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Book Details
Abstract
Written specifically for non-sleep medicine specialists, this one-of-a-kind reference guides you through every aspect of this complex field with authoritative advice from Dr. Meir Kryger and other experts. Vibrantly illustrated in full color, it thoroughly covers the types of patients you’re most likely to see in the outpatient setting and brings you up to date with the latest treatment methods, both surgical and non-surgical.
- Consult this title on your favorite e-reader , conduct rapid searches, and adjust font sizes for optimal readability.
- Complete coverage of the patients you’re most likely to encounter, including special populations such as those with COPD, obesity hypoventilation, pregnancy, neuromuscular disorders, stroke, and more.
- Specific information on topics of interest to a wide variety of physicians: heart failure and sleep disordered breathing; surgical treatments, including hypoglossal nerve stimulation; oral appliances and the treatment of sleep apnea; home sleep testing; and different types of PAP devices.
- Ideal for pulmonologists, otolaryngologists, cardiologists, primary care physicians, dentists, and other healthcare providers who encounter patients with sleep and breathing disorders.
- Full-color illustrations throughout, including a profusely illustrated chapter on physical diagnosis.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Sleep and Breathing Disorders | i | ||
| Copyright Page | iv | ||
| Contributors | v | ||
| Preface | xi | ||
| Assessment and Pathophysiology | xi | ||
| Sleep Apnea Syndromes | xi | ||
| Management | xi | ||
| Consequences | xi | ||
| Special Populations | xi | ||
| Table Of Contents | xiii | ||
| Video Contents | xv | ||
| Abbreviations | xvii | ||
| 1 Assessment and Pathophysiology | 1 | ||
| 1 Approach and Evaluation of the Patient | 1 | ||
| Chapter Highlights | 1 | ||
| Chief Complaint and History | 1 | ||
| Insomnia | 2 | ||
| Excessive Sleepiness | 2 | ||
| Nocturnal Movements, Behaviors, and Sensations | 2 | ||
| Medication Use and Medical History | 2 | ||
| Family History | 2 | ||
| Social History | 2 | ||
| Review of Systems | 3 | ||
| Physical Examination | 3 | ||
| Summary | 3 | ||
| Review Questions | 3.e1 | ||
| Answers | 3.e2 | ||
| 2 Cardinal Manifestations of Sleep Disorders | 4 | ||
| Chapter Highlights | 4 | ||
| Insomnia | 4 | ||
| Excessive Daytime Sleepiness | 7 | ||
| Fatigue | 8 | ||
| Snoring | 8 | ||
| Sleep Apnea | 9 | ||
| Cataplexy | 10 | ||
| Sleep Paralysis | 10 | ||
| Hypnagogic and Hypnopompic Hallucinations | 10 | ||
| Automatic Behavior | 10 | ||
| Excessive Movement in Sleep or Parasomnia | 11 | ||
| Sleeptalking | 11 | ||
| Sleepwalking | 11 | ||
| Sleep Terrors | 11 | ||
| Confusional Arousals | 11 | ||
| Sleep-Related Groaning (Catathrenia) | 12 | ||
| Dream Enactment | 12 | ||
| Nightmares | 12 | ||
| Sleep-Related Rhythmic Movement Disorder | 12 | ||
| Sleep-Related Bruxism | 12 | ||
| Restless Legs Syndrome and Periodic Movements of Sleep | 12 | ||
| Morning Headache | 13 | ||
| Systemic Features | 13 | ||
| Pediatric Cardinal Manifestations | 13 | ||
| Summary | 14 | ||
| Selected Readings | 14 | ||
| References | 14.e1 | ||
| Review Questions | 14.e2 | ||
| Answers | 14.e3 | ||
| 3 Physical Examination in Sleep Medicine | 15 | ||
| Chapter Highlights | 15 | ||
| Sleep Apnea | 16 | ||
| Anthropometric Measurements in Patients with Suspected Sleep Apnea | 16 | ||
| Body Mass Index Calculations | 16 | ||
| Overall Inspection | 17 | ||
| Craniofacial Factors | 21 | ||
| Nasal Factors | 23 | ||
| Neck Circumference | 23 | ||
| Examination of the Pharynx | 24 | ||
| Examination of the Tonsils | 26 | ||
| Neurologic Examination | 26 | ||
| Cardiopulmonary Examination | 28 | ||
| Central Nervous System Hypersomnia | 28 | ||
| Narcolepsy | 28 | ||
| Parasomnias | 31 | ||
| Nocturnal Eating Disorder and Sleep-Related Eating Disorder | 31 | ||
| REM Sleep Behavior Disorder | 31 | ||
| Sleep-Related Movement Disorders | 31 | ||
| Willis-Ekbom Disease | 31 | ||
| Bruxism | 33 | ||
| Insomnia | 33 | ||
| Summary | 34 | ||
| Selected Readings | 34 | ||
| References | 34.e1 | ||
| Review Questions | 34.e2 | ||
| Answers | 34.e3 | ||
| 4 Use of Clinical Tools and Tests in Sleep Medicine | 35 | ||
| Chapter Highlights | 35 | ||
| Evaluation for Sleep-Related Breathing Disorders | 35 | ||
| History and Questionnaires | 35 | ||
| Physical Examination | 35 | ||
| Nocturnal Polysomnography | 37 | ||
| Modified Forms of the Polysomnogram | 38 | ||
| Home Sleep Tests | 38 | ||
| Studies of Airway Morphology | 39 | ||
| Evaluation of Hypersomnolence | 40 | ||
| History and Questionnaires | 40 | ||
| Physical Examination | 40 | ||
| Sleep Logs and Actigraphy | 40 | ||
| Nocturnal Polysomnography | 40 | ||
| Multiple Sleep Latency Test | 41 | ||
| Nocturnal Polysomnography and MSLT in the Diagnosis of Narcolepsy | 41 | ||
