Sleep-disordered breathing is a widespread disease 1. Breath-to-Breath Variability Correlates With Apnea-Hypopnea Index in Obstructive Sleep Apnea*
|
|
- Ilene Byrd
- 6 years ago
- Views:
Transcription
1 Breath-to-Breath Variability Correlates With Apnea-Hypopnea Index in Obstructive Sleep Apnea* Peter Kowallik, MD; Ilka Jacobi, MD; Alexander Jirmann, MD; Malte Meesmann, MD; Michael Schmidt, MD; and Hubert Wirtz, MD Background: Breathing in patients with obstructive sleep apnea (OSA) is frequently interrupted by periods of hypopnea and apnea. There is limited information regarding a possible disturbance of breathing outside these periods. Study objective: To analyze the degree of breathing disturbance during nonocclusion. Design: Prospective determination of breathing variability during full polysomnographic sleep studies. Patients: Breath-to-breath variation was monitored in 34 patients with OSA and in 9 healthy subjects. Measurements and results: All breath-to-breath intervals were automatically analyzed from flow signal, displayed, and manually corrected for artifacts. Distribution of all nonapneic breath intervals was analyzed for the extent of difference from a normal distribution pattern by specifying kurtosis. In untreated OSA patients, kurtosis was significantly reduced ( , mean SD) compared to control subjects ( ), indicating increased variability of nonoccluded breathing. This effect was present in all sleep stages, and the extent depended significantly on the degree of disease. Continuous positive airway pressure breathing was able to normalize kurtosis ( ) immediately. Conclusions: Breathing in OSA is not only characterized by interruptions of breathing during occlusion, but by a greater variation in the pattern of normal-length breaths. (CHEST 2001; 119: ) Key words: airflow obstruction; breathing variability; continuous positive airway pressure; obstructive sleep apnea Abbreviations: AHI apnea-hypopnea index; AI apnea index; CPAP continuous positive airway pressure; OSA obstructive sleep apnea; REM rapid eye movement; UARS upper-airway resistance syndrome *From the Department of Medicine (Drs. Kowallik, Jacobi, Jirmann, Meesmann, and Schmidt), University of Würzburg, Würzburg; and the Department of Medicine (Dr. Wirtz), University of Leipzig, Leipzig, Germany. Manuscript received January 12, 2000; revision accepted September 6, Correspondence to: Peter Kowallik, MD, Medizinische Universitätsklinik, Josef-Schneider-Str. 2, D Würzburg, Germany; kowallik@mail.uni-wuerzburg.de Sleep-disordered breathing is a widespread disease 1 with varying forms of manifestation. 2 The most severe form is obstructive sleep apnea (OSA), with daytime sleepiness and associated cardiovascular disease and other sequelae. 3 5 The underlying condition is increased upper-airway collapsibility for reasons yet to be determined. 6 Even if upper-airway obstruction is incomplete, increased upper-airway resistance will still cause clinical symptoms similar to OSA 7 because of respiratory effort-related arousals. 8 Diagnosis of OSA involves screening as well as respiratory nocturnal polysomnography. 9 For detection of upper-airway resistance syndrome (UARS), measurement of esophageal pressure in combination with arousal detection is the gold standard. 10 Both of these diagnostic procedures are time-consuming and require considerable technical expense, while causing patient discomfort. In general, an increase in resistance of the upper airway will lead to changes in the flow contour 11 and lengths of the breathing cycle, as well as increasing the variability of breath-cycle length. 12,13 Thus, sleep-disordered breathing with the common underlying condition of increased upper-airway resistance may be characterized by a varying degree of breath cycle-length variability different from the normal pattern of breathing. The purpose of this study was to verify whether or not breath cycle-length variability, readily determined by standard thermistor flow-sensor equipment, is significantly different in OSA patients compared to healthy control subjects, and whether or not it correlates with the extent of OSA estimated by apnea-hypopnea index (AHI). CHEST / 119 / 2/ FEBRUARY,
2 Study Population Materials and Methods Thirty-four patients (age range, 30 to 68 years) were referred to this institution for polysomnographic evaluation because of daytime sleepiness or other sleep apnea-related symptoms (Table 1). Nine healthy volunteers (age range, 22 to 52 years) without a history of daytime sleepiness, and having normal findings on physical examination and functional tests, such as resting ECG, echocardiography, lung function assessed by body plethysmography, and home sleep study (Jäger Apnoe Screen 2 Plus; Jäger- Tönnies; Würzburg, Germany), served as a control group. Control subjects gave informed consent to participate in the study. Study Protocol Patients as well as healthy subjects underwent a full-night polysomnographic sleep study. Patients in whom OSA was diagnosed and who received continuous positive airway pressure (CPAP) treatment underwent a second polysomnographic study the next night. Polysomnography Polysomnography was performed for 8 h during the night (Sleep Lab 1000 P; Jäger-Tönnies). Fourteen channels were recorded continuously: airflow signal (32-Hz sampling rate) recorded by a nasal/oral thermistor flow sensor (Jäger-Tönnies), two EEG channels, two electromyogram channels, two electrooculogram channels, one channel recording limb activity, one channel recording body position, two channels recording thoracic and abdominal effort, one channel recording snoring, one channel recording transdermal oxygen saturation, and one ECG channel. Therapy Patients with an AHI of 30, or an AHI 5 and a history of symptoms typical for sleep apnea, received treatment with CPAP (Somnotron 2; Weinman; Hamburg, Germany) if they consented to this kind of treatment, as recently recommended in a consensus statement. 14 A nasal CPAP mask was fitted, and the effective pressure individually determined for each of these seven patients. Starting from a pressure of 5 millibars (5.1 cm H 2 O), the CPAP pressure was increased by 1 millibar (1.02 cm H 2 O) whenever there was more than one significant fall in oxygen saturation, apnea, or hypopnea. 14 When this did not occur for 1 h, pressure was slowly decreased until desaturations reappeared, in which case pressure was increased again. Data Analysis Polysomnographic Sleep Study: Evaluation of the sleep studies were done according to guidelines. 15,16 Sleep stage was defined according to standard criteria 15 and grouped into four different levels: awake, rapid eye movement (REM), sleep stages 1 and 2, and sleep stages 3 and 4. Hypopnea was determined as a reduction in the flow signal of 50%, lasting 10 s and causing a decrease in the oxygen saturation of 4%. 