Sleep apnea causes: Difference between revisions

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{{Sleep apnea}}
{{Sleep apnea}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Kashish Goel|Kashish Goel, M.D.]]
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.


==Overview==
Sleep apnea may be commonly caused by a large neck/abodminal circumference (e.g. obese individuals), administration of medications, diseases that narrow the respiratory airways (e.g. [[enlarged adenoids]], [[Palatine tonsil#Tonsillar hypertrophy|enlarged tonsils]]), diseases that affect the [[central nervous system]] (e.g. [[cerebrovascular accident]], [[spinal cord injury]]), or infectious diseases (e.g. [[polio]]).


==Obesity==
==Causes==
==Craniofacial syndromes==
There are patterns of unusual facial features that occur in recognizable syndromes. Some of these craniofacial syndromes are genetic, others are from unknown causes. In many craniofacial syndromes, the features that are unusual involve the nose, mouth and jaw, or resting muscle tone, and put the individual at risk for obstructive sleep apnea syndrome.


[[Down Syndrome]] is one such syndrome. In this chromosomal abnormality, several features combine to make the presence of obstructive sleep apnea more likely. The specific features in Down Syndrome that predispose to obstructive sleep apnea include: relatively low muscle tone, narrow [[nasopharynx]], and large tongue. Obesity and enlarged tonsils and adenoids, conditions that occur commonly in the western population, are much more likely to be obstructive in a person with these features than without them.  Obstructive sleep apnea does occur even more frequently in people with Down Syndrome than in the general population. A little over 50% of all people with Down Syndrome suffer from obstructive sleep apnea (de Miguel-Díez, et al 2003), and some physicians advocate routine testing of this group (Shott, et al 2006).
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.


In other craniofacial syndromes, the abnormal feature may actually improve the airway- but its correction may put the person at risk for obstructive sleep apnea ''after'' surgery, when it is modified. [[Cleft palate]] syndromes are such an example. During the newborn period, all humans are obligate nasal breathers. The palate is both the roof of the mouth and the floor of the nose. Having an open palate may make feeding difficult, but generally does not interfere with breathing, in fact - if the nose is very obstructed an open palate may relieve breathing. There are a number of clefting syndromes in which the open palate is not the only abnormal feature, additionally there is a narrow nasal passage - which may not be obvious. In such individuals, closure of the cleft palate- whether by surgery or by a temporary oral appliance, can cause the onset of obstruction.
*[[Cerebrovascular accident]]
*[[Obesity hypoventilation syndrome]]
*[[Opioids#Mortality and Overdose|Opioid overdose]]
*[[Post-polio syndrome]]
*[[Postoperative complication]]
*[[Spinal cord injury]]


Skeletal advancement in an effort to physically increase the pharyngeal airspace is often an option for craniofacial patients with upper airway obstruction and small lower jaws (mandibles). These syndromes include [[Treacher Collins Syndrome]] and [[Pierre Robin Sequence]]. [[Mandibular advancement surgery]] is often just one of the modifications needed to improve the airway, others may include reduction of the tongue, tonsillectomy or modified[[uvulopalatoplasty]].
===Common Causes===
*[[Common cold]]
*[[Diabetic neuropathy]]
*[[Enlarged adenoids]]
*[[Palatine tonsil#Tonsillar hypertrophy|Enlarged tonsils]]
*[[Hypothyroidism]]
*[[Obesity]]
*[[Opioids#Mortality and Overdose|Opioid overdose]]
*[[Postoperative complication]]
*[[Sinusitis]]
*[[Tonsilitis]]


