Presentation
We present a patient whose OSA was inadequately controlled with PAP who underwent HNS as a salvage procedure despite not meeting these indications. [jamanetwork.com]
At the present time there are no proven effective treatments for central sleep apnea. Often people with central sleep apnea have another medical condition, such as heart failure. [rtrespiratory.com]
In this article, the authors present the mechanisms, clinical scenarios, and treatment options for central sleep apnea. Key points • Central sleep apnea is caused by a brief failure of the normal ventilatory rhythm. [medlink.com]
The effects of CSA will differ between sufferers depending on how severe their apnea is but tends to present milder symptoms unless the condition exists alongside other health problems such as those with the heart or nervous system. [sleepio.com]
Entire Body System
- Inflammation
Causes and Risk Factors for CSA Advancing age, especially over at 65 Heart disease or heartbeat irregularities Stroke Narcotic medications Severe obesity Sleeping at high altitudes Head injury Brain infection or inflammation Brain tumor Neurologic disorders [drmommasays.com]
In patients who have just undergone surgery for the treatment of their OSA, the airway can be narrowed from swelling and inflammation. Also, the lingering sedative and ventilatory depressant effects of the anesthetic can pose difficulty. [apsf.org]
It can cause inflammation and fluid retention in the upper airways that can impede airflow. [alaskasleep.com]
This can lead to inflammation and swelling, which increases the likelihood of obstruction Better sleep hygiene. Maintaining a strict sleep schedule and adhering to good sleep hygiene will help you achieve better rest. [sleepyscientist.com]
In people with sinusitis and nasal congestion, the swelling and inflammation of the upper airway passages can cause snoring and sleep apnea. [medicinenet.com]
- Epilepsy
Short of death, drops in blood oxygen may trigger seizures, even in the absence of epilepsy. [en.wikipedia.org]
[…] sleep study, or polysomnography, should be considered, especially in patients who have serious medical conditions that could be worsened or caused by sleep apnea (e.g., heart disease, high blood pressure, heart failure, diabetes, chronic headaches, epilepsy [uspharmacist.com]
- Enuresis
OSA symptoms in children Abnormal breathing during sleeping, frequent awakenings or restlessness, frequent nightmares, enuresis, difficult awakening, excessive daytime sleepiness, hyperactivity-behavior problems, daytime mouth breathing, poor or irregular [intechopen.com]
Respiratoric
- Nasal Congestion
Being overweight or obese Being over the age of 40 Being male Large tonsils or adenoids (the prominent oval masses of lymphoid tissues on either side of the throat) Physical characteristics such as a deviated septum, receding chin or enlarged tongue Nasal [laportehealth.com]
congestion or blockage due to a cold, sinusitis, allergies or smoking Overly relaxed throat muscles or tongue during sleep (due to alcohol or sedative use or age) Fact About Sleep The National Institutes of Health reports that 40 million Americans suffer [porterhealth.com]
[…] sprays or breathing strips to keep air flowing if you have sinus problems or nasal congestion Avoiding sleep deprivation Continued Another treatment is continuous positive airway pressure ( CPAP ), which is the preferred initial treatment for most people [webmd.com]
Temporary treatment for nasal congestion or other reversible and transient causes may also be beneficial when necessary. [emedicinehealth.com]
In people with sinusitis and nasal congestion, the swelling and inflammation of the upper airway passages can cause snoring and sleep apnea. [medicinenet.com]
- Abnormal Breathing
Historical note and terminology The term "central sleep apnea" was coined by Gastaut and his collaborators in their report on the abnormal breathing patterns observed in a subtype of so-called "Pickwickian patients," morbidly obese subjects with somnolence [medlink.com]
Symptoms Common signs and symptoms of central sleep apnea include: Observed episodes of stopped breathing or abnormal breathing patterns during sleep Abrupt awakenings accompanied by shortness of breath Shortness of breath that's relieved by sitting up [mayoclinic.org]
Most of the patients with moderate and severe AHI abnormality fell into obesity Class-1. [omicsonline.org]
OSA symptoms in children Abnormal breathing during sleeping, frequent awakenings or restlessness, frequent nightmares, enuresis, difficult awakening, excessive daytime sleepiness, hyperactivity-behavior problems, daytime mouth breathing, poor or irregular [intechopen.com]
- Tonsillar Hypertrophy
However, non-obese patients can have OSA from tonsillar hypertrophy or craniofacial abnormalities. [apsf.org]
Cardiovascular
- Heart Disease
disease is more common in obese people, and obesity is a risk factor of heart disease, high blood pressure, and sleep apnea. [healthline.com]