| Variations of the Multiple Sleep Latency Test and Other Physiologic Tests | 41 | ||
| Evaluation of Insomnia | 42 | ||
| 2 Sleep Apnea Syndromes | 78 | ||
| 9 Sleep-Related Breathing Disorders | 78 | ||
| Chapter Highlights | 78 | ||
| Obstructive Sleep Apnea Disorders | 79 | ||
| Central Sleep Apnea Disorders | 81 | ||
| Central Sleep Apnea with Cheyne-Stokes Breathing | 81 | ||
| Central Sleep Apnea Due to a Medical Disorder without Cheyne-Stokes Breathing | 82 | ||
| Central Sleep Apnea Due to High-Altitude Periodic Breathing | 82 | ||
| Central Sleep Apnea Due to a Medication or Substance | 83 | ||
| Primary Central Sleep Apnea | 83 | ||
| Treatment-Emergent Central Sleep Apnea | 84 | ||
| Sleep-Related Hypoventilaton Disorders | 85 | ||
| Obesity-Hypoventilation Syndrome | 85 | ||
| Idiopathic Central Alveolar Hypoventilation | 85 | ||
| Sleep-Related Hypoventilation Due to a Medication or Substance | 86 | ||
| Sleep-Related Hypoventilation Due to a Medical Disorder | 86 | ||
| Sleep-Related Hypoxemia Disorder | 86 | ||
| Other Sleep-Related Breathing Disorders | 87 | ||
| Summary | 87 | ||
| Selected Readings | 87 | ||
| References | 87.e1 | ||
| Review Questions | 87.e2 | ||
| Answers | 87.e3 | ||
| 10 Sleep Breathing Disorders | 88 | ||
| Chapter Highlights | 88 | ||
| Historical Perspective | 88 | ||
| Overview of the Pathophysiologic Basis of Sleep Breathing Disorders Informing the Treatment Approach | 89 | ||
| Clinical Assessments and Decision Making | 90 | ||
| Sleep Breathing Disorders in Disease-Specific Populations | 91 | ||
| Cardiovascular Disease | 91 | ||
| Pulmonary Disease | 93 | ||
| Other Comorbid States | 94 | ||
| Ecologic Features | 94 | ||
| Summary | 95 | ||
| Selected Readings | 95 | ||
| References | 95.e1 | ||
| Review Questions | 95.e3 | ||
| Answers | 95.e4 | ||
| 11 Obstructive Sleep Apnea | 96 | ||
| Chapter Highlights | 96 | ||
| Definition of the Obstructive Sleep Apnea Phenotype | 96 | ||
| Intermediate Disease Pathways and Phenotypes | 97 | ||
| Obesity and Body Fat Distribution | 97 | ||
| Craniofacial Morphology | 98 | ||
| Ventilatory Control | 98 | ||
| Control of Sleep and Circadian Rhythm | 99 | ||
| Familial Aggregation of Obstructive Sleep Apnea | 99 | ||
| Genetic Analyses | 100 | ||
| Candidate Gene Studies | 100 | ||
| Serotoninergic Pathways | 101 | ||
| Leptin Signaling | 101 | ||
| Inflammatory Pathways | 102 | ||
| Apolipoprotein E. | 102 | ||
| Angiotensin II Converting Enzyme. | 102 | ||
| Linkage Analysis | 102 | ||
| Genome-Wide Association Analyses | 102 | ||
| Summary | 103 | ||
| Selected Readings | 103 | ||
| References | 103.e1 | ||
| Review Questions | 103.e4 | ||
| Answers | 103.e5 | ||
| 12 Central Sleep Apnea | 104 | ||
| Chapter Highlights | 104 | ||
| Definitions | 104 | ||
| Pathophysiology | 105 | ||
| Mechanisms | 106 | ||
| Chemical Aspects of Ventilation | 106 | ||
| Hypoxic Stimulus and Peripheral and Central Chemoreceptors. | 106 | ||
| Hypercapnic Stimulus and Peripheral and Central Chemoreceptors. | 106 | ||
| Apneic Threshold and Implications for Central Sleep Apnea. | 106 | ||
| Interactions between the Central and Peripheral Chemoreceptors. | 107 | ||
| Mechanical Aspects of Ventilation | 107 | ||
| Neural Aspects of Ventilation | 107 | ||
| Ventilatory Control in Central Sleep Apnea | 108 | ||
| Metabolic Control of Ventilation | 108 | ||
| Neural Control of Ventilation | 109 | ||
| Examples of Pathophysiologic to Clinical Applications | 109 | ||
| Cheyne-Stokes Breathing with or without Central Sleep Apnea | 109 | ||
| High-Altitude Periodic Breathing | 110 | ||
| Treatment Emergent Central Sleep Apnea | 110 | ||
| Obesity-Hypoventilation Syndrome | 110 | ||
| Congenital Central Alveolar Hypoventilation Syndrome | 110 | ||
| Hypercapnic Chronic Obstructive Pulmonary Disease | 111 | ||
| Opioid-Induced Central Sleep Apnea | 111 | ||
| Genetics | 111 | ||
| Congenital Central Alveolar Hypoventilation Syndrome | 111 | ||
| Epidemiology | 111 | ||
| Risk Factors | 111 | ||
| Prevalence | 111 | ||
| Cheyne-Stokes Breathing | 111 | ||
| Primary Central Sleep Apnea | 112 | ||
| High-Altitude Periodic Breathing | 112 | ||
| Treatment Emergent Central Sleep Apnea | 112 | ||
| Central Sleep Apnea Due to a Medical Disorder | 112 | ||
| Central Sleep Apnea Due to a Medication or Substance | 112 | ||
| Age | 112 | ||
| Gender | 112 | ||
| Race | 112 | ||
| Morbidity | 112 | ||
| Central Sleep Apnea and Cardiac Hemodynamics | 112 | ||
| Central Sleep Apnea and Cardiac-Related Hospital Readmission | 112 | ||
| Central Sleep Apnea and Cerebrovascular Accident | 112 | ||
| Mortality | 112 | ||
| Summary | 113 | ||
| Selected Readings | 113 | ||
| References | 113.e1 | ||
| Review Questions | 113.e4 | ||
| Answers | 113.e5 | ||
| 13 Anatomy and Physiology of Upper Airway Obstruction | 114 | ||
| Chapter Highlights | 114 | ||
| Baseline Determinants of Upper Airway Patency | 114 | ||
| Upper Airway Function and Structure | 114 | ||