2,17,18 Apnea was defined as an interruption of the flow signal for a duration of at least 10 s. 2,17 The number of apneas and hypopneas were calculated to obtain the AHI. Results of the polysomnographic sleep study are shown in Table 1. Flow Signal: Analysis was performed off-line. Data were exported in raw format and further processed using software specially developed for this study by one of the authors. The digitized flow signal was extracted from the raw data file of the sleep study. Flow-signal minima were identified automatically. The distance between two minima was taken as the duration of one breath. This marker was used instead of zero flow, because mimima were more reliable to detect, compared to the onset of flow. All breath-to-breath intervals were determined and displayed (Fig 1). The actual flow signals of all breaths were scanned on a monitor, and artifacts were corrected manually. Distribution of Breath-to-Breath Intervals: Means and standard deviations of all breath-to-breath intervals 10 s were calculated (ie, apneic episodes were not included). Furthermore, normal length of breath-to-breath intervals was defined by a duration within 50% of the median breath-to-breath interval duration. The distribution of these breath-to-breath intervals of normal length was analyzed for deviation from a normal distribution by specifying its kurtosis. The kurtosis of a distribution compares the shape of a distribution to a normal distribution (ie, the fact whether the distribution curve is more flat or more pointed, compared to a normal distribution). 19 If the distribution is normal, the value of kurtosis is, by definition, zero. A positive value of kurtosis indicates a sharp peak with longer tails including only few cases. That is, individual values are crowded together around the mean. A negative value indicates that the peak is flattened, compared to a normal distribution with many cases widely apart from the mean. Statistical analysis was performed using commercial software (Systat for Windows; SPSS; Chicago, IL). Data of measurements for single subjects were expressed as mean SD. Data of measurements between groups were expressed as mean SEM, Table 1 Polysomnographic Sleep Study* OSA Patients Variables Control Subjects (n 9) All (n 34) Without CPAP (n 27) Before CPAP (n 7) Age BMI AI AHI *Data are expressed as mean SD. Data show comparison of healthy subjects and patients with OSA. Patients with OSA (All) are classified in retrospect in a group that did not receive CPAP therapy (Without CPAP) and a group that eventually received CPAP therapy (Before CPAP) following the polysomnographic sleep study. BMI body mass index. p 0.05 control subjects vs OSA patients. 452 Clinical Investigations
3 Figure 1. Breath-to-breath intervals of the total recording period for OSA patient 2 (top, A) and OSA patient 12 (bottom, B), treated the first night with nasal CPAP. and the Mann-Whitney test was used for comparison. A p value of 0.05 was considered significant. Results Breathing Pattern in Healthy Subjects The breathing pattern in healthy subjects was very regular. Apneas did not occur, and the standard deviation for the duration of all nonapneic breaths was small. In addition, the distribution of all breathto-breath intervals within the normal range (ie, within 50% of the median breath-to-breath interval) was very narrow (Fig 2, left, A). This was expressed by a kurtosis significantly more than zero, indicating that the density distribution of the regular breath-to-breath intervals was more acute than expected for a normal distribution. Breathing Pattern in Untreated OSA Patients Breathing in OSA patients was characterized by frequent discontinuations. This became obvious in apneic breath-to-breath intervals of 10sinthe tachogram of all consecutive breath-to-breath intervals (Fig 1, top, A). However, nonapneic breathing in these patients was also altered by OSA. The standard deviations of these nonapneic breaths was increased, compared to that of healthy subjects. In addition, the frequency distribution of breath-to-breath intervals of normal length was also different from that of the control subjects. The kurtosis of this distribution was significantly lower compared to that in control subjects (Fig 3). This is equivalent to a less-regular breathing pattern, as was obvious in the analysis of breath-to-breath intervals of a single patient over the entire duration of sleep (Fig 2, middle, B) compared to a healthy subject (Fig 2, left, A). Compared to the total nighttime analysis, the same decrease in kurtosis was also found in periods that were not interrupted by apneas. One example would be the breath-tobreath intervals of 3,160 to 3,560 of patient 2 CHEST / 119 / 2/ FEBRUARY,
4 Figure 2. Distribution of all breath-to-breath intervals for control subject 1 (left, A) [kurtosis, 0.62], OSA patient 2 (middle, B) [kurtosis, 0.67], and OSA patient 12, (right, C) treated the first night with nasal CPAP (kurtosis, 1.20). (arrows in Fig 1, top, A) with a kurtosis of Age did not significantly influence kurtosis within the group of OSA patients (Table 2). Relation of Regularity of Breathing to Occurrence and Severity of OSA In patients with OSA, we found a significant positive correlation of AHI and the standard deviations of nonapneic breath-to-breath intervals (r 0.77; p ; Fig 4, top, A). In addition, the apnea index (AI; r 0.45; p ) as well as the AHI (r 0.64; p ) had significant negative correlations with the kurtosis of breath-to-breath frequency distribution (Fig 4, bottom, B). Although both AHI and AI correlated significantly with kurtosis of breath-to-breath frequency distribution, the correlation with AHI was considerably stronger. Influence of Sleep Stages on Breathing in Healthy Subjects and OSA Patients In healthy subjects, breathing became more regular with non-rem sleep and deep sleep stages, compared to wakefulness or REM sleep (Fig 5, top, A), indicated by an increase in kurtosis. For OSA patients, this increase in kurtosis with increased sleep stages was preserved, but compared to healthy subjects, kurtosis was significantly reduced in OSA patients in each sleep stage (Fig 5, top, A). Thus, changes in distribution of sleep stages with a small reduction of time spent in sleep stage 3 and sleep stage 4 (Fig 5, bottom, B) could not explain the reduction of kurtosis in OSA patients. In addition, we did not observe a difference in the time subjects were asleep between the groups (Fig 5, bottom, B). Breathing Pattern in OSA Patients With CPAP Therapy In OSA patients, where CPAP therapy was applied, episodes of apnea and hypopnea were promptly reduced during the first night of treatment. In the tachogram of all consecutive breath-to-breath intervals, the number of apneic intervals (ie, with a duration 10 s) dramatically decreased after the initial CPAP titration period (Fig 1, bottom, B), and thus the AI significantly decreased ( vs ; p 0.001). Together with the disappearance of frequent apneas, nonapneic breathing normalized. This more regular breathing is readily visible by comparing the 454 Clinical Investigations
5 (Fig 1, bottom, B). In line with this, the standard deviations of the length of these nonapneic breaths decreased ( ), compared to the untreated state ( ; p 0.02). The frequency distribution (Fig 2, right, C) of breath-to-breath intervals narrowed and was no longer different from that of control subjects. This was indicated by a significant (p 0.01) increase in kurtosis in treated vs untreated patients (Fig 3). In addition, kurtosis of treated patients no longer differed from that of control subjects (Fig 3). Discussion We found greater variation in nonapneic breathto-breath intervals in patients with OSA compared to healthy subjects. The extent of variation depended on the degree of disease. In addition to the presence of hypopnea and apnea, OSA is also characterized by a disturbance in the pattern of normal-length breaths. Figure 3. Comparison of kurtosis between OSA patients before and with nasal CPAP therapy and healthy subjects (mean SEM; *p 0.01, Mann-Whitney test). tachograms of breath-interval duration before (Fig 1, top, A) and after (Fig 1, bottom, B) CPAP therapy. CPAP treatment clearly reduced the width of the distribution around the mean duration of 3 s, resulting in a more narrow appearance of the black line Table 2 Polysomnographic Sleep Study and Kurtosis By Age* Variables Control yr (n 7) yr (n 17) OSA yr (n 17) Age BMI AI AHI Kurtosis *Data are expressed as mean SD. Patients with OSA are classified in two subgroups of younger and older patients and compared with older control subjects. p 0.05 control subjects vs OSA patients. p 0.05 younger vs older OSA patients. Breathing Pattern in Healthy Subjects Recurring changes in the rate of breathing was noticed 35 years ago in healthy subjects with short changes in respiratory frequency every three to four breaths superimposed on greater and more prolonged periodic changes. 