BOOK
Ambulatory Sleep Medicine, An Issue of Sleep Medicine Clinics, E-Book
Nicholas A. Antic | Teofilo Lee-Chiong, Jr
(2016)
Additional Information
Book Details
Abstract
This issue of Sleep Medicine Clinics focuses on Ambulatory Sleep Medicine. Article topics include: Diagnosis of Obstructive Sleep Apnea; Personalised medicine for Obstructive Sleep Apnea therapies: Are we there yet?, Cardiovascular risk of Obstructive Sleep Apnea; Motor Vehicle Accident risk related to Obstructive Sleep Apnea; Impact of Obstructive Sleep Apnea Syndrome on Neurocognitive function and impact of CPAP; CPAP therapy for Obstructive Sleep Apnea; Maximizing adherence including using novel IT based systems; Mandibular advancement splints; Surgical approaches to Obstructive Sleep Apnea; Consequences of Obstructive Sleep Apnea; and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Ambulatory Sleep\rMedicine | i | ||
| Copyright\r | ii | ||
| CME Accreditation Page | iii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iv | ||
| TO ENROLL | iv | ||
| METHOD OF PARTICIPATION | iv | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| SLEEP MEDICINE CLINICS\r | v | ||
| FORTHCOMING ISSUES | v | ||
| December 2016 | v | ||
| March 2017 | v | ||
| June 2017 | v | ||
| RECENT ISSUES | v | ||
| June 2016 | v | ||
| March 2016 | v | ||
| December 2015 | v | ||
| Contributors | vii | ||
| CONSULTING EDITOR | vii | ||
| EDITORS | vii | ||
| AUTHORS | vii | ||
| Contents | xi | ||
| Ambulatory Diagnosis and Management of Obstructive Sleep Apnea: Screening\rQuestionnaires, Diagnostic Tests, and the Care Team\r | xi | ||
| Consequences of Obstructive Sleep Apnea: Cardiovascular Risk of Obstructive\rSleep Apnea and Whether Continuous Positive Airway Pressure Reduces that Risk\r | xi | ||
| Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure\r | xi | ||
| Personalized Medicine for Obstructive Sleep Apnea Therapies: Are We There Yet?\r | xi | ||
| Managing Comorbid Illness in Obstructive Sleep Apnea: What Can We Learn from Other Diseases? \r | xii | ||
| Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea:\rMaximizing Adherence Including Using Novel Information Technology–based\rSystems\r | xii | ||
| Surgical Approaches to Obstructive Sleep Apnea\r | xii | ||
| Mandibular Advancement Splints\r | xii | ||
| Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive\rAirway Pressure Optimization: Causes and Management\r | xiii | ||
| Disorders of Excessive Daytime Sleepiness Including Narcolepsy and Idiopathic Hypersomnia\r | xiii | ||
| Diagnosis and Treatment of Insomnia Comorbid with Obstructive Sleep Apnea\r | xiii | ||
| Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder\r | xiii | ||
| Ambulatory Diagnosis and Management of Obstructive Sleep Apnea | 265 | ||
| Key points | 265 | ||
| THE IMPORTANCE OF PATIENT HISTORY, EXAMINATION, AND CLINICAL JUDGEMENT | 266 | ||
| OBSTRUCTIVE SLEEP APNEA SCREENING QUESTIONNAIRES AND CLINICAL PREDICTION TOOLS | 266 | ||
| HOME SLEEP TESTS VERSUS IN-LABORATORY POLYSOMNOGRAPHY | 268 | ||
| HOME AUTO-ADJUSTING POSITIVE AIRWAY PRESSURE TREATMENT VERSUS IN-LABORATORY CONTINUOUS POSITIVE AIRWAY PRESSURE TITRATION | 268 | ||
| PRINCIPLES OF OBSTRUCTIVE SLEEP APNEA CARE | 268 | ||
| THE OBSTRUCTIVE SLEEP APNEA CARE TEAM | 269 | ||
| An Expanded Role for Specialist Sleep Nurses? | 270 | ||
| REFERENCES | 270 | ||
| Consequences of Obstructive Sleep Apnea | 273 | ||
| Key points | 273 | ||