| Neuromuscular Function of the Upper Airway | 115 | ||
| Nonneuromuscular Factors Contributing to Upper Airway Patency and Obstruction | 116 | ||
| Upper Airway Muscle Histology | 116 | ||
| Craniofacial Structure | 116 | ||
| Surrounding Tissues and Pressures | 117 | ||
| Intrinsic Properties of the Upper Airway | 119 | ||
| Sleep Effects on Upper Airway Patency and Collapsiblity | 119 | ||
| Upper Airway Caliber and Resistance | 120 | ||
| Measurements and Meanings of Compliance and Collapsibility | 120 | ||
| Phase of the Respiratory Cycle: Inspiratory Versus Expiratory Narrowing | 122 | ||
| Gender, Body Mass Index, and Weight Effects on Upper Airway Structure and Function | 123 | ||
| Hormonal Activity and Upper Airway Activity | 124 | ||
| Summary | 124 | ||
| Selected Readings | 125 | ||
| References | 125.e1 | ||
| Review Questions | 125.e4 | ||
| Answers | 125.e5 | ||
| 14 Snoring and Pathologic Upper Airway Resistance Syndromes | 126 | ||
| Chapter Highlights | 126 | ||
| Background | 126 | ||
| Glossary of Terms Central to This Chapter | 126 | ||
| Upper Airway Resistance Versus Pharyngeal Collapse | 127 | ||
| Upper Airway Resistance Syndrome | 127 | ||
| Inspiratory Airflow Limitation | 128 | ||
| Recognizing Inspiratory Airflow Limitation with Physiologic Testing | 128 | ||
| Pathologic Upper Airway Resistance Syndromes: Clinical Aspects | 131 | ||
| Snoring | 131 | ||
| Upper Airway Resistance Syndrome | 134 | ||
| Anthropometric Features and Risk Factors | 134 | ||
| Signs and Symptoms | 134 | ||
| Polysomnographic Findings | 135 | ||
| Polysomnographic Findings Characterizing Breathing. | 135 | ||
| Polysomnographic Findings Characterizing Sleep Architecture. | 135 | ||
| Pathophysiology and Clinical Correlates | 137 | ||
| Treatment | 138 | ||
| Summary | 138 | ||
| Selected Readings | 139 | ||
| References | 139.e1 | ||
| Review Questions | 139.e3 | ||
| Answers | 139.e4 | ||
| 3 Management | 140 | ||
| 15 Central Sleep Apnea | 140 | ||
| Chapter Highlights | 140 | ||
| Definitions | 141 | ||
| Classification of Central Sleep Apnea Syndromes | 141 | ||
| Pathophysiology of Central Sleep Apnea Syndromes That Affect Diagnosis and Treatment | 141 | ||
| Pathophysiologic Changes that Lead to Central Sleep Apneas and Periodic Breathing | 142 | ||
| Pathophysiologic Changes in Specific Central Sleep Apnea Syndromes | 143 | ||
| Nonhypercapnic Central Sleep Apnea | 143 | ||
| Central Sleep Apnea and Periodic Breathing of Heart Failure. | 143 | ||
| Central Sleep Apnea Due to High-Altitude Periodic Breathing. | 143 | ||
| Primary Central Sleep Apnea. | 144 | ||
| Other Nonhypercapnic Central Sleep Apnea Syndromes and Their Associated Medical Conditions. | 144 | ||
| Hypercapnic Central Sleep Apnea | 144 | ||
| Congenital Central Alveolar Hypoventilation Syndrome and Idiopathic Central Alveolar Hypoventilation. | 144 | ||
| Obesity-Hypoventilation Syndrome (“Pickwickian Syndrome”). | 144 | ||
| Other Central Nervous System−Related Disorders. | 145 | ||
| Peripheral Nerve and Muscle Disorders. | 145 | ||
| Disintegrative Central Sleep Apnea and Hypoventilation Associated with Opiates. | 145 | ||
| Disordered Interplay Among Upper Airway Obstruction, Breathing Control, and Sleep-Arousal Propensity: Treatment Emergent Central Sleep Apnea (“Complex Sleep Apnea”). | 145 | ||
| Epidemiology of Central Sleep Apnea and Its Subtypes | 147 | ||
| Clinical Features and Diagnosis of Central Sleep Apnea and Its Subtypes | 148 | ||
| Clinical Presentation | 148 | ||
| Polysomnographic Features Important in Central Sleep Apnea | 148 | ||
| Unique Features of the Disorders | 148 | ||
| Nonhypercapnic Central Sleep Apnea | 148 | ||
| Central Sleep Apnea at High Altitude. | 148 | ||
| Primary Central Sleep Apnea. | 148 | ||
| Heart Failure and Central Sleep Apnea. | 148 | ||
| Other Medical Conditions Associated with Central Sleep Apnea. | 149 | ||
| Hypercapnic Central Sleep Apnea | 149 | ||
| Central Congenital Alveolar Hypoventilation Syndrome. | 149 | ||
| Obesity-Hypoventilation Syndrome. | 150 | ||
| Neurodegenerative Disorders. | 151 | ||
| Muscular and Peripheral Nervous System Disorders Associated with Central Sleep Apnea. | 151 | ||
| Opiate-Induced Central Apneas and Hypoventilation (Disintegrative Central Sleep Apnea). | 151 | ||
| Treatment-Emergent Central Sleep Apnea. | 151 | ||
| Treatment of Central Sleep Apnea | 151 | ||
| Positive Pressure−Based Therapy | 151 | ||
| General Principles Regarding the Use of Adaptive Servo Ventilation Devices | 152 | ||
| Recognition of Efficacy and Scoring of Respiratory Events During Adaptive Servo Ventilation Use | 152 | ||
| Considerations for the Treatment of Hypercapnic Central Sleep Apnea | 152 | ||
| Alternative Approaches to Positive Pressure Therapy | 153 | ||
| Minimization of Hypocapnia | 153 | ||
| Oxygen | 155 | ||
| Enhancing Sleep Consolidation | 155 | ||
| Opioid-Induced Central Sleep Apnea | 155 | ||
