Note: Page numbers of article titles are in boldface type. A Accidents. See Motor vehicle accidents. Acetazolamide, in OSA therapy, 531 Acetylcholinesterase inhibitors, in OSA therapy, 532 533 Acromegaly, OSA and, 534 Acupuncture, for OSA therapy, 549 550 Adaptive servoventilation (ASV), treatment of complex OSA with, 470 471 Adenoidectomy, for OSA therapy, 496 497 Adenotonsillectomy, for OSA therapy in children, 484 486, 498 Age, effect on pathophysiology of OSA, 429 Airway collapsibility, in OSA pathophysiology, 427 Alternative therapies, for OSA, 543 556 acupuncture, 549 550 diaphragmatic pacing, 553 hypoglossal nerve stimulation, 547 549 musical instruments, 550 551 nasal cannulas, 551 552 nasal resistive devices, 543 545 nasal strips, 552 553 positional therapy, 545 547 snore pillows, 547 speech exercises, 550 Amphetamines, use in CPAP users with residual Anatomy, influence on pathophysiology of OSA, 425 427 Anesthetic agents, to avoid or monitor in OSA patients, 537 Apnea. See Obstructive sleep apnea. Appliances, oral. See Oral appliance therapy. Armodafinil. See Modafinil. Arousal response, in OSA pathophysiology, 428 Arrhythmias, effects of OSA therapy on, 456 457 Atherosclerosis, subclinical, effects of OSA therapy on, 454 456 Automobile driving, by patients with OSA. See Transportation. B Barbiturates, to avoid or monitor in OSA patients, 536 Bariatric surgery, to treat OSA in children, 488 Benzodiazepines, to avoid or monitor in OSA patients, 536 Bilevel positive airway pressure (BPAP), mask interfaces for, 477 481 Sleep Med Clin 8 (2013) 607 613 http://dx.doi.org/10.1016/s1556-407x(13)00114-8 1556-407X/13/$ see front matter Ó 2013 Elsevier Inc. All rights reserved. treatment of complex OSA with, 470 Biomarkers, for EDS in OSA patients, 576 578 C Caffeine, use in CPAP users with residual sleepiness, 529 530 Cannulas, nasal, for OSA therapy, 551 552 Cardiac arrhythmias, effects of OSA therapy on, 456 457 Cardiovascular disease, effects of OSA therapy on, 453 461 arrhythmias, 456 457 coronary heart disease, 457 458 overview, 453 454 stroke, 458 460 subclinical atherosclerosis, 454 456 Central sleep apnea, as part of complex OSA, 463 467 Cheyne-Stokes respiration, in complex OSA, 464 465 Children. See Pediatrics. Commercial driver s licenses, OSA and, 599 601 Comorbid conditions, with OSA, medications for, Complex obstructive sleep apnea, 463 475 clinical characteristics, 468 469 natural history, 469 470 pathophysiology, 464 467 primary, 467 treatment-emergent, 464 467 prevalence, 467 468 treatment, 470 472 ASV, 470 471 BPAP and APAP, 470 CPAP, 470 dead space, 471 472 oxygen, 472 pharmacotherapy, 471 Compliance, costs of inadequate adherence to CPAP, 564 566 with OSA treatment, mask interfaces for, 477 481 Continuous positive airway pressure (CPAP), as means of weight loss in OSA therapy, 522 cost -effectiveness of, versus oral appliances, 561 562 costs of inadequate adherence to, 564 566 mask interfaces for, 477 481 residual sleepiness in OSA patients treated with, 571 582 sleep.theclinics.com
608 Coronary heart disease, effects of OSA therapy on, 457 458 Costs, of OSA diagnosis and therapy, 557 569 CPAP vs. oral appliances, 561 562 diagnosis, 557 560 novel therapies, 566 567 nasal expiratory PAP, 567 oral pressure therapy, 567 oral appliances, 561 related to lack of treatment for, 563 566 inadequate adherence to CPAP, 564 566 societal costs of unrecognized OSA, 563 564 surgical procedures, 562 563 Craniofacial abnormalities, OSA therapy in children with, 489 Craniofacial surgery, in therapy of OSA, 499 500 Cytokines, as cause of EDS in OSA patients, 576 578 D Dead space, in treatment of complex OSA, 471 472 Decongestants, in OSA therapy, 530 531 Depression, as cause of EDS in OSA patients, 574 major, stimulants in OSA and, 529 Dermatologic side effects, and mask interfaces for OSA treatment, 480 Diagnosis, of OSA, cost of, 557 560 Diaphragmatic pacing, for OSA therapy, 553 Didgeridoo playing, as OSA therapy, 550 domperidone, in OSA therapy, 530 531 Down syndrome, OSA therapy in children with, 489 Doxapram, in OSA therapy, 532 Driver s licenses, commercial, OSA and, 599 601 Driving performance, in assessment of excessive sleepiness, 596 real world, 597 simulated, 596 597 Dyslipidemia, comorbid with OSA, medications for, E EDS. See Excessive daytime sleepiness. Endocrinologic disorders, OSA and, 534 535 acromegaly, 534 hypothyroidism, 534 535 