Sleep Apnea Syndromes: Planet Earth

Schroeder BM, Anonymous00062. · No affiliation provided · Am Fam Physician. · Pubmed #12387446 links to  free full text

This publication has no abstract.

Schechter MS, Anonymous00181. · No affiliation provided · Pediatrics. · Pubmed #11927742 links to  free full text

Abstract: OBJECTIVE: This technical report describes the procedures involved in developing the recommendations of the Subcommittee on Obstructive Sleep Apnea Syndrome in children. The group of primary interest for this report was otherwise healthy children older than 1 year who might have adenotonsillar hypertrophy or obesity as underlying risk factors of obstructive sleep apnea syndrome (OSAS). The goals of the committee were to enhance the primary care clinician's ability to recognize OSAS, identify the most appropriate procedure for diagnosis of OSAS, identify risks associated with pediatric OSAS, and evaluate management options for OSAS. METHODS: A literature search was initially conducted for the years 1966-1999 and then updated to include 2000. The search was limited to English language literature concerning children older than 2 and younger than 18 years. Titles and abstracts were reviewed for relevance, and committee members reviewed in detail any possibly appropriate articles to determine eligibility for inclusion. Additional articles were obtained by a review of literature and committee members' files. Committee members compiled evidence tables and met to review and discuss the literature that was collected. RESULTS: A total of 2115 titles were reviewed, of which 113 provided relevant original data for analysis. These articles were mainly case series and cross-sectional studies; overall, very few methodologically strong cohort studies or randomized, controlled trials concerning OSAS have been published. In addition, a minority of studies satisfactorily differentiated primary snoring from true OSAS. Reports of the prevalence of habitual snoring in children ranged from 3.2% to 12.1%, and estimates of OSAS ranged from 0.7% to 10.3%; these studies were too heterogeneous for data pooling. Children with sleep-disordered breathing are at increased risk for hyperactivity and learning problems. The combined odds ratio for neurobehavioral abnormalities in snoring children compared with controls is 2.93 (95% confidence interval: 2.23-3.83). A number of case series have documented decreased somatic growth in children with OSAS; right ventricular dysfunction and systemic hypertension also have been reported in children with OSAS. However, the risk growth and cardiovascular problems cannot be quantified from the published literature. Overnight polysomnography (PSG) is recognized as the gold standard for diagnosis of OSAS, and there are currently no satisfactory alternatives. The diagnostic accuracy of symptom questionnaires and other purely clinical approaches is low. Pulse oximetry appears to be specific but insensitive. Other methods, including audiotaping or videotaping and nap or home overnight PSG, remain investigational. Adenotonsillectomy is curative in 75% to 100% of children with OSAS, including those who are obese. Up to 27% of children undergoing adenotonsillectomy for OSAS have postoperative respiratory complications, but estimates are varied. Risk factors for persistent OSAS after adenotonsillectomy include continued snoring and a high apnea-hypopnea index on the preoperative PSG. CONCLUSIONS: OSAS is common in children and is associated with significant sequelae. Overnight PSG is currently the only reliable diagnostic modality that can differentiate OSAS from primary snoring. However, the PSG criteria for OSAS have not been definitively validated, and it is not clear that primary snoring without PSG-defined OSAS is benign. Adenotonsillectomy is the first-line treatment for OSAS but requires careful postoperative monitoring because of the high risk of respiratory complications. Adenotonsillectomy is usually curative, but children with persistent snoring (and perhaps with severely abnormal preoperative PSG results) should have PSG repeated postoperatively.

Anonymous00178. · No affiliation provided · Pediatrics. · Pubmed #11927718 links to  free full text

Abstract: This clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of obstructive sleep apnea syndrome (OSAS). The Section on Pediatric Pulmonology of the American Academy of Pediatrics selected a subcommittee composed of pediatricians and other experts in the fields of pulmonology and otolaryngology as well as experts from epidemiology and pediatric practice to develop an evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for the diagnosis and management of childhood OSAS. The guideline contains the following recommendations for the diagnosis of OSAS: 1) all children should be screened for snoring; 2) complex high-risk patients should be referred to a specialist; 3) patients with cardiorespiratory failure cannot await elective evaluation; 4) diagnostic evaluation is useful in discriminating between primary snoring and OSAS, the gold standard being polysomnography; 5) adenotonsillectomy is the first line of treatment for most children, and continuous positive airway pressure is an option for those who are not candidates for surgery or do not respond to surgery; 6) high-risk patients should be monitored as inpatients postoperatively; 7) patients should be reevaluated postoperatively to determine whether additional treatment is required. This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OSAS. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decision-making. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.

Littner M, Hirshkowitz M, Davila D, Anderson WM, Kushida CA, Woodson BT, Johnson SF, Merrill SW, Anonymous00004. · VA Greater Los Angeles Healthcare System, and UCLA School of Medicine, Sepulveda, CA, USA. · Sleep. · Pubmed #11902424 No free full text.