| Carbonic Anhydrase Inhibition | 155 | ||
| Other Drugs with Possible Benefits in Nonhypercapnic Central Sleep Apnea | 155 | ||
| Other Treatment Options | 155 | ||
| Summary | 156 | ||
| Selected Readings | 156 | ||
| References | 156.e1 | ||
| Review Questions | 156.e5 | ||
| Answers | 156.e6 | ||
| 16 Obstructive Sleep Apnea | 157 | ||
| Chapter Highlights | 157 | ||
| Definition | 157 | ||
| Brief History | 157 | ||
| Physiologic Effects | 157 | ||
| Epidemiology | 158 | ||
| Prevalence in Disease-Specific Cohorts | 158 | ||
| Risk Factors | 159 | ||
| Anatomy | 159 | ||
| Relationship of Upper Airway Anatomic Factors to Development of Inspiratory Flow Limitation and Obstruction | 160 | ||
| Clinical Identification and Assessment | 161 | ||
| Daytime Symptoms and Functional Consequences | 161 | ||
| Deficits in Cognition, Vigilance, and Executive Function | 161 | ||
| Mood Disorders | 161 | ||
| Sleep-Related Signs and Symptoms | 162 | ||
| Physical Findings | 162 | ||
| Assessment | 162 | ||
| In-Laboratory or Full Polysomnographic Sleep Testing | 162 | ||
| Out-of-Center Sleep Testing | 166 | ||
| Principles of Management | 168 | ||
| Summary | 170 | ||
| Selected Readings | 171 | ||
| References | 171.e1 | ||
| Review Questions | 171.e5 | ||
| Answers | 171.e6 | ||
| 17 Obstructive Sleep Apnea | 172 | ||
| Chapter Highlights | 172 | ||
| Therapies Primarily Targeting Upper Airway Anatomic Loads | 173 | ||
| Medical and Surgical Weight Loss | 173 | ||
| Positional Therapy for Obstructive Sleep Apnea | 175 | ||
| Expiratory Nasal Resistors | 176 | ||
| Oral Pressure Therapy | 177 | ||
| High Flow Nasal Therapy | 177 | ||
| Nasopharyngeal Stents | 178 | ||
| Venous Compression Stockings | 178 | ||
| Therapies Targeting Primarily Neural and Neuromuscular Mechanisms | 179 | ||
| Hypoglossal Nerve Stimulation | 179 | ||
| Myofunctional Therapy | 179 | ||
| Pharmacotherapy for Obstructive Sleep Apnea Targeting Neuromuscular Control | 181 | ||
| Serotoninergic Agents | 181 | ||
| Cholinergic Agents | 183 | ||
| Cannabinoids | 183 | ||
| Therapies Targeting Primarily Neuroventilatory Mechanisms | 183 | ||
| Supplemental Oxygen | 183 | ||
| Transtracheal Oxygen Delivery | 184 | ||
| Pharmacotherapy for Obstructive Sleep Apnea Targeting Neuroventilatory Control | 184 | ||
| Carbonic Anhydrase Inhibitors | 184 | ||
| Methylxanthines, Opioid Antagonists, and Dopamine Agonists | 184 | ||
| Sedatives and Hypnotics | 184 | ||
| Complementary and Alternative Medicine Therapy for Obstructive Sleep Apnea | 185 | ||
| Acupuncture | 185 | ||
| Pharmacologic Management of “Residual” Excessive Daytime Sleepiness with Adequately Treated Obstructive Sleep Apnea | 185 | ||
| Summary | 187 | ||
| Selected Readings | 187 | ||
| References | 187.e1 | ||
| Review Questions | 187.e5 | ||
| Answers | 187.e6 | ||
| 18 Obstructive Sleep Apnea: Positive Airway Pressure Therapy | 188 | ||
| Chapter Highlights | 188 | ||
| Continuous Positive Airway Pressure Treatment | 188 | ||
| Determining the Optimal Setting | 189 | ||
| Benefits of Therapy | 190 | ||
| Effect on Daytime Sleepiness | 190 | ||
| Effect on Neurocognitive Function, Mood, and Quality of Life | 191 | ||
| Effect on Cardiovascular Disease | 191 | ||
| Effect on Mild Obstructive Sleep Apnea | 193 | ||
| Effect on REM-Predominant Obstructive Sleep Apnea | 193 | ||
| Effect on Obstructive Sleep Apnea and Comorbid Diseases | 193 | ||
| Comparison with Other Obstructive Sleep Apnea Treatments | 194 | ||
| Oxygen Therapy | 194 | ||
| Outcomes Summary | 194 | ||
| Adherence and Problems with Continuous Positive Airway Pressure Treatment | 194 | ||
| Role of Objective Adherence Monitoring and Limitations with Current Technology | 195 | ||
| Interventions to Promote Adherence | 195 | ||
| Role of the Sleep Specialist in Improving Adherence | 196 | ||
| Technology to Improve Adherence | 197 | ||
| Technologic Advancements in the Delivery of Positive Airway Pressure Therapy for Obstructive Sleep Apnea | 197 | ||
| Bilevel Positive Airway Pressure Therapy | 197 | ||
| Expiratory Pressure Relief Systems | 197 | ||
| Autotitrating Positive Airway Pressure | 198 | ||
| Autobilevel Therapy for Obstructive Sleep Apnea | 199 | ||
| Summary | 200 | ||
| Selected Readings | 200 | ||
| References | 200.e1 | ||
| Review Questions | 200.e5 | ||
| Answers | 200.e6 | ||
| 19 Obstructive Sleep Apnea: Oral Appliance Therapy | 201 | ||
| Chapter Highlights | 201 | ||
| Why Use Oral Appliances for Sleep-Disordered Breathing and Obstructive Sleep Apnea–Hypopnea Syndrome? | 201 | ||
| Types of Oral Appliances for Sleep-Disordered Breathing and Sleep Bruxism | 202 | ||
| Oral Appliance Mechanism of Action | 202 | ||
| Clinical Outcomes and Measures of Success | 203 | ||
| Snoring | 203 | ||
| Polysomnographic Variables and Reduction of the Apnea-Hypopnea Index | 203 | ||
| Daytime Somnolence and Quality of Life Measures | 203 | ||
| Cardiovascular Outcomes | 204 | ||
| Neurocognitive Outcomes | 205 | ||