20 These nonperiodic short changes could not be attributed solely to random fluctuations. The average length of increase and decrease in breathing frequency, and hence the factors controlling it, were to some extent characteristic for an individual subject. 21 This was later confirmed in identical twins, where pattern of breathing was significantly similar within twin pairs, 22 and in another study of healthy adults, where the unique characteristics of breathing pattern were maintained over a time period of 4 to 5 years. 23 Various mechanisms, which were previously reviewed, 24 are thought to cause temporal variations in the pattern of breathing. Periodic variations were contributed to oscillations originated in chemoreflex feedback loops and to central neural memory mechanisms. Nonrandom, nonperiodic variability of respiratory pattern was attributed to nonlinear interactions between pulmonary and airway afferent activities and integrative central respiratory mechanisms. Breath-by-breath variations decrease in non-rem sleep compared to wakefulness This is in accordance with our finding in healthy subjects that the distribution of breath-to-breath intervals was narrow during non-rem sleep. It has been reported that the inspiratory flow curve changes in patients with OSA from a regular CHEST / 119 / 2/ FEBRUARY,
6 Figure 4. Relation between AHI and standard deviation (top, A) and AHI and kurtosis (bottom, B) of breath-to-breath intervals in 9 control subjects (triangles) and 34 OSA patients (circles and linear regression line). sinusoidal shape to a more flattened shape during elevated upper-airway resistance. 28 This would influence measurements of mere inspiratory time and could lead to a wider distribution of breath intervals in OSA patients compared to healthy subjects. We therefore chose to analyze total interval duration only. Analyzing total interval duration is also supported by the fact that expiratory duration is linearly dependent on inspiratory duration. 29 However, there is no dependence of inspiratory duration on expiratory timing. 30 Breathing Pattern in OSA Patients The site of obstruction in OSA is thought to be the upper or lower pharynx, where the inward collapsing action of subatmospheric intrapharyngeal pressure during inspiration is normally prevented by an adequate tone of the genioglossus muscle. 31 In patients with OSA, maximum pharyngeal area tends to be decreased for a variety of reasons. 32 During wakefulness, this anatomic narrowing is compensated by increased genioglossal muscle tone. However, during sleep the compensation is lost. 33 Because these features are continuously present, they will also continuously affect breathing, although the extent may vary depending on the presence of confounding factors. After inspiratory resistive loading in healthy subjects, an increase in the scatter of inspiratory time intervals has been observed. 12 Magnitude and changes in scatter depend on the extent of load. Similarly, varying degrees of upper-airway narrowing in OSA patients during sleep 34 may be followed by an increase in breathing variability, as has been observed in the present study. Our finding of an increase in breathing variability in OSA patients cannot be explained by the appearance of a few breaths of extraordinary duration in comparison to a bulk of breath intervals that were unchanged, as may be suggested by a mere increase in standard deviations. Rather, this increase in 456 Clinical Investigations
7 Figure 5. Kurtosis (top, A) and duration (bottom, B) of different sleep stages in OSA patients (hatched circles/bars) and healthy subjects (open circles/bars) [mean SEM; *p 0.05]. breathing variability was caused by a change in the distribution of breath-to-breath intervals with normal length because kurtosis of these intervals was reduced. In addition, the increased fluctuation in the duration of each breath was not restricted to periods immediately after apnea, where a compensatory increase in breath flow is known to occur. Periods without apneic breathing also showed a reduction of kurtosis, compared to healthy subjects. The increased breathing variability of OSA patients was present during all sleep stages. Thus, the observed reduction in stage 3 and stage 4 sleep in OSA patients, where breathing variability is decreased in healthy subjects as well as in OSA patients, was not responsible for the increase in breathing variability in OSA patients. An age-dependent increase in breath-to-breath variability was suggested by some authors. 25,26,35 Therefore, an age-dependent difference in kurtosis between the two groups had to be excluded because the 10-year difference in mean age was statistically significant. Two factors oppose the possibility that the difference in breathing variability could be explained by age. First, within the group of patients with OSA, the younger and older patients did not differ in terms of mean kurtosis, as shown in Table 2. Secondly, the more severely affected OSA patients, who exhibited a greater breathing variability than the CHEST / 119 / 2/ FEBRUARY,
8 less affected OSA patients, tended to be even younger than the less affected patient group. The lack of an age-dependent effect in the present study might be explained by the relatively small difference in age between the two groups, compared to previous studies where an age dependence of breathing patterns was examined. In these studies, the age difference between the study groups was much greater (approximately 40 years), 25,26,35 the mean age of the younger subjects was much lower (25 to 29 years), and the mean age of the older subjects was much higher (69 to 76 years). Compared to the considerable variability in AHI for an individual patient, there appears to be a good correlation between kurtosis and AHI in the present study. This suggests that there might be a common underlying cause for the increase in breathto-breath variability and the increase in the severity of OSA. The link might be the increase in upperairway resistance, because a significant increase in breathing variability was also reported during snoring episodes leading to arousals in patients without OSA. 40 Increases in upper-airway resistance could thus lead to increases in breath-to-breath variability, but will finally result in apnea if a threshold value is reached. Effective CPAP therapy did not only reduce episodes of apnea and hypopnea, but also normalized breathing variability in the present study. This normalization of breathing pattern with the onset of CPAP therapy indicates that the altered breathing pattern in OSA patients is likely because of peripheral mechanisms such as the proposed increase in respiratory resistance, rather than to primarily central effects or to an altered chemoreceptor sensitivity. Analyzing the contour of the flow signal instead of its timing provided similar evidence for a relationship between flow limitations and changes in flow signal in a study 28 of CPAP titration in OSA patients. CPAP levels entirely eliminating upper-airway resistance in this study resulted in a regularly shaped inspiratory flow signal. In contrast, a high resistance was associated with a flattened inspiratory flow signal. The change to a more flattened flow contour remained detectable at suboptimal CPAP pressure that led to a decrease in apneic events with a concomitant increase in hypopneas. In this situation, esophageal pressure remained elevated. 