Presentation
Most often, the disorder will have been present for years by the time it is diagnosed. [sleep.health.am]
It is also possible that some patients will present both RDB and OSA. The aim of the present study was to review all articles that reported on pseudo RDB. [sleepscience.org.br]
Table 2 Comparison of PSG parameters between the two groups Note: Data are presented as mean±SD, or n (%). [dovepress.com]
Nocturnal hypoventilation seems to be present in more than 29 percent of severe obese population. [smjournals.com]
In the illustrative case, the patient presented with depression without psychotic features. Sleep history was not obtained until the second visit, which delayed treatment of OSA. [healio.com]
Entire Body System
- Falling
Talk to your doctor if your child: snores regularly is a restless sleeper falls asleep during the day has other signs of sleep apnea Your doctor might refer you to a sleep specialist or recommend a sleep study. [kidshealth.org]
There are 10 Sleep Disorders: Insomnia Disorder - having trouble falling asleep, staying asleep, or going back to sleep after waking up. [gulfbend.org]
Symptoms of a sleep disorder may include: excessive snoring, witnessed pauses in breathing while sleeping, excessive daytime sleepiness or fatigue, falling asleep easily during the day, problems falling asleep or staying asleep, morning headaches or sore [columbushosp.org]
Excessive sleepiness during the day causes a reduction in quality of life, decreased ability to drive safely, decline in intellect, and can be an antecedent to falls in the elderly. [qvh.nhs.uk]
DEFINITION The breathing-related sleep disorders comprise breathing anomalies characterized by: Chronic or habitual snoring and upper airway resistance Hypoventilation, often in the context of a medical condition Breathing-related sleep disorders fall [hopkinsguides.com]
- Collapse
This can cause an obstruction in the airway if there is collapse of tissue in the back of the throat. This collapse can lead to a pause in breathing, also called apnea, which is usually temporary. [n.neurology.org]
[…] an intermittent collapse of the airway during sleep. [healio.com]
Upper airway collapsibility is greater in males than in females. Some reports support that upper airway resistance during sleep is higher in males than in females [16,17]. [smjournals.com]
The maneuver is performed as an attempt to simulate the pharyngeal collapse that may be occurring during sleep. [emedicine.medscape.com]
- Pain
Sleep loss and pain coexist in a vicious circle: sleep loss lowers pain threshold and pain disrupts sleep. Sedative hypnotics to promote sleep and opioid analgesics reduce respiratory drive, raise arousal threshold, and generally worsen SDB. [psychiatrictimes.com]
The use of some narcotic pain relievers may increase the risk of central sleep apnea. Narcotic pain relievers work by binding to brain receptors, and may influence the brain’s signaling process. [tuck.com]
In pregnancy, aches and pains, leg cramps, hormonal changes and emotional stress can all increase the risk of developing insomnia. [sleepio.com]
The test is not painful and is generally performed in a sleep laboratory or hospital. Sleep tests occasionally produce inaccurate results, especially in children. [enthealth.org]
CSA is usually associated with an underlying medical condition, such as a stroke or heart failure, recent ascent to high altitude, or the use of pain relief medication. [medicalnewstoday.com]
- Weight Gain
Causes include weight gain, the changed position of the diaphragm and fluid accumulation in the breathing passages due to hormonal changes. [sleepio.com]
Obesity and weight gain are major contributing factors to obstructive sleep apnea. In some reports, weight loss has shown to be an important step in the treatment of sleep apnea. [emedicinehealth.com]
Risk factors Risk factors for sleep apnea include: supine (flat on back) sleeping obesity chronic sinusitis large neck circumference recent weight gain menopause large tonsils or adenoids Down syndrome smoking family history of sleep apnea recessed chin [medicalnewstoday.com]
gain, and chronic mouth breathing. [sleepapnea.org]
There is a relationship between body weight change and Apnea-Hypopnea Index (AHI): a 10% weight gain has been shown to predict an approximate 32% increase in the AHI; a 10% weight loss predicted a 26% decrease in the AHI, and a 10% increase in weight [smjournals.com]
- Surgical Procedure
Another surgical procedure that is sometimes conducted on very obese patients with obstructive sleep apnea is a tracheostomy, or an artificial opening made in the windpipe. [encyclopedia.com]