| Outcome Comparison between Types of Oral Appliances and Positive Airway Pressure Therapy | 205 | ||
| Fixed versus Adjustable Appliances | 205 | ||
| Oral Appliances versus Positive Airway Pressure Therapy | 206 | ||
| Patient and Device Selection | 206 | ||
| Indications and Contraindications | 206 | ||
| Predictors of Successful Oral Appliance Therapy | 208 | ||
| Appliance Selection | 208 | ||
| Optimization of Treatment | 209 | ||
| Side Effects and Complications | 209 | ||
| Adherence and Patient Perceptions | 210 | ||
| Sleep Bruxism in Patients with Obstructive Sleep Apnea– Hypopnea Syndrome | 210 | ||
| The Impact of Bruxism Therapies on the Upper Airway | 211 | ||
| The Use of Oral Appliances in Patients with Sleep Bruxism and Obstructive Sleep Apnea–Hypopnea Syndrome | 211 | ||
| Future Directions | 212 | ||
| Summary | 212 | ||
| Selected Readings | 213 | ||
| References | 213.e1 | ||
| Review Questions | 213.e5 | ||
| Answers | 213.e6 | ||
| 20 Obstructive Sleep Apnea: Anesthesia for Upper Airway Surgery | 214 | ||
| Chapter Highlights | 214 | ||
| Preoperative Evaluation of Patients Presenting for Obstructive Sleep Apnea Surgery | 215 | ||
| Drug-Induced Sedation Endoscopy | 215 | ||
| Anesthesia for Surgery to Treat Obstructive Sleep Apnea | 215 | ||
| Tracheal Intubation | 216 | ||
| Airway Patency after Extubation | 217 | ||
| Early Postoperative Care | 217 | ||
| Postoperative Sleep | 217 | ||
| Discharge Requirements | 217 | ||
| Conclusions | 217 | ||
| Summary | 218 | ||
| Selected Readings | 218 | ||
| References | 218.e1 | ||
| Review Questions | 218.e2 | ||
| Answers | 218.e3 | ||
| 21 Upper Airway Surgery to Treat Obstructive Sleep Apnea | 219 | ||
| Chapter Highlights | 219 | ||
| Overview and Background | 219 | ||
| Preoperative Evaluation | 219 | ||
| Surgical Upper Airway Modifications | 221 | ||
| Nasal Surgery | 221 | ||
| Pharyngeal Surgery | 222 | ||
| Upper Airway Neurostimulation Therapy | 225 | ||
| Skeletal Modifications | 227 | ||
| General Outcomes of Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea | 228 | ||
| Preoperative Evaluation for Maxillomandibular Advancement | 230 | ||
| Postoperative Management after Maxillomandibular Advancement | 231 | ||
| Upper Airway Bypass: Tracheostomy | 231 | ||
| Bariatric Surgery | 231 | ||
| Combination Therapy Including Multilevel Surgery | 232 | ||
| Summary | 232 | ||
| Selected Readings | 233 | ||
| References | 233.e1 | ||
| Review Questions | 233.e4 | ||
| Answers | 233.e5 | ||
| 22 Obstructive Sleep Apnea, Obesity, and Bariatric Surgery | 234 | ||
| Chapter Highlights | 234 | ||
| Definitions and Overview | 234 | ||
| Epidemiology | 234 | ||
| Epidemiology of Overweight and Obesity | 234 | ||
| Epidemiologic Association between Overweight/Obesity and Obstructive Sleep Apnea | 235 | ||
| Pathogenesis | 236 | ||
| Mechanism Linking Obesity to Obstructive Sleep Apnea Risk | 236 | ||
| Bariatric Surgery for Medically Complicated Obesity | 236 | ||
| Patient Selection | 236 | ||
| Rationale for Patient Assessment for Obstructive Sleep Apnea before Bariatric Surgery | 237 | ||
| Preoperative Assessment for Bariatric Surgery in the Patient without Known Obstructive Sleep Apnea | 237 | ||
| Preoperative Assessment for Bariatric Surgery in the Patient with Established Obstructive Sleep Apnea | 239 | ||
| Common Bariatric Surgical Procedures | 239 | ||
| Clinical Course | 240 | ||
| Management of Obstructive Sleep Apnea Immediately after Bariatric Surgery | 240 | ||
| Benefits of Bariatric Surgery | 242 | ||
| Long-term Impact of Bariatric Surgery on Obstructive Sleep Apnea | 242 | ||
| Risks and Complications of Bariatric Surgery | 243 | ||
| Pitfalls and Controversy | 243 | ||
| Summary | 244 | ||
| Selected Readings | 244 | ||
| References | 244.e1 | ||
| Review Questions | 244.e3 | ||
| Answers | 244.e4 | ||
| 4 Consequences | 245 | ||
| 23 Obstructive Sleep Apnea and the Central Nervous System | 245 | ||
| Chapter Highlights | 245 | ||
| Neuropathology of Obstructive Sleep Apnea | 247 | ||
| Affected Neurocognitive Domains | 247 | ||
| Proposed Mechanistic Role for Perturbed Sleep in Patients with Obstructive Sleep Apnea | 248 | ||
| Mental Health and Sleep Associations in Obstructive Sleep Apnea Patients | 249 | ||
| Neuroinflammation and Ischemic Preconditioning | 251 | ||
| Neuroinflammation in Obstructive Sleep Apnea | 252 | ||
| Neurologic Disorders and Cognitive and Performance Deficits Associated with Obstructive Sleep Apnea | 253 | ||
| Assessment of Cognitive and Neurobehavioral Performance Deficits in Obstructive Sleep Apnea | 254 | ||
| Effect of Obstructive Sleep Apnea Treatment on Associated Neurocognitive Deficits and Disorders | 255 | ||
| Summary | 256 | ||
| Acknowledgments | 257 | ||
| Selected Readings | 257 | ||
| References | 257.e1 | ||
| Review Questions | 257.e4 | ||
| Answers | 257.e5 | ||
| 24 Obstructive Sleep Apnea and Metabolic Disorders | 258 | ||
