Review article on sleep apnea
Abstract
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that involves a reduces or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway. This results in partial reductions (hypopneas) and complete block (apneas) in breathing that lasts a minimum of 10 seconds during sleep. Most pauses last between 10 and 30 seconds, but some may persist for one minute or longer. This can cause abrupt reductions in blood oxygen saturation. The brain responds to the lack of oxygen by alerting the body, causing a brief arousal from sleep that restores normal breathing. This pattern can occur many times in one night. The result is a fragmented quality of sleep that often produces an excessive level of daytime sleepiness. Most people with OSA snore loudly and regullarly, with periods of silence when airflow is reduced or blocked. They then make choking, snorting or gasping sounds when their airway reopens. A common measurement of sleep apnea is the apnea-hypopnea index (AHI).
Keywords:
Obstructive sleep apnea, apneas, arousal, hyponea, snorting
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References
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Javaheri S, dragger LF, Lorenzi-filho G. sleep and cardiovascular disease: present and future. In: kryger MH, roth T, dement WC, editors. Principles and practices of sleep medicine 6th edition. Philadelphia, PA; Elsevier, 2017;1222-8.
Javaheri S, Dempsey JA. Central sleep apnea. Compr physiol 2013; 3:141=63.
Lyons OD, bradely TD. Heart failure and sleep apnea. Can J cardiol 2015; 31:898-908.
May AM, Blackwell T, Stone PH, et al, for the Mr OS sleep (outcomes of sleep disorders in older men) study group. Central sleep-disordered breathing predicts incident atrial fibrillation in older men. Am J respir crit care med 2016; 193:783-91
Javaheri S, plackwell T, ancoli- Israel S, et al, for the osteoporotic fractures in Men study research group. Sleep – discorded breathing and incident heart failure in older men. Am J respir crit care Med 2016;193;561-8
Javaheri S. Cardiovascular diseases. In: Kryger MH, Avidan AY, Berry RB, editors. Atlas of clinical sleep medicine. 2nd edition. Philadelphia, PA; saunders, 2014:316=28.
Dempsey AS, Mcsharry DG, Malhotra A. pathophysiology of sleep apnea. Physiol REV 2010; 90:47-112
Jordan JA, Veasey SC, morgan BJ, et al. obstructive sleep apnea. Lalcet 2014; 383:736-47.
Mendelson lyons OD, yadollahi A, et al. effects of exercise training on sleep apnea in patients with coronary artery disease: a randomised trail. Eur respir J 2016; 48:142-50.
White DP, Gleeson K, pichett CK, rannels AM, cymerman A, weil JV. Altitude acclimatization: influence on periodic breathing and chemo responsiveness during sleep. J appl physiol 1987; 63:401-412.
Zhou XS, shaha buddin S, zahn BR, babeock MA, development of hypocapnic apnea/ hypopnea during NREM sleep. J appl physiol 2000; 89:192-199.
Somers V, javaheri S. cardiovascular effects of sleep-releated breathing disorders. In: Kryger MH, roth T, dement WC, editors. Principles and practices of sleep medicine, 6th edition. Philadelphia PA: elaevier, 2017;1243-52.
Xie A, wong B, Phillipson EA, Slutsky AS, bradlety TD. Interaction of hyperventilation and arousal in the pathogenesis of idiopathic central sleep apnea. Am J reserpir crit care Med 1994; 150:489-495.
Xie A, Rutherford R, rankin F, wong B, Bradley TD. Hypocapnia and increased ventilatory responsiveness in patients with idiopathic central sleep apnea. Am J respir crit care Med 1995;152:489-495.
Lorenzi-filho G, rankin F, Bradley. T. effects of inhaled carbon dioxide and oxygen on Cheyne stokes respiration in patients with heart failure Am J respir crit care Med 1999; 159:1490-1498.
Sin D, fitzgerald F, parker J. risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J respir crit care Med 1999; 160:1101-1106.
Mellins R, balfour H, turion G, winters RW. Failure of automatic control of ventilation (ondines curse). Medicine (Baltimore) 1970; 49:487-504.
Tassinari C, dalla Bernardina B, cirignotta F, Ambrosetto G. apnoeic periods and the respiratory related arousal patterns during sleep in the pickwikian syndrome. Bull physiopathol respir (Nancy) 1972; 8:1087-1102.
