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Sleep Related Breathing Disorders
Vivek Nangia, Shivani Swami
CHAPTER 1:
Normal Human Sleep
NORMAL HUMAN SLEEP
Age Related Sleep Alterations
Age Related Sleep Changes
Adult Sleep
STAGES OF SLEEP
Physiological Changes Associated with Sleep
Sleep Influence on Endocrine System
How Sleep Problems are Diagnosed?
SLEEP HYGIENE
SLEEP MYTHS
CHAPTER 2:
Anatomy and Physiology of Obstructive Sleep Apnea Airways
INTRODUCTION
ANATOMY OF UPPER AIRWAY OBSTRUCTION
Possible Sites of Upper Airway Obstruction
Nasopharynx
Oropharynx
Hypopharynx
PHYSIOLOGY
PATHOPHYSIOLOGY
Collapsibility of Upper Airways
Effects of Lung Volumes
Upper Airway Dilator Muscle Activity and Reflex Responsiveness
AROUSAL RESPONSE IN OBSTRUCTIVE SLEEP APNEA
Ventilatory Control Stability and Pharyngeal Neuropathy
CONCLUSION
CHAPTER 3:
Clinical Approach to Patient with Sleep Related Breathing Disorders
INTRODUCTION
CLASSIFICATION
HISTORY
QUESTIONNAIRES
Epworth Sleepiness Score
Berlin Questionnaire
CLINICAL EXAMINATION
CONCLUSION
CHAPTER 4:
Diagnostic Approach to Sleep Disordered Breathing
INTRODUCTION
DIAGNOSIS
History and Physical Examination
Subjective Assessment
Systemic Examination
Objective Tests
Polysomnography11
SLEEP STAGE SCORING
Split Night Polysomnography
Portable Sleep Monitoring (Level 3 Studies)
Other Diagnostic Tests
Multiple Sleep Latency Test and Maintenance of Wakefulness Test
Cephalometry
Actigraphy
CONCLUSION
CHAPTER 5:
Snoring and Upper Airways Resistance Syndrome
INTRODUCTION
DEFINITION AND PREVALANCE
PATHOPHYSIOLOGY
CLINICAL FEATURES
DIAGNOSIS
CONSEQUENCES OF UPPER AIRWAY RESPIRATORY SYNDROME
TREATMENT
CONCLUSION
CHAPTER 6:
Obstructive Sleep Apnea
INTRODUCTION
PATHOPHYSIOLOGY
EPIDEMIOLOGY
RISK FACTORS
CLINICAL PRESENTATION
CONSEQUENCES
Inflammatory Changes17
Pulmonary17
Metabolic
Cardiovascular
Cerebrovascular
Erectile Dysfunction
Renal Disease
Neurobehavioral and Social
DIAGNOSIS
TREATMENT
CONCLUSION
CHAPTER 7:
Central Sleep Apnea
INTRODUCTION
DEFINITION
CLASSIFICATION
Epidemiology of Central Sleep Apnea
Mechanisms of Causation of Central Sleep Apnea
Conditions Associated with Central Sleep Apnea
Physiologic Central Sleep Apnea
Non-hypercapnic Central Sleep Apnea
Hypercapnic Central Sleep Apnea
Central Sleep Apnea Associated with Endocrine Disorders
CSA Associated with OSA (Complex Sleep Apnea/Treatment Emergent Sleep Apnea)
Diagnosis of Central Sleep Apnea
Treatment of Central Sleep Apnea
CONCLUSION
CHAPTER 8:
Obesity Hypoventilation Syndrome and Complex Sleep Apnea
INTRODUCTION
DEFINITION AND PREVALENCE
PATHOPHYSIOLOGY
Respiratory Muscle Function
Central Ventilatory Drive
Ventilation Perfusion (V/Q) Mismatching
Sleep-Disordered Breathing
CLINICAL FEATURES
DIAGNOSIS
Arterial Blood Gases
Pulmonary Function Tests
Chest Radiograph
Cardiac Studies
Polysomnography
Specific Tests
TREATMENT
Positive Airway Pressure Therapy
Supplemental Oxygen
Weight Loss
Tracheostomy
Pharmacotherapy
MORBIDITY AND MORTALITY
CONCLUSION
INTRODUCTION
Epidemiology and Natural History
PATHOGENESIS
Clinical Presentation
TREATMENT
CONCLUSION
CHAPTER 9:
Cardiac Effects of Sleep Related Breathing Disorders
INTRODUCTION
CARDIOVASCULAR INVOLVEMENT IN OBSTRUCTIVE SLEEP APNEA
Pathophysiology
Mechanical Effects
Autonomic Effects
Inflammation and Oxidative Stress
Endothelial Dysfunction
Thrombosis
Burden of Cardiovascular Disease in Patients with Obstructive Sleep Apnea
Hypertension
Arrhythmias
Heart Failure
Coronary Artery Disease
Cardiovascular Diagnostic Evaluation in Patients with Obstructive Sleep Apnea
Management of Cardiovascular Disease in Obstructive Sleep Apnea
Effect of Continuous Positive Airway Pressure on Cardiovascular Health in Patients with Obstructive Sleep Apnea
Specific Treatment of Cardiovascular Disorders in Patients with Obstructive Sleep Apnea
CARDIOVASCULAR INVOLVEMENT IN OTHER FORMS OF SLEEP RELATED BREATHING DISORDERS
Central Sleep Apnea
Cardiovascular Effects of Central Sleep Apnea
Diagnosis of Central Sleep Apnea
Management of Central Sleep Apnea
Complex Sleep Apnea
CONCLUSION
CHAPTER 10:
Systemic Effects of Sleep Related Breathing Disorders: Noncardiac
INTRODUCTION
METABOLIC EFFECTS OF OSA
Obstructive Sleep Apnea and Type 2 diabetes Mellitus
Insulin Resistance and Glucose Intolerance in Obstructive Sleep Apnea
Potential Mechanisms
Obstructive Sleep Apnea and Metabolic Consequence of Obesity
Obstructive Sleep Apnea and Liver Damage
Management Considerations
NEUROCOGNITIVE EFFECTS
Patterns of Cognitive Impairment in Obstructive Sleep Apnea: Which Domains?
