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Which Of The Following Is Symptomatic Of Sleep Apnea

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Sites Of Airway Obstruction

What are the symptoms of sleep apnea?

Airway obstruction can occur in many areas of the nasopharynx, oropharynx and hypopharynx . Although the contribution of nasal polyps and septal deviation to obstructive sleep apnea remains controversial, some investigators believe that partial or total nasal obstruction can lead to hypopnea and apnea.12

FIGURE 1A.

Normal airway. The soft palate and uvula are normal in length and total size. The tongue is normal in size and is angled forward. The upper airway at the level of the nasopharynx, oropharynx and hypopharynx is normal in size and contour.

FIGURE 1A.

Normal airway. The soft palate and uvula are normal in length and total size. The tongue is normal in size and is angled forward. The upper airway at the level of the nasopharynx, oropharynx and hypopharynx is normal in size and contour.

FIGURE 1B.

Abnormal airway during sleep. Multiple sites of obstruction often occur in patients with obstructive sleep apnea. An elongated and enlarged soft palate impinges on the posterior airway at the level of the nasopharynx and oral pharynx. In addition, a retruding jaw pushes an enlarged tongue posteriorly to impinge on the hypopharyngeal space.

FIGURE 1B.

Evidence Used In This Review

We conducted a structured literature search of MEDLINE and the Cochrane Database of Systematic Reviews for âobstructive sleep apneaâ or âsleep apnea,â in addition to targeted searches on PubMed. We excluded other forms of sleep disordered breathing. We limited our search to human studies that involved adults and that were published in the previous five years and written in English however, we included several key papers that were published more than five years ago that substantially contributed to the field. We found 2921 articles, which were screened for relevance based on a review of titles and abstracts. Studies were selected for inclusion based upon the quality of evidence and relevance to the clinical questions discussed in this review.

How Is Sleep Apnea Diagnosed

If doctors suspect obstructive sleep apnea, they first ask about symptoms and habits. This is then followed by a physical examination. The patient may be given a wearable device with which their sleep can be studied. It will record, for example, the breathing, the heart rate, oxygen saturation in the blood, snoring, and the body position. If the analysis highlights anomalies, additional testing in a sleep laboratory may be useful.

The patient then spends one or more nights in a sleep lab. Their sleep is monitored with other recording devices and a video camera.

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Chief Complaint: Involuntary Sleep

Involuntary individual movements or movement patterns during sleep are only partially perceived by the patient in the majority of cases with sleep-related movement disorders, the condition is detected by injuries of the patient or the bedpartner, or by reports of the bed partner. Diagnoses typically associated with motor symptoms are parasomnias and restless legs syndrome. Parasomnias are classified into rapid eye movement sleep and nonrapid eye movement sleep parasomnias. Nocturnal seizurestypically requiring examination in a sleep laboratory or seizure monitoring unitare the main differential diagnosis of parasomnias .

Occult Sleep Apnea: The Dilemma Of Negative Polysomnography In Symptomatic Patients

Common Signs And Symptoms of Sleep Apnea
  • Journal of sleep research
  • 2018
  • 2008
  • 2009
  • View 1 excerpt, cites background
  • Journal of oral & facial pain and headache
  • 2014
  • Journal of occupational and environmental medicine
  • 2005
  • View 5 excerpts, cites background
  • Journal of occupational and environmental medicine
  • 2012
  • 2000
  • 1996
  • American journal of respiratory and critical care medicine
  • 1997
  • 1993
  • 2000
  • American journal of respiratory and critical care medicine
  • 1999
  • 1997

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Rem Sleep Behavior Disorder

REM-sleep behavior disorder is characterized by movements during REM sleep, at times associated with vocalizations . Simultaneously, complex movements may be displayed which are associated with significant risk of injury to self or others. The existing questionnaires on RBD are not very sensitive, since patients typically miss their symptoms . Therefore, a third-party medical history and examination in a sleep laboratory are required for a definite diagnosis of RBD. The latter demonstrates the characteristic increase in muscle tone during REM sleep . A fact that increases the relevance of RBD is that it is thought to be a precursor to neurodegenerative disease, such as Parkinsons disease or multiple system atrophy therefore, it will be of special significance to future treatment studies as a specific early symptom of neurodegeneration . More than 50% of all patients with Parkinsons disease experience RBD, albeit of various severity treatment should comprise prevention of injuries and pharmacotherapy with clonazepam or melatonin .

