Download PDF
CC BY-NC-ND 4.0 · Avicenna J Med 2012; 02(01): 3-8
DOI: 10.4103/2231-0770.94803
REVIEW ARTICLE

Obstructive sleep apnea-hypopnea syndrome: Etiology and diagnosis

Abdul Ghani Sankri-Tarbichi
Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University- School of Medicine, John D. Dingell VA Medical Center and Detroit Medical Center, Detroit, USA
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

Sleep disordered breathing is a common chronic condition in the general population. This review will highlight the prevalence of different types of sleep apnea in general and obstructive type in particular in the United States and Middle East. Despite the extensive research studies on the sleep apnea pathogenesis, the exact mechanism is not well known. Obesity, however, is the leading risk factor to upper airway narrowing and obstruction and main contributor to the escalating prevalence of morbidity worldwide including the Arab countries. Due to the serious consequences of the untreated sleep disordered breathing, this article will emphasize on the importance of early recognition, key clinical manifestations, and how to treat and prevent the disease.

Keywords

Apnea - breathing - sleep


Publication History

Article published online:
09 August 2021

© 2012. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr. S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
  • 2 Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA 2000;283:1829-36.
  • 3 Punjabi NM, Bandeen-Roche K, Marx JJ, Neubauer DN, Smith PL, Schwartz AR. The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep. Sleep 2002;25:307-14.
  • 4 Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: A population-based study. Am J Respir Crit Care Med 2005;172:1590-5.
  • 5 Punjabi N, Newman AB, Young TB, Resnick HE, Sanders MH. Sleep-disordered breathing and cardiovascular disease: An outcome-based definition of hypopneas. Am J Respir Crit Care Med 2008;177:1150-5.
  • 6 Badr. MS. Effect of ventilatory drive on upper airway patency in humans during NREM sleep. Respir Physiol 1996;103:1-10.
  • 7 Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 1997;82:1319-26.
  • 8 Rowley JA, Sanders CS, Zahn BR, Badr. MS. Gender differences in upper airway compliance during NREM sleep: Role of neck circumference. J Appl Physiol 2002;92:2535-41.
  • 9 Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med 1995;152:1673-89.
  • 10 Whittle AT, Marshall I, Mortimore IL, Wraith PK, Sellar RJ, Douglas NJ. Neck soft tissue and fat distribution: Comparison between normal men and women by magnetic resonance imaging. Thorax 1999;54:323-8.
  • 11 Shiota S, Ryan CM, Chiu KL, Ruttanaumpawan P, Haight J, Arzt M, et al. Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects. Thorax 2007;62:868-72.
  • 12 Condos R, Norman RG, Krishnasamy I, Peduzzi N, Goldring RM, Rapoport DM. Flow limitation as a noninvasive assessment of residual upper-airway resistance during continuous positive airway pressure therapy of obstructive sleep apnea. Am J Respir Crit Care Med 1994;150:475-80.
  • 13 Davies RJ, Stradling JR. The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. Eur Respir J 1990;3:509-14.
  • 14 Sanders MH, Moore SE. Inspiratory and expiratory partitioning of airway resistance during sleep in patients with sleep apnea. Am Rev Respir Dis 1983;127:554-8.
  • 15 Onal E, Burrows DL, Hart RH, Lopata M. Induction of periodic breathing during sleep causes upper airway obstruction in humans. J Appl Physiol 1986;61:1438-43.
  • 16 Sankri-Tarbichi AG, Rowley JA, Badr. MS. Expiratory pharyngeal narrowing during central hypocapnic hypopnea. Am J Respir Crit Care Med 2009;179:313-9.
  • 17 Schneider H, Boudewyns A, Smith PL, O′Donnell CP, Canisius S, Stammnitz A, et al. Modulation of upper airway collapsibility during sleep: Influence of respiratory phase and flow regimen. J Appl Physiol 2002;93:1365-76.
  • 18 Badr. MS, Toiber F, Skatrud JB, Dempsey J. Pharyngeal narrowing/occlusion during central sleep apnea. J Appl Physiol 1995;78:1806-15.
  • 19 19. Morrell MJ, Arabi Y, Zahn B, BaDr. MS. Progressive retro palatal n arrowing preceding obstructive apnea. Am J Respir Crit Care Med 1998;158:1974-81.
  • 20 Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O′Connor GT, Resnick HE, et al. Obstructive sleep apnea-hypopnea and incident stroke, the Sleep Heart Health Study. Am J Respir Crit Care Med 2010;182:269-77.
  • 21 Portier F, Portmann A, Czernichow P, Vascaut L, Devin E, Benhamou D, et al. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Respir Crit Care Med 2000;162:814-8.
  • 22 Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J; Cooperative Group Burgos-Santander. The association between sleep apnea and the risk of traffic accidents. N Engl J Med 1999;340:847-51.
  • 23 Mulgrew AT, Fox N, Ayas NT, Ryan CF. Diagnosis and initial management of obstructive sleep apnea without polysomnography: A randomized validation study. Ann Intern Med 2007;146:157-66.
  • 24 Javaheri S, Wexler L. Prevalence and treatment of breathing disorders during sleep in patients with heart failure. Curr Treat Options Cardiovasc Med 2005;7:295-306.
  • 25 Leduc BE, Dagher JH, Mayer P, Bellemare F, Lepage Y. Estimated prevalence of obstructive sleep apnea-hypopnea syndrome after cervical cord injury. Arch Phys Med Rehabil 2007;88:333-7.
  • 26 Kaneko Y, Hajek VE, Zivanovic V, Raboud J, Bradley TD. Relationship of sleep apnea to functional capacity and length of hospitalization following stroke. Sleep 2003;26:293-7.
  • 27 Bassetti C, Aldrich MS, Chervin RD, Quint D. Sleep apnea in patients with transient ischemic attack and stroke: A prospective study of 59 patients. Neurology 1996;47:1167-73.
  • 28 Wessendorf TE, Teschler H, Wang YM, Konietzko N, Thilmann AF. Sleep-disordered breathing among patients with first-ever stroke. J Neurol 2000;247:41-7.
  • 29 Patil SP, Punjabi NM, Schneider H, O′Donnell CP, Smith PL, Schwartz AR. A simplified method for measuring critical pressures during sleep in the clinical setting. Am J Respir Crit Care Med 2004;170:86-93.
  • 30 Sankri-Tarbichi AG, Rowley JA, Badr. MS. Inhibition of ventilatory motor output increases expiratory retro palatal compliance during sleep. Respir Physiol Neurobiol 2011;176:136-43.
  • 31 Jordan AS, Eckert DJ, Wellman A, Trinder JA, Malhotra A, White DP. Termination of respiratory events with and without cortical arousal in obstructive sleep apnea. Am J Respir Crit Care Med 2011;184:1183-91.
  • 32 Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd D. Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: A critical review. J Int Neuropsychol Soc 2004;10:772-85.
  • 33 Canessa N, Castronovo V, Cappa SF, Aloia MS, Marelli S, Falini A, et al. Obstructive sleep apnea: Brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med 2011;183:1419-26.
  • 34 Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2007;3:737-47.