Schwab RJ, gupta KB, gefter WB, Metzger LJ, Hoffman EA, pack Al. upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls. Am J respir crit care Med 1995:152:1673-1689.
Fogel R, Malhotra A, Pillar G, Edwards J, shea S. whgite D. genioglossal activation in patients with obstructive sleep apnea versus control subjects: mechanisms of muscle control. Am J respir crit care Med 2001; 164:2025-2030.
Nan lunteren E. muscle of the pharynx: structal and contractile properties. Ear nose throat J 1993; 72:27-29,33.
Wheattey J, white D, mezzanotte W, white D. influence of sleep on response to negative airway pressure of tensor palatini muscle and retropalatal airway. J appl physiol 1993; 75:2117-2124.
Ballard R, Irvin CG, Martin RJ, Pak J, Pandey R, White DP. Influence of sleep on lung volume in asthmatic patients and normal subjects. J Appl Physiol 1990; 68:2034–2041.
Gleeson K, Zwillich CW, White DP. The influence of increasing ventilatory effort on arousal from sleep. Am Rev Respir Dis 1990; 142:295–300.
Berry RB, McNellis MI, Kouchi K, Light RW. Upper airway anesthesia reduces phasic genioglossus activity during sleep apnea. Am J Respir Crit Care Med 1997; 156:127–132.
Gyulay S, Olson LG, Hensley MJ, King MT, Allen KM, Saunders NA. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis 1993; 147:50-3.
Rosen CL, D’Andrea L, Haddad GG. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis 1992; 146:1231-4.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 1985; 103:850-5.
Sugerman HJ, Fairman RP, Baron PL, Kwentus JA. Gastric surgery for respiratory insufficiency of obesity. Chest 1986;90:81-6.
National Heart, Lung, and Blood Institute. Fact Book: Fiscal Year 1993. U.S. Department of Health and Human Services, U.S. Public Health Service, National Institutes of Health, February 1994.
Fletcher EC, DeBehnke RD, Lovoi MS, Gorin AB. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med 1985;103:190-5.
Sanders MH, Kern NB, Stiller RA, Strollo PJ, Martin TJ, Atwood CW. CPAP therapy via oronasal mask for obstructive sleep apnea. Chest 1994;106:774-9.
American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes. Am J Respir Crit Care Med 1994;150:1738-45.
Waldhorn RE, Wood K. Attended home titration of nasal continuous positive airway pressure therapy for obstructive sleep apnea. Chest 1993;104:1707-10.
Riley RW, Powell NB, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest 1990;98: 1421-5.
Keenan SP, Burt H, Ryan CF, Fleetham JA. Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest 1994;105:155-9.
Polo O, Berthon-Jones M, Douglas NJ, Sullivan CE. Management of obstructive sleep apnoea/hypopnoea syndrome. Lancet 1994;344:656-60. 28. Kribbs NB, Pack AI, Kline L.
Kribbs NB, Pack AI, Kline LR, et al. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 1993;147(5):1162-8.
Fletcher EC. The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. Am J Med 1995;98:118-28.
Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983;52:490-4.
Shepard JW Jr., Garrison MW, Grither DA, Dolan GF. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 1985;88:335-40
Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet 1990;336:261-4.
Rapoport DM, Garay SM, Epstein H, Goldring RM. Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the “Pickwickian syndrome.” Chest 1986;89:627-34.
Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest 1995;107:362-6
American Sleep Disorders Association. Practice parameters for the use of laserassisted uvulopalatoplasty. Sleep 1994;17:744-8.
Fletcher EC, Munafo DA. Role of nocturnal oxygen therapy in obstructive sleep apnea. When should it be used? Chest 1990; 98:1497-504.
Phillips BA, Schmitt FA, Berry DTR, Lamb DG, Amin M, Cook YR. Treatment of obstructive sleep apnea: a preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest 1990.
Friberg D, Gazelius B, Hokfelt T, Nordlander B. Abnormal afferent nerve endings in the soft palatal mucosa of sleep apnoics and habitual snorers. Regul Pept 1997;71:29–36.
Boyd J, Petrof B, Hamid Q, Fraser R, Kimoff R. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med 2004;170:541–546.
Peppard PE, Young T, Barnet JH, et al. increased prevalence of sleep-disordered breathing in adults. Am J epidermiol 2013; 177:1006=14.
