Sleep apnea polysomnography

Chervin RD, Murman DL, Malow BA, Totten V. Cost-utility of three approaches to the diagnosis of sleep apnea polysomnography, home testing, and empirical therapy. Ann Intern Med 1999 130(6) 496-505. 

FIGURE 38-1. Primary assessment and initial treatment for complaint of excessive daytime sleepiness. RLS, restless-legs syndrome NPSG, nocturnal polysomnography OSA, obstructive sleep apnea DA, dopamine agonist MSLT, multiple sleep latency test BZDRA, benzodiazepine receptor agonist SNRI, serotonin and norepinephrine reuptake inhibitor TCA, tricyclic antidepressant CPAP, continuous positive airway pressure. 

In 10 stable patients maintained on methadone (50-120 mg/day) and nine healthy subjects assessed using polysomnography, the methadone-maintained patients had more abnormalities of sleep architecture, with a higher prevalence of central sleep apnea (23). Methadone depresses respiration, probably by acting on p opioid receptors in the ventral surface of the medulla and possibly on other receptor sites in the lung and spinal cord. All the patients taking methadone also used benzodiazepines and cannabis, which may have influenced the above findings. 

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