Recognition and consequences of obstructive sleep apnea hypopnea syndrome.

There is a growing recognition of sleep-disordered breathing (SDB) in patient groups and in the general population. This article reviews issues related to recognizing the disorder, including the problems of relying on narrowly defined polysomnographic data for case findings and for assessment of disease severity. The distributions of symptoms and physiologic measurements of SDB in the population and their inter-relationships are reviewed. The epidemiological data that address risk factors and consequences of sleep apnea hypopnea syndrome (SAHS) also are discussed, with recommendations regarding recognition priorities.

[1]  M. Partinen,et al.  Obstructive sleep apnoea syndrome in morbidly obese patients , 1991, Journal of internal medicine.

[2]  F. Schmitt,et al.  Sleep Apnea: Prevalence of Risk Factors in a General Population , 1989, Southern medical journal.

[3]  D. Wetter,et al.  Smoking as a risk factor for sleep-disordered breathing. , 1994, Archives of internal medicine.

[4]  S. Redline,et al.  Daytime hypertension in obstructive sleep apnea. Prevalence and contributing risk factors. , 1991, Chest.

[5]  P. Cistulli,et al.  Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. , 1994, The Journal of clinical endocrinology and metabolism.

[6]  R Mathur,et al.  Family Studies in Patients with the Sleep Apnea-Hypopnea Syndrome , 1995, Annals of Internal Medicine.

[7]  M. Zucconi,et al.  Atrial natriuretic peptide and catecholamines in obstructive sleep apnea syndrome. , 1991, Sleep.

[8]  E. Fletcher,et al.  Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension. , 1987, Sleep.

[9]  C. Guilleminault,et al.  Hemodynamics in sleep-induced apnea. Studies during wakefulness and sleep. , 1976, Annals of internal medicine.

[10]  J. Hedner,et al.  Occurrence and correlates of sleep disordered breathing in the Australian town of Busselton: a preliminary analysis. , 1993, Sleep.

[11]  David Handelsman,et al.  Snoring in paradise - the Western Samoa sleep survey , 1989 .

[12]  S. Redline,et al.  Neuropsychological function in mild sleep-disordered breathing. , 1997, Sleep.

[13]  F. Richer,et al.  Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. , 1991, Journal of clinical and experimental neuropsychology.

[14]  D. Deptula,et al.  Neuropsychological dysfunction in sleep apnea. , 1987, Sleep.

[15]  W. White,et al.  Central hemodynamics and 24-hour blood pressure in obstructive sleep apnea syndrome: effects of corrective surgery. , 1990, The American journal of medicine.

[16]  D. Hillman,et al.  Association of sleep apnoea with myocardial infarction in men , 1990, The Lancet.

[17]  J. Kaprio,et al.  SNORING AS A RISK FACTOR FOR HYPERTENSION AND ANGINA PECTORIS , 1985, The Lancet.

[18]  L. Findley,et al.  Automobile accidents involving patients with obstructive sleep apnea. , 1988, The American review of respiratory disease.

[19]  A. Pack,et al.  A survey screen for prediction of apnea. , 1995, Sleep.

[20]  J. Sierra,et al.  Changes in Psychopathological Symptoms in Sleep Apnea Patients After Treatment with Nasal Continuous Positive Airway Pressure , 1991 .

[21]  E. Bixler,et al.  SLEEP APNOEA IN A HYPERTENSIVE POPULATION , 1984, The Lancet.

[22]  M. Kryger,et al.  Quality of life in mild obstructive sleep apnea. , 1993, Sleep.

[23]  A J Block,et al.  Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. , 1979, The New England journal of medicine.

[24]  N J Douglas,et al.  The sleep hypopnea syndrome. , 1988, The American review of respiratory disease.

[25]  D. Kripke,et al.  Sleep-disordered breathing in community-dwelling elderly. , 1991, Sleep.

[26]  A. Gorin,et al.  Undiagnosed sleep apnea in patients with essential hypertension. , 1985, Annals of internal medicine.

[27]  K. Woo,et al.  Obstructive sleep apnea presenting with nocturnal angina, heart failure, and near-miss sudden death. , 1991, Chest.

[28]  J. Croft,et al.  Habitual sleep patterns and risk for stroke and coronary heart disease , 1997, Neurology.

[29]  L J Findley,et al.  Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. , 1986, Chest.

