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Source: Dopp JM, Phillips BG. Sleep–wake disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=134128126. Accessed May 11, 2017.
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OSA is characterized by partial or complete closure of the upper airway, posterior from the nasal septum to the epiglottis, during inspiration.
Obstructive sleep apnea results from relaxation of soft tissue in back of throat during sleep, blocking airway.
Central sleep apnea occurs when brain does not signal muscles that control breathing.
Complex sleep apnea is combination of obstructive sleep apnea and central sleep apnea.
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Obstructive sleep apnea caused by upper airway obstruction secondary to loss of pharyngeal muscle tone during sleep.
Central sleep apnea caused by temporary loss of respiratory effort during sleep due to autonomic nervous system lesions, neurologic diseases, high altitudes, or heart failure.
Contributing factors include:
Apneic episodes terminated by a reflex action in response to fall in blood oxygen saturation that causes brief arousal, during which breathing resumes.
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Common disease affecting 20–25 million Americans.
Prevalence higher in men.
More common in African American and Hispanic populations.
Can occur in children and adolescents.
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CLINICAL PRESENTATION
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Hallmarks are witnessed apnea, gasping, or both.
Complaints of:
History of loud snoring with witnessed apneic events.
May have systemic hypertension.
Severe episodes involve:
Heavy snoring.
Severe gas exchange disturbances.
Respiratory failure, causing gasping.
Episodes may occur up to 600 times/night.
Complications include:
Arrhythmias.
Hypertension.
Cor pulmonale.
Sudden death.
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DIAGNOSTIC PROCEDURES
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TREATMENT: NONPHARMACOLOGIC THERAPY
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Weight loss in overweight patients.
Nasal positive airway pressure (PAP), which may be continuous or bilevel.
Surgical therapy.
Uvulopalatopharyngoplasty opens the upper airway by removing the tonsils, trimming and reorienting the posterior and anterior tonsillar pillars, and removing the uvula and posterior portion of the palate.
Not first-line due to invasiveness.
Tracheostomy may be necessary in severe cases.