BOOK
Obstructive Sleep Apnea, An Issue of Sleep Medicine Clinics, E-Book
(2013)
Additional Information
Book Details
Abstract
This issue of Sleep Medicine Clinics will be Guest Edited by Jim Barker, MD CPE, FACP, FCCP, FAASM Shirley Fong Jones, MD, FCCP of Scott and White Memorial Hospital and will focus on Obstructive Sleep Apnea. Article topics include Weight loss, Pharmacologic therapy of obstructive sleep apnea, Alternative Therapies, Masks and Interfaces, Outcomes of treatment of hypersomnia for OSA, Effects of therapy on CV outcomes, Complex Sleep Apnea, Oral appliances, Cost of therapy, Medicolegal aspects of treatment, Residual sleepiness, Therapy and Metabolic Outcomes, and Therapies for Children with OSA.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Obstructive Sleep Apnea | i | ||
| Copyright\r | ii | ||
| Sleep Medicine Clinics\r | iv | ||
| Contributors | v | ||
| Contents | ix | ||
| Preface | xiii | ||
| Anatomy and Physiology of Obstructive Sleep Apnea | 425 | ||
| Key points | 425 | ||
| Anatomy | 425 | ||
| Pathophysiology | 427 | ||
| Upper Airway Collapsibility | 427 | ||
| Effect of Lung Volumes | 427 | ||
| Upper Airway Dilator Muscle Activity | 427 | ||
| Arousal Response in OSA | 428 | ||
| Ventilatory Control Stability | 428 | ||
| Pharyngeal Neuropathy | 428 | ||
| Effect of risk factors on OSA | 428 | ||
| Obesity | 428 | ||
| Male Sex | 429 | ||
| Age | 429 | ||
| Summary | 429 | ||
| References | 429 | ||
| Obstructive Sleep Apnea Therapy and Metabolic Outcomes | 433 | ||
| Key points | 433 | ||
| Introduction | 433 | ||
| Epidemiology and interrelationships of obstructive sleep apnea, metabolic syndrome, and obesity | 434 | ||
| Physiologic and biological mechanisms of altered metabolic regulation in obstructive sleep apnea | 435 | ||
| Impact of Hypoxemia on Metabolic Function | 435 | ||
| Relationship of Sleep Fragmentation with Metabolic Regulation | 436 | ||
| Systemic Inflammation and Oxidative Stress in Obstructive Sleep Apnea as Instigators of Altered Metabolic Function | 436 | ||
| Effect of obstructive sleep apnea treatment with continuous positive airway pressure on lipid biology and visceral adiposity | 437 | ||
| Obstructive sleep apnea treatment and hypertension | 438 | ||
| Effect of positive airway pressure and non–positive airway pressure modalities of obstructive sleep apnea therapy on compon ... | 439 | ||
| Uncontrolled Trials | 439 | ||
| Randomized Controlled Interventional Trials | 442 | ||
| Effect of Non–Positive Airway Pressure Modalities of Obstructive Sleep Apnea Therapy on Components of Metabolic Syndrome | 447 | ||
| Summary | 447 | ||
| References | 448 | ||
| Effects of Obstructive Sleep Apnea Therapy on Cardiovascular Disease | 453 | ||
| Key points | 453 | ||
| Overview of obstructive sleep apnea and associated cardiovascular outcomes | 453 | ||
| Subclinical atherosclerosis | 454 | ||
| Arrhythmias | 456 | ||
| Coronary heart disease | 457 | ||
| Stroke | 458 | ||
| References | 460 | ||
| Complex Sleep Apnea | 463 | ||
| Key points | 463 | ||
| Introduction | 463 | ||
| Pathophysiology | 464 | ||
| Treatment-emergent CompSA | 464 | ||
| Primary CompSA | 467 | ||
| Prevalence | 467 | ||
| Clinical characteristics | 468 | ||
| Natural history | 469 | ||
| Treatment | 470 | ||
| PAP | 470 | ||
| CPAP | 470 | ||
| BPAP and APAP | 470 | ||
| ASV | 470 | ||
| Non-PAP Management | 471 | ||
| Pharmacotherapy | 471 | ||
| Dead space | 471 | ||
| Oxygen | 472 | ||
| Clinical implications | 472 | ||
| References | 472 | ||
| Mask Interfaces | 477 | ||
| Key points | 477 | ||
| Introduction | 477 | ||
| Nasal mask | 477 | ||
| Full face mask/oronasal mask | 478 | ||
| Oral mask | 479 | ||
| Nasal pillows | 479 | ||
| Combination devices | 480 | ||
| Pediatric population | 480 | ||
| General considerations | 480 | ||
