathing mechanisms can get numbed,” Capasso explains.

      RELATED: Obesity and Heart Disease: What’s the Connection?

      Your doctor may refer you to a sleep specialist for a diagnosis if he or she suspects central sleep apnea, which may involve an overnight sleep test to rule out obstructive sleep apnea or other . The sleep specialist may also work with your or order scans of your head and heart to rule out other contributing illnesses.

      What Are The Different Types Of Central Sleep Apnea

      second sleep study

      Central sleep apnea is divided into two categories, and each of the categories has its subtypes.

      The first category we will walk you through is the hypoventilation type. In this type of central sleep apnea, the brain fails to effectively send signals to the respiratory muscle to initiate breathing. Often, carbon dioxide builds up in these cases. Hypoventilation-type of central sleep apnea includes the following subtypes:

      • Narcotic-Induced Central Sleep Apnea: In this type of central sleep apnea, the use of narcotics, such as opioids, diminishes the brain’s ability to properly initiate and regulate breathing.
      • Central Sleep Apnea Related to a Medical Condition: This type of central sleep apnea often occurs as a result of a stroke, tumor, or trauma affecting the brain. Typically, the brain stem, a part of the brain that helps control breathing, is affected.

      Related Reading

      • Congenital Central Hypoventilation Syndrome : CCHS is a very rare genetic condition that most often affects newborns or very young children. There is a lack of signal to breathe during wakefulness and sleep
      • Central Sleep Apnea Due to Neuromuscular Disease: Typically seen in amyotrophic lateral sclerosis or multiple sclerosis, central sleep apnea emerges due to extreme weakness in the respiratory muscles.

      Learn About Other Precautions To Help You Stay Safe

      Sleep apnea can increase your risks of complications if you are having surgery, and it can affect your ability to drive.

      • Before surgery. If you are having any type of surgery that requires medicine to put you to sleep or for pain management, let your surgeon and doctors know that you have sleep apnea. They might have to take extra steps to make sure that your upper airway stays open during the surgery and when selecting your pain medicines.
      • Driving precautions. Undiagnosed and untreated sleep apnea can decrease learning capabilities, slow down decision making, and decrease attention span, which can result in drowsy driving.


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