Source: Dopp JM, Phillips BG. Sleep
Disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG,
Posey LM, eds. Pharmacotherapy: A Pathophysiologic
Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7990389.
Accessed June 3, 2012.
- Repetitive episodes of cessation of breathing during sleep.
- 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.
- 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.
- Prevalence in US adult population: 4% in males
and 2% in females.
- More common in African Americans and less common in Asians.
- Can occur in children and adolescents.
- Cigarette smoking
- Ingestion of alcohol or sedatives before sleep and nasal obstruction
may precipitate or worsen condition.
- Complaints of:
- Daytime somnolence or
- Morning headache
- Poor memory
- 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:
- Overnight polysomnography shows apneic episodes with hypoxemia.
- Relieve signs and symptoms.
- Eliminate sleep-disordered breathing.
- Weight loss in all overweight patients.
- Nasal positive airway pressure (PAP), which may be continuous
- Surgical therapies include tonsillectomy and nasal septal
repair; uvulopalatopharyngoplasty and tracheostomy may be necessary
in severe cases.
- Obstructive sleep apnea
- Avoidance of CNS
depressants and drugs that promote weight gain. Angiotensin-converting enzyme
(ACE) inhibitors can also worsen sleep-disordered breathing.
- Modafinil FDA approved to improve wakefulness in patients
with residual daytime sleepiness while on PAP. Use only in patients
using optimal PAP therapy and free of cardiovascular disease.
- Central sleep apnea
- PAP with or without supplemental
- Acetazolamide causes metabolic acidosis that stimulates respiratory
drive and may be beneficial for high altitude, heart failure, and
- Evaluate patients with OSA after 1–3 months of
treatment for improvement in:
- Daytime symptoms
- Weight reduction
- Ask bed partner to report on episodes of snoring and gasping.
- Can be managed successfully in many patients.
- Untreated sleep apnea increases risk of:
- May increase likelihood of having work-related or driving
Ulualp SO. Snoring and obstructive sleep apnea. Med Clin North Am
Eckert DJ, Jordan AS, Merchia P, et al. Central ...