Abstract: Continuous positive airway pressure (CPAP) is used to treat patients with the obstructive sleep apnea syndrome (OSAS). The current standard is for an attendant technician to titrate CPAP during full polysomnography to obtain a fixed single pressure. The patient uses CPAP nightly at this fixed single pressure. Recently, devices using new technology that automatically titrate positive airway pressure (APAP) have become available. Such devices continually adjust pressure, as needed, to maintain airway patency (APAP titration). These adjustments can be made with or without attendant technician intervention. Data obtained during APAP titration can be used to provide a fixed single pressure for subsequent treatment. Alternatively, APAP devices can be used in self-adjusting mode for treatment (APAP treatment). A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guide to the appropriate use of APAP. Recommendations are as follows: 1) A diagnosis of OSAS must be established by an acceptable method. 2) APAP titration and APAP treatment are not currently recommended for patients with congestive heart failure, significant lung disease (e.g., chronic obstructive pulmonary disease), daytime hypoxemia and respiratory failure from any cause, or prominent nocturnal desaturation other than from OSA (e.g., obesity hypoventilation syndrome). In addition, patients who do not snore (either due to palate surgery or naturally) should not be titrated with an APAP device that relies on vibration or sound in the device's algorithm. 3) APAP devices are not currently recommended for split-night studies since none of the reviewed research studies examined this issue. 4) Certain APAP devices may be used during attended titration to identify by polysomnography a single pressure for use with standard CPAP for treatment of OSA. 5) Once an initial successful attended CPAP or APAP titration has been determined by polysomnography, certain APAP devices may be used in the self-adjusting mode for unattended treatment of patients with OSA. 6) Use of unattended APAP to either initially determine pressures for fixed CPAP or for self-adjusting APAP treatment in CPAP naïve patients is not currently established. 7) Patients being treated with fixed CPAP on the basis of APAP titration or being treated with APAP must be followed to determine treatment effectiveness and safety, and 8) a re-evaluation and, if necessary, a standard attended CPAP titration should be performed if symptoms do not resolve or the CPAP or APAP treatment otherwise appears to lack efficacy.

Hein H, Raschke F, Köhler D, Mayer G, Peter JH, Rühle KH, Anonymous00003, Anonymous00004. · Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Grosshansdorf. · Pneumologie. · Pubmed #11481581 No free full text.

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Littner M, Kushida CA, Hartse K, Anderson WM, Davila D, Johnson SF, Wise MS, Hirshkowitz M, Woodson BT. · VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA. · Sleep. · Pubmed #11480657 No free full text.

Abstract: Laser-assisted uvulopalatoplasty (LAUP) is an outpatient surgical procedure which is in use as a treatment for snoring. LAUP also has been used as a treatment for sleep-related breathing disorders, including obstructive sleep apnea. The Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature, and developed these practice parameters as a guide to the appropriate use of this surgery. Adequate controlled studies on the LAUP procedure for sleep-related breathing disorders were not found in peer-reviewed journals. This is consistent with findings in the original practice parameters on LAUP published in 1994. The following recommendations are based on the review of the literature: LAUP is not recommended for treatment of sleep-related breathing disorders. However, it does appear to be comparable to uvulopalatopharyngoplasty (UPPP) for treatment of snoring. Individuals who are candidates for LAUP as a treatment for snoring should undergo a polysomnographic or cardiorespiratory evaluation for sleep-related breathing disorders prior to LAUP and periodic postoperative evaluations for the development of same. Patients should be informed of the best available information of the risks, benefits, and complications of the procedure.

Estopá Miró R, Villasante Fernández-Montes C, de Lucas Ramos P, Ponce De León Martínez L, Mosteiro Añón M, Masa Jiménez J, Servera Pieras E, Quiroga J. · Grupo de Trabajo de la Ventilación Mecánica a Domicilio, Barcelona, Spain. · Arch Bronconeumol. · Pubmed #11333540 links to  free full text

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Anonymous60422. · No affiliation provided · Conn Med. · Pubmed #10984971 No free full text.

Abstract: Obstructive sleep apnea is a state-dependent syndrome. It is characterized by repeated collapse of the upper airway as the result of the loss of waking neuromuscular drive as the brain changes from wakefulness to sleep. This produces a state-dependent decrease in muscle tone, which, together with other predisposing factors such as obesity and anatomical narrowing of the upper airway, results in the spectrum of sleep disordered breathing. Sleep-disordered breathing describes the continuum from simple snoring (pharyngeal vibration), to flow limitation (hypopnea), to complete cessation of breathing (apnea). Obstructive sleep apnea (OSA) is the common description of what is now appreciated as the sleep apnea/hypopnea syndrome. The cardinal symptoms are snoring, observed apneas, and excessive daytime sleepiness. The immediate physical consequences are hypoxia, repeated sympathetic discharges, increased cardiac load, and repeated brain arousals. The repetitive arousals are required to restore airway patency, resulting in severely fragmented sleep and consequent sleep deprivation. The syndrome, untreated, produces significant cognitive and cardiorespiratory morbidity, and potential mortality. Compared to matched controls, patients with undiagnosed sleep apnea use twice the health resources and spend double the health-care dollars in the 10 years prior to diagnosis. Both trends are reversed by successful treatment. It is by definition a sleep-related illness and can be observed and evaluated only when the patient is asleep. Polysomnography is the laboratory procedure to study sleep and its protean dysfunctions. Multiple physiologic parameters are required to document the various types of sleep disorders as well as to establish the origin of pathologic sleep fragmentation. Complete polysomnography includes (but is not limited to) electroencephalogram (EEG), electrooculogram ((EOG), electromyogram (EMG), electrocardiogram (ECG), respiratory effort, air flow, and oxygen saturation. Treatment options for obstructive sleep apnea include continuous positive airway pressure (CPAP), oral appliances, uvulopalatal and/or maxillomandibular surgery, positional control, and weight loss. The efficacy of each depends on the individual anatomy and the severity of the sleep-disordered breathing. CPAP is accepted as the most reliable treatment regardless of anatomy and severity. It is currently the only treatment modality which can be titrated during sleep and requires simultaneous polysomnography.

