Sleep Apnea
Sleep Apnea is:
• Common
• Dangerous
• Easily recognized
• Treatable
Types of Sleep Disordered
Breathing
• Apnea
• Cessation of airflow > 10 seconds
• Hypopnea
• Decreased airflow 30% from baseline
lasting > 10 seconds associated with > 4%
oxyhemoglobin desaturation
Apnea Patterns An obstructive apnea is defined by
the absence of airflow despite
Obstructive Mixed Central persistent ventilatory efforts,
demonstrated by contraction of
respiratory muscles such as the
diaphragm.
Airflow
A central apnea, in contrast, is the
absence of airflow due to the lack of
ventilatory effort. Since no effort is
made to breathe, no airflow occurs.
Respiratory
A mixed apnea includes both central
effort
and obstructive components, usually
with an initial central component
followed by the obstructive
component.
Obstructive Apnea
Central Apnea
Mixed Apnea
Obstructive Hypopnea
Respiratory Effort-related Arousals
Why Get a Sleep Study?
• Signs and symptoms poorly predict
disease severity
• Appropriate therapy dependent on severity
• Failure to treat leads to:
• Increased morbidity
• Motor vehicle crashes
• Mortality
• Other causes of daytime sleepiness
What Test Should be Used?
• In-laboratory full night polysomnography
• Split night studies
• Home diagnostic systems
• Oximetry to full polysomnography
Polysomnography
multi-channel all-night polysomnogram.
Sleep stage is determined using the electroencephalogram (EEG), the
electrooculogram (EOG), and the electromyogram (Chin EMG). The
lower series of channels measures respiratory parameters and are
used to detect sleep apnea. They represent nasal pressure airflow,
thermal sensor for airflow, chest and abdominal respiratory
inductance plethysmography, and arterial oxygen saturation.
Additional parameters measured include the electrocardiogram
(ECG), intercostal/diaphragmatic EMG, and leg muscle activity. Such a
recording allows for a careful assessment of all desired variables over
the course of an entire night, providing a relatively complete picture
of the events occurring during sleep.
Polysomnogram
Full-Night In-Laboratory
Polysomnography
• Pro
• Full set of variables obtained
• Equipment problems can be repaired
• Technician can address patient problems
• Con
• Cost
• Accessibility
• Patient sleeps away from home
Split-Night In-Laboratory
Polysomnography
• Pro
• Reduced cost
• Patient may be studied only once
• Reduces time to treatment initiation
• Con
• Diagnostic time may be inadequate
• Treatment time limited
• Protocol decisions to start CPAP may be difficult to make
during data acquisition
Home Study Tracing
Home Study
• Pro
• Potentially less expensive
• Patient sleeps at home
• Con
• Generally fewer signals are recorded
• Equipment cannot be adjusted
• Technician cannot assist patient
Diagnostic Conclusions
• Signs and symptoms
• Excessive daytime sleepiness
• Hypertension and other cardiovascular sequelae
• Sleep study results
• Apnea / hypopnea frequency
• Sleep fragmentation
• Oxyhemoglobin desaturation
Treatment Objectives
• Reduce morbidity and mortality
• Reduce sleepiness
• Decrease cardiovascular consequences
• Improve quality of life
