Concise Review for CliniciansObstructive Sleep Apnea-Hypopnea Syndrome
Section snippets
Neurobehavioral and Social
Excessive daytime sleepiness, impaired vigilance, mood disturbances, and cognitive dysfunction are features of OSAHS. Accordingly, pretreatment personal and public health ramifications include increased risk for motor vehicle crashes, occupational injuries, and decreased quality of life.5 Performance deficits during neuropsychological testing can be documented with even mild OSAHS. With a frequency of 15 apneas-hypopneas per hour of sleep, the decrement is equivalent to that associated with 5
History and Physical Examination
The history focuses on breathing disturbances during sleep, unsatisfactory sleep quality, daytime dysfunction, and OSAHS risk factors. A collateral history should be obtained from the patient's bed partner. Reports of habitual, socially disruptive snoring and witnessed apneas terminated by snorts or gasps increase diagnostic accuracy. Sleepiness lacks diagnostic sensitivity and specificity (Table 1). The onset of sleepiness may be so insidious that the patient is unaware of its development, and
LABORATORY DIAGNOSIS OF OSAHS
The diagnosis of OSAHS is based on an integration of clinical information and laboratory testing. The recommended diagnostic test for sleep-related breathing disorders is polysomnography.20 The standard polysomnogram is a laboratory-based, technician-attended multimodality recording of sleep architecture by electroencephalography, electro-oculography, and electromyography; respiratory activity by nasal and oral airflow or pressure, thoracoabdominal inductance plethysmography, and oximetry;
TREATMENT OF OSAHS
Obstructive sleep apnea-hypopnea syndrome is a chronic disease that requires patient education, alleviation of upper airway obstruction, and ongoing follow-up with adjustment of treatment strategies to ensure efficacy. Because many patients with OSAHS are overweight or have comorbid cardiovascular risk factors or diseases, they must be informed of the interaction of OSAHS and overall health. Prospective data on the cardiovascular and perioperative benefits of OSAHS treatment are emerging, but
CONCLUSION
Even mild OSAHS can be associated with pronounced behavioral, social, and cardiovascular morbidity. Thus, it is not surprising that patients with untreated OSAHS have higher health care utilization rates and incur greater medical costs.42 Further data are needed to define the specific cardiovascular risks of untreated OSAHS and to determine the extent of the impact of treatment. Clinicians should suspect OSAHS in patients with habitually loud snoring; witnessed apneas, choking, or gasping
Questions About OSAHS
- 1.
Which one of the following is not independently associated with untreated OSAHS?
- a.
Systemic hypertension
- b.
Stroke
- c.
Motor vehicle crash
- d.
Excessive daytime sleepiness
- e.
Fibromyalgia
- a.
- 2.
Which one of the following statements is falseregarding recognition of OSAHS?
- a.
Prevalence of OSAHS rises inevitably each year after age 65 years
- b.
Snoring and sleepiness are not specific for OSAHS
- c.
OSAHS is an underappreciated component of the preoperative evaluation
- d.
Neck circumference of 43 cm or greater correlates with
- a.
REFERENCES (42)
- et al.
The effect of snoring and obstructive sleep apnea on the sleep quality of bed partners
Mayo Clin Proc
(1999) - et al.
Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study
Mayo Clin Proc
(2001) - et al.
New directions for pulse oximetry in sleep disorders
Mayo Clin Proc
(1995) - et al.
A cause of excessive daytime sleepiness: the upper airway resistance syndrome
Chest
(1993) - et al.
Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement
Chest
(1999) - et al.
Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask: physiologic and clinical implications
Chest
(1990) - et al.
Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure
Chest
(1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine Task Force
Sleep
(1999)- et al.
Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women
Sleep
(1997) - et al.
Prevalence and trends in obesity among US adults, 1999-2000
JAMA
(2002)
Sleep apnea and cardiovascular disease
Am J Respir Crit Care Med
Epidemiology of obstructive sleep apnea: a population health perspective
Am J Respir Crit Care Med
Sleep-disordered breathing and neuropsychological deficits: a population-based study
Am J Respir Crit Care Med
Prospective study of the association between sleep-disordered breathing and hypertension
N Engl J Med
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report [published correction appears in JAMA. 2003;290:197]
JAMA
Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study
Am J Respir Crit Care Med
Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea
N Engl J Med
Prevalence of sleep-disordered breathing in women: effects of gender
Am J Respir Crit Care Med
Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study
Arch Intern Med
Physical findings and the risk for obstructive sleep apnea: the importance of oropharyngeal structures
Am J Respir Crit Care Med
Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study
Am J Respir Crit Care Med
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A question-and-answer section appears at the end of this article.