Epiglottitis, surgery of, in therapy of OSA, 499 Excessive daytime sleepiness (EDS), assessment of alertness and, 594 in OSA, 571 582 causes of, 573 578 biomarkers, cytokines, and hormones, 576 578 chronic intermittent hypoxia theory, 573 574 G depression, 574 inadequate CPAP treatment, 575 576 insufficient sleep, 574 narcolepsy, 574 575 restless legs syndrome and periodic leg movements, 575 definition of, 571 572 measurement of, 572 573 treatment of, 578 579 outcomes of therapy for, in patients with OSA, 583 590 stimulant use in CPAP users with, 528 530 Gamma-aminobutyric acid (GABA) agonists, in OSA therapy, 535 Genial tubercle advancement, in therapy of OSA, 498 499 Glutamate antagonists, in OSA therapy, 532 H Hard palate, rapid maxillary expansion for therapy of OSA, 497 498 transpalatal advancement pharyngoplasty for therapy of OSA, 498 Heart failure, comorbid with OSA, medications for, Hormones, as cause of EDS in OSA patients, 576 578 Hypersomnia. See also Excessive daytime sleepiness (EDS). outcomes of therapy for, in patients with OSA, 583 590 causes and effects in OSA patients, 584 585 definition, 584 despite PAP treatment, 586 587 measurements of EDS, 585 586 possible causes and changes noted in, 587 treatments for, in patents on PAP therapy, 588 Hypertension, and OSA treatment, 438 439 comorbid with OSA, medications for, Hypoglossal nerve stimulation, for OSA therapy, 547 549 Hypopharynx, surgery of, in therapy of OSA, 498 499 Hypothyroidism, OSA and, 534 535 Hypoxemia, in OSA, impact on metabolic function, 435 436 Hypoxia, chronic intermittent, as theory for EDS in OSA patients, 573 574 I Infants, OSA therapy in, 488 489 Inflammation, systemic, in OSA, as instigator of altered metabolic function, 436 437
609 Insufficient sleep, as cause of EDS in OSA patients, 574 L Larynx, surgery of, in therapy of OSA, 499 Legal issues, laws and regulations regarding OSA screening, 599 602 Leuktriene inhibitors, in OSA therapy, 530 531 Lifestyle interventions, for weight loss in management of OSA, 521 522 Lipid biology, effect of OSA treatment on, 438 439 M Maintenance of Wakefulness Test, in assessment of excessive sleepiness, 585 586, 596 Male gender, effect on pathophysiology of OSA, 429 Mask interfaces, for positive airway pressure machines, 477 481 combination devices, 480 full face mask, 478 479 general considerations, 480 481 in pediatric population, 480 nasal mask, 477 478 nasal pillows, 479 480 oral mask, 479 oronasal mask, 478 479 Maxillary expansion, rapid, to treat OSA in children, 487 Maxillomandibular advancement, in therapy of OSA, 499 500 Medications. See Pharmacotherapy and individual agents. Medicolegal issues, OSA and transportation, 591 605 assessment of excessive sleepiness and alertness, 594 effects on neurocognitive performance, 592 594 neurocognitive function, 592 sleep loss, consequences and perception of, 592 594 laws and regulations regarding OSA screening, 599 602 motor vehicle accidents and, 599 effects of therapy for OSA on accidents, 599 role of the sleep physician, 602 Menopause, OSA and, 535 Metabolic syndrome, OSA therapy and, 433 452 effect of CPAP on lipid biology and visceral adiposity, 437 438 effect on components of metabolic syndrome, 439 447 non-pap modalities, 447 PAP, 439 447 epidemiology, 434 435 hypertension, 438 439 interrelationships with obesity and, 434 435 mechanisms of altered metabolic regulation in, 435 437 hypoxemia, 435 436 sleep fragmentation, 436 systemic inflammation and oxidative stress, 436 437 Methamphetamine, use in CPAP users with residual Methylphenidate, use in CPAP users with residual Methylxanthine derivatives, in OSA therapy, 531 Modafinil, to promote alertness in OSA patients, 528 529 in CPAP users with residual excessive sleepiness, 528 529 major depression and, 529 possible long-term use of, 529 possible role in acute withdrawal from CPAP, 529 Motor vehicle accidents, OSA and, 599 effects of OSA therapy accidents, 599 Multiple Sleep Latency Test, in assessment of excessive sleepiness, 585 586, 595 596 Musical instruments, OSA therapy with, 550 551 N Narcolepsy, as cause of EDS in OSA patients, 574 575 Nasal cannulas, for OSA therapy, 551 552 Nasal cavity, surgical therapy of OSA in, 496 497 Nasal expiratory PAP (EPAP), cost of, 567 Nasal masks, 477 478 Nasal pillows, 478 479 Nasal resistive devices, for OSA therapy, 543 545 Nasal steroid sprays, in OSA therapy, 530 531 Nasal strips, for OSA therapy, 552 553 Nasopharynx, surgical therapy of OSA in, 496 497