Some other considerations are: – How sleepy you feel – How low your oxygen level dips – How long your oxygen level stays below 90% – Other medical conditions you may have, such as heart disease Back to the Top [rtrespiratory.com]
Related: Workshops on Heart Disease and Comorbid Conditions The researchers followed 1,325 patients for a median of 31 months. [mdedge.com]
People with brain stem injuries such as stroke and brain tumours, those with chronic respiratory conditions or people with heart conditions such as congestive heart disease or atrial fibrillation are more at risk of developing CSA. [healthysleep.net.au]
Sleep apnea is often linked to heart disease and metabolic issues like diabetes. What are the signs of sleep apnea? There are two kinds of sleep apnea : obstructive sleep apnea and central sleep apnea. [hopkinsmedicine.org]
Jaw & Teeth
- Bruxism
TRD contraindications Severe periodontal diseases, bruxism, chronic nasal obstruction, patients who are unable to move their tongue anteriorly, and obese OSA patients. 13.3. [intechopen.com]
Musculoskeletal
- Restless Legs Syndrome
An EMG of the legs can be used to detect " restless legs syndrome " or periodic leg movements during sleep. Oral and nasal airflow can be measured by several different methods to help determine the size and frequency of breaths during sleep. [medicinenet.com]
Neurologic
- Headache
If untreated, sleep apnea may cause conditions such as cardiovascular disease, stroke, memory problems, weight gain, impotence, headaches, diabetes, depression or mood swings, attention-deficit/hyperactivity disorder, and gastroesophageal reflux disease [fortherecordmag.com]
Some of the main symptoms of Obstructive Sleep Apnea include loud snoring, very frequent pauses in breathing which are caused by an obstruction, daytime fatigue/sleepiness, headaches in the morning, restless sleep, and even irritability or depression [sleeprestfully.com]
Snoring and pauses in breathing Gasping or choking during sleep Excessive daytime sleepiness High blood pressure Morning headaches Poor judgment or concentration Dry mouth in the mornings Higher risk people include those with obesity, a thick neck, and [clinicalsleep.com]
“Symptoms noticeable during the day might be less dramatic, such as irritability, sleepiness, fatigue, headache, but could also be the result of sleep apnea,” he added. [nashunchealthcare.org]
Shortness of breath that disrupts sleep Chronic fatigue Irregular breathing during sleep Morning headaches Difficulty concentrating Snoring Mood changes Excessive daytime drowsiness Poor or restless sleep 3. [nectarsleep.co.uk]
- Hyperactivity
If untreated, sleep apnea may cause conditions such as cardiovascular disease, stroke, memory problems, weight gain, impotence, headaches, diabetes, depression or mood swings, attention-deficit/hyperactivity disorder, and gastroesophageal reflux disease [fortherecordmag.com]
People with sleep apnea may also experience the following symptoms: headaches that are difficult to treat feeling disgruntled (grumpy) forgetfulness drowsiness Other symptoms include: hyperactivity in children worsening depression poor job and school [healthline.com]
Learning and some behavior problems (such as hyperactivity, impulsivity, and aggression) are often common symptoms of severe obstructive sleep apnea in children. Children may also have growth delays. [msdmanuals.com]
In children, it may contribute to increased hyperactivity and difficulty with concentrating in school. Sleep Apnea Causes Causes of sleep apnea depend on whether the main problem is central or obstructive. [emedicinehealth.com]
Workup
Colonoscopy
- Polyps
• Removal of nasal polyps (21.31). • Repair of deviated nasal septum. • Removal of tonsils and adenoids. [fortherecordmag.com]
[…] sleep apnea are more likely to suffer sleep-related motor vehicle accidents, hypertension and other serious cardiovascular complications, and increased mortality and morbidity. 8 The most common risk factors of obstructive sleep apnea include obesity; polyps [uspharmacist.com]
In the nose, this includes the septum, turbinates, nasal polyps, adenoid hypertrophy, and nasopharynx (back of the nose). In the mouth, the palate, tonsils, uvula, pharyngeal walls, and neck circumference are all examined. [medicinenet.com]
[…] muscle activity, soft tissue anomalies, micrognathia, retrognathia, macroglossia, enlarged soft palate, steep mandibular plane angle, nasal obstruction, adenotonsillar hypertrophy, reduced airway lumen, vocal cord dysfunction, edema of the epiglottis, polyps [intechopen.com]
Treatment
Learn about this condition, the features and causes, how it is diagnosed, and the most effective treatments (and if treatment is even necessary). [verywellhealth.com]
Treatment Optimal treatment options for mixed sleep apnea still need to be refined. [alaskasleep.com]