The Relationship Between the Obstructive Sleep Apnea and Neurocognitive Dysfunction
Pathophysiology
Management Recommendations
Management
OBSTRUCTIVE SLEEP APNEA AND PSYCHIATRIC DISORDERS
Cerebrovascular Consequences of Obstructive Sleep Apnea
OBSTRUCTIVE SLEEP APNEA AND GASTROESOPHAGEAL REFLUX DISEASE
Impact of Obstructive Sleep Apnea on Chronic Kidney Disease
ERECTILE DYSFUNCTION
OTHER POTENTIAL CONSEQUENCES OF OBSTRUCTIVE SLEEP APNEA
CONCLUSION
CHAPTER 11:
Positive Airway Pressure Treatment in Obstructive Sleep Apnea
INTRODUCTION
POSITIVE AIRWAY PRESSURE THERAPY MODALITIES TO TREAT OBSTRUCTIVE SLEEP APNEA
Autotitrating Positive Airway Pressure
Pressure Relief Positive Airway Pressure
Adaptive Servoventilation
COMPLIANCE
MASK INTERFACES
Nasal Mask
Full Face Mask/Oronasal Mask
Oral Mask
Nasal Pillows
Combination Devices
General Considerations Including Adverse Effects of Interfaces
Nasal Mask
Orofacial Mask
Oral Mask
VARIED DEVICES TO IMPROVE COMPLIANCE
Role of Cognitive Behavioral Therapy
CONCLUSION
CHAPTER 12:
Pharmacotherapy
INTRODUCTION
AGENTS THAT IMPACT SLEEP PATTERN
Protryptyline
Serotonergic Agents
AGENTS THAT PROMOTE WAKEFULNESS
Modafinil
Armodafinil
Other Stimulants
AGENTS THAT REDUCE NASAL AIR RESISTANCE
AGENTS THAT PROMOTE VENTILATION
Qnexa
AGENTS TO BE AVOIDED
CONCLUSION
CHAPTER 13:
Surgical Management of Obstructive Sleep Apnea
INTRODUCTION
LEVELS OF OBSTRUCTION
EVALUATION OF LEVEL OF OBSTRUCTION
General ENT Examination
Muller Maneuver
Sleep Nasoendoscopy
Computed Tomography
Magnetic Resonance Imaging
Somnofluoroscopy
Lateral Cephalometry
Pharyngeal Manometry
TREATMENT
Corrective Nasal Surgical Procedures
Tonsillectomy
Uvulopalatopharyngoplasty
Tongue Base Reduction with or without Hyoid Suspension
Tongue Base Resection and Other Procedures for Retroglossal Obstruction
Genioglossus Advancement
Maxillomandibular Advancement
Distraction Osteogenesis
Laryngeal Surgery
Multilevel Surgery
Tracheostomy
CONCLUSION
CHAPTER 14:
Dental Sleep Medicine: An Overview
INTRODUCTION
UNIQUENESS OF HUMAN PHARYNX
HISTORICAL PERSPECTIVE OF DENTAL SLEEP APPLIANCES
SLEEP MEDICINE AND DENTISTRY
Craniofacial Risk Factors
CLINICAL EVALUATION AND DIAGNOSIS
Oral Appliance Therapy
Tongue Retaining Devices
Mandibular Advancement Devices
Maxillomandibular Surgical Advancement
PREVENTION OF SLEEP DISORDERED BREATHING IN CHILDREN
SLEEP BRUXISM
CONCLUSION
CHAPTER 15:
Obstructive Sleep Apnea in Children
INTRODUCTION
PRIMARY SNORING
Upper Airway Resistance Syndrome
Obstructive Sleep Apnea Syndrome
PATHOPHYSIOLOGY
Anatomical Factors
Control of Airway Patency
Obesity
Obstructive Sleep Apnea and Inflammation
Sequelae of Obstructive Sleep Apnea
Cardiovascular System
Behavioral and Neurocognitive Impairment
Metabolic Sequelae
DIAGNOSIS
Clinical Manifestations
Examination
Polysomnography
TREATMENT
Surgical
Other Surgical Options
Positive Airway Pressure
Other Nonsurgical Therapies
FUTURE DEVELOPMENTS
CONCLUSION
CHAPTER 16:
Perioperative Management of Sleep Related Breathing Disorders
INTRODUCTION
PREOPERATIVE EVALUATION OF OBSTRUCTIVE SLEEP APNEA
PERIOPERATIVE COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Difficult Intubation in Patients with Obstructive Sleep Apnea
Strategies to Mitigate Difficult Intubation and/or Mask Ventilation
Postoperative Respiratory Failure in Obstructive Sleep Apnea
Unanticipated Intensive Care Unit Transfer after Surgery
Postoperative Mortality
Perioperative Risk Reduction Strategies in Obstructive Sleep Apnea
Perioperative Obstructive Sleep Apnea Protocols
CONCLUSION
INDEX
TOC
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