[30]  J. Halter,et al.  Obstructive apnea: Sympathetic activiy, respiration and sleep, a case report , 1982, Neurobiology of Aging.

[31]  D T Berry,et al.  What is hypopnea, anyway? , 1994, Chest.

[32]  M Partinen,et al.  Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. , 1988, Chest.

[33]  M J Hensley,et al.  A community study of snoring and sleep-disordered breathing. Health outcomes. , 1995, American journal of respiratory and critical care medicine.

[34]  J. Stradling,et al.  Relation between systemic hypertension and sleep hypoxaemia or snoring: analysis in 748 men drawn from general practice. , 1990, BMJ.

[35]  S. Linder-Aronson The development of the posterior nasopharyngeal wall in boys and girls between the ages of 3-16 years. A longitudinal study. , 1983, Zahn-, Mund-, und Kieferheilkunde mit Zentralblatt.

[36]  K M Hla,et al.  Sleep Apnea and Hypertension: A Population-based Study , 1994, Annals of Internal Medicine.

[37]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[38]  S. Redline,et al.  Assessment of the validity and utility of a sleep-symptom questionnaire. , 1994, American journal of respiratory and critical care medicine.

[39]  L. Findley,et al.  Drivers with untreated sleep apnea. A cause of death and serious injury. , 1991, Archives of internal medicine.

[40]  P. Jennum,et al.  Self-assessed cognitive function in snorers and sleep apneics. An epidemiological study of 1,504 females and males aged 30-60 years: the Dan-MONICA II Study. , 1994, European neurology.

[41]  S. Quan,et al.  Risk factors in a general population for snoring. Importance of cigarette smoking and obesity. , 1988, Chest.

[42]  H. Colt,et al.  Hypoxemia vs sleep fragmentation as cause of excessive daytime sleepiness in obstructive sleep apnea. , 1991, Chest.

[43]  I. Webster,et al.  Sleep-related respiratory disturbance and dementia in elderly females. , 1988, Journal of gerontology.

[44]  C. Sullivan,et al.  Alcohol, snoring and sleep apnea. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[45]  J. Fleetham,et al.  Facial morphology and obstructive sleep apnea. , 1986, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[46]  F. Schmitt,et al.  Sleep-disordered breathing in the healthy elderly. Clinically significant? , 1992, Chest.

[47]  M. Kryger,et al.  Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. , 1988, Chest.

[48]  D. White,et al.  Assessment of accuracy and analysis time of a novel device to monitor sleep and breathing in the home. , 1995, Sleep.

[49]  J. Pépin,et al.  Deficits of cognitive executive functions in patients with sleep apnea syndrome. , 1995, Sleep.

[50]  W. Flemons,et al.  Likelihood ratios for a sleep apnea clinical prediction rule. , 1994, American journal of respiratory and critical care medicine.

[51]  J. Kaprio,et al.  Snoring as a risk factor for ischaemic heart disease and stroke in men. , 1987, British medical journal.

[52]  N. Saunders,et al.  Estimation of the probability of disturbed breathing during sleep before a sleep study. , 1990, The American review of respiratory disease.

[53]  P Lavie,et al.  Mortality in sleep apnea patients: a multivariate analysis of risk factors. , 1995, Sleep.

[54]  T. Penzel,et al.  Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy. , 1991, Cardiology.

[55]  S. Ancoli-Israel,et al.  Sleep-disordered breathing in African-American elderly. , 1995, American journal of respiratory and critical care medicine.

[56]  J. Hedner,et al.  Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. , 1990, Journal of hypertension.

[57]  J. Hedner,et al.  Snoring and sleep apnoea in men: association with central obesity and hypertension. , 1993, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[58]  C Guilleminault,et al.  MESAM 4: an ambulatory device for the detection of patients at risk for obstructive sleep apnea syndrome (OSAS). , 1992, Chest.

[59]  M. Zetin,et al.  Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. , 1989, Journal of clinical psychology.

[60]  W. Flemons,et al.  Sleep apnea and cardiac arrhythmias. Is there a relationship? , 1993, The American review of respiratory disease.

[61]  F. Richer,et al.  Nocturnal hypoxemia as a determinant of vigilance impairment in sleep apnea syndrome. , 1991, Chest.

[62]  B. Rappaport,et al.  Verification of Sleep Apnea Using a Portable Sleep Apnea Screening Device , 1990, Southern medical journal.

