Obstructive sleep apnea syndrome

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PVT performance in sleepy individuals frequently shows the effects of time-on-task on lapse rates at any severity of experimental sleep deprivation (e.g., see Fig. 1). Sleep deprivation can markedly worsen this fatigue effect in PVT performance, regardless of whether the elevated sleep pressure is experimentally induced (5), or through sleep disorders such as the obstructive sleep apnea syndrome (32). Thus, cognitive performance becomes more variable with both time awake and time-on-task (44). 

Psychomotor vigilance task performance has also been shown to be sensitive to reduced behavioral alertness associated with obstructive sleep apnea syndrome (OSAS), and the efficacy of interventions for OSAS. Performance of patients with OSAS is impaired on tasks that rely on the ability to sustain attention (85,86). As a measure of behavioral alertness, PVT performance has been demonstrated to be a sensitive method for assessing the attentional capability of patients with OSAS (32,87,88). Kribbs and colleagues (89) found that PVT performance and sleepiness, measured by the MSLT, both reflected the benefits of CPAP use (reduction in respiratory events during sleep). Similarly, the PVT has been used to demonstrate the positive effects of modafinil (a wake-promoting compound) on the capacity to sustain attention in a group of OSAS patients (34). 

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Moreover, there is evidence for increased rates of ADHD symptoms in clinical populations of children with sleep disorders, including children with the obstructive sleep apnea syndrome (OSAS), periodic limb movements of sleep (PLMS), narcolepsy, and sleep-wake schedule disorders. Studies indicate that treating the primary sleep disorder can produce significant improvement in ADHD symptoms (103). 

Of the 88 sleep disorders listed in the International Classification of Sleep Disorders (12), the better-known and more prevalent disorders are the obstructive sleep apnea syndrome, insomnia, restless legs syndrome/periodic limb movement disorder, and narcolepsy (see also Chap. 5).These sleep disorders are common, and are known to interfere with the quality of sleep this chapter addresses the socioeconomic impact of these disorders. 

Obstructive sleep apnea syndrome (OSAS) has been well reported to affect 4% of middle-aged men, and 2% of women aged 30-60 years (15). This prevalence rate is similar to that of asthma (16). Recent literature suggests a higher prevalence rate among minority groups and the elderly (2,17-22). 

Mostly older data suggested daytime impairments similar to the obstructive sleep apnea syndrome. A Gallup poll in 1991 found subjects with insomnia complained more of lack of concentration, memory impairment, and difficulty enjoying family and social relationships compared to those without insomnia (59). The Gallup poll also found that 5% of insomniacs, compared to 2% without insomnia, reported a motor-vehicle crash related to fatigue at some time in their lives. Balter and Uhlenhuth in 1992 reported that insomniacs before treatment were more than four times as likely as controls to report a motor-vehicle accident or other serious accidents within the past year (60). 

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Akashiba T, Kawahara S, Akahoshi T, et al. Relationship between quality of life and mood or depression in patients with severe obstructive sleep apnea syndrome. Chest 2002 122(3) 861-865. 

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Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Rryger MH. Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep 1999 22(6) 740-747. 

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Finally, sleep disorders per se can have the same outcome on operator performance as sleep loss or alcohol intoxication. It does not make sense that commercial truck drivers must be screened for arterial hypertension but not for obstructive sleep apnea syndrome. The need for general screening of commercial and public operators for obstructive sleep apnea syndrome is highlighted by the fatal train accident in Clarkston, Michigan on November 15, 2001, in which the engineer s untreated and conductor s insufficiently treated sleep apnea were determined as the probable primary cause of the accident. 

Liu H, Kiu J, Xiong S, Sgen G, Zhang Z, Xu Y. The change in interleukin-6 and tumor necrosis factor in patients with obstructive sleep apnea syndrome. J Tongji Med Univ 2000 20 200-202. 

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Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, Hirano T, Adachi M (2003) Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. 

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Cochlear implants are a great achievement of modern medicine. They represent the most successful of all neural prostheses developed to date. Obstructive sleep apnea syndrome is a complex chronic clinical syndrome, characterized by snoring, periodic apnea, reduced blood oxygen during sleep, and daytime somnolence. It affects 4 to 5 percent of the general population and appears to be linked to genetic factors. 

Makino, S., Fujiwara, M., Suzukawa, K. et al. 2009. Visceral obesity is associated with the metabolic syndrome and elevated plasma retinol-binding protein-4 level in obstructive sleep apnea syndrome. Horm Metab Res 41 221-226. 

As already noted, apart from being induced by hypoxia, induction of HO-1 by agents that cause oxidative stress occurs in human skin fibroblasts (116), glial cells and astrocytes (117-119), the retina (120), and cultured retinoblastoma cells (121). The induction of HO-1 in response to oxidative stress is believed to have a protective role through the antioxidant properties of biliverdin and bilirubin. Of particular interest is the fact that in clinical conditions associated with chronic repeated episodes of hypoxia, such as obstructive sleep apnea syndrome (OSA), the episodic occurrence of hypoxia and reoxygenation provides for a potential scenario of not only hypoxia but also repetitive oxidative stress providing two stimuh for the induction of HO-1. 

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