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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. 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.

  • Obesity
  • Cigarette smoking
  • Hypothyroidism
  • Ingestion of alcohol or sedatives before sleep and nasal obstruction may precipitate or worsen condition.

Signs and Symptoms

  • Complaints of:
    • Daytime somnolence or fatigue
    • Morning headache
    • Poor memory
    • Irritability
  • 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:

Diagnostic Procedures

  • 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 or bilevel.
  • 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 oxygen.
    • Acetazolamide causes metabolic acidosis that stimulates respiratory drive and may be beneficial for high altitude, heart failure, and idiopathic causes.

  • Evaluate patients with OSA after 1–3 months of treatment for improvement in:
    • Alertness
    • 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 accidents.

Ulualp SO. Snoring and obstructive sleep apnea. Med Clin North Am 2010;94(5):1047–1055.   [PubMed: 20736112] [[XSLOpenURL/ 20736112]]
Eckert DJ, Jordan AS, Merchia P, et ...

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