[63]  Christian Guilleminault,et al.  Obstructive Sleep Apnea Syndrome: Clinical Research and Treatment , 1990 .

[64]  Shepard Jw,et al.  Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. , 1992 .

[65]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[66]  A. Chaouat,et al.  Association of chronic obstructive pulmonary disease and sleep apnea syndrome. , 1995, American journal of respiratory and critical care medicine.

[67]  M. Partinen,et al.  Sleep apnea and mortality in an aged cohort. , 1988, American journal of public health.

[68]  C. Guilleminault,et al.  Leftward shift of the interventricular septum and pulsus paradoxus in obstructive sleep apnea syndrome. , 1991, Chest.

[69]  N. Ozaki,et al.  Plasma norepinephrine in sleep apnea syndrome. , 1986, Neuropsychobiology.

[70]  M. Dealberto,et al.  Factors related to sleep apnea syndrome in sleep clinic patients. , 1994, Chest.

[71]  N. Saunders,et al.  Four-year follow-up of mortality and sleep-related respiratory disturbance in non-demented seniors. , 1995, Sleep.

[72]  S. Redline,et al.  Cephalometric assessment in obstructive sleep apnea. , 1996, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[73]  H. Levin,et al.  Sleep apnea and vigilance performance in a community-dwelling older sample. , 1994, Sleep.

[74]  W. Miller Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome. Prevalence and significance. , 1982, The American journal of medicine.

[75]  P. Cowen,et al.  Evaluation of first night effect using ambulatory monitoring and automatic sleep stage analysis. , 1988, Sleep.

[76]  R G Priest,et al.  Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample , 1997, BMJ.

[77]  J. Krieger,et al.  Craniofacial characteristics in patients with obstructive sleep apneas syndrome. , 1988, The Cleft palate journal.

[78]  J. Szalai,et al.  Predictive value of clinical features in diagnosing obstructive sleep apnea. , 1993, Sleep.

[79]  J Zieliński,et al.  Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea , 1996, Journal of sleep research.

[80]  C. Guilleminault,et al.  Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients. , 1993, Sleep.

[81]  S. Redline,et al.  Racial differences in sleep-disordered breathing in African-Americans and Caucasians. , 1997, American journal of respiratory and critical care medicine.

[82]  R. Asplund Sleep and cardiac diseases amongst elderly people , 1994, Journal of internal medicine.

[83]  S. Redline,et al.  Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects. , 2009, The Angle orthodontist.

[84]  C. Guilleminault,et al.  Obstructive sleep apnea and cardiac index. , 1986, Chest.

[85]  C. Guilleminault State of the art. Sleep and control of breathing. , 1978, Chest.

[86]  D. Kripke,et al.  Natural history of sleep disordered breathing in community dwelling elderly. , 1993, Sleep.

[87]  J. Hedner,et al.  Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea. , 1993, Sleep.

[88]  B. Lundbäck,et al.  Symptoms related to snoring and sleep apnoea in subjects with chronic bronchitis: report from the Obstructive Lung Disease in Northern Sweden Study. , 1997, Respiratory medicine.

[89]  P. Lavie,et al.  Incidence of sleep apnea in a presumably healthy working population: a significant relationship with excessive daytime sleepiness. , 1983, Sleep.

[90]  S. Ancoli-Israel,et al.  Sleep and breathing in the elderly , 1994 .

[91]  N. Saunders,et al.  Differences in the symptoms of men and women with obstructive sleep apnoea. , 1991, Australian and New Zealand journal of medicine.

[92]  H. Zwick,et al.  Systemic hypertension in snorers with and without sleep apnea. , 1992, Chest.

[93]  J. Stradling,et al.  Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. , 1991, Thorax.

[94]  M Partinen,et al.  Familial aggregates in obstructive sleep apnea syndrome. , 1995, Chest.

[95]  W. B. Webb,et al.  Nocturnal hypoxia and neuropsychological variables. , 1986, Journal of clinical and experimental neuropsychology.

[96]  H. Zwick,et al.  Nasal CPAP and weight loss in hypertensive patients with obstructive sleep apnoea. , 1993, Thorax.

[97]  M Hirshkowitz,et al.  Hypertension, erectile dysfunction, and occult sleep apnea. , 1989, Sleep.

