Sleep apnea classification
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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
There are three types of sleep apnea: obstructive, central, and mixed. The majority of patients have obstructive sleep apnea (OSA). Individuals of untreated sleep apnea stop breathing repeatedly during the night usually for a minute or longer, during their sleep. Most of the time, these individuals are unaware of these episodes because the episodes don't trigger an awakening. Obstructive sleep apnea results from the narrowing or total blockage of the airway. In central sleep apnea, there is failure of the central nervous system to send appropriate signals to the muscles of respiration. These signals control the individual's breathing. It is also possible for an individual to have a combination of these two types, referred to as mixed apnea.
Classification
Sleep apnea can be classified into three categories:
Obstructive Sleep Apnea (OSA)
- The majority of the three forms
- It results from the narrowing or total blockage of the respiratory airway which occurs when the soft tissue at the back of the throat collapses during sleep
- OSA can be classified into three classes based on severity of disease[1]:
- The severity of disease is assessed by Apnea Hypopnea index (AHI), which combines apneas and hypopneas
- Apneas are defined as breathing pauses lasting 10 seconds
- Hypopneas are defined as events lasting 10 seconds in which there is continued breathing but ventilation is reduced by at least 50% from the previous baseline during sleep
- Mild OSA: AHI of 5-15: These patients may be relatively asymptomatic or complain of sleepiness when they are sedentary. The daytime sleepiness often does not impair their daily life.
- Moderate OSA: AHI of 15-30: These patients are usually aware of daytime sleepiness and they try to avoid falling asleep at inappropriate times. These patients continue their daily activities at reduced levels.
- Severe OSA: AHI of greater than 30: These patients often have daytime sleepiness that interferes with daily activities. They can fall a sleep during activities that require more active attention, such as driving increasing risk of accidents and injuries.
Central Sleep Apnea
- The brain is unable to send appropriate signals to the muscles that control breathing due to the instability of the respiratory center
- It is named idiopathic central sleep apnea if there is no underlying cause
- Cheyne-Stokes breathing is similar to central sleep apnea
- This is periodic breathing with recurrent episodes of apnea alternating with episodes of rapid breathing
- Respirations occur while both awake and asleep
Mixed Apnea/Complex Sleep Apnea
- Some individuals may have a combination of both types of sleep apnea
- Complex sleep apnea (CompSA), also called treatment-emergent central sleep apnea, is the emergence of central apneas during the use of continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) treatment
References
- ↑ Loscalzo, Joseph; Longo, Dan L.; Fauci, Anthony S.; Dennis L. Kasper; Hauser, Stephen L (2011). Harrison's Principles of Internal Medicine, 18th Edition. McGraw-Hill Professional. ISBN 0-07-174889-X.