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Breathing-Related Sleep Disorder


Presentation

  • Most often, the disorder will have been present for years by the time it is diagnosed.[sleep.health.am]
  • Nocturnal hypoventilation seems to be present in more than 29 percent of severe obese population.[smjournals.com]
  • In the illustrative case, the patient presented with depression without psychotic features. Sleep history was not obtained until the second visit, which delayed treatment of OSA.[healio.com]
  • Adjustment for symptoms of insomnia and for hypnotic or benzodiazepine medication use had no effect on presented models.[jamanetwork.com]
  • It is also possible that some patients will present both RDB and OSA. The aim of the present study was to review all articles that reported on pseudo RDB.[sleepscience.org.br]
Weight Gain
  • Causes include weight gain, the changed position of the diaphragm and fluid accumulation in the breathing passages due to hormonal changes.[sleepio.com]
  • There is a relationship between body weight change and Apnea-Hypopnea Index (AHI): a 10% weight gain has been shown to predict an approximate 32% increase in the AHI; a 10% weight loss predicted a 26% decrease in the AHI, and a 10% increase in weight[smjournals.com]
  • Obesity and weight gain are major contributing factors to obstructive sleep apnea. In some reports, weight loss has shown to be an important step in the treatment of sleep apnea.[emedicinehealth.com]
  • Risk factors Risk factors for sleep apnea include: supine (flat on back) sleeping obesity chronic sinusitis large neck circumference recent weight gain menopause large tonsils or adenoids Down syndrome smoking family history of sleep apnea recessed chin[medicalnewstoday.com]
  • In addition to insomnia, patients with depressed mood may have a poor appetite, resulting in weight gain or weight loss, fatigue, psychomotor retardation or agitation, difficulty concentrating, or poor memory.[emedicine.medscape.com]
Lymphadenopathy
  • Masses, including significant lymphadenopathy, should be noted. Lab Tests and Diagnostic Procedures Clinical scenarios dictate the type and extent of testing beyond the polysomnogram.[emedicine.medscape.com]
Laboratory Technician
  • We used in-laboratory, technician-attended polysomnography, the diagnostic “gold standard,” to classify SRBD status. However, night-to-night variability and instrumentation errors are involved in the assessment of SRBD.[jamanetwork.com]
Italian
  • Minerva Stomatologica 2015 April;64(2):97-109 language: English, Italian: Obstructive sleep apnea syndrome: a literature review Maspero C,.Giannini L., Galbiati G., Rosso G., ferronato G.[fdiworlddental.org]
Labored Breathing
  • In children younger than 5 years, nighttime symptoms such as observed apneas or labored breathing are more often the presenting symptoms.[sleep.health.am]
Respiratory Distress
  • distress Diagnostic criteria include: an AHI 5 accompanied by symptoms (snoring, daytime sleepiness, mood disorders, impaired cognition, comorbid medical illness such as hypertension, heart disease) or an AHI 15 (regardless of symptoms reported) Central[healio.com]
Macroglossia
  • Craniodentofacial examination In addition to the features described above (eg, retrognathia, micrognathia, macroglossia), mandibular alignment, dental occlusion, and cephalometric data are often helpful.[emedicine.medscape.com]
  • Certain medical conditions such as Prader-Willi syndrome or trisomy 21 (Down syndrome) increase the risk for OSA because of midline deformities such as macroglossia, micrognathia, midface hypoplasia.[sleepapnea.org]
  • Children with Down syndrome are predisposed to OSAS and hypoventilation due to midfacial and mandibular hypoplasia, shortened palate, relative macroglossia, narrow lumen of the nasopharynx and pharyngeal hypotonia, although parents may not report SDB[erj.ersjournals.com]
Periorbital Edema
  • If associated with adenotonsillar enlargement (the most common cause of obstructive sleep apnea in children), typical “adenoid facies” can be seen with a dull expression, periorbital edema, and mouth breathing.[sleep.health.am]
Tinnitus
Dermatitis
  • Sinusitis and dermatitis can also occur with positive airway pressure (PAP) devices. Tinnitus and dyspnea are other possible complications, but they are less frequently seen.[emedicine.medscape.com]
Dysthymic Disorder
  • Mood Disorders (particularly Major Depressive Disorder and Dysthymic Disorder), Anxiety Disorders (particularly Panic Disorder), and dementia are commonly associated with Breathing-Related Sleep Disorder.[sleep.health.am]
Panic Attacks
  • Nocturnal Panic Attacks may include symptoms of gasping or choking during sleep that may be difficult to distinguish clinically from Breathing-Related Sleep Disorder.[sleep.health.am]
Psychomotor Retardation
  • In addition to insomnia, patients with depressed mood may have a poor appetite, resulting in weight gain or weight loss, fatigue, psychomotor retardation or agitation, difficulty concentrating, or poor memory.[emedicine.medscape.com]
Renal Impairment
  • For instance, individuals with arthritis or renal impairment may complain of insomnia or hypersomnia, but this does not result from breathing impairment during sleep.[sleep.health.am]

