Intermittent Versus Sustained Hypoxemia from Sleep-disordered Breathing
In a variety of physiologic and pathologic states, people may experience both chronic sustained hypoxemia and intermittent hypoxemia ( “combined” or “overlap” hypoxemia). In general, hypoxemia in such instances predicts a variety of maladaptive outcomes, including excess cardiovascular disease or mortality. However, hypoxemia may be one of the myriad phenotypic effects in such states, making it difficult to ascertain whethe r adverse outcomes are primarily driven by hypoxemia, and if so, whether these effects are due to intermittent versus sustained hypoxemia. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - March 21, 2024 Category: Sleep Medicine Authors: Alyssa A. Self, Omar A. Mesarwi Source Type: research
How Important Is it to Address Sleep-Disordered Breathing in Patients with Chronic Lung Disease?
The human airway is a remarkably versatile structure with different portions of the airway undertaking differing functions. The nasal passages serve as the initial conduit for air performing tasks of filtration, olfaction, and humidification. The muscular upper airway starting from the velopharynx performs additional functions of swallowing and speaking, and to undertake these volitional activities, the upper airway is endowed with skeletal musculature which relaxes during sleep, making it vulnerable to collapse during each breath. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - March 21, 2024 Category: Sleep Medicine Authors: Krishna M. Sundar Tags: Preface Source Type: research
Targeting Hypercapnia in Chronic Lung Disease and Obesity Hypoventilation
Hypoventilation is a complication that is not uncommon in chronic obstructive pulmonary disease and calls for both medical treatment of the underlying disease and, frequently, noninvasive ventilation either during exacerbations requiring hospitalization or in a chronic state in the patient at home. Obesity hypoventilation syndrome by definition is associated with ventilatory failure and hypercapnia. It may or may not be accompanied by obstructive sleep apnea, which when detected becomes an additional target for positive airway pressure treatment. Intensive research has not completely resolved the best choice of treatment, ...
Source: Sleep Medicine Clinics - March 15, 2024 Category: Sleep Medicine Authors: Lee K. Brown Source Type: research
Untreated Obstructive Sleep Apnea in Interstitial Lung Disease and Impact on Interstitial Lung Disease Outcomes
Subjects with interstitial lung disease (ILD) often suffer from nocturnal cough, insomnia, and poor sleep quality. Subjects with ILD and obstructive sleep apnea (OSA) seem to have relatively mild symptoms from sleep fragmentation compared to subjects with only ILD. The overlap of ILD, OSA, and sleeping hypoxemia may be associated with poor outcome, even though there is no agreement on which sleep parameter is mostly associated with worsening ILD prognosis. Randomized controlled trials are needed to understand when positive airway pressure (PAP) treatment is required in subjects with ILD and OSA and the impact of PAP treatm...
Source: Sleep Medicine Clinics - March 13, 2024 Category: Sleep Medicine Authors: Andrea S. Melani, Sara Croce, Maddalena Messina, Elena Bargagli Source Type: research
Chronic Cough and Obstructive Sleep Apnea
Chronic cough, defined as a cough lasting more than 8 weeks, is a common medical condition occurring in 5% to 10% of the population. Its overlap with another highly prevalent disorder, obstructive sleep apnea (OSA), is therefore not surprising. The relationship between chronic cough and OSA extends beyond this overlap with higher prevalence of OSA in patients with chronic cough than in the general population. The use of continuous positive airway pressure can result in improvement in chronic cough although further studies are needed to understand which patients will experience benefit in their cough from the treatment of...
Source: Sleep Medicine Clinics - March 12, 2024 Category: Sleep Medicine Authors: Krishna M. Sundar, Amanda Carole Stark, Peter Dicpinigaitis Source Type: research
Does Obstructive Sleep Apnea Lead to Progression of Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) have important bidirectional relationships that influence the pathophysiology of each disorder. The slim hyperinflated “pink puffer” phenotype of COPD protects against OSA, whereas the heavier “blue bloater” phenotype predisposes to OSA by fluid retention. OSA may aggravate COPD by promoting airway inflammation. COPD-OSA overlap patients have lower quality of life and are at higher risk of cardiovascular com orbidity than either disorder alone due to greater nocturnal oxygen desaturation and sympathetic activation. Management of OSA with...
Source: Sleep Medicine Clinics - March 12, 2024 Category: Sleep Medicine Authors: Walter T. McNicholas Source Type: research
Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, and Pulmonary Hypertension
The pathophysiological interplay between sleep-disordered breathing (SDB) and pulmonary hypertension (PH) is complex and can involve a variety of mechanisms by which SDB can worsen PH. These mechanistic pathways include wide swings in intrathoracic pressure while breathing against an occluded upper airway, intermittent and/or sustained hypoxemia, acute and/or chronic hypercapnia, and obesity. In this review, we discuss how the downstream consequences of SDB can adversely impact PH, the challenges in accurately diagnosing and classifying PH in the severely obese, and review the limited literature assessing the effect of tre...
Source: Sleep Medicine Clinics - March 12, 2024 Category: Sleep Medicine Authors: Sarah Bjork, Deepanjali Jain, Manuel Hache Marliere, Sanda A. Predescu, Babak Mokhlesi Source Type: research
The Role of Obstructive Sleep Apnea in Hypercapnic Respiratory Failure Identified in Critical Care, Emergency, Inpatient, and Outpatient Settings
An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single “cause” of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing—particularly obstructive sleep apnea (OSA)—often contributes to the development of hypercapnia. In this review, the a uthors summarize the frequency of contributing conditions to hyp...