| Chapter Highlights | 258 | ||
| Obstructive Sleep Apnea and Metabolic Dysregulation: Pathogenesis and Mechanisms | 258 | ||
| Obesity and Adiposity | 258 | ||
| Insulin Resistance and Glucose Metabolism | 259 | ||
| Lipid Metabolism and Dyslipidemia | 259 | ||
| Liver Injury and Related Metabolic Dysregulation | 261 | ||
| Neurohumoral Activation | 261 | ||
| Intermittent Hypoxia | 261 | ||
| Derangement of Sleep Quality and Quantity | 263 | ||
| Oxidative Stress | 263 | ||
| Inflammation and Alteration of the Adipocytokine Profile | 263 | ||
| Obstructive Sleep Apnea and Metabolic Dysregulation: Clinical Associations and Treatment | 263 | ||
| Obesity | 263 | ||
| Insulin and Glucose Metabolism | 264 | ||
| Dyslipidemia | 266 | ||
| Hepatic Dysfunction and Nonalcoholic Fatty Liver Disease | 266 | ||
| Inflammation and Alteration of Adipocytokines | 266 | ||
| Obstructive Sleep Apnea and Metabolic Syndrome | 267 | ||
| Conclusions and Perspectives | 267 | ||
| Summary | 268 | ||
| Selected Readings | 269 | ||
| References | 269.e1 | ||
| Review Questions | 269.e4 | ||
| Answers | 269.e5 | ||
| 25 Cardiovascular Effects of Sleep-Related Breathing Disorders | 270 | ||
| Chapter Highlights | 270 | ||
| Arterial Blood Gas Abnormalities and Their Consequences | 270 | ||
| Hypoxemia and Reoxygenation | 271 | ||
| Direct Effects of Hypoxia on Myocardium | 271 | ||
| Hypoxemia-Reoxygenation and Coronary Endothelial Dysfunction | 271 | ||
| Hypoxemia-Hypercapnia and the Autonomic Nervous System | 271 | ||
| Alveolar Hypoxia-Hypercapnia and Pulmonary Arteriolar Vasoconstriction | 273 | ||
| Hypocapnia | 273 | ||
| Arousals, Shift to Light Sleep Stages, and the Autonomic Nervous System | 273 | ||
| Exaggerated Negative Intrathoracic Pressure and Its Consequences | 274 | ||
| Acute Hemodynamic Effects of Sleep Apnea | 274 | ||
| Obstructive Sleep Apnea, Left Ventricular Dysfunction, and Heart Failure | 275 | ||
| Obstructive Sleep Apnea and Systolic Heart Failure | 275 | ||
| Obstructive Sleep Apnea and Diastolic Heart Failure | 276 | ||
| Arrhythmias in Obstructive Sleep Apnea | 277 | ||
| Obstructive Sleep Apnea Predisposing to an Arrhythmogenic Substrate | 277 | ||
| Tachycardia-Bradycardia Oscillations | 277 | ||
| Bradyarrhythmias | 277 | ||
| Ventricular Arrhythmias | 278 | ||
| Atrial Fibrillation | 278 | ||
| Summary | 278 | ||
| Selected Readings | 279 | ||
| References | 279.e1 | ||
| Review Questions | 279.e4 | ||
| Answers | 279.e5 | ||
| 26 Systemic and Pulmonary Hypertension in Obstructive Sleep Apnea | 280 | ||
| Chapter Highlights | 280 | ||
| Systemic Hypertension | 280 | ||
| Epidemiologic Evidence for a Role of Obstructive Sleep Apnea in Systemic Hypertension | 280 | ||
| Obstructive Sleep Apnea and Hypertension in Population Subgroups | 283 | ||
| Obstructive Sleep Apnea and Diurnal Blood Pressure | 283 | ||
| Blood Pressure Changes in Patients with Obstructive Sleep Apnea after Positive Airway Pressure Treatment | 284 | ||
| Clinical Relevance of the Role of Obstructive Sleep Apnea in Hypertension | 285 | ||
| Pulmonary Hypertension | 286 | ||
| Obstructive Sleep Apnea as a Cause of Pulmonary Hypertension | 286 | ||
| Mechanisms of Pulmonary Hypertension in Patients with Obstructive Sleep Apnea | 287 | ||
| Changes in Pulmonary Artery Pressure after Positive Airway Pressure Treatment of Obstructive Sleep Apnea | 288 | ||
| Summary | 289 | ||
| Selected Readings | 290 | ||
| References | 290.e1 | ||
| Review Questions | 290.e3 | ||
| Answers | 290.e4 | ||
| 27 Coronary Artery Disease and Obstructive Sleep Apnea | 291 | ||
| Chapter Highlights | 291 | ||
| Epidemiology | 291 | ||
| Prevalence of Obstructive Sleep Apnea and Coronary Artery Disease in the General Population | 292 | ||
| Prevalence of Coronary Artery Disease in Patients with Obstructive Sleep Apnea | 292 | ||
| Prevalence of Obstructive Sleep Apnea in Patients with Coronary Artery Disease | 292 | ||
| Incidence of Coronary Artery Disease in Longitudinal Studies | 293 | ||
| Effect of Obstructive Sleep Apnea Treatment on Coronary Artery Disease | 295 | ||
| Pathogenesis | 295 | ||
| Clinical Course and Prevention | 296 | ||
| Summary | 297 | ||
| Selected Readings | 297 | ||
| References | 297.e1 | ||
| Review Questions | 297.e3 | ||
| Answers | 297.e4 | ||
| 28 Heart Failure | 298 | ||
| Chapter Highlights | 298 | ||
| Epidemiology of Heart Failure and Sleep-Related Breathing Disorders | 298 | ||
| Sleep Apnea in Heart Failure with Reduced Ejection Fraction | 299 | ||
| Sleep Apnea in Heart Failure with Preserved Ejection Fraction | 300 | ||
| Sex and Sleep-Related Breathing Disorders in Heart Failure | 301 | ||
| Mechanisms of Sleep-Related Breathing Disorders in Heart Failure | 301 | ||
| Mechanisms of Central Sleep Apnea in Heart Failure | 301 | ||
| Mechanisms of Obstructive Sleep Apnea in Heart Failure | 302 | ||
| Pathologic Consequences and Prognostic Significance of Sleep-Related Breathing Disorders | 302 | ||
