Sleep disordered breathing

Monitor compliance with CPAP therapy. CPAP machines have a built-in compliance meter to measure the hours used at effective pressure. Patients should use CPAP therapy for at least 5 hours each night. In addition to alleviating sleep-disordered breathing, CPAP therapy may improve cardiovascular outcomes. 

Peppard P, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000 342 1378-1384. 

Continuous positive airway pressure Therapy delivered using a nasal mask to improve the patency of the upper airway by maintaining sufficient air pressure to alleviate sleep-disordered breathing. 

Apnea is repetitive episodes of cessation of breathing during sleep. The goals of therapy are to alleviate sleep disordered breathing (Fig. 72-1). 

Modafinil is approved by the FDA to improve wakefulness in those who have residual daytime sleepiness while treated with PAP. It should be used only after patients are using optimal PAP therapy to alleviate sleep-disordered breathing. 

Nieto FJ, Young TB, Link BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA 2000 283 1829-1836. 

Insomnia secondary to a general medical condition, especially with pain- or sleep-disordered breathing Circadian rhythm disturbance Periodic limb movement disorder Restless legs syndrome... 

Those with sleep-disordered breathing had worse RT performance than subjects with blood alcohol concentrations of 0.057% or greater. 

Powell NB, Riley RW, Schechtman KB, Blumen MB, Dinges DF, Guilleminault C. A comparative model reaction time performance in sleep-disordered breathing versus alcohol-impaired controls. Laryngoscope 1999 109 1648-1654. 

Guilleminault C, Palombini L, Poyares D, Chowdhury S. Chronic insomnia, post menopausal women and sleep disordered breathing (SDB). Part 1. Frequency of SDB in a cohort. J Psychosom Res 2002 53 611-615. 

Hypertension and obesity are common symptoms of both diabetes and sleep-disordered breathing the presence of these symptoms also represents an increased risk for cardiovascular disease. While a relationship between sleep-disordered breathing and cardiovascular disease has been well established, a link between diabetes and cardiovascular disease is less clear. It has been proposed that the cardiovascular autonomic neuropathy (CAN) common in diabetes may contribute to an increased risk for cardiovascular disease (155). 

Not all patients with diabetes also have CAN however, one quarter of diabetes patients with CAN also have OSAS, which has a significantly higher incidence than in diabetic patients without CAN (156). It is this correlation between sleep-disordered breathing and diabetic-associated CAN that suggests a link... 

Edwards N, Middleton PG, Blyton DM, Sullivan CE. Sleep disordered breathing and pregnancy. Thorax 2002 57 555-558. 

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993 328(17) 1230-1235. 

Ancoli-Israel S, Kripke DF, Klauber MR, et al. Morbidity, mortality and sleep-disordered breathing in community dwelling elderly. Sleep 1996 19(4) 277-282. 

Stoohs RA, Guilleminault C, Itoi A, Dement WC. Traffic accidents in commercial long-haul truck drivers the influence of sleep-disordered breathing and obesity. Sleep 1994 17(7) 619-623. 

Ulfberg J, Carter N, Edling C. Sleep-disordered breathing and occupational accidents. Scand J Work Environ Health 2000 26(3) 237-242. 

Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med 2000 160(15) 2289-2295. 

Kim HC, Young T, Matthews CG, Weber SM, Woodward AR, Palta M. Sleep-disordered breathing and neuropsychological deficits a population-based study. Am J Respir Crit Care Med 1997 156(6) 1813-1819. 

Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998 102(3 Pt l) 616-620. 

Baldwin CM, Griffith KA, Nieto FJ, O Connor GT, Walsleben JA, Redline S. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep 2001 24(1) 96-105. 

Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997 20 608-613. 

Stoohs RA, Bingham LA, Itoi A, Guilleminault C, Dement WC. Sleep and sleep-disordered breathing in commercial long-haul truck drivers. Chest 1995 107 1275-1282. 

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