Sleep-disordered breathing syndromes

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

The primary sleep disorders found in elderly that may lead to sleep disturbances are (1) circadian rhythm disturbances (CRD) (2) sleep disordered breathing (SDB) (3) insomnia and (4) restless legs syndrome and periodic limb movement disorder. 

In addition to the sleep disturbances that result from normal aging or brain disease, sleep quality may be impaired by primary sleep disorders, some of which occur with increasing prevalence with age. Sleep disordered breathing (sleep apnea), restless legs syndrome (RLS) and REM sleep behavior disorder (RBD) are three such primary sleep disorders that are more prevalent in older adults. 

OHS, previously called the Pickwickian syndrome (6), is defined as the association of obesity, sleep-disordered breathing (SDB) with daytime h)q)ersomnolence, and hypercapnia (Pacc>2 > 45 mmHg) in the absence of any other respiratory disease (Fig. 1). SDB can present as obstructive apneas and hypopneas, obstructive hypoventilation due to increased upper airway resistance, and/or central hypoventilation (7). The prevalence of OHS is 36% in patients with BMI between 35 and 40 kg/m, and 48%, if BMI equals or exceeds 50 (8). Without adequate treatment, patients with OHS develop cor pulmonale and recurrent episodes of hypercapnic respiratory failure, and loss of survival (Fig. 2). OHS is one of the many etiologies of CRF and has become a growing indication to initiate longterm noninvasive ventilation (NIV) in most European countries (9,10). 

American Academy of Sleep Medicine Task Force. Sleep related breathing disorders in adults recommendations for syndrome definition and measurements techniques in clinical research. Sleep 1999 22 667-689. 

Sleep apnea syndromes the absence of respiration during sleep (breathing related sleep disorder)... 

Side effects of benzodiazepines include sedation, dizziness, poor coordination, and, at higher doses, amnesia. Benzodiazepines also increase the effects of alcohol therefore, alcohol use should be avoided or markedly curtailed. Benzodiazepines can also exacerbate the breathing problems of patients with sleep apnea and other respiratory disorders such as emphysema. Like the barbiturates, long-term use of benzodiazepines can lead to physical dependence, and abrupt discontinuation can produce an unpleasant, or even dangerous, withdrawal syndrome. 

The respiratory system is responsible for generating and regulating the transpulmonary pressures needed to inflate and deflate the lung. Normal gas exchange between the lung and blood requires breathing patterns that ensure appropriate alveolar ventilation. Ventilatory disorders that alter alveolar ventilation are defined as hypoventilation or hyperventilation syndromes. Hyperventilation results in an increase in the partial pressure of arterial CO2 above normal limits and can lead to acidosis, pulmonary hypertension, congestive heart failure, headache, and disturbed sleep. Hypoventilation results in a decrease in the partial pressure of arterial CO2 below normal limits and can lead to alkalosis, syncope, epileptic attacks, reduced cardiac output, and muscle weakness. 

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