Javaheri S, dragger LF, Lorenzi-filho G. sleep and cardiovascular disease: present and future. In: kryger MH, roth T, dement WC, editors. Principles and practices of sleep medicine 6th edition. Philadelphia, PA; Elsevier, 2017;1222-8.
Javaheri S, Dempsey JA. Central sleep apnea. Compr physiol 2013; 3:141=63.
Lyons OD, bradely TD. Heart failure and sleep apnea. Can J cardiol 2015; 31:898-908.
May AM, Blackwell T, Stone PH, et al, for the Mr OS sleep (outcomes of sleep disorders in older men) study group. Central sleep-disordered breathing predicts incident atrial fibrillation in older men. Am J respir crit care med 2016; 193:783-91
Javaheri S, plackwell T, ancoli- Israel S, et al, for the osteoporotic fractures in Men study research group. Sleep – discorded breathing and incident heart failure in older men. Am J respir crit care Med 2016;193;561-8
Javaheri S. Cardiovascular diseases. In: Kryger MH, Avidan AY, Berry RB, editors. Atlas of clinical sleep medicine. 2nd edition. Philadelphia, PA; saunders, 2014:316=28.
Dempsey AS, Mcsharry DG, Malhotra A. pathophysiology of sleep apnea. Physiol REV 2010; 90:47-112
Jordan JA, Veasey SC, morgan BJ, et al. obstructive sleep apnea. Lalcet 2014; 383:736-47.
Mendelson lyons OD, yadollahi A, et al. effects of exercise training on sleep apnea in patients with coronary artery disease: a randomised trail. Eur respir J 2016; 48:142-50.
White DP, Gleeson K, pichett CK, rannels AM, cymerman A, weil JV. Altitude acclimatization: influence on periodic breathing and chemo responsiveness during sleep. J appl physiol 1987; 63:401-412.
Zhou XS, shaha buddin S, zahn BR, babeock MA, development of hypocapnic apnea/ hypopnea during NREM sleep. J appl physiol 2000; 89:192-199.
Somers V, javaheri S. cardiovascular effects of sleep-releated breathing disorders. In: Kryger MH, roth T, dement WC, editors. Principles and practices of sleep medicine, 6th edition. Philadelphia PA: elaevier, 2017;1243-52.
Xie A, wong B, Phillipson EA, Slutsky AS, bradlety TD. Interaction of hyperventilation and arousal in the pathogenesis of idiopathic central sleep apnea. Am J reserpir crit care Med 1994; 150:489-495.
Xie A, Rutherford R, rankin F, wong B, Bradley TD. Hypocapnia and increased ventilatory responsiveness in patients with idiopathic central sleep apnea. Am J respir crit care Med 1995;152:489-495.
Lorenzi-filho G, rankin F, Bradley. T. effects of inhaled carbon dioxide and oxygen on Cheyne stokes respiration in patients with heart failure Am J respir crit care Med 1999; 159:1490-1498.
Sin D, fitzgerald F, parker J. risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J respir crit care Med 1999; 160:1101-1106.
Mellins R, balfour H, turion G, winters RW. Failure of automatic control of ventilation (ondines curse). Medicine (Baltimore) 1970; 49:487-504.
Tassinari C, dalla Bernardina B, cirignotta F, Ambrosetto G. apnoeic periods and the respiratory related arousal patterns during sleep in the pickwikian syndrome. Bull physiopathol respir (Nancy) 1972; 8:1087-1102.
Schwab RJ, gupta KB, gefter WB, Metzger LJ, Hoffman EA, pack Al. upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls. Am J respir crit care Med 1995:152:1673-1689.
Fogel R, Malhotra A, Pillar G, Edwards J, shea S. whgite D. genioglossal activation in patients with obstructive sleep apnea versus control subjects: mechanisms of muscle control. Am J respir crit care Med 2001; 164:2025-2030.
Nan lunteren E. muscle of the pharynx: structal and contractile properties. Ear nose throat J 1993; 72:27-29,33.
Wheattey J, white D, mezzanotte W, white D. influence of sleep on response to negative airway pressure of tensor palatini muscle and retropalatal airway. J appl physiol 1993; 75:2117-2124.