Another surgical procedure that is sometimes done in very obese patients with obstructive sleep apnea is a tracheostomy, or an artificial opening made in the windpipe. [minddisorders.com]
Surgery: There are various surgical procedures for OSA that can widen the airway. Surgery can be used to stiffen or shrink obstructing tissue, or remove excess tissue, or enlarged tonsils. [medicalnewstoday.com]
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. [emedicine.medscape.com]
Several surgical procedures ( sleep surgery ) are used to treat sleep apnea, although they are normally a third line of treatment for those who reject or are not helped by CPAP treatment or dental appliances. [55] Surgical treatment for obstructive sleep [en.wikipedia.org]
Respiratoric
- Pharyngitis
The relationship of the tongue, palate, and posterior pharyngeal wall can cause posterior pharyngeal crowding and predisposition to OSA. [emedicine.medscape.com]
It is characterized by obstruction of the upper airways due to the collapse of the pharyngeal muscles. OSA results in multiple episodes of interrupted breathing ( apnea and hypopnea ) during sleep, leading to alveolar hypoventilation. [amboss.com]
They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system–acting signaling proteins (adipokines) that may affect airway neuromuscular control. [smjournals.com]
Drug-induced sleep endoscopy in children with persistent SDB may demonstrate laryngomalacia, adenoidal tissue regrowth, tongue base obstruction and pharyngeal collapse (class III and IV) [ 69, 263 – 265 ]. [erj.ersjournals.com]
Some common reasons include: a deviated nasal septum, nasal congestion, narrow airway passages, enlarged tonsils, weak pharyngeal muscles, lowered vocal tone (may be related to medications or alcohol), vocal cord injury, facial trauma leading to distorted [emedicinehealth.com]
- Abnormal Breathing
This causes abnormal breathing during sleep that can lead to drops in oxygen levels. Patients with SDB performed worse on cognitive tests. The authors of the study used these results to suggest that SDB can be a warning sign for future dementia. [n.neurology.org]
Photo by: russelllinton Definition Breathing-related sleep disorder is marked by sleep disruption caused by abnormal breathing during sleep. [minddisorders.com]
People who have obstructive sleep apnea and are not overweight often have breathing passages that are narrowed by swollen tonsils, abnormally large adenoids, or other abnormalities of the various structures of the mouth and throat. [encyclopedia.com]
Abnormal respiratory events during sleep in Breathing-Related Sleep Disorder include apneas (episodes of breathing cessation), hypopneas (abnormally slow or shallow respiration), and hypoventilation (abnormal blood oxygen and carbon dioxide levels). [sleep.health.am]
- Respiratory Disorders
The centre diagnoses and treats all aspects of adult sleep medicine, but respiratory disorders during sleep constitute the largest part of the workload. [qvh.nhs.uk]
Gastrointestinal
- Failure to Thrive
Children with Breathing-Related Sleep Disorder may have failure to thrive, developmental delay, learning difficulties, poor attention, and hyperactive behavior. [sleep.health.am]
High-risk children, including those with obesity or failure to thrive, young age, severe apnea, craniofacial anomalies, or neuromuscular or cardiac disease should be monitored as inpatients. [emedicine.medscape.com]
OSA may lead to cor pulmonale, pulmonary hypertension, right-side heart failure, growth retardation, and failure to thrive. The treatment of primary insomnia often is difficult. Associated anxiety is often responsive to psychotherapy. [sleepapnea.org]
Cardiovascular
- Hypertension
Many patients with OSA ( > 50% ) are affected by secondary hypertension. The cardiovascular consequences of secondary hypertension reduce life expectancy. [amboss.com]
Patients with hypertension have an increased incidence of OSA (ie, up to 30% [10] ), and questions about sleep should be included in the workup of patients with hypertension. [emedicine.medscape.com]
BW, birth weight; APGAR, APGAR score; PTB, preterm birth; GDM, gestational diabetes mellitus; PIH, pregnancy-induced hypertension; PEC, preeclampsia. [frontiersin.org]
OSA is a risk factor for cardiovascular disease, hypertension, atrial fibrillation, and cognitive problems. [healio.com]
Left untreated, the disorders can lead to hypertension, stroke and cognitive deterioration. They can also affect a person’s daily routine and disrupt his or her familial, social and professional life. [news.stanford.edu]