| Effects of Obstructive Sleep Apnea on Sympathetic Activity, Cardiovascular Function, Hospital Readmission, and Mortality | 303 | ||
| Effects of Central Sleep Apnea on Sympathetic Activity, Cardiovascular Function, Hospital Readmission, and Mortality | 304 | ||
| Clinical Presentation of Obstructive and Central Sleep Apneas in Patients with Heart Failure | 305 | ||
| Indications for Polysomnography in Heart Failure | 305 | ||
| Treatment of Sleep-Related Breathing Disorders in Patients with Heart Failure | 306 | ||
| Treatment for Obstructive Sleep Apnea | 306 | ||
| Optimization of Cardiopulmonary Function | 306 | ||
| Weight Loss | 306 | ||
| Avoidance of Alcoholic Beverages, Benzodiazepines, and Phosphodiesterase-5 Inhibitors at Bedtime, and Smoking | 307 | ||
| Positive Airway Pressure Devices | 307 | ||
| Supplemental Nasal Oxygen | 307 | ||
| Upper Airway Surgical Procedures | 307 | ||
| Oral Appliances | 307 | ||
| Treatment for Central Sleep Apnea | 307 | ||
| Optimization of Cardiopulmonary Function | 308 | ||
| Cardiac Transplantation | 308 | ||
| Positive Airway Pressure Devices | 308 | ||
| Continuous Positive Airway Pressure | 308 | ||
| Adaptive Servoventilation | 309 | ||
| Cardiac Pacing | 310 | ||
| Transvenous Unilateral Phrenic Nerve Stimulation | 310 | ||
| Medications | 311 | ||
| Nasal Nocturnal Oxygen. | 311 | ||
| Theophylline. | 311 | ||
| Acetazolamide. | 311 | ||
| Benzodiazepines. | 311 | ||
| Inhaled CO2 and Addition of External Dead Space. | 311 | ||
| Summary | 312 | ||
| Selected Readings | 312 | ||
| References | 312.e1 | ||
| Review Questions | 312.e4 | ||
| Answers | 312.e5 | ||
| 5 Special Populations | 313 | ||
| 29 Overlap Syndromes of Sleep and Breathing Disorders | 313 | ||
| Chapter Highlights | 313 | ||
| Overview | 313 | ||
| Chronic Obstructive Pulmonary Disease | 314 | ||
| Chronic Obstructive Lung Disease and Obstructive Sleep Apnea Overlap Syndrome | 314 | ||
| Definitions and Classifications | 314 | ||
| Epidemiology of COPD/OSA Overlap Syndrome | 314 | ||
| Sleep in Patients with COPD/OSA Overlap Syndrome | 315 | ||
| Risk Factors for COPD/OSA Overlap Syndrome | 315 | ||
| Sleep and Breathing Pathophysiology of COPD/OSA Overlap Syndrome | 315 | ||
| Clinical Features of COPD/OSA Overlap Syndrome | 316 | ||
| Diagnosis and Management of COPD/OSA Overlap Syndrome | 317 | ||
| Asthma | 318 | ||
| Asthma and OSA Overlap Syndrome | 319 | ||
| Epidemiology | 319 | ||
| Pathophysiology and Risk Factors for Asthma/OSA Overlap Syndrome | 319 | ||
| Clinical Outcomes and Treatment in Asthma/Overlap Syndrome | 320 | ||
| Interstitial Lung Disease | 320 | ||
| ILD and Obstructive Sleep Apnea Overlap Syndrome | 320 | ||
| Pulmonary Hypertension | 321 | ||
| Pulmonary Hypertension and Sleep-Disordered Breathing Overlap Syndrome | 321 | ||
| Insomnia in Pulmonary Diseases | 322 | ||
| Summary | 322 | ||
| Selected Readings | 323 | ||
| References | 323.e1 | ||
| Review Questions | 323.e4 | ||
| Answers | 323.e5 | ||
| 30 Obesity-Hypoventilation Syndrome | 324 | ||
| Chapter Highlights | 324 | ||
| Historical Perspective | 324 | ||
| Definition | 324 | ||
| Epidemiology | 324 | ||
| Clinical Presentation and Diagnosis | 326 | ||
| Morbidity and Mortality | 328 | ||
| Pathophysiology | 329 | ||
| Treatment | 330 | ||
| Positive Airway Pressure Therapy | 330 | ||
| Oxygen Therapy | 332 | ||
| Weight Reduction | 332 | ||
| Tracheostomy | 333 | ||
| Respiratory Stimulation | 333 | ||
| Summary | 333 | ||
| Selected Readings | 334 | ||
| References | 334.e1 | ||
| Review Questions | 334.e4 | ||
| Answers | 334.e5 | ||
| 31 Stroke | 335 | ||
| Chapter Highlights | 335 | ||
| Stroke | 335 | ||
| Sleep-Disordered Breathing and Stroke | 335 | ||
| Epidemiology | 335 | ||
| Sleep-Disordered Breathing as a Risk Factor for Stroke | 335 | ||
| Sleep-Disordered Breathing in Acute and Postacute Stroke Patients | 336 | ||
| Clinical Features | 336 | ||
| Breathing Disturbances During Sleep | 336 | ||
| Breathing Disturbances During Wakefulness | 336 | ||
| Pathophysiology | 337 | ||
| Sleep-Disordered Breathing as a Risk Factor for Stroke: Acute Effects | 337 | ||
| Sleep-Disordered Breathing as a Risk Factor for Stroke: Chronic Effects | 338 | ||
| Sleep-Disordered Breathing as a Consequence of Stroke | 338 | ||
| Acute and Chronic Clinical Effects and Consequences | 339 | ||
| Diagnosis | 339 | ||
| Treatment of Sleep-Disordered Breathing | 339 | ||
| Treatment of Obstructive Sleep-Disordered Breathing | 339 | ||
| Treatment of Central Sleep-Disordered Breathing | 340 | ||
| Sleep-Wake Disturbances and Stroke | 340 | ||
| Epidemiology | 340 | ||
| Sleep-Wake Disturbances and Short Sleep Duration as Risk Factors for Stroke | 340 | ||
| Sleep-Wake Disturbances in Stroke Patients | 340 | ||
| Clinical Features, Pathophysiology, and Treatment | 340 | ||
| Hypersomnia and Excessive Daytime Sleepiness | 340 | ||
| Fatigue | 343 | ||
| Insomnia | 343 | ||