41 A similar classification of the shape of inspiratory flow curves in 10 patients with various degrees of upper-airway resistance (ie, OSA, UARS, and snoring) also indicates a relation between upper-airway resistance and changes in breathing pattern, 11 as is suggested by our observations. Additional strength is added to this interpretation by a stronger correlation of kurtosis with AHI rather than AI alone in the present study. The greater variation in breath-to-breath interval described in this study may constitute a characteristic feature of OSA. Although a direct relation between UARS and increased breath-to-breath variability remains to be shown, we have demonstrated significantly increased breath-to-breath variability in OSA patients correlating to the extent of upperairway obstruction as indicated by AHI. This variability resolved immediately with the onset of effective CPAP therapy. Analysis of breath-to-breath intervals might therefore prove to be a valuable diagnostic tool to assess upper-airway obstruction during sleep. It seems likely that increased resistance without overt obstruction, as is characteristic for UARS, can be detected with this technique. However, this will have to await further evaluation. In the future it may be possible to incorporate breathing variability into automated control algorithm for CPAP adjustment in order to avoid not only overt complete airway obstruction by autoadjusted CPAP, but also the increase in upper-airway resistance that might be indicated by increased breathing variability. References 1 Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: Strollo PJ Jr, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996; 334: Shepard JWJ. Cardiopulmonary consequences of obstructive sleep apnea. Mayo Clin Proc 1990; 65: Nasser S, Rees PJ. Sleep apnoea: causes, consequences and treatment. Br J Clin Pract 1992; 46: He J, Kryger MH, Zorick FJ, et al. Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients. Chest 1988; 94: Badr MS. Pathogenesis of obstructive sleep apnea. Prog Cardiovasc Dis 1999; 41: Loube DI, Andrada TF. Comparison of respiratory polysomnographic parameters in matched cohorts of upper airway resistance and obstructive sleep apnea syndrome patients. Chest 1999; 115: Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999; 115: Strohl KP, Redline S. Recognition of obstructive sleep apnea. Am J Respir Crit Care Med 1996; 154: Guilleminault C, Stoohs R, Clerk A, et al. A cause of excessive daytime sleepiness: the upper airway resistance syndrome. Chest 1993; 104: Hosselet J-J, Norman RG, Ayappa I, et al. Detection of flow limitation with a nasal cannula/pressure transducer system. Am J Respir Crit Care Med 1998; 157: Brack T, Jubran A, Tobin MJ. Effect of resistive loading on variational activity of breathing. Am J Respir Crit Care Med 1998; 157: Brack T, Jubran A, Tobin MJ. Effect of elastic loading on variational activity of breathing. Am J Respir Crit Care Med 1997; 155: Loube DI, Gay PC, Strohl KP, et al. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest 1999; 115: Clinical Investigations
9 15 Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles, CA: Brain Information Service/ Brain Research Institute, EEG arousals: scoring rules and examples; a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 1992; 15: Moser NJ, Phillips BA, Berry DT, et al. What is hypopnea, anyway? Chest 1994; 105: Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med 1999; 159: Press WH, Flannery BP, Teukolsky SA, et al. Statistical description of data. In: Numerical recipes in Pascal. 1st ed. Cambridge, UK: Cambridge University Press 1989; Priban IP. An analysis of some short-term patterns of breathing in man at rest. J Physiol 1962; 166: Shea SA, Walter J, Murphy K, et al. Evidence for individuality of breathing patterns in resting healthy man. Respir Physiol 1987; 68: Shea SA, Benchetrit G, Dinh TP, et al. The breathing patterns of identical twins. Respir Physiol 1989; 75: Benchetrit G, Shea SA, Dinh TP, et al. Individuality of breathing patterns in adults assessed over time. Respir Physiol 1989; 75: Bruce EN. Temporal variations in the pattern of breathing. J Appl Physiol 1996; 80: Shore ET, Millman RP, Silage DA, et al. Ventilatory and arousal patterns during sleep in normal young and elderly subjects. J Appl Physiol 1985; 59: Tobin MJ, Mador MJ, Guenther SM, et al. Variability of resting respiratory drive and timing in healthy subjects. J Appl Physiol 1988; 65: Morrell MJ, Harty HR, Adams L, et al. Breathing during wakefulness and NREM sleep in humans without an upper airway. J Appl Physiol 1996; 81: Condos R, Norman RG, Krishnasamy I, et al. 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: Clark FJ, von Euler C. On the regulation of depth and rate of breathing. J Physiol 1972; 222: Rafferty GF, Evans J, Gardner WN. Control of expiratory time in conscious humans. J Appl Physiol 1995; 78: Remmers JE, DeGroot WJ, Sauerland EK, et al. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol 1978; 44: Isono S, Remmers JE, Tanaka A, et al. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol 1997; 82: Remmers JE, Lahiri S. Regulating the ventilatory pump: a splendid control system prone to fail during sleep. Am J Respir Crit Care Med 1998; 157:S95 S Schwartz AR, O Donnell CP, Baron J, et al. The hypotonic upper airway in obstructive sleep apnea. Am J Respir Crit Care Med 1998; 157: Tobin MJ, Chadha TS, Jenouri G, et al. Breathing patterns: 1. Normal subjects. Chest 1983; 84: Parra O, García-Esclasans N, Montserrat JM, et al. Should patients with sleep apnoea/hypopnoea syndrome be diagnosed and managed on the basis of home sleep studies? Eur Respir J 1997; 10: Fanfulla F, Patruno V, Bruschi C, et al. Obstructive sleep apnoea syndrome: is the half-night polysomnography an adequate method for evaluating sleep profile and respiratory events? Eur Respir J 1997; 10: Wittig RM, Romaker A, Zorick FJ, et al. Night-to-night consistency of apneas during sleep. Am Rev Respir Dis 1984; 129: Mosko SS, Dickel MJ, Ashurst J. Night-to-night variability in sleep apnea and sleep-related periodic leg movements in the elderly. Sleep 1988; 11: Bloch KE, Li Y, Sackner MA, et al. Breathing pattern during sleep disruptive snoring. Eur Respir J 1997; 10: Montserrat JM, Ballester E, Olivi H, et al. Time-course of stepwise CPAP titration: behavior of respiratory and neurologic variables. Am J Respir Crit Care Med 1995; 152: CHEST / 119 / 2/ FEBRUARY,
(To be filled by the treating physician)
CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type
More informationSLEEP DISORDERED BREATHING The Clinical Conditions
SLEEP DISORDERED BREATHING The Clinical Conditions Robert G. Hooper, M.D. In the previous portion of this paper, the definitions of the respiratory events that are the hallmarks of problems with breathing
More informationDuring the therapeutic titration of nasal continuous
Cardiogenic Oscillations on the Airflow Signal During Continuous Positive Airway Pressure as a Marker of Central Apnea* Indu Ayappa, PhD; Robert G. Norman, MS, RRT; and David M. Rapoport, MD, FCCP Therapeutic
More informationObstructive sleep apnoea How to identify?
Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential conflict of interest None Obstructive
More informationPharyngeal Critical Pressure in Patients with Obstructive Sleep Apnea Syndrome Clinical Implications
Pharyngeal Critical Pressure in Patients with Obstructive Sleep Apnea Syndrome Clinical Implications EMILIA SFORZA, CHRISTOPHE PETIAU, THOMAS WEISS, ANNE THIBAULT, and JEAN KRIEGER Sleep Disorders Unit,
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential
More informationPhilip L. Smith, MD; Christopher P. O Donnell, PhD; Lawrence Allan, BS; and Alan R. Schwartz, MD
A Physiologic Comparison of Nasal and Oral Positive Airway Pressure* Philip L. Smith, MD; Christopher P. O Donnell, PhD; Lawrence Allan, BS; and Alan R. Schwartz, MD Study objectives: The effectiveness
More informationThe diagnosis of obstructive sleep apnea syndrome. Combined Effects of a Nasal Dilator and Nasal Prongs on Nasal Airflow Resistance*
Combined Effects of a Nasal Dilator and Nasal Prongs on Nasal Airflow Resistance* Anne Marie Lorino, PhD; Marie Pia d Ortho, MD; Estelle Dahan; Olivier Bignani; Carine Vastel; and Hubert Lorino, PhD Study
More informationDiagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea
Original Article Diagnostic Accuracy of the Multivariable Apnea Prediction (MAP) Index as a Screening Tool for Obstructive Sleep Apnea Ahmad Khajeh-Mehrizi 1,2 and Omid Aminian 1 1. Occupational Sleep
More informationNasal pressure recording in the diagnosis of sleep apnoea hypopnoea syndrome
56 Unité de Recherche, Centre de Pneumologie de l Hôpital Laval, Université Laval, Québec, Canada F Sériès I Marc Correspondence to: Dr F Sériès, Centre de Pneumologie, 2725 Chemin Sainte Foy, Sainte Foy
More informationComparison of two in-laboratory titration methods to determine evective pressure levels in patients with obstructive sleep apnoea
Thorax 2000;55:741 745 741 Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l Université Laval, Sainte-Foy, Québec G1V 4G5, Canada M P Bureau F Sériès Correspondence
More informationDr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012
Dr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012 Why screen of OSA prior to surgery? What factors increase the risk? When due to anticipate problems?
More informationPrecision Sleep Medicine
Precision Sleep Medicine Picking Winners Improves Outcomes and Avoids Side-Effects North American Dental Sleep Medicine Conference February 17-18, 2017 Clearwater Beach, FL John E. Remmers, MD Conflict
More informationPatients commonly arouse from sleep and experience awake states.
Sensitive to Sleep Patients commonly arouse from sleep and experience awake states. PATIENTS are intolerant of the delivered pressure and can have difficulty returning to sleep. To aid the transition back
More informationSleep Apnea: Diagnosis & Treatment
Disclosure Sleep Apnea: Diagnosis & Treatment Lawrence J. Epstein, MD Sleep HealthCenters Harvard Medical School Chief Medical Officer for Sleep HealthCenters Sleep medicine specialty practice group Consultant
More informationDetection of Increased Upper Airway Resistance During Overnight Polysomnography
Sleep Disordered 245.qxp 12/30/2004 8:49 AM Page 85 Detection of Increased Upper Airway Resistance During Overnight Polysomnography Pamela L Johnson, MSc 1 ; Natalie Edwards, PhD 1 ; Keith R Burgess, PhD
More informationThe Familial Occurrence of Obstructive Sleep Apnoea Syndrome (OSAS)
Global Journal of Respiratory Care, 2014, 1, 17-21 17 The Familial Occurrence of Obstructive Sleep Apnoea Syndrome (OSAS) Piotr Bielicki, Tadeusz Przybylowski, Ryszarda Chazan * Department of Internal
More informationCPAP titration by an auto-cpap device based on snoring detection: a clinical trial and economic considerations
Eur Respir J 199; : 759 7 DOI:.113/09031936.9.0759 Printed in UK - all rights reserved Copyright ERS Journals Ltd 199 European Respiratory Journal ISSN 0903-1936 CPAP titration by an auto-cpap device based
More informationPhysiological consequences of prolonged periods of flow limitation in patients with sleep apnea hypopnea syndrome
Respiratory Medicine (2006) 100, 813 817 Physiological consequences of prolonged periods of flow limitation in patients with sleep apnea hypopnea syndrome Gabriel Calero, Ramon Farre, Eugeni Ballester,
More informationThe most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome
The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome Natsios Georgios University Hospital of Larissa, Greece Definitions Obstructive Sleep Apnea (OSA)
More informationNATIONAL COMPETENCY SKILL STANDARDS FOR PERFORMING POLYSOMNOGRAPHY/SLEEP TECHNOLOGY
NATIONAL COMPETENCY SKILL STANDARDS FOR PERFORMING POLYSOMNOGRAPHY/SLEEP TECHNOLOGY Polysomnography/Sleep Technology providers practice in accordance with the facility policy and procedure manual which
More informationIn 1994, the American Sleep Disorders Association
Unreliability of Automatic Scoring of MESAM 4 in Assessing Patients With Complicated Obstructive Sleep Apnea Syndrome* Fabio Cirignotta, MD; Susanna Mondini, MD; Roberto Gerardi, MD Barbara Mostacci, MD;
More informationKey words: Medicare; obstructive sleep apnea; oximetry; sleep apnea syndromes
Choice of Oximeter Affects Apnea- Hypopnea Index* Subooha Zafar, MD; Indu Ayappa, PhD; Robert G. Norman, PhD; Ana C. Krieger, MD, FCCP; Joyce A. Walsleben, PhD; and David M. Rapoport, MD, FCCP Study objectives:
More informationA Sleep Laboratory Evaluation of an Automatic Positive Airway Pressure System for Treatment of Obstructive Sleep Apnea
A Sleep Laboratory Evaluation of an Automatic Positive Airway Pressure System for Treatment of Obstructive Sleep Apnea Khosrow Behbehani, 1 Fu-Chung Yen, 1 Edgar A. Lucas, 2 and John R. Burk 2 (1) Joint
More informationUpper Airway Stimulation for Obstructive Sleep Apnea
Upper Airway Stimulation for Obstructive Sleep Apnea Background, Mechanism and Clinical Data Overview Seth Hollen RPSGT 21 May 2016 1 Conflicts of Interest Therapy Support Specialist, Inspire Medical Systems
More informationA 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy
More informationBasics of Polysomnography. Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC
Basics of Polysomnography Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC Basics of Polysomnography Continuous and simultaneous recording
More informationGOALS. Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) FINANCIAL DISCLOSURE 2/1/2017
Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) 19th Annual Topics in Cardiovascular Care Steven Khov, DO, FAAP Pulmonary Associates of Lancaster, Ltd February 3, 2017 skhov2@lghealth.org
More informationUpper airway resistance syndrome: evaluation of patients with excessive day time sleepiness non-invasively
International Journal of Research in Medical Sciences Ingle VK. Int J Res Med Sci. 2017 Jun;5(6):2753-2759 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Original Research Article DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172482
More informationCircadian Variations Influential in Circulatory & Vascular Phenomena
SLEEP & STROKE 1 Circadian Variations Influential in Circulatory & Vascular Phenomena Endocrine secretions Thermo regulations Renal Functions Respiratory control Heart Rhythm Hematologic parameters Immune
More informationSleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease
1 Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease Rami Khayat, MD Professor of Internal Medicine Director, OSU Sleep Heart Program Medical Director, Department of
More informationSplit-Night Studies for the Diagnosis and Treatment of Sleep-Disordered Breathing
Sleep, 19(10):S255-S259 1996 American Sleep Disorders Association and Sleep Research Society Split-Night Studies for the Diagnosis and Treatment of Sleep-Disordered Breathing ". Patrick J. Strollo Jr.,
More informationEffect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea
European Journal of Orthodontics 20 (1998) 293 297 1998 European Orthodontic Society Effect of two types of mandibular advancement splints on snoring and obstructive sleep apnoea J. Lamont*, D. R. Baldwin**,
More informationPEDIATRIC SLEEP GUIDELINES Version 1.0; Effective
MedSolutions, Inc. Clinical Decision Support Tool Diagnostic Strategies This tool addresses common symptoms and symptom complexes. Requests for patients with atypical symptoms or clinical presentations
More informationComparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty: A Single University Experience
771395AORXXX10.1177/0003489418771395Annals of Otology, Rhinology & LaryngologyHuntley et al research-article2018 Original Article Comparing Upper Airway Stimulation to Expansion Sphincter Pharyngoplasty:
More informationIs CPAP helpful in severe Asthma?