The appearance of treatment-emergent central apnea is well known and recently described. 2 However the identification of central apnea appearing years after treatment of obstructive apnea is an older observation. [ncbi.nlm.nih.gov]
1 [Association between mixed sleep apnea and treatment-emergent central sleep apnea]. 38 31269581 2019 2 Implication of mixed sleep apnea events in adult patients with obstructive sleep apnea-hypopnea syndrome. 38 Yang X...Chen X 30343435 2019 3 Emergence [malacards.org]
The hypoglossal nerve stimulator (HNS) is approved for the treatment of obstructive sleep apnea (OSA) in patients who cannot tolerate positive airway pressure (PAP) therapy. [jamanetwork.com]
Prognosis
In fact, CSA is an independent marker for poor prognosis and death in HF. Thus, suppressing these apneas and hypopneas seemed to be a good idea. [mdedge.com]
• In patients with heart failure, the presence of Cheyne-Stokes respiration carries worse prognosis. • There is no evidence that treatment of central sleep apnea reduces mortality. • The use of adaptive servo-ventilation in treatment of central sleep [medlink.com]
If there's underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) worsen prognosis and increase the risk of abnormal heart rhythms. [mayoclinic.org]
Philadelphia) defines disease: Disease [Fr. dès from + aise ease] any deviation from or interruption of the normal structure or function of a part, organ, or system of the body as manifested by characteristic symptoms and signs; the etiology, pathology, prognosis [ncbi.nlm.nih.gov]
With treatment, the prognosis is usually excellent. Life span is not affected, and most serious complications can be prevented. Losing weight, quitting smoking, and not using alcohol excessively can help. [msdmanuals.com]
Etiology
Etiology of obstructive sleep apnea The etiology of OSAS is multifaceted. The factors that lead to OSA can change in adults and pediatric and adolescent patients. 5.1. [intechopen.com]
Dictionary (WB Saunders, Philadelphia) defines disease: Disease [Fr. dès from + aise ease] any deviation from or interruption of the normal structure or function of a part, organ, or system of the body as manifested by characteristic symptoms and signs; the etiology [ncbi.nlm.nih.gov]
Our findings would suggest that for the typical heart failure patient in the community, OSA is much more likely to be the etiology of SDB than CSA, and that clinical suspicion and pretest probabilities should be adjusted accordingly. [academic.oup.com]
Epidemiology
Minnesota; 4 Department of Health Sciences and Research, Mayo Clinic, Rochester, Minnesota Study Objectives: A strong association between sleep-disordered breathing (SDB) and atrial fibrillation and/or atrial flutter (AF) has consistently been observed in epidemiologic [jcsm.aasm.org]
References Roger VL (2013) Epidemiology of heart failure. Circ Res 113: 646-659. Mosterd A, Hoes AW (2007) Clinical epidemiology of heart failure. Heart 93: 1137-1146. [omicsonline.org]
"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. [en.wikipedia.org]
“A number of large epidemiological studies have shown that there’s a two to three-fold greater risk for sleep apnea among women who are postmenopausal, with some of that risk occurring during peri-menopause,” said Dr. Pien. [nytimes.com]
Pathophysiology
The pathophysiology is based on coexisting ventilatory control instability and upper airway collapsibility. [erj.ersjournals.com]
Daly PA, Sole MJ (1990) Myocardial catecholamines and the pathophysiology of heart failure. Circulation. 82: I35-I43. Floras JS (1993) Clinical aspects of sympathetic activation and parasympathetic withdrawal in heart failure. [omicsonline.org]
Central Sleep Apnea: Pathophysiology and Treatment. Published in the medical journal Chest in 2007. Accessed on September 27, 2018. 4. Mayo Clinic. [cpap.com]
Pharmacotherapy: A Pathophysiological Approach. 6th ed. New York, NY: McGraw-Hill; 2005:1326-1327. 4. Dincer HE, O'Neill W. Deleterious effects of sleep-disordered breathing on the heart and vascular system. Respiration. 2006;73:124-130. 5. [uspharmacist.com]
Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007 Jul. 132(1):325-37. [Medline]. [Full Text]. Schwab RJ, Pasirstein M, Pierson R, Mackley A, Hachadoorian R, Arens R, et al. [medscape.com]
Prevention
Obstructive Sleep Apnea : Occurs when the throat physically closes during sleep, preventing air from passing through to the lungs and temporarily stopping breathing. [sparksleep.com]
The airway of the patients has been successfully open to prevent obstructions, but they still struggled with difficulty in breathing and this is when they were diagnosed with Mixed Sleep Apnea instead of just OSA. [sleeprestfully.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]
SleepQuest experts have successfully treated CSA with an in-home, non-invasive ventilator device that prevents breathing stoppages. [sleepquest.com]
“Sleep apnea happens when upper airway muscles relax during sleep and pinch off the airway, which prevents you from getting enough air. [hopkinsmedicine.org]