The Crucial Role of Craniofacial Growth on Airway, Sleep, and the Temporomandibular Joint
Aruna Bakhru in Nutrition and Integrative Medicine, 2018
Sleep apnea is a condition marked by pauses in breathing during sleep. A pause, called an apnea, can last between 10 seconds to minutes. Pauses can occur 5 to 30 or more times per hour. Figure 8.6. shows an obstructed airway because of lax muscular tone of the pharyngeal airway as well as an edematous tongue and narrow palatal arch. Obstructive sleep apnea occurs when a physical barrier blocks or collapses the air passageway.Central sleep apnea occurs when the brain fails to send signals to muscles that control breathing.Complex or mixed sleep apnea is a combination of both obstructive and central sleep apnea.
Sleep apnoea in heart failure
ILEANA PIÑA, SIDNEY GOLDSTEIN, MARK E DUNLAP in The Year in Heart Failure, 2005
Sleep apnoea has long been recognized as being associated with heart failure. Indeed, in his original description of abnormal patterns of ventilation, John Cheyne 111 observed periods of hyperpnoea alternating with apnoea in a patient with probable alcoholic cardiomyopathy (CM). More recent has been the recognition that heart failure patients who demonstrate sleep apnoea carry a worse prognosis, and that the apnoea may actually contribute to worsening heart failure. For further reading, the reader is directed to these recent excellent reviews of sleep apnoea and heart failure: Bradley TD, Floras JS. Sleep apnoea and heart failure. Part I: obstructive sleep apnea. Circulation 2003; 107: 1671-8. Bradley TD, Floras JS. Sleep apnoea and heart failure. Part II: central sleep apnea. Circulation 2003; 107: 1822-6. Syndromes of sleep apnoea occur in approximately 50% of patients with heart failure. The prevalence is somewhat lower in women, a potential explanation of improved prognosis in female patients with heart failure compared to males. While syndromes of both central (CSA) and obstructive sleep apnoea (OSA) occur, CSA, often referred to as Cheynes- Stokes respiration CSA, is the most common manifestation of the apnoea syndromes seen in patients with heart failure. OSA also occurs, although less often than CSA. Heart failure patients in whom sleep apnoea should be considered are those with the typical symptoms of the syndrome, such as snoring, daytime somnolence, and excessive fatigue. Other patients in whom the diagnosis should be considered are those with nocturnal dyspnoea, persistent hypertension,
Troubled sleep and dreams
Frederick L. Coolidge, Ernest Hartmann in Dream Interpretation as a Psychotherapeutic Technique, 2018
The word apnea comes from Greek and means a lack of breathing. Sleep apnea occurs when people stop breathing or have trouble breathing while sleeping. In DSM-IV-TR sleep apnea is classified under the rubric ‘Breathing-Related Disorder’. By far the most common type of sleep apnea is obstructive sleep apnea. This type of apnea implies that something is blocking the trachea (windpipe). These obstructions tend to be more common in men (at a ratio of about 2:1 to 4:1) compared to women and seem to increase with age. The obstructions tend to be fatty tissue, relaxed throat muscles, tongue, tonsils, and other tissues. The more rare form of sleep apnea is central sleep apnea, and this form implies that the breathing problems are related to dysfunction in the central nervous system (CNS). Sleep apnea becomes a disorder when these periods of non-breathing, usually 10 to 30 seconds each, begin to disrupt sleep by waking a person up, or leave the person exhausted after a typical sleep period (e.g. 8 hours of sleep). As noted earlier, daytime sleepiness can have dire consequences when waking performance demands full alertness, e.g. driving a car.
Sleep apnea and atrial fibrillation: challenges in clinical and translational research
Published in Expert Review of Cardiovascular Therapy, 2022
Benedikt Linz, Julie Norup Hertel, Jeroen Hendriks, Arnela Saljic, Dobromir Dobrev, Mathias Baumert, Thomas Jespersen, Dominik Linz
Even though most AF patients suffer predominantly from obstructive sleep apnea (OSA) and single obstructive respiratory events are described to increase AF-susceptibility, central sleep apnea has also been associated with AF. The most common cause for central sleep apnea is congestive heart failure [31]. In heart failure patients, increased sensitivity of chemoreceptors, pulmonary congestion, and slowing in circulation may impair regulated respiratory control and predispose for central apneic events [32–34]. Additionally, a change in posture at night from upright to supine is associated with a prominent distribution of body fluid from the lower body part to the chest and neck area, also called rostral shift [35]. This is associated with an increase in neck volume, which increases the risk for upper airway collapsibility. Moreover, heart failure is associated with increased atrial volume and stretch and reduced repolarizing potassium currents, which might contribute to early or late afterdepolarizations, thus increasing AF-trigger formation [36].
Successful microvascular decompression surgery for dolichoectatic vertebral artery compression of medulla oblongata in a patient with hypersomnia disorder
Published in British Journal of Neurosurgery, 2023
Mohammad Ghorbani, Maziar Azar, Karan Bavand, Hamidreza Shojaei, Reza Mollahoseini
A 43 year old male presenting with hypersomnia from 7 years ago referred to our practice for more diagnostic and therapeutic interventions. His symptoms exacerbated with snoring, slurred speech and sleep apnea since 6 months which was affected his job as a driver. He had a past history of palatine surgery that was not helpful for him. On admission time, his physical examinations seemed normal. Early diagnostic evaluation was done with polysomnography and revealed a central sleep apnea. Therefore a brain MRI was requested and showed a vertebrobasilar dolichoectatasia (Figure 1). Also a spiral brain CT angiography was performed and confirmed that an abnormal vascular loop has kinked the brainstem. After ruling out of other causes and considering disable condition of the patient, consultation with him and his family was done and then the authors decided to do microvascular decompression surgery for him.
Diagnosis and management of central sleep apnea syndrome
Published in Expert Review of Respiratory Medicine, 2019
Sébastien Baillieul, Bruno Revol, Ingrid Jullian-Desayes, Marie Joyeux-Faure, Renaud Tamisier, Jean-Louis Pépin
As mentioned by Randerath et al. in their recent task force report, idiopathic central sleep apnea is rare and of unknown prevalence and origin [1], occurring in patients without any underlying cardiac or neurological disease [9]. Described as an hypocapnic CSA, the episodes of CSB are approximatively 30–40 seconds long, mainly driven by an elevated chemosensitivity to PaCO2 (high-loop gain per se) [9]. Arousals, occurring in a characteristic manner at the peak of hyperventilation, contribute to the increase in ventilation, perpetrating cyclical breathing patterns through enhanced chemo-responsiveness [9]. Controlling PaCO2 levels, as well as reducing the arousal index are two potential therapeutic targets. Thus, added dead space, by elevating CO2 levels, or CO2 inhalation have been proposed as treatment strategies for idiopathic CSA. Zolpidem and Acetazolamide have shown efficacy in reducing arousals and central apneas in this condition [9]. Sharing the same mechanisms, hyperventilation syndrome (HVS), a frequent behavioral condition, is associated with CSA [42]. Taking into account the underlying mechanisms, ASV may be indicated for symptomatic idiopathic CSA and HVS.
Related Knowledge Centers
- Action Potential
- Breathing
- Carbon Dioxide
- Chemoreceptor
- Exhalation
- Oxygen
- Respiration
- Sleep
- Oxygen Saturation
- Chiari Malformation