| Summary | 481 | ||
| References | 481 | ||
| Therapies for Children with Obstructive Sleep Apnea | 483 | ||
| Key points | 483 | ||
| Diagnosis of obstructive sleep apnea syndrome in children | 483 | ||
| Specific therapies | 484 | ||
| Adenotonsillectomy | 484 | ||
| Partial Tonsillectomy | 486 | ||
| Positive Airway Pressure | 486 | ||
| Pharmacologic Therapies | 487 | ||
| Nasal steroids | 487 | ||
| Leukotriene receptor antagonists | 487 | ||
| Other Nonsurgical Therapies | 487 | ||
| Rapid maxillary expansion | 487 | ||
| Oral appliances | 487 | ||
| Positional therapy | 487 | ||
| Weight loss | 488 | ||
| Supplemental oxygen | 488 | ||
| Other Surgical Therapies | 488 | ||
| Uvulopalatopharyngoplasty | 488 | ||
| Tracheostomy | 488 | ||
| Bariatric surgery | 488 | ||
| Special populations | 488 | ||
| Infants | 488 | ||
| Children with Craniofacial Abnormalities | 489 | ||
| Obese Children | 489 | ||
| Down Syndrome | 489 | ||
| Prader-Willi Syndrome | 489 | ||
| Summary | 490 | ||
| References | 490 | ||
| Surgical Treatment of Obstructive Sleep Apnea | 495 | ||
| Key points | 495 | ||
| Introduction | 495 | ||
| Nose, nasal cavity, and nasopharynx | 496 | ||
| Soft palate | 497 | ||
| Hard palate | 497 | ||
| Oropharynx | 498 | ||
| Tonsillectomy | 498 | ||
| Tongue Surgeries | 498 | ||
| Hypopharynx | 498 | ||
| Epiglottis | 499 | ||
| Larynx | 499 | ||
| Craniofacial | 499 | ||
| Neck | 500 | ||
| Summary | 501 | ||
| References | 502 | ||
| Overview of Oral Appliance Therapy for the Management of Obstructive Sleep Apnea | 505 | ||
| Key points | 505 | ||
| Introduction | 505 | ||
| Classification and mechanism of action | 506 | ||
| Efficacy and side effects | 506 | ||
| Symptoms of temporomandibular disorder | 506 | ||
| Occlusal symptoms | 508 | ||
| Bite registration | 509 | ||
| Clinical evaluation | 509 | ||
| Nasal Obstruction | 509 | ||
| Maxillomandibular Shape | 510 | ||
| Oropharyngeal | 510 | ||
| Musculoskeletal | 511 | ||
| Summary | 512 | ||
| References | 512 | ||
| Appendix Clinical evaluation form | 514 | ||
| Weight Loss in the Management of Obstructive Sleep Apnea | 517 | ||
| Key points | 517 | ||
| Surgical therapies | 518 | ||
| Pharmacologic therapies | 520 | ||
| Lifestyle interventions | 521 | ||
| Continuous positive airway pressure | 522 | ||
| Summary | 522 | ||
| References | 522 | ||
| Pharmacologic Therapy for Obstructive Sleep Apnea | 527 | ||
| Key points | 527 | ||
| Introduction | 527 | ||
| Pharmacotherapeutic agents | 528 | ||
| Medications that Promote Alertness in Treated OSA Patients | 528 | ||
| Modafinil and armodafinil use in CPAP users with RES | 528 | ||
| Possible long-term use of stimulant therapy in sleepy OSA patients | 529 | ||
| Possible role of stimulants in acute withdrawal from CPAP | 529 | ||
| Stimulants in OSA and major depression | 529 | ||
| Other stimulants (caffeine, amphetamine, methamphetamine, methylphenidate) | 529 | ||
| Pharmacologic Agents that Reduce Nasal Air Resistance and Congestion | 530 | ||
| Nasal steroid sprays, leukotriene inhibitors, decongestants, domperidone | 530 | ||
| Pharmacotherapeutic Agents that Stimulate Ventilation | 531 | ||
| Acetazolamide | 531 | ||
| Methylxanthine derivatives (theophylline, aminophylline) | 531 | ||
| Nicotinic agents | 531 | ||
| Glutamate antagonists | 532 | ||
| Doxapram | 532 | ||
| Opioid antagonists | 532 | ||
| Acetylcholinesterase inhibitors | 532 | ||
| Serotonergic agents and REM suppressants | 533 | ||
| Endocrinologic Disorders and Sleep Apnea | 534 | ||
| Acromegaly | 534 | ||
| Hypothyroidism | 534 | ||
| Should all patients with OSA be screened for thyroid dysfunction? | 534 | ||
| Does treatment of hypothyroidism improve sleep apnea? | 534 | ||
| Should female patients with severe OSA be screened for Hashimoto thyroiditis? | 535 | ||