Sleep Apnea Affects More Than 25 Million Americans And Has Serious Consequences

The National Commission on Sleep Disorders Research has identified sleep disorders as a major public health burden affecting millions of North Americans. OSA is one of the most common and serious of these sleep disorders and affects approximately 6% of women and 13% of men, which means that more than 25 million Americans are affected and hundreds of millions more are also affected around the globe.

OSA is characterized by partial or complete upper airway obstruction during sleep. This occurs when the muscles that support the soft tissues in the throat, such as the tongue and soft palate, temporarily relax. When these muscles relax, the airway is narrowed or completely closed, and breathing is momentarily cut off, resulting in hypoxemia below-normal level of oxygen in the blood. OSA can result in arousal or broken sleep, loud snoring, daytime sleepiness or fatigue, and, long-term, can result in cardiac and metabolic morbidity and mortality.

OSA is caused by a combination of predisposing anatomical factors and a reduction in sleep-related neuromuscular control of the upper airway muscles.

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Identification And Description Of Included Studies

The systematic literature search identified 171 articles. After applying the exclusion criteria, both authors agreed that 7 articles were eligible with 1,541 patients in total. The reasons for excluding the other 164 studies are shown in Figure 1. One study about the effect of CPAP on cardiovascular biomarkers in minimally symptomatic OSA patients was excluded because the study only involved 13 patients, and among them, 2 patients had ESS values greater than 10. One article about the 1-year effects of CPAP on hypertension was excluded because more exhaustive results were published in another article . The MOSAIC trial reported many aspects of the effects of CPAP in minimally symptomatic OSA, such as the vascular function , cardiac function , calculated cardiovascular risk , inflammation factors , subjective sleepiness measured by the maintenance of wakefulness test and quality of life assessments but we did not find enough data published in other trials, so we could not include these papers in our meta-analysis. Of the remaining articles, 5 studies recorded the change in BP and ESS, 3 studies reported the change of AHI or ODI and 3 studies reported the cardiovascular events in long term follow-up.

Figure 1Table 1

First What All Types Of Sleep Apnea Have In Common

What are the Signs and Symptoms of Sleep Apnea | How do you know if you have Sleep Apnea | theSITREP

Because these awakenings are typically very brief, the person with sleep apnea may not even be aware that they are experiencing interrupted sleep. But the episodes can wreak havoc on the sleep cycle and prevent the person with sleep apnea from reaching the deep, restful phases of sleep. And thats why people who have sleep apnea can experience significant exhaustion and drowsiness the next day, despite getting what they thought was a full night of sleep.

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History And Physical Examination

  • History and physical examination are crucial first steps towards the recognition and diagnosis of OSA.2 Patient history should focus on nocturnal breathing abnormalities, daytime sleepiness, and family and personal medical history.
  • Consider using the STOP-Bang questionnaire to help determine if a patient is at increased risk of moderate to severe OSA .2
  • Determine the patients risk factors for OSA .
  • While the clinical presentation of OSA can vary, the most common symptom is excessive daytime sleepiness. Inquire about the impact of daytime sleepiness . Request completion of the Epworth Sleepiness Scale. A score of greater than 10 suggests significant daytime sleepiness, although a score of 10 or less does not exclude daytime sleepiness or OSA.
  • Other OSA symptoms include:

What Are The Signs And Symptoms Of Obstructive Sleep Apnea

The signs and symptoms of obstructive and central sleep apneas overlap, sometimes making it difficult to determine which type you have. The most common signs and symptoms of obstructive and central sleep apneas include: Loud snoring can indicate a potentially serious problem, but not everyone who has sleep apnea snores.

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Irritability And Mood Swings

People with sleep apnea might also suffer from unexplained irritability and mood swings. This is because the breathing interruptions that continually wake them up prevents getting deep and nourishing sleep.

Sleep and mood disorders are closely linked. When you dont get enough sleep as a result of sleep apnea, the bodys stress levels increase, leading to negative moods like anger, irritability, frustration, or sadness.