Ballard R, Irvin CG, Martin RJ, Pak J, Pandey R, White DP. Influence of sleep on lung volume in asthmatic patients and normal subjects. J Appl Physiol 1990; 68:2034–2041.
Gleeson K, Zwillich CW, White DP. The influence of increasing ventilatory effort on arousal from sleep. Am Rev Respir Dis 1990; 142:295–300.
Berry RB, McNellis MI, Kouchi K, Light RW. Upper airway anesthesia reduces phasic genioglossus activity during sleep apnea. Am J Respir Crit Care Med 1997; 156:127–132.
Gyulay S, Olson LG, Hensley MJ, King MT, Allen KM, Saunders NA. A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. Am Rev Respir Dis 1993; 147:50-3.
Rosen CL, D’Andrea L, Haddad GG. Adult criteria for obstructive sleep apnea do not identify children with serious obstruction. Am Rev Respir Dis 1992; 146:1231-4.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 1985; 103:850-5.
Sugerman HJ, Fairman RP, Baron PL, Kwentus JA. Gastric surgery for respiratory insufficiency of obesity. Chest 1986;90:81-6.
National Heart, Lung, and Blood Institute. Fact Book: Fiscal Year 1993. U.S. Department of Health and Human Services, U.S. Public Health Service, National Institutes of Health, February 1994.
Fletcher EC, DeBehnke RD, Lovoi MS, Gorin AB. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med 1985;103:190-5.
Sanders MH, Kern NB, Stiller RA, Strollo PJ, Martin TJ, Atwood CW. CPAP therapy via oronasal mask for obstructive sleep apnea. Chest 1994;106:774-9.
American Thoracic Society. Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes. Am J Respir Crit Care Med 1994;150:1738-45.
Waldhorn RE, Wood K. Attended home titration of nasal continuous positive airway pressure therapy for obstructive sleep apnea. Chest 1993;104:1707-10.
Riley RW, Powell NB, Guilleminault C. Maxillofacial surgery and nasal CPAP. A comparison of treatment for obstructive sleep apnea syndrome. Chest 1990;98: 1421-5.
Keenan SP, Burt H, Ryan CF, Fleetham JA. Long-term survival of patients with obstructive sleep apnea treated by uvulopalatopharyngoplasty or nasal CPAP. Chest 1994;105:155-9.
Polo O, Berthon-Jones M, Douglas NJ, Sullivan CE. Management of obstructive sleep apnoea/hypopnoea syndrome. Lancet 1994;344:656-60. 28. Kribbs NB, Pack AI, Kline L.
Kribbs NB, Pack AI, Kline LR, et al. Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 1993;147(5):1162-8.
Fletcher EC. The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. Am J Med 1995;98:118-28.
Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983;52:490-4.
Shepard JW Jr., Garrison MW, Grither DA, Dolan GF. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest 1985;88:335-40
Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnoea with myocardial infarction in men. Lancet 1990;336:261-4.
Rapoport DM, Garay SM, Epstein H, Goldring RM. Hypercapnia in the obstructive sleep apnea syndrome. A reevaluation of the “Pickwickian syndrome.” Chest 1986;89:627-34.
Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD. Body fat distribution and sleep apnea severity in women. Chest 1995;107:362-6
American Sleep Disorders Association. Practice parameters for the use of laserassisted uvulopalatoplasty. Sleep 1994;17:744-8.
Fletcher EC, Munafo DA. Role of nocturnal oxygen therapy in obstructive sleep apnea. When should it be used? Chest 1990; 98:1497-504.
Phillips BA, Schmitt FA, Berry DTR, Lamb DG, Amin M, Cook YR. Treatment of obstructive sleep apnea: a preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest 1990.
Friberg D, Gazelius B, Hokfelt T, Nordlander B. Abnormal afferent nerve endings in the soft palatal mucosa of sleep apnoics and habitual snorers. Regul Pept 1997;71:29–36.
Boyd J, Petrof B, Hamid Q, Fraser R, Kimoff R. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med 2004;170:541–546.
Published
06/02/2021
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Simhavalli.Godavarthi, B. Pravallika, B. Tushara, and L. Krishnapriya. “Review Article on Sleep Apnea”. International Journal of Health Care and Biological Sciences, Feb. 2021, pp. 18-24, doi:10.46795/ijhcbs.vi.136.
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