[98]  G. Bowes,et al.  The influence of sleep fragmentation on arousal and ventilatory responses to respiratory stimuli. , 1980, Sleep.

[99]  M. Kryger,et al.  Review: sleep in heart failure. , 1993, Sleep.

[100]  P Lavie,et al.  Prevalence of sleep apnea syndrome among patients with essential hypertension. , 1984, American heart journal.

[101]  A. Chediak,et al.  Obstructive sleep apnea. , 1994, Postgraduate medicine.

[102]  S. Redline,et al.  Gender differences in sleep disordered breathing in a community-based sample. , 1994, American journal of respiratory and critical care medicine.

[103]  J. Samet,et al.  Comparison of self- and spouse reports of snoring and other symptoms associated with sleep apnea syndrome. , 1990, Sleep.

[104]  N. Douglas,et al.  Ambulatory blood pressure on and off continuous positive airway pressure therapy for the sleep apnea/hypopnea syndrome: effects in "non-dippers". , 1996, Sleep.

[105]  M J Hensley,et al.  A comparison of clinical assessment and home oximetry in the diagnosis of obstructive sleep apnea. , 1993, The American review of respiratory disease.

[106]  W. Dement,et al.  Relative validity of self-reported snoring as a symptom of sleep apnea in a sleep clinic population. , 1991, Chest.

[107]  H. Palomäki Snoring and the risk of ischemic brain infarction. , 1991, Stroke.

[108]  F. Sériès,et al.  Utility of Nocturnal Home Oximetry for Case Finding in Patients with Suspected Sleep Apnea Hypopnea Syndrome , 1993, Annals of Internal Medicine.

[109]  S. Redline,et al.  Hematocrit levels in sleep apnea. , 1994, Chest.

[110]  C. Guilleminault,et al.  Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. , 1984, Chest.

[111]  Tetsuo Inoue,et al.  Sleep apnea in patients with acute myocardial infarction , 1991, Critical care medicine.

[112]  E V Dunn,et al.  Snoring as a risk factor for disease: an epidemiological survey. , 1985, British medical journal.

[113]  D. Kripke,et al.  Sleep apnea in female patients in a nursing home. Increased risk of mortality. , 1989, Chest.

[114]  S. Redline,et al.  The familial aggregation of obstructive sleep apnea , 1995 .

[115]  E. Berman,et al.  Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. , 1991, Chest.

[116]  A. Taube,et al.  Snoring and systemic hypertension--an epidemiological study. , 2009, Acta medica Scandinavica.

[117]  S. Redline,et al.  The association between hypertension and sleep apnea in obese patients. , 1993, Chest.

[118]  J. Samet,et al.  Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. , 1990, Archives of internal medicine.

[119]  L. Peterson,et al.  High prevalence of hypertension in sleep apnea patients independent of obesity. , 1994, American journal of respiratory and critical care medicine.

[120]  B. Magnani,et al.  Snoring every night as a risk factor for myocardial infarction: a case-control study. , 1990, BMJ.

[121]  P. Jennum,et al.  Blood pressure, catecholamines, and pancreatic polypeptide in obstructive sleep apnea with and without nasal Continuous Positive Airway Pressure (nCPAP) treatment. , 1989, American journal of hypertension.

[122]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[123]  A J Block,et al.  Indications and standards for cardiopulmonary sleep studies. , 1985, Sleep.

[124]  M J Hensley,et al.  A community study of snoring and sleep-disordered breathing. Prevalence. , 1995, American journal of respiratory and critical care medicine.

[125]  J. Stradling,et al.  Ambulatory blood pressure and left ventricular hypertrophy in subjects with untreated obstructive sleep apnoea and snoring, compared with matched control subjects, and their response to treatment. , 1994, Clinical science.

[126]  J. Peter,et al.  [Risk of accidents in patients with nocturnal respiration disorders]. , 1991, Pneumologie.

[127]  S. Redline,et al.  Relationship between sleepiness and general health status. , 1996, Sleep.

[128]  F. Richer,et al.  Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP). , 1993, Journal of clinical and experimental neuropsychology.

[129]  M. Franceschi,et al.  Excessive daytime sleepiness: a 1-year study in an unselected inpatient population. , 1982, Sleep.

[130]  E. Phillipson,et al.  Obstructive sleep apnea as a cause of systemic hypertension. Evidence from a canine model. , 1997, The Journal of clinical investigation.