Treatments May Be Trial And Error Until You And Your Doctor Get It Right

Why Obstructive Sleep Apnea needs to be Identified and ...

When sleep apnea is mild, treatment recommendations are less clear-cut, and should be determined based on the severity of your symptoms, your preferences, and other co-occurring health problems. Working in conjunction with your doctor, you can try a stepwise approach if one treatment doesnt work, you can stop that and try an alternative. Managing mild sleep apnea involves shared decision-making between you and your doctor, and you should consider just how bothered you are by sleep apnea symptoms, as well as other components of your health that could be made worse by untreated sleep apnea.

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Oral Appliances / Functional Orthopedic Appliances

Evidence to support oral appliances/functional orthopedic appliances in children is insufficient with very low evidence of effect. However, the oral appliances/functional orthopedic appliances may be considered in specified cases as an auxiliary in the treatment of children who have craniofacial anomalies which are risk factors of apnea.

Continuous Positive Airway Pressure

Nasal continuous positive airway pressure is the treatment of choice for most patients with OSA and subjective daytime sleepiness adherence is lower in patients who do not experience sleepiness. CPAP improves upper airway patency by applying positive pressure to the collapsible upper airway segment. Effective pressures typically range from 3 to 15 cm water. Disease severity does not correlate with pressure requirements. Many CPAP devices monitor CPAP efficacy and titrate pressures automatically, according to internal algorithms. If clinical improvement is not apparent, CPAP efficacy should be reviewed and patients should be reassessed for a second sleep disorder or a comorbid disorder. If necessary, pressure can be titrated manually during monitoring with repeat polysomnography. Regardless of improvement in the AHI, CPAP will reduce cognitive impairment and improve quality of life, and it may reduce blood pressure. If CPAP is withdrawn, symptoms recur over several days, though short interruptions of therapy for acute medical conditions are usually well tolerated. Duration of therapy is indefinite consists of episodes of partial or complete closure of the upper airway that occur during sleep and lead to breathing cessation .

Nasal dilatory devices and throat sprays sold OTC for snoring have not been studied sufficiently to prove benefits for OSA.

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Problem Solving Cpap Therapy

After treatment, non-adherence to CPAP therapy, CPAP intolerance and persistent sleepiness after therapy may occur. Considerations include:

  • CPAP non-adherence: Lack of interest/understanding of OSA importance of treatment can be reinforced depends on indications for treatment and severity of disease.24

CPAP intolerance is common and should be addressed by the CPAP provider.24 See table below for common causes of intolerance. See Table 2: CPAP Intolerance and Treatment Recommendations below.

Table 2: CPAP Intolerance and Treatment Recommendations

CPAP Intolerance/Problem

Prevalence And Characteristic Features

What Are the Symptoms of Sleep Apnea?

Obstructive sleep apnea is more common than was previously thought. Reported prevalence rates vary widely, and asymptomatic sleep apnea is more common than symptomatic, clinically significant obstructive sleep apnea. Population-based studies suggest that 2 percent of women and 4 percent of men over the age of 50 years have symptomatic obstructive sleep apnea.13

Considering the prevalence rates, most family physicians probably have a number of patients with undiagnosed sleep apnea. The way to find these patients is to be aware of the common signs and symptoms of obstructive sleep apnea and to carefully examine any patient who complains of snoring or daytime sleepiness . A suggested self-administered screening questionnaire is presented in Figure 2.14 Because the patient is often unaware of the nocturnal arousals, it may be helpful to have the bedroom partner also complete the questionnaire.

Common Features in Patients with Sleep Apnea

Loud snoring

Common Features in Patients with Sleep Apnea

Loud snoring

Do You Have Sleep Apnea?

FIGURE 2.

A suggested self-administered questionnaire for use in the diagnosis of obstructive sleep apnea.

Adapted with permission from Victor LD. Obstructive sleep apnea in primary care. Dearborn, Mich.: Oakwood Hospital, 1997.

Do You Have Sleep Apnea?

FIGURE 2.

A suggested self-administered questionnaire for use in the diagnosis of obstructive sleep apnea.

