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Ambulatory Sleep Medicine, An Issue of Sleep Medicine Clinics, E-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