| INTRODUCTION | 273 | ||
| OVERVIEW OF SLEEP-DISORDERED BREATHING | 274 | ||
| MECHANISM OF CARDIOVASCULAR DISEASE IN OBSTRUCTIVE SLEEP APNEA | 274 | ||
| Intermittent Hypoxia | 274 | ||
| Sympathetic Activation, a Critical Mediator for Cardiovascular Disease in Obstructive Sleep Apnea | 274 | ||
| Oxidative Stress | 275 | ||
| Metabolic Dysregulation in Obstructive Sleep Apnea | 275 | ||
| CLINICAL LINK BETWEEN OBSTRUCTIVE SLEEP APNEA/SLEEP-DISORDERED BREATHING AND SPECIFIC CARDIOVASCULAR DISEASES | 275 | ||
| Systemic Hypertension and Obstructive Sleep Apnea: A Critical Causative Relationship | 275 | ||
| Coronary Artery Disease and Obstructive Sleep Apnea | 276 | ||
| Cardiac Arrhythmia (with a Focus on Atrial Fibrillation) and Obstructive Sleep Apnea | 277 | ||
| Cerebrovascular Accidents and Obstructive Sleep Apnea | 277 | ||
| Pulmonary Hypertension and Obstructive Sleep Apnea | 278 | ||
| Cardiomyopathy, Heart Failure, and Sleep-disordered Breathing | 278 | ||
| Treatment of Sleep-disordered Breathing as a Therapeutic Intervention to Modify Cardiovascular Disease Risk | 279 | ||
| SUMMARY | 281 | ||
| REFERENCES | 281 | ||
| Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure | 287 | ||
| Key points | 287 | ||
| INTRODUCTION | 287 | ||
| OBSTRUCTIVE SLEEP APNEA EFFECTS ON ATTENTION AND VIGILANCE | 288 | ||
| OBSTRUCTIVE SLEEP APNEA EFFECTS ON VERBAL MEMORY | 288 | ||
| OBSTRUCTIVE SLEEP APNEA EFFECTS ON VISUAL AND VISUOSPATIAL MEMORY | 289 | ||
| OBSTRUCTIVE SLEEP APNEA EFFECTS ON PSYCHOMOTOR FUNCTION AND PROCEDURAL MEMORY | 289 | ||
| OBSTRUCTIVE SLEEP APNEA EFFECTS ON EXECUTIVE FUNCTION | 290 | ||
| OBSTRUCTIVE SLEEP APNEA EFFECTS ON OVERALL IQ | 290 | ||
| NEUROCOGNITIVE EFFECTS OF OBSTRUCTIVE SLEEP APNEA FOR CHILDREN | 291 | ||
| IMAGING: MAGNETIC RESONANCE SPECTROSCOPY, DIFFUSION TENSOR IMAGING, FUNCTIONAL MRI STUDIES | 291 | ||
| MECHANISMS OF OBSTRUCTIVE SLEEP APNEA EFFECTS ON COGNITION | 292 | ||
| IMPACT OF CONTINUOUS POSITIVE AIR PRESSURE | 292 | ||
| CONTINUOUS POSITIVE AIR PRESSURE WITHDRAWAL | 294 | ||
| SUMMARY | 295 | ||
| REFERENCES | 295 | ||
| Personalized Medicine for Obstructive Sleep Apnea Therapies | 299 | ||
| Key points | 299 | ||
| CURRENT TREATMENT OPTIONS FOR OBSTRUCTIVE SLEEP APNEA PATIENTS | 300 | ||
| Continuous Positive Airway Pressure | 300 | ||
| Mandibular Advancement Splints | 300 | ||
| Upper Airway Surgery | 300 | ||
| Weight Loss | 300 | ||
| Summary | 300 | ||
| OBSTRUCTIVE SLEEP APNEA IS A MULTIFACTORIAL DISORDER | 301 | ||
| Alternative Therapies Targeting the Nonanatomic Traits | 301 | ||
| High loop gain | 301 | ||
| Low arousal threshold | 302 | ||
| Poor upper airway muscle responsiveness | 302 | ||
| Combinations of Therapies | 303 | ||
| PERSONALIZED MEDICINE FOR OBSTRUCTIVE SLEEP APNEA | 303 | ||
| Currently Applied/Available Methods to Personalize or Predict Therapeutic Response | 303 | ||
| Supine predominant obstructive sleep apnea and supine avoidance therapy | 303 | ||
| Mandibular advancement titration and prediction algorithms | 304 | ||
| Drug-induced sleep endoscopy | 304 | ||
| Summary | 304 | ||
| Personalized Treatment for Obstructive Sleep Apnea: A Physiologically Driven Treatment Model | 305 | ||
| A predictive model for assessing the effectiveness of targeted therapeutic interventions | 305 | ||
| Clinically implementable methods for measuring the physiology responsible for obstructive sleep apnea | 305 | ||
