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==Overview==
==Overview==


==Natural History==
==Natural History<ref name="Grunstein1994">{{cite journal|last1=Grunstein|first1=R.R.|title=Sleep apnoea - evolution and doubt|journal=European Respiratory Journal|volume=7|issue=10|year=1994|pages=1741–1743|issn=00000000|doi=10.1183/09031936.94.07101741}}</ref>==
*Sleep apnea is a progressive disease that evolves from snoring
*Heavy snoring moves towards intermittent apneas predominantly in rapid eye movement (REM) sleep


==Complications==
==Complications==
Complications that can develop as a result of sleep apnea are:
*Daytime sleepiness
*Depression
*Hypertension
*Coronary artery disease
*Stroke
*CHF
*Atrial fibrillation
*Complications with surgery
*Complications with anesthesia and other medications
*Headaches
*Impotence
*Sleep-deprived partners
*Failure to thrive in small children
*Attention deficits and hyperactivity in children


==Prognosis==
==Prognosis==
Although it takes some trial and error, most patients find a combination of treatments which reduce apnea events and improve their overall health, energy, and well-being.  Without treatment, the [[sleep deprivation]] and lack of oxygen caused by sleep apnea increases health risks such as [[cardiovascular disease]], [[high blood pressure]], [[stroke]], [[diabetes]], [[clinical depression]],<ref name="pmid15982424">{{cite journal |author=Schröder CM, O'Hara R|title=Depression and Obstructive Sleep Apnea (OSA) |journal=Ann Gen Psychiatry |volume=4 |issue= |pages=13|year=2005|pmid=15982424|doi=10.1186/1744-859X-4-13 |url=http://www.annals-general-psychiatry.com/content/4//13}}</ref> weight gain and [[obesity]].
*The prognosis for patients is very good if properly treated and managed
*Obstructive sleep apnea can be a serious, life-threatening condition if left untreated
:*The repeated stops and starts in breathing throughout the sleep period elevates blood pressure and causes stress on the heart


The most serious consequence of untreated obstructive sleep apnea is to the heart. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure (''[[cor pulmonale]]'').
*Poor prognostic factors in central sleep apnea include:
 
:*Alterations in neuromuscular control of breathing
Elevated arterial pressure (commonly called [[high blood pressure]]) can be a consequence of obstructive sleep apnea syndrome.<ref name="Sleep Apnea">{{cite journal
:*Drug usage for mental health conditions
|url=http://www.aafp.org/afp/20020115/229.html
:*Long-acting opioid medications<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref>
|author=Silverberg DS, Iaina A and Oksenberg A
|journal=American Family Physicians
|title=Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life
|year = 2002
|month = January
|volume = 65
|issue = 2
|pages = 229-36
|pmid = 11820487
}}</ref> When high blood pressure is caused by OSA, it is distinctive in that, unlike most cases of high blood pressure (so-called [[essential hypertension]]), the readings do ''not'' drop significantly when the individual is sleeping.<ref>{{cite journal
|author=Grigg-Damberger M.
|title=Why a polysomnogram should become part of the diagnostic evaluation of stroke and transient ischemic attack
|journal=Journal of Clinical Neurophysiology|
volume=23
|issue=1
|pages=21-38
|date=2006-02
|pmid=16514349}}</ref> [[Stroke]] is associated with obstructive sleep apnea.<ref>{{cite journal
  |author = H. Klar Yaggi, M.D., M.P.H.
  |coauthors = John Concato, M.D., M.P.H., Walter N. Kernan, M.D., Judith H. Lichtman, Ph.D., M.P.H., Lawrence M. Brass, M.D., and Vahid Mohsenin, M.D.
  |title = Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
  |journal = The New England Journal of Medicine
  |volume = 353
  |issue = Number 19
  |pages= 2034-2041
  |date= November 10, 2005
  |accessdate = 2007-04-10
  |pmid = 16282178}}</ref>  Sleep apnea sufferers also have a 30% higher risk of heart attack or death than those unaffected.<ref> {{cite web|url=http://www.thoracic.org/sections/publications/press-releases/conference/articles/2007/press-releases/sleep-apnea-increases-risk-of-heart-attack-or-death-by-30.html|title=Sleep Apnea Increases Risk of Heart Attack or Death by 30% |last=N.A. Shah, M.D., N.A. Botros, M.D., H.K. Yaggi, M.D., M., V. Mohsenin, M.D., New Haven, CT|date=May 20, 2007 |work=American Thoracic Society }}</ref>
 
Many studies indicate that it is the effect of the "fight or flight" response on the body that happens with each apneic event that increases these risks. The [[fight or flight]] response causes many hormonal changes in the body; those changes, coupled with the low oxygen saturation level of the blood, cause damage to the body over time.<ref>[http://www.yale.edu/opa/v35.n30/story17.htmlwww.yale.edu]</ref><ref>[http://www.sciencedaily.com/releases/2002/04/020403025512.htmwww.sciencedaily.com]</ref><ref>http://www.schlaflabor-breisgau.de/Bild_gif/Peppard.pdf</ref><ref>[http://www.sciencedaily.com/releases/2007/05/070520183530.htmwww.sciencedaily.com] </ref>
 
====Prognostic Factors====
Poor prognostic factors in central sleep apnea include:
*Alterations in neuromuscular control of breathing
*Drug usage for mental health conditions
*Long-acting opioid medications<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558}}</ref>


==References==
==References==

Revision as of 20:30, 6 July 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kashish Goel, M.D.

Overview

Natural History[1]

  • Sleep apnea is a progressive disease that evolves from snoring
  • Heavy snoring moves towards intermittent apneas predominantly in rapid eye movement (REM) sleep

Complications

Complications that can develop as a result of sleep apnea are:

  • Daytime sleepiness
  • Depression
  • Hypertension
  • Coronary artery disease
  • Stroke
  • CHF
  • Atrial fibrillation
  • Complications with surgery
  • Complications with anesthesia and other medications
  • Headaches
  • Impotence
  • Sleep-deprived partners
  • Failure to thrive in small children
  • Attention deficits and hyperactivity in children

Prognosis

  • The prognosis for patients is very good if properly treated and managed
  • Obstructive sleep apnea can be a serious, life-threatening condition if left untreated
  • The repeated stops and starts in breathing throughout the sleep period elevates blood pressure and causes stress on the heart
  • Poor prognostic factors in central sleep apnea include:
  • Alterations in neuromuscular control of breathing
  • Drug usage for mental health conditions
  • Long-acting opioid medications[2]

References

  1. ↑ Grunstein, R.R. (1994). "Sleep apnoea - evolution and doubt". European Respiratory Journal. 7 (10): 1741–1743. doi:10.1183/09031936.94.07101741. ISSN 0000-0000.
  2. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.

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