Source: Sleep Medicine Clinics - March 12, 2024 Category: Sleep Medicine Authors: Brian W. Locke, Jeanette P. Brown, Krishna M. Sundar Source Type: research
Mechanical Interactions Between the Upper Airway and the Lungs that Affect the Propensity to Obstructive Sleep Apnea in Health and Chronic Lung Disease
Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive narrowing and collapse of the upper airways during sleep. It is caused by multiple anatomic and nonanatomic factors but end-expiratory lung volume (EELV) is an important factor as increased EELV can stabilize the upper airway via caudal traction forces. EELV is impacted by changes in sleep stages, body position, weight, and chronic lung diseases, and this article reviews the mechanical interactions between the lungs and upper airway that affect the propensity to OSA. In doing so, it highlights the need for additional research in this area. (Sour...
Source: Sleep Medicine Clinics - March 8, 2024 Category: Sleep Medicine Authors: Bernie Y. Sunwoo, Atul Malhotra Source Type: research
Obstructive Sleep Apnea and Sarcoidosis Interactions
Obstructive sleep apnea (OSA) is very prevalent in sarcoidosis patients. Sarcoidosis of the upper respiratory tract may affect upper airway patency and increase the risk of OSA. Weight gain due to steroid use, upper airway myopathy due to steroids and sarcoidosis itself, and interstitial lung disease with decreased upper airway patency are other reasons for the higher OSA prevalence seen in sarcoidosis. Several clinical manifestations such as fatigue, hypersomnolence, cognitive deficits, and pulmonary hypertension are common to both OSA and sarcoidosis. Therefore, early screening and treatment for OSA can improve symptoms ...
Source: Sleep Medicine Clinics - March 8, 2024 Category: Sleep Medicine Authors: Chitra Lal Source Type: research
Effects of Obstructive Sleep Apnea on Airway Immunity and Susceptibility to Respiratory Infections
Obstructive sleep apnea is a prevalent sleep disorder characterized by recurrent episodes of partial or complete upper airway collapse during sleep, leading to disrupted breathing patterns and intermittent hypoxia. OSA results in systemic inflammation but also directly affects the upper and lower airways leading to upregulation of inflammatory pathways and alterations of the local microbiome. These changes result in increased susceptibility to respiratory infections such as influenza, COVID-19, and bacterial pneumonia. This relationship is more complex and bidirectional in individuals with chronic lung disease such as chro...
Source: Sleep Medicine Clinics - March 7, 2024 Category: Sleep Medicine Authors: Samuel Epstein, Dale Jun, Jane C. Deng, Michelle Zeidler Source Type: research
Hypoxic and Autonomic Mechanisms from Sleep-Disordered Breathing Leading to Cardiopulmonary Dysfunction
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Its prevalence has increased due to increasing obesity and improved screening and diagnostic strategies. OSA overlaps with cardiopulmonary diseases to promote intermittent hypoxia and autonomic dysfunction. Intermittent hypoxia increases the risk for oxidative stress and inflammation, which promotes endothelial dysfunction and predisposes to atherosclerosis and other cardiovascular complications. OSA is associated with an increased sympathetic nervous system drive resulting in autonomic dysfunction leading to worsening of cardiopulmonary diseases. ...
Source: Sleep Medicine Clinics - March 7, 2024 Category: Sleep Medicine Authors: Avantika Nathani, Amy Attaway, Reena Mehra Source Type: research
Contribution of Obstructive Sleep Apnea to Asthmatic Airway Inflammation and Impact of Its Treatment on the Course of Asthma
Asthma and obstructive sleep apnea (OSA) are very common respiratory disorders in the general population. Beyond their high prevalence, shared risk factors, and genetic linkages, bidirectional relationships between asthma and OSA exist, each disorder affecting the other ’s presence and severity. The author reviews here some of the salient links between constituents of the alternative overlap syndrome, that is, OSA comorbid with asthma, with an emphasis on the effects of OSA or its treatment on inflammation in asthma. In the directional relationship from OSA towar d asthma, beyond direct influences, multiple factors and c...
Source: Sleep Medicine Clinics - March 7, 2024 Category: Sleep Medicine Authors: Octavian C. Ioachimescu Source Type: research
Obstructive Sleep Apnea Effects on Chronic Airway Disease Exacerbations —Missed Opportunities for Improving Outcomes in Chronic Obstructive Pulmonary Disease and Asthma
In patients with chronic obstructive pulmonary disease (COPD) and asthma, exacerbations determine the natural history of both diseases. Patients with both respiratory diseases who suffer from obstructive sleep apnea (OSA) as a comorbidity (overlap syndromes) have a higher risk of exacerbations and hospitalization. In cases of OSA/COPD and OSA/asthma, continuous positive airway pressure treatment is indicated. Adequate adherence to therapy appears to reduce exacerbations and their severity, especially in OSA/COPD overlap. However, there is a lack of randomized trials that definitively demonstrate this evidence. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - March 5, 2024 Category: Sleep Medicine Authors: Marta Marin-Oto, Jose M. Marin Source Type: research
The Parasomnias
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - February 16, 2024 Category: Sleep Medicine Authors: Alon Y. Avidan Source Type: research