| Necessary clinical trials | 307 | ||
| SUMMARY | 308 | ||
| REFERENCES | 308 | ||
| Managing Comorbid Illness in Obstructive Sleep Apnea | 313 | ||
| Key points | 313 | ||
| INTRODUCTION | 313 | ||
| CARDIOVASCUAR DISORDERS | 313 | ||
| Overview | 314 | ||
| Hypertension | 314 | ||
| Atrial fibrillation | 314 | ||
| Congestive heart failure | 314 | ||
| Management Goals | 314 | ||
| Treatment Considerations | 314 | ||
| Monitoring Therapy | 314 | ||
| PULMONARY DISORDERS | 314 | ||
| Overview | 315 | ||
| Obstructive lung disease | 315 | ||
| Interstitial lung disease | 315 | ||
| Chronic hypoventilation | 315 | ||
| Management Goals | 315 | ||
| Treatment Considerations | 315 | ||
| Monitoring Therapy | 315 | ||
| PSYCHIATRIC | 315 | ||
| Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea | 323 | ||
| Key points | 323 | ||
| REFERENCES | 329 | ||
| Surgical Approaches to Obstructive Sleep Apnea | 331 | ||
| Key points | 331 | ||
| INTRODUCTION | 331 | ||
| DEFINITION OF OBSTRUCTIVE SLEEP APNEA SURGERY | 331 | ||
| PHILOSOPHY OF SURGERY | 331 | ||
| CLINICAL ASSESSMENT IN OBSTRUCTIVE SLEEP APNEA SURGERY, INCLUDING DYNAMIC AIRWAY ASSESSMENT | 332 | ||
| PREPHASE NASAL SURGERY | 332 | ||
| CONTEMPORARY SURGICAL INTERVENTION PARADIGMS AND SELECTION | 333 | ||
| COMPLICATIONS OF SURGERY | 335 | ||
| EFFECTIVENESS OF OBSTRUCTIVE SLEEP APNEA SURGERY: CURRENT STATUS OF LITERATURE: NONRANDOMIZED TRIALS | 335 | ||
| EFFECTIVENESS OF OBSTRUCTIVE SLEEP APNEA SURGERY: CURRENT STATUS OF LITERATURE AND CHALLENGES OF RANDOMIZED CONTROLLED TRIALS | 336 | ||
| How to Define Obstructive Sleep Apnea Surgery | 336 | ||
| Patient Selection | 336 | ||
| Recruitment/Enrollment | 336 | ||
| Economics | 336 | ||
| Comparator Group | 337 | ||
| Outcome Measures | 337 | ||
| RECENT/CURRENT INNOVATIONS | 337 | ||
| FUTURE DIRECTIONS AND INNOVATIONS | 338 | ||
| ACKNOWLEDGMENTS | 338 | ||
| REFERENCES | 338 | ||
| Mandibular Advancement Splints | 343 | ||
| Key points | 343 | ||
| INTRODUCTION | 343 | ||
| EFFICACY AND HEALTH OUTCOMES OF MANDIBULAR ADVANCEMENT SPLINTS | 343 | ||
| MANDIBULAR ADVANCEMENT SPLINTS COMPARED WITH OTHER OBSTRUCTIVE SLEEP APNEA TREATMENT MODALITIES | 344 | ||
| FACTORS INFLUENCING THE EFFICACY OF MANDIBULAR ADVANCEMENT SPLINTS | 345 | ||
| Design of Mandibular Advancement Splints | 345 | ||
| Preference and Adherence to Mandibular Advancement Splints | 346 | ||
| SIDE EFFECTS | 346 | ||
| PATIENT SELECTION | 346 | ||
| SUMMARY | 347 | ||
| REFERENCES | 348 | ||
| Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization | 353 | ||
| Key points | 353 | ||
| PREVALENCE AND PREDICTORS OF RESIDUAL SLEEPINESS IN OBSTRUCTIVE SLEEP APNEA | 353 | ||
| Fatigue or Sleepiness? | 354 | ||
| A Distinct Phenotype? Permanent Brain Injury | 355 | ||
| MEASUREMENT OF EXCESSIVE DAYTIME SLEEPINESS | 355 | ||
| Subjective Measures | 355 | ||
| Objective Measures | 355 | ||
| DIAGNOSTIC APPROACH | 356 | ||
| Optimizing Continuous Positive Airway Pressure | 356 | ||
| Insufficient Sleep | 356 | ||
| Ruling Out Concomitant Sleep Disorders | 356 | ||
| Mood Disorders | 356 | ||
| Medications or Illicit Drug Use | 356 | ||
| Neurologic Disorders | 357 | ||
| Other Uncontrolled or Undiagnosed Medical Conditions | 357 | ||
| Unrealistic Expectations | 357 | ||
| Investigations | 357 | ||
| MANAGEMENT OF RESIDUAL DAYTIME SLEEPINESS IN OBSTRUCTIVE SLEEP APNEA | 357 | ||
| Treat Comorbidities | 357 | ||