==Pharyngeal flap surgery may cause obstructive sleep apnea==
===Causes by Organ Systems===
Obstructive sleep apnea is a serious complication that seems to be most frequently associated with [[pharyngeal flap]] surgery, compared to other procedures for treatment of [[velopharyngeal inadequacy]] (VPI).<ref name=Sloan>Sloan, G.M. (2000). Posterior pharyngeal flap and sphincter pharyngoplasty: The state of the art. ''Cleft Palate-Craniofacial Journal'', 37(2), 112-122.</ref> In OSA, recurrent interruptions of [[Respiration (physiology)|respiration]] during sleep are associated with temporary [[airway obstruction]]. Following pharyngeal flap surgery, depending on size and position, the flap itself may have an “[[obturator]]” or obstructive effect within the [[pharynx]] during sleep, blocking ports of airflow and hindering effective [[Respiration (physiology)|respiration]].<ref name=Pugh>Pugh, M.B. et al. (2000). Apnea. ''Stedman’s Medical Dictionary (27th ed.)'' Retrieved [[June 18]], [[2006]] from STAT!Ref Online Medical Library database.</ref><ref name=Liao2004>Liao, Y., Noordhoff, M.S., Huang, C., Chen, P.K.T., Chen N., Yun, C. et al. (2004). Comparison of obstructive sleep apnea syndrome in children with cleft palate following Furlow palatoplasty or pharyngeal flap for velopharyngeal insufficiency. ''Cleft Palate-Craniofacial Journal'', 41(2), 152-156.</ref> There have been documented instances of severe airway obstruction, and reports of post-operative OSA continue to increase as healthcare professionals (i.e. physicians, speech language pathologists) become more educated about this possible dangerous condition.<ref name=PetersonFalzone>Peterson-Falzone, S.J., Hardin-Jones, M.A., & Karnell, M.P. (2001). ''Cleft Palate Speech (3rd ed.)''. St. Louis: Mosby.</ref> Subsequently, in clinical practice, concerns of OSA have matched or exceeded interest in speech outcomes following pharyngeal flap surgery.
{|style="width:80%; height:100px" border="1"
 
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
The surgical treatment for velopalatal insufficiency may cause obstructive sleep apnea syndrome. When velopalatal insufficiency is present, air leaks into the nasopharynx even when the soft palate should close off the nose. A simple test for this condition can be made by placing a tiny mirror at the nose, and asking the subject to say "P". This p sound, a plosive, is normally produced with the nasal airway closed off - all air comes out of the pursed lips, none from the nose. If it is impossible to say the sound without fogging a nasal mirror, there is an air leak - reasonable evidence of poor palatal closure. Speech is often unclear due to inability to pronounce certain sounds. One of the surgical treatments for velopalatal insufficiency involves tailoring the tissue from the back of the throat and using it to purposefully cause partial obstruction of the opening of the nasopharynx. This may actually''cause''obstructive sleep apnea syndrome in susceptible individuals, particularly in the days following surgery, when swelling occurs (see below: Special Situation: Anesthesia and Surgery)
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
 
|-
{| class="wikitable" align="center" style="margin: 1em 1em "
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
! AHI||Rating
|bgcolor="Beige"| No underlying causes
|-
|-
| <5||Normal
|bgcolor="LightSteelBlue"| '''Dental'''
|-  
|bgcolor="Beige"| No underlying causes
| 5-15||Mild
|-
|bgcolor="LightSteelBlue"| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Drug Side Effect'''
|bgcolor="Beige"| [[Elosulfase alfa]], [[galsulfase]], [[laronidase]]
|-
|bgcolor="LightSteelBlue"| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Enlarged adenoids]], [[Palatine tonsil#Tonsillar hypertrophy|enlarged tonsils]], malformations of the nose, malformations of the throat
|-
|bgcolor="LightSteelBlue"| '''Endocrine'''
|bgcolor="Beige"| [[Diabetic neuropathy]], [[hypothyroidism]]
|-  
|-  
| 15-30||Moderate
|bgcolor="LightSteelBlue"| '''Environmental'''
|-  
|bgcolor="Beige"| No underlying causes
| >30||Severe
|-
|bgcolor="LightSteelBlue"| '''Gastroenterologic'''
|bgcolor="Beige"| [[Gastroesophageal reflux]]
|-
|bgcolor="LightSteelBlue"| '''Genetic'''
|bgcolor="Beige"| [[Charcot-Marie-Tooth disease]], [[Hallermann-Streiff syndrome]], [[Joubert syndrome]], [[Marfan syndrome]], [[muscular dystrophy]], [[myotonic dystrophy]], [[Potocki-Lupski syndrome]], [[WAGR syndrome]]
|-
|bgcolor="LightSteelBlue"| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Iatrogenic'''
|bgcolor="Beige"| [[Postoperative complication]]
|-
|bgcolor="LightSteelBlue"| '''Infectious Disease'''
|bgcolor="Beige"| [[Common cold]], [[meningoencephalitis]], [[post-polio syndrome]], [[sinusitis]], [[tonsilitis]]
|-
|bgcolor="LightSteelBlue"| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Muscular dystrophy]], [[myotonic dystrophy]]
|-
|bgcolor="LightSteelBlue"| '''Neurologic'''
|bgcolor="Beige"| [[Amyotrophic lateral sclerosis]], [[Arnold-Chiari malformation]], [[cerebrovascular accident]], [[Charcot-Marie-Tooth disease]], [[diabetic neuropathy]], [[idiopathic intracranial hypertension]], [[Joubert syndrome]], [[multiple system atrophy]], [[post-polio syndrome]], [[spinal cord injury]]
|-
|bgcolor="LightSteelBlue"| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Hurler syndrome]], [[metabolic syndrome]], [[obesity]], [[Glycogen storage disease type II|Pompe disease]]
|-
|bgcolor="LightSteelBlue"| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[Alcoholism|Alcohol intoxication]], [[Opioids#Mortality and Overdose|opioid overdose]]
|-
|bgcolor="LightSteelBlue"| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Pulmonary'''
|bgcolor="Beige"| [[Obesity hypoventilation syndrome]]
|-
|bgcolor="LightSteelBlue"| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Chronic kidney disease]]
|-
|bgcolor="LightSteelBlue"| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Trauma'''
|bgcolor="Beige"| [[Spinal cord injury]]
|-
|bgcolor="LightSteelBlue"| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|bgcolor="LightSteelBlue"| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
|}