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Sleep Studies And Cpap

Attended polysomnographic sleep studies were performed and analyzed according to standard methods. Apnea were defined as a reduction in the amplitude of chest wall motion by > 90% from baseline over the previous 2 min for > 10 s, and hypopnea were defined as a reduction in the amplitude of chest wall motion by > 50% from baseline over the previous 2 min for > 10 s, associated with a 4% drop in oxygen saturation . In patients randomized to subtherapeutic CPAP, the subtherapeutic pressure was achieved by setting the CPAP machine to the lowest pressure, inserting a flow-restricting connector at the machine outlet, and inserting 6 extra holes in the collar of the main tubing at the end of the mask to allow air escape and to prevent rebreathing of carbon dioxide as previously described . Sleepiness was assessed using the Epworth sleepiness score .

If You Are Concerned You Might Have Osa Talk To Your Doctor

Based on your symptoms, exam, and risk factors, your doctor may recommend a sleep study, or you might be referred to see a sleep medicine specialist. A comprehensive sleep assessment is needed to accurately evaluate sleep complaints, since sleep disorders tend to overlap. Treatment for mild OSA may improve sleep-related symptoms and your quality of life. However, there is no one-size-fits-all approach when it comes to sleep disorders, but rather a multidimensional and individualized approach to find what works for you.

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What Parts Of Respiratory System Are Affected By Sleep Apnea

Obstructive sleep apnea happens when the tissues at the back of your throat collapse and partly or fully block your upper airways. Even though you are still trying to breathe, there is very little or no air getting into your lungs. OSA is the most common form of sleep apnea and is the focus of this handbook.

Home Sleep Apnea Testing

Obstructive Sleep Apnea

Several types of home sleep apnea testing are in clinical use. Level III sleep studies record a minimum of three channels of data while the patient sleeps at home. Level III studies usually monitor airflow, snoring, respiratory excursion, body position, heart rate and oxygen saturation, but some validated devices use surrogate measurements for these variables, such as tonometry or actigraphy, and the technology is constantly evolving.51 Level III studies do not record sleep therefore, severity of OSA is estimated using the respiratory event index, which is the number of desaturation events per hour of total recording time.

The respiratory event index underestimates AHI because it measures time when the patient is not actually asleep52 and does not detect arousals from sleep.20 In symptomatic patients with a moderate-to-high pretest probability of OSA and no substantial cardiopulmonary comorbidity, level III studies are adequate for the diagnosis of OSA .53,54 As many as 17% of home sleep apnea tests are false negatives55 and up to 18% have technical failures.56 Therefore, if results for home sleep apnea testing are negative in a patient for whom there is a high index of suspicion, physicians should seek testing using polysomnography. Level III studies may also be useful when immobility, safety or illness preclude attendance for polysomnography and for confirmation of treatment efficacy.20

Benefits of treatment for obstructive sleep apnea, by disease severity

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Cardinal Symptom: Disorders Of Initiating And Maintaining Sleep

Disorders of initiating and maintaining sleep are collectively referred to as insomnias . They represent the typical cardinal symptom of poor sleep. Transient insomnia has a 1-year prevalence of up to 30%, but does not necessarily require treatment due to its short duration. If it persists for more than 4 weeks, is of high intensity or associated with other signs and symptoms, a comprehensive work-up is indicated . Insomnia may be a symptom of an underlying disease or a distinct entity.

How Is Sleep Apnea Treated

Obese people can help their sleep apnea by losing weight. Many different treatments are also available: for example devices that help breathing, positional aids, devices such as lower jaw splints, and surgery. It has been scientifically proven that some of these treatments can help.

Medication currently has no role to play in treating sleep apnea. The effectiveness of the drugs available has not been proven.

The most effective treatment for severe sleep apnea is so-called CPAP therapy. CPAP stands for continuous positive airway pressure. This treatment involves pumping ambient air at slightly high pressure into the airways during the night. Patients wear a breathing mask attached to a breathing device. The slightly higher pressure keeps the upper airways open. CPAP therapy prevents all or almost all interruptions to breathing. So symptoms such as daytime tiredness can be significantly helped.

The CPAP therapy that is best at alleviating the symptoms needs some getting used to: not everyone wants to put up with wearing a breathing mask every night.

More information about sleep apnea and how it can be treated can be found at gesundheitsinformation.de.

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