- Heart Disease
If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat. Type 2 diabetes. [mayoclinic.org]
Sleep apnea is often linked to heart disease and metabolic issues like diabetes. What are the signs of sleep apnea? There are two kinds of sleep apnea : obstructive sleep apnea and central sleep apnea. [hopkinsmedicine.org]
If overweight and obese people lose weight, it would make both sleep apnea and other health problems [such as heart disease] go away. Losing just 10% of body weight can have a big effect on sleep apnea symptoms. [health.harvard.edu]
Some of these complications may include: high blood pressure ( hypertension ), ischemic heart disease (poor blood flow to the heart), heart attack, heart failure, irregular heart rate, pulmonary hypertension (elevation of blood pressure in blood vessels [emedicinehealth.com]
Jaw & Teeth
- Mouth Breathing
Symptoms in children may not be as obvious and include: Poor school performance Sluggishness or sleepiness, often misinterpreted as laziness in the classroom Daytime mouth breathing and swallowing difficulty Inward movement of the ribcage when inhaling [my.clevelandclinic.org]
Daytime mouth breathing, difficulty in swallowing, and poor speech articulation are also common features in children. [sleep.health.am]
Summary Frequent loud snoring, witnessed apnoeas, restless sleep and mouth breathing are associated with the presence of obstructive SDB. [erj.ersjournals.com]
[…] dry mouth/throat, night-time bed wetting, early morning thirst, feelings of grogginess or fatigue upon awakening, history of chronic ear infections, recent weight gain, and chronic mouth breathing. [sleepapnea.org]
In children younger than 5, other symptoms include: Mouth breathing. Sweating. Restlessness. Waking up a lot. In children 5 years and older, other symptoms include: Bedwetting. Doing poorly in school. [healthlinkbc.ca]
- Macroglossia
Craniodentofacial examination In addition to the features described above (eg, retrognathia, micrognathia, macroglossia), mandibular alignment, dental occlusion, and cephalometric data are often helpful. [emedicine.medscape.com]
Certain medical conditions such as Prader-Willi syndrome or trisomy 21 (Down syndrome) increase the risk for OSA because of midline deformities such as macroglossia, micrognathia, midface hypoplasia. [sleepapnea.org]
Children with Down syndrome are predisposed to OSAS and hypoventilation due to midfacial and mandibular hypoplasia, shortened palate, relative macroglossia, narrow lumen of the nasopharynx and pharyngeal hypotonia, although parents may not report SDB [erj.ersjournals.com]
Musculoskeletal
- Muscle Hypotonia
Orofacial muscular training is used to: prevent tongue and orofacial muscles hypotonia; encourage their appropriate position during wakefulness and sleep; re-establish nasal breathing; and eliminate mouth-breathing and pharyngeal airway obstruction [ [erj.ersjournals.com]
Skin
- Sweating
[…] nighttime awakenings Sudden awakenings with a sensation of gasping or choking Dry mouth or sore throat upon awakening Cognitive impairment, such as trouble concentrating, forgetfulness, or irritability Mood disturbances ( depression or anxiety ) Night sweats [my.clevelandclinic.org]
[…] sleep Abrupt awakenings accompanied by gasping or choking Awakening with a dry mouth or sore throat Morning headache Difficulty concentrating during the day Experiencing mood changes, such as depression or irritability High blood pressure Nighttime sweating [mayoclinic.org]
Sweating and chest pain while you are sleeping. Symptoms others may notice include: Episodes of not breathing (apnea), which may occur as few as 5 times an hour (mild apnea) to 30 or more times an hour (severe apnea). [healthlinkbc.ca]
Other nocturnal symptoms can include restlessness, nocturia, excessive salivation and sweating, gastroesophageal reflux, as well as headache, and dry mouth, or dry throat in the morning, on awakening. [scielo.br]
Psychiatrical
- Distractibility
In a second systematic review, low quality evidence on the application of midface distraction osteogenesis for midface hypoplasia/retrusion was summarised [ 248 ]. [erj.ersjournals.com]
Now their sleep is disrupted by TV, computer games, texting, and other digital distractions. Sleep deprivation is often the primary cause now of inattention, school failure, poor peer relations, and obesity. [sleepapnea.org]
Neurologic
- Irritability
The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely. [mayoclinic.org]
