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Obesity
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Obstructive sleep apnoea is a disorder which features repetitive episodes of breathing cessation with complete or partial collapse of the upper airway during sleep62. Daytime sleepiness is a key symptom of obstructive sleep apnoea. A combination of the physiological changes in pregnancy such as capillary engorgement in the upper airway and the cardio-respiratory demands of obesity predisposes women with raised BMI to obstructive sleep apnoea. Complications of pregnancy linked to this condition include hypertension, gestational diabetes, stillbirth, fetal growth restriction, cardiomyopathy and increased risk of admission to the intensive care unit63.
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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Classically, obstructive sleep apnoea affects overweight, middle-aged men. It is often their partner that is most concerned, as they witness the apnoeic episodes. They often give a long history of snoring, but may complain of feeling increasingly tired, or falling asleep, during the day. Relaxation of the muscles responsible for maintaining the airway during sleep causes occlusion of the airway, resulting in apnoeic episodes. Each time this happens, the patient is woken from sleep due to hypoxia. This may happen hundreds of times per night, but occurs for such a short period of time they are unaware of it. The Epworth Sleepiness Scale is a questionnaire that helps determine the degree of sleepiness during the day, asking the likelihood that the patient would fall asleep in a number of everyday scenarios. Sleep studies are ultimately used to confirm the diagnosis, requiring evidence of at least 15 apnoeic/hypopnoeic episodes per hour of sleep. Simple management strategies include sleeping more upright, losing weight and avoiding alcohol/tobacco. If these fail, CPAP increases the pressure in the pharynx, helping to maintain the airway during sleep. This, however, is poorly tolerated in a number of patients.
Paediatric Obstructive Sleep Apnoea
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Obstructive sleep apnoea can be defined as ‘a disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction that disrupts ventilation during sleep and normal sleep patterns’.10Primary snoring is defined as noisy breathing (snoring) without obstructive apnoea, frequent arousals from sleep, or gas exchange abnormalities.10Sleep-disordered breathing is a term which can be used to describe both snoring and OSA.
Sex differences in the association between obesity and hypertension
Published in Archives of Physiology and Biochemistry, 2023
Anastasiya M. Kaneva, Evgeny R. Bojko
Hypertension is a chronic disease, the main clinical sign of which is a prolonged and persistent increase in blood pressure. Hypertension can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death. Obesity is one of the most important risk factors for the development of hypertension (Re 2009). Up to two-thirds of cases of hypertension are linked to excess weight (Haslam and James 2005, Fu 2019). There are several potential mechanisms linking obesity with hypertension. The major underlying mechanism linking obesity to hypertension is thought to be adipose tissue dysfunction, characterised by marked changes in secretion of adipokines and free fatty acids, resulting in the activation of the renin-angiotensin-aldosterone system, the development of insulin resistance and leptin resistance, increased procoagulatory activity and blood viscosity, sympathetic overdrive, inflammation and oxidative stress (Re 2009, Dorresteijn et al. 2012). Another mechanism includes an increase in blood volume associated with greater body mass (Haslam and James 2005). Finally, obstructive sleep apnoea may be an important mechanism linking obesity and hypertension in some individuals (Wolk et al. 2003).
The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea
Published in Annals of Medicine, 2022
Alonço Viana, Débora Estevão, Chen Zhao
Obstructive sleep apnoea (OSA) is characterized by the recurrence of respiratory disorder events associated with decreased oxygen saturation and awakenings during sleep, causing cardiovascular, occupational, and neurocognitive consequences and increasing morbidity and mortality [1]. In 1999, the American Academy of Sleep Medicine (AASM) defined criteria for determining disease diagnosis and severity using the apnoea-hypopnoea index (AHI) obtained on polysomnography (PSG). From this index, the prevalence in the adult population is quite variable: 9 to 38% for AHI ≥5 events/h, and 6 to 17% for AHI ≥15 events/h. Several phenotypic characteristics, such as male sex, obesity, increased age, cervical circumference and increased waist circumference, craniofacial deformities, and race, contribute to OSA. The treatments include continuous positive airway pressure (CPAP), oral appliance (OA), positional therapy, and surgery [2,3].
Feasibility of conducting type III home sleep apnoea test in children
Published in Acta Oto-Laryngologica, 2021
Tina Kissow Lildal, Jannik Buus Bertelsen, Therese Ovesen
Obstructive sleep apnoea (OSA) is characterized by recurrent events of partial or complete obstruction of the upper airways during sleep. This can lead to hypoxia and sleep fragmentation with detrimental effects on physical and psychological health. Polysomnography (PSG) is the gold standard for diagnosing OSA in children [1]. PSG measures respiratory events and sleep stages allowing objective assessment and quantification of arousals and impaired sleep due to the obstructive respiratory events [2]. However, due to expensive and labour-intensive procedures, PSGs are not accessible in most clinics treating paediatric OSA [3,4]. Therefore, diagnostics are often based solely on the clinical examination and on the medical history despite the low diagnostic validity of this approach [5]. To reduce the discrepancy between gold standard and clinical reality, an alternative objective assessment modality of respiratory events during sleep is highly warranted.