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Control of the Upper Airway during Sleep
Published in Susmita Chowdhuri, M Safwan Badr, James A Rowley, Control of Breathing during Sleep, 2022
Motor innervation of upper airway muscles originates in the trigeminal, facial, glossopharyngeal, ambiguous, and hypoglossal (XII) cranial motor nuclei. The contribution of upper airway muscles to the maintenance of airway patency for breathing varies from accessory to essential depending on the physiologic and pathophysiologic conditions. The high prevalence of the obstructive apnea/hypopnea syndrome (OSA), and its association with major cardiovascular, metabolic and cognitive consequences, stimulate tremendous interest in the regulatory mechanisms that operate in association with OSA. The focus of this chapter is on those aspects of the regulation of upper airway muscle activity that help reduce excessive upper airway resistance.
Pulmonary Medicine
Published in James M. Rippe, Manual of Lifestyle Medicine, 2021
Nocturnal apneas are defined as a cessation of airflows during sleep. The term apnea specifically describes a cessation of airflow for ≥10 seconds. Hypopnea is a transient reduction in airflow that lasts ≥10 seconds and is associated with a ≥4% decrease in oxygen saturation. Frequent nocturnal apneas and hypopneas may result in hypoventilation. The diagnostic criteria for clinically significant obstructive sleep apnea is an average of greater than five apneas or hypopneas per hour of sleep. This is typically referred to as “Apnea-Hypopnea Index” (AHI). A sleep study must be performed to accurately measure AHI.
Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
There is an alternative definition, which defines a hypopnea as a drop in peak nasal pressure transducer airflow ≥ 50% of baseline, lasting at least 10 seconds, with ≥ 3% oxygen desaturation from the pre-event baseline, or an arousal, and at least 90% of the event's duration meeting the airflow amplitude reduction criteria (Figure 28.19). Which of the two definitions for hypopnea is used should be mentioned in the report of the polysomnogram.
Interaction between slow wave sleep and elevated office blood pressure in non-hypertensive obstructive sleep apnea patients: a cross-sectional study
Published in Blood Pressure, 2023
Ning Xia, Hao Wang, Lin Zhang, Xiao-Jun Fan, Xiu-Hong Nie
This is the first study to report the interaction between SWS and elevated office BP in non-hypertensive OSA patients. Moreover, use of a large sample increases generalizability in our study. However, there are still some limitations in our study. First, BP was measured only once per time point, and we cannot exclude the influence of white coat effects. Besides, we lack the 24-h ambulatory BP monitoring to describe BP changes accurately. Second, some patients included in our study were actually naïve-hypertensive in the non-hypertensive group according to the standard diagnostic criteria, which may produce the main bias of the result. Third, we also only measured SWS sleep using one night of PSG. It is possible that some individuals who had poorer sleep quality during PSG because they were sensitive to environmental changes. However, SWS sleep has been confirmed to have high night-to-night reproducibility [45]. Fourth, in our study, we used the alternative definition of hypopnea. Compared to use of the recommended hypopnea definition, the alternative definition added a modest increase to the percentage diagnosed with OSA [46]. This may increase the percentage of OSA diagnosis and severity. However, some studies also found the AHI based on ≥3% desaturation criterion had the some effect on predicting of adverse outcomes as an AHI based on ≥4% oxygen desaturation criterion [25,47]. Finally, our study is retrospective, which may lack some details affected BP. Further prospective study is needed to evaluate the interaction between SWS and BP in OSA patients.
Health-related impact of illness associated with excessive daytime sleepiness in patients with obstructive sleep apnea
Published in Postgraduate Medicine, 2023
Michael A. Grandner, Jae S. Min, Ragy Saad, Eileen B. Leary, Lev Eldemir, Danielle Hyman
A major predisposing factor for OSA is excess body weight. In fact, approximately 60% of moderate to severe cases of OSA can be attributed to obesity [2]. Consequently, weight loss is an important behavioral treatment strategy for the management of OSA. American Academy of Sleep Medicine (AASM) clinical guidelines for the treatment of OSA state that dietary weight loss may improve apnea hypopnea index in obese patients with OSA [10], and weight loss should be recommended for all overweight patients with OSA [11]. Additional behavioral therapies include exercise, positional therapy, and avoidance of alcohol and sedatives before bed [11]. Some of the consequences associated with EDS in OSA include impaired quality of life, cognitive functioning, work productivity, social interactions, relationship satisfaction, increased risk of motor vehicle and occupational accidents, and greater healthcare resource utilization [12–19]. However, there is limited evidence describing how EDS impacts patients’ health, behavioral choices, and lifestyle in the real world. Data on how EDS affects these outcomes may provide clinicians with insight into potential challenges that patients with EDS may face (eg, losing weight, getting adequate exercise, avoiding alcohol). Therefore, the aim of the current study was to evaluate how the presence of EDS affects the quality of life of patients with OSA and to characterize the burden of illness associated with EDS in patients with OSA who are adherent to CPAP (≥4 hours/night, ≥5nights/week for≥6 months).
Continuous positive airway pressure affects mitochondrial function and exhaled PGC1-α levels in obstructive sleep apnea
Published in Experimental Lung Research, 2021
Ching-Chi Lin, Wei-Ji Chen, Yi-Kun Sun, Chung-Hsin Chiu, Mei-Wei Lin, I-Shiang Tzeng
According to the American Academy of Sleep Medicine (AASM) scoring rules, respiration and related events are manually scored to evaluate them.18 In short, apnea is defined when the amplitude of the airflow during the apnea period is less than 10% of the baseline amplitude during evaluation by an oronasal thermal sensor. The amplitude standard for apnea is an event that lasts more than 10 s and meets the amplitude standard for more than 9 s. Hypopnea is defined as a reduction of ≥50% in one of the following three respiratory parameters: airflow signal (detected by nasal pressure sensor), or abdominal or chest breathing signal (detected by induction plethysmography) over 10 s, and oxygen desaturation ≥3% or arousal from sleep.18 More than 90% of the duration of the event must meet the amplitude criterion. The AHI is defined as the mean of the sum of hypopnea and apnea per hour of sleep. The desaturation event frequency was defined as the average number of episodes of oxygen desaturation per hour of sleep. The arousal index was defined as the average number of arousals per hour of sleep, and sleep efficiency was calculated as a percentage of the total sleep time divided by the total bed time.18 Obstructive sleep apnea with an AHI score ≥5 and AHI score ≥ 20 was defined as moderate and severe OSA, respectively.