| Treating Sleepiness with Pharmacotherapy | 358 | ||
| Modafinil and armodafinil | 358 | ||
| Mechanism of action | 358 | ||
| Evidence from clinical trials | 358 | ||
| Common side effects | 358 | ||
| Clinical application | 358 | ||
| Amphetamines and Other Sympathomimetics | 358 | ||
| Caffeine | 359 | ||
| Potential Future Drugs | 359 | ||
| Summary of Pharmacologic Strategies | 359 | ||
| SUMMARY | 360 | ||
| REFERENCES | 360 | ||
| Disorders of Excessive Daytime Sleepiness Including Narcolepsy and Idiopathic Hypersomnia | 365 | ||
| Key points | 365 | ||
| INTRODUCTION | 365 | ||
| PATIENT EVALUATION | 367 | ||
| Clinical History | 367 | ||
| Subjective questionnaires | 367 | ||
| Symptoms of Central Disorders of Hypersomnolence | 367 | ||
| Physical Examination | 369 | ||
| Laboratory Testing | 370 | ||
| General medical testing | 370 | ||
| Cerebrospinal fluid testing | 370 | ||
| Human leukocyte antibody testing | 370 | ||
| Diagnostic Evaluation | 370 | ||
| Sleep logs | 370 | ||
| Actigraphy | 370 | ||
| Polysomnography | 370 | ||
| Multiple sleep latency test | 372 | ||
| Evaluation of the results from the polysomnogram and multiple sleep latency test | 372 | ||
| Miscellaneous tests | 372 | ||
| TREATMENT OF CENTRAL DISORDERS OF HYPERSOMNOLENCE | 372 | ||
| Pharmacologic Treatment | 372 | ||
| Medication Side Effects | 375 | ||
| Alternative Therapies | 375 | ||
| SUMMARY AND FUTURE CONSIDERATIONS | 376 | ||
| REFERENCES | 376 | ||
| Diagnosis and Treatment of Insomnia Comorbid with Obstructive Sleep Apnea | 379 | ||
| Key points | 379 | ||
| INTRODUCTION | 379 | ||
| CONSEQUENCES OF COMORBID INSOMNIA/OSA | 380 | ||
| MUTUAL INTERACTIONS BETWEEN OBSTRUCTIVE SLEEP APNEA AND INSOMNIA | 380 | ||
| SHOULD INSOMNIA COMORBID WITH OBSTRUCTIVE SLEEP APNEA BE TREATED? | 381 | ||
| DIAGNOSIS OF INSOMNIA COMORBID WITH OBSTRUCTIVE SLEEP APNEA | 381 | ||
| TREATMENT OF INSOMNIA COMORBID WITH OBSTRUCTIVE SLEEP APNEA | 383 | ||
| BEHAVIORAL THERAPIES | 384 | ||
| EFFECTIVENESS OF BEHAVIORAL THERAPIES | 384 | ||
| COGNITIVE ELEMENTS AND THERAPY | 385 | ||
| SUMMARY ABOUT THE TREATMENT OF INSOMNIA COMORBID WITH OBSTRUCTIVE SLEEP APNEA | 386 | ||
| TREATMENT OF INSOMNIA BEFORE OR DURING POSITIVE AIRWAY PRESSURE THERAPY? | 386 | ||
| RECOMMENDATIONS FOR SLEEP MEDICINE CLINICS | 386 | ||
| REFERENCES | 387 | ||
| Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder | 389 | ||
| Key points | 389 | ||
| INTRODUCTION | 389 | ||
| CLASSIFICATION OF DELAYED SLEEP-WAKE PHASE DISORDER | 390 | ||
| PATIENT EVALUATION OVERVIEW | 391 | ||
| Diagnostic Issues | 391 | ||
| Current Assessment Tools | 391 | ||
| Sleep logs | 391 | ||
| Actigraphy | 392 | ||
| Morningness-eveningness questionnaires | 392 | ||
| Circadian phase markers | 392 | ||
| CAUSE | 393 | ||
| Physiologic | 393 | ||
| Delay in timing of circadian rhythm | 393 | ||
| Longer circadian period (tau) | 393 | ||
| Phase relationships between circadian phase and sleep timing | 394 | ||
| Hypersensitivity to light | 394 | ||
| Decreased buildup of homeostatic sleep drive | 394 | ||
| Behavioral Modulation of Light Exposure | 394 | ||
| Genetic | 395 | ||
| TREATMENT OPTIONS | 395 | ||
| Chronotherapeutic Treatment | 395 | ||
| Chronobiotic Treatment | 396 | ||
| Melatonin | 396 | ||
| Melatonin receptor agonists | 396 | ||
| Photic Treatment | 397 | ||
| Other Treatments | 397 | ||
| SUMMARY | 397 | ||
| DISCLOSURE STATEMENT | 397 | ||
| REFERENCES | 398 |