Is CPAP helpful in severe Asthma? P RAP UN KI TTIVORAVITKUL, M.D. PULMONARY AND CRITICAL CARE DIVISION DEPARTMENT OF MEDICINE, PHRAMONGKUTKLAO HOSPITAL Outlines o Obstructive sleep apnea syndrome (OSAS)
More informationRespiratory Inductance Plethysmography Improved Diagnostic Sensitivity and Specificity of Obstructive Sleep Apnea
Respiratory Inductance Plethysmography Improved Diagnostic Sensitivity and Specificity of Obstructive Sleep Apnea Dmitriy Kogan MD, Arad Jain, Shawn Kimbro RPSGT, Guillermo Gutierrez MD PhD, and Vivek
More informationSplit-Night Protocol*
Titration for Sleep Apnea Using a Split-Night Protocol* Yoshihiro Yamashiro, MD, and Meir H. Kryger, MD, FCCP We studied 107 patients with sleep-disordered breathing to confirm the effectiveness of continuous
More informationNovel pathophysiological concepts for the development and impact of sleep apnea in CHF.
Olaf Oldenburg Novel pathophysiological concepts for the development and impact of sleep apnea in CHF. Sleep apnea the need to synchronize the heart, the lung and the brain. Heart Failure 2011 Gothenburg,
More informationComparison of Nasal Prong Pressure and Thermistor Measurements for Detecting Respiratory Events during Sleep
Clinical Investigations Respiration 2004;71:385 390 DOI: 10.1159/000079644 Received: August 25, 2003 Accepted after revision: March 16, 2004 Comparison of Nasal Prong Pressure and Thermistor Measurements
More informationPolysomnography (PSG) (Sleep Studies), Sleep Center
Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)
More informationBrian Palmer, D.D.S, Kansas City, Missouri, USA. April, 2001
Brian Palmer, D.D.S, Kansas City, Missouri, USA A1 April, 2001 Disclaimer The information in this presentation is for basic information only and is not to be construed as a diagnosis or treatment for any
More informationRESEARCH PACKET DENTAL SLEEP MEDICINE
RESEARCH PACKET DENTAL SLEEP MEDICINE American Academy of Dental Sleep Medicine Dental Sleep Medicine Research Packet Page 1 Table of Contents Research: Oral Appliance Therapy vs. Continuous Positive Airway
More informationAssessment of a wrist-worn device in the detection of obstructive sleep apnea
Sleep Medicine 4 (2003) 435 442 Original article Assessment of a wrist-worn device in the detection of obstructive sleep apnea Najib T. Ayas a,b,c, Stephen Pittman a,c, Mary MacDonald c, David P. White
More informationCOMPLEX SLEEP APNEA IS IT A DISEASE? David Claman, MD UCSF Sleep Disorders Center
COMPLEX SLEEP APNEA IS IT A DISEASE? David Claman, MD UCSF Sleep Disorders Center CENTRAL APNEA Central Apnea Index > 5 ( >50% of apnea are central) Mayo Clinic Proc 1990; 65:1255 APNEA AT SLEEP ONSET
More informationSleep disordered breathing (SDB), which includes. Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep*
Bilevel Positive Airway Pressure Worsens Central Apneas During Sleep* Karin G. Johnson, MD; and Douglas C. Johnson, MD Study objectives: While most patients with sleep-disordered breathing are treated
More informationUsing the Pathophysiology of Obstructive Sleep Apnea (OSA) to Teach Cardiopulmonary Integration
Using the Pathophysiology of Obstructive Sleep Apnea (OSA) to Teach Cardiopulmonary Integration Michael G. Levitzky, Ph.D. Department of Physiology Louisiana State University Health Sciences Center 1901
More informationObstructive sleep apnea (OSA) is characterized by. Quality of Life in Patients with Obstructive Sleep Apnea*
Quality of Life in Patients with Obstructive Sleep Apnea* Effect of Nasal Continuous Positive Airway Pressure A Prospective Study Carolyn D Ambrosio, MD; Teri Bowman, MD; and Vahid Mohsenin, MD Background:
More informationDiabetes & Obstructive Sleep Apnoea risk. Jaynie Pateraki MSc RGN
Diabetes & Obstructive Sleep Apnoea risk Jaynie Pateraki MSc RGN Non-REM - REM - Both - Unrelated - Common disorders of Sleep Sleep Walking Night terrors Periodic leg movements Sleep automatism Nightmares
More informationInspiratory flow-volume curve in snoring patients with and without obstructive sleep apnea
Brazilian Journal of Medical and Biological Research (1999) 32: 407-411 Flow-volume curve and obstructive sleep apnea ISSN 0100-879X 407 Inspiratory flow-volume curve in snoring patients with and without
More informationObstructive sleep apnea (OSA) is the periodic reduction
Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis 1 Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto,
More informationOSA and COPD: What happens when the two OVERLAP?
2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine
More informationSleep Diordered Breathing (Part 1)
Sleep Diordered Breathing (Part 1) History (for more topics & presentations, visit ) Obstructive sleep apnea - first described by Charles Dickens in 1836 in Papers of the Pickwick Club, Dickens depicted
More informationExcessive Daytime Sleepiness Associated with Insufficient Sleep
Sleep, 6(4):319-325 1983 Raven Press, New York Excessive Daytime Sleepiness Associated with Insufficient Sleep T. Roehrs, F. Zorick, J. Sicklesteel, R. Wittig, and T. Roth Sleep Disorders and Research
More informationBTS sleep Course. Module 10 Therapies I: Mechanical Intervention Devices (Prepared by Debby Nicoll and Debbie Smith)
BTS sleep Course Module 10 Therapies I: Mechanical Intervention Devices (Prepared by Debby Nicoll and Debbie Smith) S1: Overview of OSA Definition History Prevalence Pathophysiology Causes Consequences
More informationPatterns of Sleepiness in Various Disorders of Excessive Daytime Somnolence
Sleep, 5:S165S174 1982 Raven Press, New York Patterns of Sleepiness in Various Disorders of Excessive Daytime Somnolence F. Zorick, T. Roehrs, G. Koshorek, J. Sicklesteel, *K. Hartse, R. Wittig, and T.