 
===Causes in Alphabetical Order===
 
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Arnold-Chiari malformation]]
*[[Cerebrovascular accident]]
*[[Charcot-Marie-Tooth disease]]
*[[Chronic kidney disease]]
*[[Common cold]]
*[[Diabetic neuropathy]]
*[[Enlarged adenoids]]
*[[Palatine tonsil#Tonsillar hypertrophy|Enlarged tonsils]]
*[[Gastroesophageal reflux]]
*[[Glycogen storage disease type II]]
*[[Hallermann-Streiff syndrome]]
{{col-break|width=33%}}
*[[Hurler syndrome]]
*[[Hypothyroidism]]
*[[Idiopathic intracranial hypertension]]
*[[Joubert syndrome]]
*[[Laronidase]]
*Malformations of the nose
*Malformations of the throat
*[[Marfan syndrome]]
*[[Meningoencephalitis]]
*[[Metabolic syndrome]]
*[[Multiple system atrophy]]
*[[Muscular dystrophy]]
{{col-break|width=33%}}
*[[Myotonic dystrophy]]
*[[Obesity]]
*[[Obesity hypoventilation syndrome]]
*[[Opioid]]
*[[Post-polio syndrome]]
*[[Postoperative complication]]
*[[Potocki-Lupski syndrome]]
*[[Sinusitis]]
*[[Spinal cord injury]]
*[[Tonsilitis]]
*[[WAGR syndrome ]]
{{col-end}}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
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{{WikiDoc Sources}}


[[Category:Sleep disorders]]
[[Category:Crowdiagnosis]]
[[Category:Medical conditions related to obesity]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Cardiology]]
[[Category:Signs and symptoms]]
[[Category:Cardiology]]
[[Category:Primary care]]
{{WikiDoc Help Menu}}
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Latest revision as of 00:12, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

Sleep apnea may be commonly caused by a large neck/abodminal circumference (e.g. obese individuals), administration of medications, diseases that narrow the respiratory airways (e.g. enlarged adenoids, enlarged tonsils), diseases that affect the central nervous system (e.g. cerebrovascular accident, spinal cord injury), or infectious diseases (e.g. polio).

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ Systems

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Elosulfase alfa, galsulfase, laronidase
Ear Nose Throat Enlarged adenoids, enlarged tonsils, malformations of the nose, malformations of the throat
Endocrine Diabetic neuropathy, hypothyroidism
Environmental No underlying causes
Gastroenterologic Gastroesophageal reflux
Genetic Charcot-Marie-Tooth disease, Hallermann-Streiff syndrome, Joubert syndrome, Marfan syndrome, muscular dystrophy, myotonic dystrophy, Potocki-Lupski syndrome, WAGR syndrome
Hematologic No underlying causes
Iatrogenic Postoperative complication
Infectious Disease Common cold, meningoencephalitis, post-polio syndrome, sinusitis, tonsilitis
Musculoskeletal/Orthopedic Muscular dystrophy, myotonic dystrophy
Neurologic Amyotrophic lateral sclerosis, Arnold-Chiari malformation, cerebrovascular accident, Charcot-Marie-Tooth disease, diabetic neuropathy, idiopathic intracranial hypertension, Joubert syndrome, multiple system atrophy, post-polio syndrome, spinal cord injury
Nutritional/Metabolic Hurler syndrome, metabolic syndrome, obesity, Pompe disease
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol intoxication, opioid overdose
Psychiatric No underlying causes
Pulmonary Obesity hypoventilation syndrome
Renal/Electrolyte Chronic kidney disease
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma Spinal cord injury
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

Template:WikiDoc Sources

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