Workup

  • Patients with hypertension have an increased incidence of OSA (ie, up to 30% [10] ), and questions about sleep should be included in the workup of patients with hypertension.[emedicine.medscape.com]
Sinus Arrhythmia
  • Cardiac arrhythmias commonly occur during sleep in individuals with Breathing-Related Sleep Disorder and may include sinus arrhythmias, premature ventricular contractions, atrioventricular block, or sinus arrest.[sleep.health.am]
Sinus Arrest
  • Cardiac arrhythmias commonly occur during sleep in individuals with Breathing-Related Sleep Disorder and may include sinus arrhythmias, premature ventricular contractions, atrioventricular block, or sinus arrest.[sleep.health.am]

Treatment

  • […] involved for successful treatment outcome and higher patient satisfaction.[fdiworlddental.org]
  • For this reason, many people have the disorder for years before seeking treatment. For many, symptoms worsen during middle age, causing people to seek treatment at that point.[minddisorders.com]
  • CPAP and avoidance of opiate medication are considered first-line treatment for OSA and CSA. References Gooneratne NS, Vitiello MV. Sleep in older adults: normative changes, sleep disorders, and treatment options.[healio.com]
  • With limited exceptions, such treatments are not effective options.[emedicine.medscape.com]

Prognosis

  • Definition Description Causes and symptoms Demographics Diagnosis Treatments Prognosis Prevention Resources Definition Breathing-related sleep disorder is marked by sleep disruption from abnormal breathing during sleep.[encyclopedia.com]
  • Prognosis Breathing-related sleep disorder often has a gradual long-term progression and a chronic course. For this reason, many people have the disorder for years before seeking treatment.[minddisorders.com]
  • Prognosis Learning difficulties, emotional lability, attention deficits, disruptive behaviors, social and school impairments, family dysfunction, low self-esteem, depression, anxiety, cognitive dysfunction hyperactivity, irritability, and memory impairment[sleepapnea.org]

Etiology

  • In case of unsuccessful treatment, all etiological and diagnostic factors should be carefully re-evaluated and the appliance should be re-adjusted.[fdiworlddental.org]
  • Etiology Obstruction of the upper airways due to the collapse of the pharyngeal muscles during sleep Risk factors Obesity, especially around the neck (short, wide “ bull neck ”) Structural abnormalities that impair respiratory flow : tonsillar hyperplasia[amboss.com]
  • […] reflux disease Hypothyroidism Obstructive sleep apnea-hypopnea syndrome Congestive heart failure Narcolepsy Nocturnal asthma Daytime sequelae of sleep deprivation, including depression, irritability, poor concentration and memory, and daytime sleepiness Etiology[emedicine.medscape.com]
  • In this case, however, the etiology is well documented and the problem diminishes or disappears when the sleep-disordered breathing is treated. Various questionnaires are available to help identify persons at high risk for SDB.[psychiatrictimes.com]
  • It is known that it is difficult to determine the etiology of neuropsychological symptoms, and the DSM-IV 1 diagnosis of depression requires that five symptoms, which may include both psychological and somatic symptoms, be present, simultaneously and[scielo.br]

Epidemiology

  • This population-based epidemiological study assesses SRBD as a longitudinal predictor of depression.[jamanetwork.com]
  • References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Obstructive sleep apnea syndrome in the São Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441-6. PMid:20362502 8. Iranzo A, Santamaría J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder.[sleepscience.org.br]
  • Epidemiology Occurrence in the United States According to estimates, at least 2-4% of the adult population experience breathing-related sleep disorders. [4, 5] In a study by Young and associates, 24% of men and 9% of women aged 30-60 years were reported[emedicine.medscape.com]
  • "Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective". Expert Review of Respiratory Medicine. 2 (3): 349–364. doi : 10.1586/17476348.2.3.349. PMC 2727690. PMID 19690624.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • BMI is a less significant risk factor in older adults. 9 This is an oversimplification of the pathophysiology of OSA, and there are many other factors involved.[healio.com]
  • Figure 2: Pathophysiology of obesity related sleep disorders. The mechanisms by which OSA may induce hypercapnia are not well understood.[smjournals.com]
  • References: [5] [3] Pathophysiology Obstruction of the upper airways apnea partial pressure of oxygen in arterial blood (PaO 2 ), partial pressure of carbon dioxide in arterial blood ( PaCO 2, also known as hypercapnia ) Hypoxic pulmonary vasoconstriction[amboss.com]
  • However, potential mechanisms remain speculative and await research methods that can disentangle multiple correlated pathophysiologic consequences of SRBD.[jamanetwork.com]
  • The identification of pathophysiological features that allow distinction between OSA and depression might assist with such diagnostic issues.[annals-general-psychiatry.biomedcentral.com]

Prevention

  • Policy FDI recommends: universities and national dental associations to provide students and dentists with basic knowledge regarding the important role of dentistry in preventing and treating SRBD, in particular early detection in children and prevention[fdiworlddental.org]
  • Prevention Because overweight people are more likely to develop the more common obstructive sleep apnea type of breathing-related sleep disorder, a good preventive measure is effective weight management.[encyclopedia.com]
  • Sleep Apnea Prevention Prevention of sleep apnea syndromes may be limited to preventive measures related to underlying medical conditions that contribute to sleep apnea.[emedicinehealth.com]
  • Research Partners Areas of Research Brain & Heart Clinical EEG & Neuroimaging Culture & Gender Forensic Mental Health Military Mental Health Mind, Brain Imaging & Neuroethics Mood Disorders Neuromodulation Schizophrenia Sleep & Mental Health Suicide Prevention[theroyal.ca]

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