More informationAuto Servo Ventilation Indications, Basics of Algorithm, and Titration
Auto Servo Ventilation Indications, Basics of Algorithm, and Titration 1 ASV Learning Objectives Understand the indications for Auto Servo Ventilation Differentiate obstructive versus central hypopneas
More informationArousal detection in sleep
Arousal detection in sleep FW BES, H KUYKENS AND A KUMAR MEDCARE AUTOMATION, OTTHO HELDRINGSTRAAT 27 1066XT AMSTERDAM, THE NETHERLANDS Introduction Arousals are part of normal sleep. They become pathological
More informationMore than 20 years ago, before obstructive sleep. Gender Differences in Sleep Apnea* The Role of Neck Circumference
Gender Differences in Sleep Apnea* The Role of Neck Circumference David R. Dancey, MD; Patrick J. Hanly, MD; Christine Soong, BSc; Bert Lee, BSc; John Shepard, Jr., MD, FCCP; and Victor Hoffstein, PhD,
More informationΣύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών;
Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών; E.N. Σημανηηράκης MD, FESC Επίκ. Καθηγηηής Καρδιολογίας Πανεπιζηημιακό Νοζοκομείο Ηρακλείοσ Epidemiology 4% 2% 24%
More informationNational Sleep Disorders Research Plan
Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING
More informationUCSD Pulmonary and Critical Care
Sleep Apnea Phenotyping Atul Malhotra, MD amalhotra@ucsd.edu UCSD Pulmonary and Critical Care Director of Sleep Medicine NAMDRC 2014 Dr. Malhotra has declared no conflicts of interest related to the content
More informationAutomated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea
302 Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 4N1 J-C Vázquez W H Tsai W W Flemons A Masuda R Brant E Hajduk W A Whitelaw J E Remmers
More informationHigh Flow Nasal Cannula in Children During Sleep. Brian McGinley M.D. Associate Professor of Pediatrics University of Utah
High Flow Nasal Cannula in Children During Sleep Brian McGinley M.D. Associate Professor of Pediatrics University of Utah Disclosures Conflicts of Interest: None Will discuss a product that is commercially
More informationThermistors have been routinely used for the. Effects of Nasal Prongs on Nasal Airflow Resistance*
Effects of Nasal Prongs on Nasal Airflow Resistance* Anne-Marie Lorino, PhD; Hubert Lorino, PhD; Estelle Dahan; Marie Pia d Ortho, MD; André Coste, MD; Alain Harf, MD; and Frédéric Lofaso, MD Study objectives:
More informationUpper Airway Muscle Stimulation for Obstructive Sleep Apnea
Upper Airway Muscle Stimulation for Obstructive Sleep Apnea M. Safwan Badr, MD, MBA Chair, Department of Medicine, Wayne State University School of Medicine. Staff Physician, John D. Dingell VA Medical
More informationCoding for Sleep Disorders Jennifer Rose V. Molano, MD
Practice Coding for Sleep Disorders Jennifer Rose V. Molano, MD Accurate coding is an important function of neurologic practice. This section of is part of an ongoing series that presents helpful coding
More informationKey words: circulatory delay; congestive heart failure; obstructive sleep apnea; periodic breathing
Periodicity of Obstructive Sleep Apnea in Patients With and Without Heart Failure* Clodagh M. Ryan, MB; and T. Douglas Bradley, MD Study objective: To determine whether the duration of the apnea-hyperpnea
More informationPediatric Sleep-Disordered Breathing
Pediatric Sleep-Disordered Breathing OSA in infants and young children is generally characterized by partial, persistent obstruction of the upper airway Continuum Benign primary snoring Upper-airway resistance
More informationPrediction of sleep-disordered breathing by unattended overnight oximetry
J. Sleep Res. (1999) 8, 51 55 Prediction of sleep-disordered breathing by unattended overnight oximetry L. G. OLSON, A. AMBROGETTI ands. G. GYULAY Discipline of Medicine, University of Newcastle and Sleep
More informationOvernight fluid shifts in subjects with and without obstructive sleep apnea
Original Article Overnight fluid shifts in subjects with and without obstructive sleep apnea Ning Ding 1 *, Wei Lin 2 *, Xi-Long Zhang 1, Wen-Xiao Ding 1, Bing Gu 3, Bu-Qing Ni 4, Wei Zhang 4, Shi-Jiang
More informationDifferentiating Obstructive from Central and Complex Sleep Apnea Using an Automated Electrocardiogram-Based Method
SLEEP APNEA Differentiating Obstructive from Central and Complex Sleep Apnea Using an Automated Electrocardiogram-Based Method Robert Joseph Thomas, MD, MMSc 1 ; Joseph E. Mietus, BS 2 ; Chung-Kang Peng,
More informationTired of being tired?
Tired of being tired? Narval CC MRD ResMed.com/Narval Sleepiness and snoring are possible symptoms of sleep apnea. Did you know that one in every four adults has some form of sleep disordered-breathing
More informationStep (2) Looked for correlations between baseline surrogates and postoperative AHI.
Development of the PSG PLUS PHYIOLOGY model Step (1) Picked possible surrogates of the physiological traits (See Table 1 in the main text). Step (2) Looked for correlations between baseline surrogates
More informationThe Effect of Altitude Descent on Obstructive Sleep Apnea*
CHEST The Effect of Altitude Descent on Obstructive Sleep Apnea* David Patz, MD, FCCP; Mark Spoon, RPSGT; Richard Corbin, RPSGT; Michael Patz, BA; Louise Dover, RPSGT; Bruce Swihart, MA; and David White,
More informationSleep Apnea in Women: How Is It Different?
Sleep Apnea in Women: How Is It Different? Grace Pien, MD, MSCE Division of Pulmonary and Critical Care Department of Medicine Johns Hopkins School of Medicine 16 February 2018 Outline Prevalence Clinical
More informationEFFICACY OF MODAFINIL IN 10 TAIWANESE PATIENTS WITH NARCOLEPSY: FINDINGS USING THE MULTIPLE SLEEP LATENCY TEST AND EPWORTH SLEEPINESS SCALE
EFFICACY OF MODAFINIL IN 10 TAIWANESE PATIENTS WITH NARCOLEPSY: FINDINGS USING THE MULTIPLE SLEEP LATENCY TEST AND EPWORTH SLEEPINESS SCALE Shih-Bin Yeh 1 and Carlos Hugh Schenck 2,3 1 Department of Neurology
More informationΚλινικό Φροντιστήριο Αναγνώριση και καταγραφή αναπνευστικών επεισοδίων Λυκούργος Κολιλέκας Επιμελητής A ΕΣΥ 7η Πνευμονολογική Κλινική ΝΝΘΑ Η ΣΩΤΗΡΙΑ
Κλινικό Φροντιστήριο Αναγνώριση και καταγραφή αναπνευστικών επεισοδίων Λυκούργος Κολιλέκας Επιμελητής A ΕΣΥ 7 η Πνευμονολογική Κλινική ΝΝΘΑ Η ΣΩΤΗΡΙΑ SCORING SLEEP -Rechtschaffen and Kales (1968) - AASM
More information* Cedars Sinai Medical Center, Los Angeles, California, U.S.A.