| Progesterone, estrogen, androgens, and androgen blockade | 535 | ||
| γ-Aminobutyric acid agonists | 535 | ||
| Medications for Comorbid Conditions (Heart Failure, Hypertension, Dyslipidemia, Obesity) | 535 | ||
| Medications to Avoid/Monitor in Patients with OSA (Benzodiazepines, Barbiturates, Narcotics, Anesthetics) | 536 | ||
| Benzodiazepines and barbiturates | 536 | ||
| Opioids | 536 | ||
| Anesthetic agents | 537 | ||
| Summary | 537 | ||
| References | 537 | ||
| Alternative Therapies for Obstructive Sleep Apnea | 543 | ||
| Key points | 543 | ||
| Introduction | 543 | ||
| Nasal resistive devices | 543 | ||
| Positional therapy | 545 | ||
| Snore pillows | 547 | ||
| Hypoglossal nerve stimulation | 547 | ||
| Acupuncture | 549 | ||
| Speech exercises | 550 | ||
| Musical instruments | 550 | ||
| Nasal cannulas | 551 | ||
| Nasal strips | 552 | ||
| Diaphragmatic pacing | 553 | ||
| Summary | 553 | ||
| References | 553 | ||
| Cost of Therapy | 557 | ||
| Key points | 557 | ||
| Background | 557 | ||
| Diagnosis | 557 | ||
| Cost of treatment | 560 | ||
| Cost-Effectiveness of Oral Appliances | 561 | ||
| Cost-Effectiveness of CPAP Versus OA | 561 | ||
| Costs Associated with Surgical Procedures | 562 | ||
| Costs related to lack of treatment for OSA | 563 | ||
| Societal Costs of Unrecognized OSA | 563 | ||
| Costs of Inadequate Adherence to CPAP | 564 | ||
| Costs of novel therapies | 566 | ||
| Nasal EPAP | 567 | ||
| OPT | 567 | ||
| Summary | 567 | ||
| References | 568 | ||
| Residual Sleepiness in Obstructive Sleep Apnea | 571 | ||
| Key points | 571 | ||
| Introduction | 571 | ||
| Definition of EDS | 571 | ||
| Measuring EDS | 572 | ||
| Causes of residual sleepiness in patients with OSA | 573 | ||
| Chronic Intermittent Hypoxia Theory | 573 | ||
| OSA in Insufficient Sleep | 574 | ||
| Depression | 574 | ||
| Narcolepsy | 574 | ||
| Restless Legs Syndrome and Periodic Leg Movements in Sleep | 575 | ||
| Inadequate CPAP Treatment | 575 | ||
| Underlying Causes of Residual Sleepiness: Biomarkers, Cytokines, and Hormones | 576 | ||
| Treatment of EDS in Patients with OSA | 578 | ||
| Summary | 579 | ||
| References | 579 | ||
| Outcomes of Therapy for Hypersomnia for Obstructive Sleep Apnea | 583 | ||
| Key points | 583 | ||
| What is hypersomnia? | 584 | ||
| Cause and effects of hypersomnia in patients with OSA | 584 | ||
| Measurements of excessive daytime sleepiness | 585 | ||
| Hypersomnia with OSA despite positive airway pressure treatment | 586 | ||
| Possible causes of excessive daytime sleepiness and changes noted in patients with OSA treated with PAP therapy | 587 | ||
| Treatments for hypersomnia with obstructive sleep apnea in patients treated with PAP therapy | 588 | ||
| Summary | 588 | ||
| References | 589 | ||
| Obstructive Sleep Apnea and Transportation | 591 | ||
| Key points | 591 | ||
| Introduction | 591 | ||
| Consequences of OSA on neurocognitive performance | 592 | ||
| Neurocognitive Function and OSA | 592 | ||
| Sleep Loss: Consequences and Perception | 592 | ||
| Assessment of excessive sleepiness and alertness | 594 | ||
| Subjective Assessments of Excessive Sleepiness | 594 | ||
| Objective Assessments of Excessive Sleepiness and Alertness | 595 | ||
| MSLT | 595 | ||
| MWT | 596 | ||
| Simulated driving performance | 596 | ||
| Real-world driving performance | 597 | ||
| OSA and MVAs | 598 | ||
| Risk and Costs of Accidents in Patients with OSA | 598 | ||
| Effects of Therapy for OSA on Accidents | 598 | ||
| Laws and regulations regarding OSA screening | 599 | ||
| Foundation of Laws and Regulations | 599 | ||
| OSA and Commercial Driver’s Licenses | 599 | ||
| OSA and Personal/Noncommercial Driving | 602 | ||
| OSA and Other Professions | 602 | ||
| Role of the sleep physician | 602 | ||
| Summary | 602 | ||
| References | 603 | ||
| Index | 607 |