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Breathing-Related Sleep Disorder

Overview

The term breathing-related sleep disorder refers to a spectrum of breathing anomalies ranging from chronic or habitual snoring to upper airway resistance syndrome (UARS) to frank obstructive sleep apnea (OSA) or, in some cases, obesity hypoventilation syndrome (OHS). 

In adults, there is a male preponderance of OSA during middle age.
In women, menopause, pregnancy, and polycystic ovaries are associated with increased risk.
In children, prevalence ranges between 1 and 4 % with habitual snoring prevalence at about 7.45 %.
Consequences of untreated sleep apnea can be life altering and include both cardiovascular and neurobehavioral morbidities. In children, growth failure can also occur.

The aim of this article is to increase the reader’s awareness of the importance of sleep-disordered breathing in daily practice.

Treatment

General treatment measures for breathing-related sleep disorders include (1) behavior modification aimed at improving sleep hygiene and avoiding additional sleep deprivation, (2) avoidance of supine positioning during sleep, and (3) avoidance of ethanol and sedative medications.

Treatment can require major changes in lifestyle. Appropriate weight management strategies and compliance with either positive airway support or the use of a dental appliance usually represent a lifetime commitment. For this reason, some patients have explored surgical alternatives. (See the images below.)

Breathing-related sleep disorder. Lateral cross-se

Breathing-related sleep disorder. Lateral cross-section diagram of continuous positive airway pressure (CPAP) system. This system forces air (arrows) through to the lungs in obstructive sleep apnea (OSA) patients.

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Breathing-related sleep disorder. Before and after

Breathing-related sleep disorder. Before and after the use of a continuous positive airway pressure (CPAP) system. Note that airflow to the lungs is restored with CPAP.

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Surgical care

Surgical treatment options for breathing-related sleep disorders include (1) procedures designed to increase upper airway size, (2) procedures designed to bypass the upper airway, and (3) procedures that ensure weight loss. The latter 2 procedures have traditionally been reserved for the more severely affected and recalcitrant patients.

For patients with morbid obesity who are refractory to diet and drug therapy, bariatric surgery has been associated with effective weight loss and significant improvement in sleep-disordered breathing.

Differentials

Differentials to consider in the diagnosis of breathing-related sleep disorders include the following:

Depression

Gastroesophageal 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

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