Roche N, Morel H, Maissonneuve H, Thoral F, Charvet-Protat S. · No affiliation provided · Rev Pneumol Clin. · Pubmed #10740116 No free full text.

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Chesson A, Hartse K, Anderson WM, Davila D, Johnson S, Littner M, Wise M, Rafecas J. · Neurology Department, Louisiana State University Medical Center, Shreveport, USA. · Sleep. · Pubmed #10737341 No free full text.

Abstract: Chronic insomnia is the most common sleep complaint which health care practitioners must confront. Most insomnia patients are not, however, seen by sleep physicians but rather by a variety of primary care physicians. There is little agreement concerning methods for effective assessment and subsequent differential diagnosis of this pervasive problem. The most common basis for diagnosis and subsequent treatment has been the practitioner's clinical impression from an unstructured interview. No systematic, evidence-based guidelines for diagnosis exist for chronic insomnia. This practice parameter paper presents recommendations for the evaluation of chronic insomnia based on the evidence in the accompanying review paper. We recommend use of these parameters by the sleep community, but even more importantly, hope the large number of primary care physicians providing this care can benefit from their use. Conclusions reached in these practice parameters include the following recommendations for the evaluation of chronic insomnia. Since the complaint of insomnia is so widespread and since patients may overlook the impact of poor sleep quality on daily functioning, the health care practitioner should screen for a history of sleep difficulty. This evaluation should include a sleep history focused on common sleep disorders to identify primary and secondary insomnias. Polysomnography, and the Multiple Sleep Latency Test (MSLT) should not be routinely used to screen or diagnose patients with insomnia complaints. However, the complaint of insomnia does not preclude the appropriate use of these tests for diagnosis of specific sleep disorders such as obstructive sleep apnea, periodic limb movement disorder, and narcolepsy that may be present in patients with insomnia. There is insufficient evidence to suggest whether portable sleep studies, actigraphy, or other alternative assessment measures including static charge beds are effective in the evaluation of insomnia complaints. Instruments such as sleep logs, self-administered questionnaires, symptom checklist, or psychological screening tests may be of benefit to discriminate insomnia patients from normals, but these instruments have not been shown to differentiate subtypes of insomnia complaints.

Anonymous54502. · No affiliation provided · Am J Respir Crit Care Med. · Pubmed #10390427 links to  free full text

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Logan A. · No affiliation provided · Am J Respir Crit Care Med. · Pubmed #19498064 No free full text.

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Steele CM. · No affiliation provided · Am J Respir Crit Care Med. · Pubmed #19423718 No free full text.

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Kakkar RK, Berry RB. · No affiliation provided · Chest. · Pubmed #19420188 No free full text.

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Boccara F, Meuleman C. · No affiliation provided · Arch Cardiovasc Dis. · Pubmed #19375667 No free full text.

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Tsivgoulis G, Alexandrov AV. · No affiliation provided · Eur J Neurol. · Pubmed #19364358 No free full text.

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Rubin LJ. · No affiliation provided · J Am Coll Cardiol. · Pubmed #19358947 No free full text.

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Farré R. · No affiliation provided · Arch Bronconeumol. · Pubmed #19286110 links to  free full text

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Riha RL, McNicholas WT. · No affiliation provided · Eur Respir J. · Pubmed #19181912 No free full text.

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Ladouceur R. · No affiliation provided · Can Fam Physician. · Pubmed #19155352 links to  free full text

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Lavie L. · No affiliation provided · Exp Physiol. · Pubmed #19144748 No free full text.

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Hrubos-Strøm H, Hilde Nordhus I. · No affiliation provided · Patient Educ Couns. · Pubmed #19138632 No free full text.

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Clerisme-Beaty E, Rand CS. · No affiliation provided · J Allergy Clin Immunol. · Pubmed #19130929 No free full text.

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Weaver JM. · No affiliation provided · Anesth Prog. · Pubmed #19108593 links to  free full text

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Lavie P. · No affiliation provided · J Sleep Res. · Pubmed #19090951 No free full text.

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