Ask your doctor about soft pads to reduce skin irritation, nasal pillows for nose discomfort, and chinstraps to keep your mouth closed and reduce throat irritation. [helpguide.org]
Morning headache Slight disorientation Irritability Memory lapses Personality changes If left untreated, the symptoms and effects of OSA can affect job performance, daytime function, sense of well-being and personal relationships. [nhpulmonaryandcriticalcare.org]
You may be a candidate for a sleep study if you experience any of these signs of sleep apnea • Snoring • Daytime sleepiness • Feeling tired when you wake in the morning • Morning headaches • High blood pressure • Irritability, fatigue, or difficulty concentrating [chimercyhealth.com]
- Difficulty Concentrating
They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. They may also be at higher risk of work-related accidents. [mayoclinic.org]
You may be a candidate for a sleep study if you experience any of these signs of sleep apnea • Snoring • Daytime sleepiness • Feeling tired when you wake in the morning • Morning headaches • High blood pressure • Irritability, fatigue, or difficulty concentrating [chimercyhealth.com]
Sleep apnea is a common problem associated with decreased overall health and a higher risk of life-threatening complications, such as motor vehicle accidents, difficulty concentrating, depression, heart attack, and stroke. [medicalnewstoday.com]
- Behavior Problem
If your child meets the criteria for sleep apnea and exhibits signs of hyperactivity or behavioral problems, talk to your doctor about getting a sleep study. [healthline.com]
Untreated obstructive sleep apnea can lead to learning, behavior, growth, and heart problems. What Causes Obstructive Sleep Apnea? When we sleep, our muscles relax. This includes the muscles in the back of the throat that help keep the airway open. [kidshealth.org]
Children and adolescents with sleep apnea might perform poorly in school or have behavior problems. High blood pressure or heart problems. [mayoclinic.org]
The consequences of untreated sleep problems may include significant emotional, behavioral, and cognitive dysfunction. [sleepapnea.org]
Workup
Patients with hypertension have an increased incidence of OSA (ie, up to 30% [10] ), and questions about sleep should be included in the workup of patients with hypertension. [emedicine.medscape.com]
Serum
- Hypercapnia
While OSA can exist with or without hypercapnia, hypercapnia in obesity patients is a defining feature of OHS. [smjournals.com]
References: [5] [3] Pathophysiology Obstruction of the upper airways → apnea → ↓ partial pressure of oxygen in arterial blood (PaO 2 ), ↑ partial pressure of carbon dioxide in arterial blood ( PaCO 2, also known as hypercapnia ) → ↑ Hypoxic pulmonary [amboss.com]
[…] these conditions of hypoxia and hypercapnia will trigger additional effects on the body. [en.wikipedia.org]
Polysomnographic findings in children differ from those in adults in that most children demonstrate labored breathing, partial obstructive hypoventilation with cyclical desaturations, hypercapnia, paradoxical movements, and snoring. [sleep.health.am]
Notably hypnotics prescribed to treat depression-related insomnia might further decrease the muscle tone in the already functionally impaired upper airway dilatator muscles, blunt the arousal response to hypoxia and hypercapnia as well as increase the [annals-general-psychiatry.biomedcentral.com]
Colonoscopy
- Polyps
[…] neck ”) Structural abnormalities that impair respiratory flow : tonsillar hyperplasia, nasal septum deviation, previous upper airway surgery, enlarged uvula, tongue, or soft palate, overbite with a small chin ;, hypertrophied pharyngeal muscles, nasal polyps [amboss.com]
[…] identified it to be an independent risk factor of OSA in adults. [12] Nasal examination The nasal examination is critical in identifying potential anatomic sites of obstruction, such as a deviated septum, enlarged adenoids, swollen nasal turbinates, polyps [emedicine.medscape.com]
If nasal polyps or other nasal/oral obstruction is suspected, a consultation with an ENT may be needed. [sleepapnea.org]
Treatment
[…] involved for successful treatment outcome and higher patient satisfaction. [fdiworlddental.org]
For this reason, many people have the disorder for years before seeking treatment. For many, symptoms worsen during middle age, causing people to seek treatment at that point. [minddisorders.com]
CPAP and avoidance of opiate medication are considered first-line treatment for OSA and CSA. References Gooneratne NS, Vitiello MV. Sleep in older adults: normative changes, sleep disorders, and treatment options. [healio.com]
