1/6/2015 1 Sleep Related Breathing Disorders Elisabeth Brandauer, MD Department of Neurology, Innsbruck Medical University, Austria Movement Disorders in Sleep Barcelona, Jan 30-31 Abnormalitiesof respiration during sleep Possible location of respiratory disturbances : • Central respiratory drive • Oropharyngeal muscles • Respiratory muscles • Ventilation Possible consequences: • Snoring • Apneas, Hypopneas • Hypoxemia • Hypercapnia Apnea: drop in the peak thermal sensor excursion by >90% of baseline, duration at least 10 sec. – obstructive apnea – central apnea – mixed apnea Definitions
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Sleep Related Breathing · PDF fileSleep Related Breathing Disorders ... Usually most severe in REM sleep ... Occurence of OSA, central sleep apnea, irregular and apneustic
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Sleep Related Breathing Disorders
Elisabeth Brandauer, MD Department of Neurology, Innsbruck Medical University, Austria
Movement Disorders in SleepBarcelona, Jan 30-31
Abnormalities of respiration during sleep
Possible location of respiratorydisturbances :
• Central respiratory drive• Oropharyngeal muscles• Respiratory muscles• Ventilation
Central Sleep Apnea Syndromes• Central Sleep Apnea with Cheyne-Stokes
Breathing• Central Apnea Due to a Medical Disorder
without Cheyne-Stokes Breathing• Central Sleep Apnea Due to High Altitude
Periodic Breathing• Central Sleep Apnea Due to a Medication
or Substance• Primary Central Sleep Apnea• Primary Central Sleep Apnea of Infancy• Primary Central Sleep Apnea of
Prematurity• Treatment-Emergent Central Sleep Apnea
Sleep Related Hypoventilation Disorders
• Obesity Hypoventilation Syndrome • Congenital Central Alveolar Hypoventilation
Syndrome • Late-Onset Central Hypoventilation with
Hypothalamic Dysfunction• Idiopathic Central Alveolar Hypoventilation• Sleep Related Hypoventilation Due to a
Medication or Substance• Sleep Related Hypoventilation Due to a
Medical Disorder
Sleep Related HypoxemiaDisorder
• Sleep Related Hypoxemia
Isolated Symptoms and Normal Variants
• Snoring• Catathrenia
Obstructive Sleep Apnea
�A. The presence of one or more of the following:
�The patient complains of sleepiness, nonrestorative sleep, fatigue, or insomniasymptoms�The patient wakes with breath holding, gasping or choking.�The bed partner or other observers reports habitual snoring, breathinginterruptions, or both during the patients sleep.�The patient has been diagnosed with hypertension, a mood disorder, cognitivedysfunction, coronary artery disease, stroke, congestive heart failure, atrialfibrillation, or type 2 diabetes mellitus
• (A and B) or C satisfy the criteria
�B. Polysomnography (PSG) or OCST (out-of-center sleep testing) demonstrates:
�Five or more predominantly obstructive respiratory events (obstructive and mixedapneas, hypopneas, or respiratory effort related arousals (RERAs) per hour of sleepduring PSG or per hour of monitoring in OCST
�C. PSG or OCST demonstrates:. The presence of one or more of the following:
�Fifteen or more predominantly obstructive respiratory events per hour of sleep duringa PSG or per hour of monitoring
International Classification of Sleep Disorders 3rd
American Academy of Sleep Medicine, 2014
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Predisposing Factors: � Obesity
� Male>female� Prevalence increases with age with a plateau reached app. at age 65
� Alcohol consumption and sedating medication� menopause
� Hints on elevated levels of circulating inflammatorymediators related to repetitive episodes of oxygendesaturation and increased sympathetic nervous systemactivity
Complications
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� Weight reduction, prevention of alcohol andsedative medication
� Prevention of back position
� Positive airway pressure therapy
� Mandibular advancement devices
� Surgery (UVPP, surgery of tongue, tonsillectomy, hypoglossal nerve stimulation)