| Sleep-Related Movement Disorders and Parasomnias | 343 | ||
| Hallucinations and Altered Dreams | 343 | ||
| Clinical Significance of Sleep-Wake Disorder after Stroke | 344 | ||
| Sleep Architecture Changes | 345 | ||
| Supratentorial Strokes | 345 | ||
| Infratentorial Strokes | 346 | ||
| Circadian Aspects and Disturbances | 346 | ||
| Summary | 346 | ||
| Selected Readings | 347 | ||
| References | 347.e1 | ||
| Review Questions | 347.e5 | ||
| Answers | 347.e6 | ||
| 32 Neuromuscular Diseases | 348 | ||
| Chapter Highlights | 348 | ||
| Epidemiology and Genetics | 348 | ||
| Pathophysiology | 348 | ||
| Clinical Features Common to Most Neuromuscular Disorders | 349 | ||
| Neurodegenerative Diseases Involving the Motor Neuron | 349 | ||
| Spinal Cord Disease | 349 | ||
| Polyneuropathies | 350 | ||
| Neuromuscular Junction Diseases | 350 | ||
| Muscle Diseases | 350 | ||
| Myotonic Dystrophy | 350 | ||
| Other Myopathies | 351 | ||
| Diagnostic Evaluation | 351 | ||
| Treatment of Sleep Abnormalities in Patients with Neuromuscular Disease | 352 | ||
| Noninvasive Positive Airway Pressure | 352 | ||
| Decision to Assist Nocturnal Ventilation | 353 | ||
| Summary | 354 | ||
| Selected Readings | 354 | ||
| References | 354.e1 | ||
| Review Questions | 354.e4 | ||
| Answers | 354.e5 | ||
| 33 Obstructive Sleep Apnea in Older Adults | 355 | ||
| Chapter Highlights | 355 | ||
| Epidemiology and Definitions | 355 | ||
| Clinical Manifestations and Presentation | 356 | ||
| Pathophysiology | 356 | ||
| Clinical Consequences | 356 | ||
| Overview | 356 | ||
| Nocturia | 357 | ||
| Impaired Cognition | 357 | ||
| Cardiovascular Disease | 358 | ||
| Hypertension | 358 | ||
| Atrial Fibrillation | 359 | ||
| Stroke | 359 | ||
| Other Effects | 359 | ||
| Treatment of Obstructive Sleep Apnea in Older Adults | 359 | ||
| Continuous Positive Airway Pressure | 359 | ||
| Oral Appliances | 360 | ||
| Surgery | 360 | ||
| Pharmacologic Treatment | 360 | ||
| Body Position | 360 | ||
| Driving and the Older Patient with Obstructive Sleep Apnea | 360 | ||
| Summary | 361 | ||
| Selected Readings | 361 | ||
| References | 361.e1 | ||
| Review Questions | 361.e4 | ||
| Answers | 361.e5 | ||
| 34 Sleep-Disordered Breathing in Pregnancy | 362 | ||
| Chapter Highlights | 362 | ||
| Pregnancy Physiology and Sleep-Disordered Breathing | 362 | ||
| Respiratory System Changes that Predispose Pregnant Women to Sleep-Disordered Breathing | 362 | ||
| Respiratory and Circulatory System Changes that May Protect against Sleep-Disordered Breathing | 363 | ||
| Epidemiology of Sleep-Disordered Breathing in Pregnancy | 363 | ||
| Sleep-Disordered Breathing and Adverse Maternal Outcomes | 364 | ||
| Potential Mechanisms for Adverse Maternal Outcomes | 364 | ||
| Impact of Sleep-Disordered Breathing on Pregnancy | 365 | ||
| Sleep-Disordered Breathing and Hypertensive Disorders of Pregnancy | 365 | ||
| Sleep-Disordered Breathing and Diabetes in Pregnancy | 365 | ||
| Sleep-Disordered Breathing and Severe Maternal Morbidity | 365 | ||
| Implications of Sleep-Disordered Breathing for Cesarean Delivery | 365 | ||
| Sleep-Disordered Breathing and Adverse Fetal Outcomes | 366 | ||
| Stillbirth | 366 | ||
| Miscarriage | 366 | ||
| Preterm Delivery | 366 | ||
| Fetal Heart Rate Abnormalities | 366 | ||
| Fetal Growth Abnormalities | 366 | ||
| Screening for Sleep-Disordered Breathing in Pregnancy | 366 | ||
| Diagnosing Sleep-Disordered Breathing in Pregnancy | 367 | ||
| Treatment of Sleep-Disordered Breathing in Pregnancy | 367 | ||
| Summary | 368 | ||
| Selected Readings | 368 | ||
| References | 368.e1 | ||
| Review Questions | 368.e3 | ||
| Answers | 368.e4 | ||
| 35 Obstructive Sleep Apnea in the Workplace | 369 | ||
| Chapter Highlights | 369 | ||
| Overview and Background | 369 | ||
| Consequences of Obstructive Sleep Apnea in Transportation Workers | 369 | ||
| Principles of Obstructive Sleep Apnea Management in the Workplace | 370 | ||
| Sleep Disorder Management | 370 | ||
| Screening and Risk Factors | 370 | ||
| Obstructive Sleep Apnea Screening Methods in the Workplace | 370 | ||
| Subjective Measures | 370 | ||
| Objective Measures | 371 | ||
| Functional Screening | 372 | ||
| Diagnosis of Obstructive Sleep Apnea in Occupational Settings | 372 | ||
| Treatment Options and Compliance Monitoring | 373 | ||
| Federal Regulations and Recommendations | 373 | ||
| Risk Factor Reduction | 373 | ||
| Summary | 375 | ||
| Selected Readings | 375 | ||
| References | 375.e1 | ||
| Review Questions | 375.e3 | ||
| Answers | 375.e4 | ||
| Index | 377 | ||
| A | 377 | ||
| B | 378 | ||
| C | 379 | ||
| D | 380 | ||
| E | 380 | ||
| F | 381 | ||
| G | 381 | ||
| H | 381 | ||
| I | 382 | ||
| J | 382 | ||
| L | 382 | ||
| M | 382 | ||
| N | 383 | ||
| O | 384 | ||
| P | 386 | ||
| Q | 386 | ||
| R | 386 | ||
| S | 387 | ||
| T | 389 | ||
| U | 389 | ||
| V | 389 | ||
| W | 389 | ||
| Z | 389 | ||
| Inside Back Cover | ibc1 |