Sleep. 18(2):115-126 1995 American Sleep Disorders Association and Sleep Research Society Home Monitoring-Actimetry Assessment of Accuracy and Analysis Time of a Novel Device to Monitor Sleep and Breathing
More informationPatients with upper airway resistance syndrome
Two-Point Palatal Discrimination in Patients With Upper Airway Resistance Syndrome, Obstructive Sleep Apnea Syndrome, and Normal Control Subjects* Christian Guilleminault, MD, BiolD; Kasey Li, MD, DDS;
More informationIndex SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type.
549 SLEEP MEDICINE CLINICS Sleep Med Clin 1 (2007) 549 553 Note: Page numbers of article titles are in boldface type. A Abdominal motion, in assessment of sleep-related breathing disorders, 452 454 Adherence,
More informationWeb-Based Home Sleep Testing
Editorial Web-Based Home Sleep Testing Authors: Matthew Tarler, Ph.D., Sarah Weimer, Craig Frederick, Michael Papsidero M.D., Hani Kayyali Abstract: Study Objective: To assess the feasibility and accuracy
More informationORIGINAL ARTICLES. Adaptation to Nocturnal Intermittent Hypoxia in Sleep-Disordered Breathing: 2,3 Diphosphoglycerate Levels: A Preliminary Study
ORIGINAL ARTICLES Adaptation to Nocturnal Intermittent Hypoxia in Sleep-Disordered Breathing: 2,3 Diphosphoglycerate Levels: A Preliminary Study Levent Öztürk, M.D., Banu Mansour, M.D., Zerrin Pelin, M.D.,
More informationQuestions: What tests are available to diagnose sleep disordered breathing? How do you calculate overall AHI vs obstructive AHI?
Pediatric Obstructive Sleep Apnea Case Study : Margaret-Ann Carno PhD, CPNP, D,ABSM for the Sleep Education for Pulmonary Fellows and Practitioners, SRN ATS Committee April 2014. Facilitator s guide Part
More informationIn-Patient Sleep Testing/Management Boaz Markewitz, MD
In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when
More informationSleep Apnea: Vascular and Metabolic Complications
Sleep Apnea: Vascular and Metabolic Complications Vahid Mohsenin, M.D. Professor of Medicine Yale University School of Medicine Director, Yale Center for Sleep Medicine Definitions Apnea: Cessation of
More informationUniversity, India.) Corresponding author: Dr. Shubham Agarwal1
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 3 Ver.15 March. (2018), PP 59-63 www.iosrjournals.org Effect of Severity of OSA on Oxygen Saturation:
More information11/13/2017. Jeremy Tabak MD, FAASM Medical Director Baptist Hospital Sleep Lab Medical Director Baptist Sleep Lab at Galloway
Jeremy Tabak MD, FAASM Medical Director Baptist Hospital Sleep Lab Medical Director Baptist Sleep Lab at Galloway HypnoLaus study: OSA effect on mortality US Preventive Services Task Force recommendations
More informationInfluence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnoea/hypopnoea syndrome
Eur Respir J 1998; 11: 1121 1127 DOI: 1.1183/931936.98.1151121 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 93-1936 Influence of correction of flow
More informationThe AASM Manual for the Scoring of Sleep and Associated Events
The AASM Manual for the Scoring of Sleep and Associated Events The 2007 AASM Scoring Manual vs. the AASM Scoring Manual v2.0 October 2012 The American Academy of Sleep Medicine (AASM) is committed to ensuring
More informationDevelopment of a portable device for home monitoring of. snoring. Abstract
Author: Yeh-Liang Hsu, Ming-Chou Chen, Chih-Ming Cheng, Chang-Huei Wu (2005-11-03); recommended: Yeh-Liang Hsu (2005-11-07). Note: This paper is presented at International Conference on Systems, Man and
More informationFrequency-domain Index of Oxyhemoglobin Saturation from Pulse Oximetry for Obstructive Sleep Apnea Syndrome
Journal of Medical and Biological Engineering, 32(5): 343-348 343 Frequency-domain Index of Oxyhemoglobin Saturation from Pulse Oximetry for Obstructive Sleep Apnea Syndrome Liang-Wen Hang 1,2 Chen-Wen
More informationJosé Haba-Rubio, MD; Jean-Paul Janssens, MD; Thierry Rochat, MD, PhD; and Emilia Sforza, MD, PhD
Rapid Eye Movement-Related Disordered Breathing* Clinical and Polysomnographic Features José Haba-Rubio, MD; Jean-Paul Janssens, MD; Thierry Rochat, MD, PhD; and Emilia Sforza, MD, PhD Objective: The existence
More information6. The Upper Airway. Anatomy of the Pharyngeal Airway in Sleep Apneics: Separating Anatomic Factors From Neuromuscular Factors
Sleep, 16:S80-S84 1993 American Sleep Disorders Association and Sleep Research Society 6 The Upper Airway (a) Response to Anatomy Anatomy of the Pharyngeal Airway in Sleep Apneics: Separating Anatomic
More informationPositive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea
Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea Policy Number: Original Effective Date: MM.01.009 11/01/2009 Line(s) of Business: Current Effective Date: HMO; PPO;
More informationSleep Disordered Breathing
Sleep Disordered Breathing SDB SDB Is an Umbrella Term for Many Disorders characterized by a lack of drive to breathe Results n repetitive pauses in breathing with no effort Occurs for a minimum of 10
More informationPublished Papers Cardio Pulmonary Coupling
Thomas RJ, Mietus JE, Peng CK, Goldberger AL An electrocardiogram-based technique to assess cardiopulmonary coupling (CPC) during sleep SLEEP 2005; 28:1151-61 O: Evaluate a new automated measure of cardiopulmonary
More informationOpioids Cause Central and Complex Sleep Apnea in Humans and Reversal With Discontinuation: A Plea for Detoxification
pii: jc-16-00020 http://dx.doi.org/10.5664/jcsm.6628 CASE REPORTS Opioids Cause Central and Complex Sleep Apnea in Humans and Reversal With Discontinuation: A Plea for Detoxification Shahrokh Javaheri,
More informationSleep and the Heart. Physiologic Changes in Cardiovascular Parameters during Sleep
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationSleep and the Heart. Rami N. Khayat, MD
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More information