With limited exceptions, such treatments are not effective options. [emedicine.medscape.com]
Prognosis
Definition Description Causes and symptoms Demographics Diagnosis Treatments Prognosis Prevention Resources Definition Breathing-related sleep disorder is marked by sleep disruption from abnormal breathing during sleep. [encyclopedia.com]
Prognosis Breathing-related sleep disorder often has a gradual long-term progression and a chronic course. For this reason, many people have the disorder for years before seeking treatment. [minddisorders.com]
Prognosis Learning difficulties, emotional lability, attention deficits, disruptive behaviors, social and school impairments, family dysfunction, low self-esteem, depression, anxiety, cognitive dysfunction hyperactivity, irritability, and memory impairment [sleepapnea.org]
Etiology
Etiology Obstruction of the upper airways due to the collapse of the pharyngeal muscles during sleep Risk factors Obesity, especially around the neck (short, wide “ bull neck ”) Structural abnormalities that impair respiratory flow : tonsillar hyperplasia [amboss.com]
In case of unsuccessful treatment, all etiological and diagnostic factors should be carefully re-evaluated and the appliance should be re-adjusted. [fdiworlddental.org]
In this case, however, the etiology is well documented and the problem diminishes or disappears when the sleep-disordered breathing is treated. Various questionnaires are available to help identify persons at high risk for SDB. [psychiatrictimes.com]
It is known that it is difficult to determine the etiology of neuropsychological symptoms, and the DSM-IV 1 diagnosis of depression requires that five symptoms, which may include both psychological and somatic symptoms, be present, simultaneously and [scielo.br]
[…] 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 Etiology [emedicine.medscape.com]
Epidemiology
References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
This population-based epidemiological study assesses SRBD as a longitudinal predictor of depression. [jamanetwork.com]
Sleep-related injury in the elderly--an epidemiological study in Hong Kong. Sleep. 2000;23(4):513-7. PMid:10875558 4. Ohayon MM, Caulet M, Priest RG. Violent behavior during sleep. [sleepscience.org.br]
"Epidemiology of Obstructive Sleep Apnea: a Population-based Perspective". Expert Review of Respiratory Medicine. 2 (3): 349–364. doi : 10.1586/17476348.2.3.349. PMC 2727690. [en.wikipedia.org]
Epidemiology Surveys report that 20–25% of youths have some type of a sleep problem. [sleepapnea.org]
Pathophysiology
References: [5] [3] Pathophysiology Obstruction of the upper airways → apnea → ↓ partial pressure of oxygen in arterial blood (PaO 2 ), ↑ partial pressure of carbon dioxide in arterial blood ( PaCO 2, also known as hypercapnia ) → ↑ Hypoxic pulmonary [amboss.com]
BMI is a less significant risk factor in older adults. 9 This is an oversimplification of the pathophysiology of OSA, and there are many other factors involved. [healio.com]
Figure 2: Pathophysiology of obesity related sleep disorders. The mechanisms by which OSA may induce hypercapnia are not well understood. [smjournals.com]
The identification of pathophysiological features that allow distinction between OSA and depression might assist with such diagnostic issues. [annals-general-psychiatry.biomedcentral.com]
Clinical spectrum of sleep-disordered breathing Pathophysiology SDB includes a wide spectrum of disorders that manifest as compromised breathing during sleep ( Table 1 ). [psychiatrictimes.com]
Prevention
Policy FDI recommends: universities and national dental associations to provide students and dentists with basic knowledge regarding the important role of dentistry in preventing and treating SRBD, in particular early detection in children and prevention [fdiworlddental.org]
Prevention Because overweight people are more likely to develop the more common obstructive sleep apnea type of breathing-related sleep disorder, a good preventive measure is effective weight management. [encyclopedia.com]
Sleep Apnea Prevention Prevention of sleep apnea syndromes may be limited to preventive measures related to underlying medical conditions that contribute to sleep apnea. [emedicinehealth.com]
Research Partners Areas of Research Brain & Heart Clinical EEG & Neuroimaging Culture & Gender Forensic Mental Health Military Mental Health Mind, Brain Imaging & Neuroethics Mood Disorders Neuromodulation Schizophrenia Sleep & Mental Health Suicide Prevention [theroyal.ca]