610 Neck, in therapy of OSA, 500 501 Neurocognitive performance, consequences of OSA on, 592 594 Nicotinic agents, in OSA therapy, 531 532 O Obesity, comorbid with OSA, medications for, effect on pathophysiology of OSA, 428 429 OSA therapy and metabolic syndrome, 433 452 OSA therapy in obese children, 489 weight loss in management of OSA, 517 525 Obstructive sleep apnea (OSA), 425 605 alternative therapies for, 543 556 acupuncture, 549 550 diaphragmatic pacing, 553 hypoglossal nerve stimulation, 547 549 musical instruments, 550 551 nasal cannulas, 551 552 nasal resistive devices, 543 545 nasal strips, 552 553 positional therapy, 545 547 snore pillows, 547 speech exercises, 550 anatomy and physiology, 425 431 anatomy, 425 427 effect of risk factors, 428 429 age, 429 male gender, 429 obesity, 428 429 pathophysiology, 427 428 arousal response, 428 effect of lung volumes, 427 pharyngeal neuropathy, 428 upper airway collapsibility, 427 upper airway dilator muscle activity, 427 428 ventilatory control stability, 428 complex, 463 475 clinical characteristics, 468 469 clinical implications, 472 natural history, 469 470 pathophysiology, 464 467 primary, 467 treatment-emergent, 464 467 prevalence, 467 468 treatment, 470 472 ASV, 470 471 BPAP and APAP, 470 CPAP, 470 dead space, 471 472 oxygen, 472 pharmacotherapy, 471 cost of diagnosis and therapy for, 557 569 CPAP vs. oral appliances, 561 562 diagnosis, 557 560 novel therapies, 566 567 nasal expiratory PAP, 567 oral pressure therapy, 567 oral appliances, 561 related to lack of treatment for, 563 566 inadequate adherence to CPAP, 564 566 societal costs of unrecognized OSA, 563 564 surgical procedures, 562 563 effects of OSA therapy on cardiovascular disease, 453 461 arrhythmias, 456 457 coronary heart disease, 457 458 overview, 453 454 stroke, 458 460 subclinical atherosclerosis, 454 456 in children, 483 493 diagnosis in, 483 483 special populations, 488 490 specific therapies, 483 488 mask interfaces, 477 481 combination devices, 480 full face mask, 478 479 general considerations, 480 481 in pediatric population, 480 nasal mask, 477 478 nasal pillows, 479 480 oral mask, 479 oronasal mask, 478 479 metabolic outcomes and therapy of, 433 452 effect of CPAP on lipid biology and visceral adiposity, 437 438 effect of therapy on components of metabolic syndrome, 439 447 non-pap modalities, 447 PAP, 439 447 epidemiology, 434 435 hypertension, 438 439 interrelationships with metabolic syndrome and obesity, 434 435 physiologic and biologic mechanisms of altered metabolic regulation in, 435 437 hypoxemia, 435 436 sleep fragmentation, 436 systemic inflammation and oxidative stress, 436 437 oral appliance therapy, 505 516 bite registration, 509 classification and mechanism of action, 506 clinical evaluation, 509 512 maxillomandibular shape, 510 musculoskeletal, 511 512 nasal obstruction, 509 510 oropharyngeal, 510 efficacy and side effects, 506 occlusal symptoms, 508 509 symptoms of TMJ disorder, 506 508
611 outcomes of therapy for hypersomnia in, 583 590 causes and effects in OSA patients, 584 585 definition, 584 despite PAP treatment, 586 587 measurements of EDS, 585 586 possible causes and changes noted in, 587 treatments for, in patents on PAP therapy, 588 pharmacologic therapy for, 527 542 for comorbid conditions, for endocrinologic disorders with, 534 535 medications to avoid in patients with OSA, 536 537 to promote alertness, 528 530 to reduce nasal air resistance and congestion, 530 531 to stimulate ventilation, 531 534 residual sleepiness in, 571 582 causes of, 573 578 definition of EDS, 571 572 measuring EDS, 572 573 treatment of EDS in patients with, 578 579 surgical treatment of, 495 503 craniofacial, 499 500 epiglottis, 499 hard palate, 497 498 hypopharynx, 498 499 larynx, 499 neck, 500 501 nose, nasal cavity, and nasopharynx, 496 497 oropharynx, 498 soft palate, 497 transportation and, medicolegal issues, 591 605 assessment of excessive sleepiness and alertness, 594 effects on neurocognitive performance, 592 594 neurocognitive function, 592 sleep loss, consequences and perception of, 592 594 laws and regulations regarding OSA screening, 599 602 motor vehicle accidents and, 599 effects of therapy for OSA on accidents, 599 role of the sleep physician, 602 weight loss in management of, 517 525 CPAP, 522 lifestyle interventions, 521 522 pharmacologic therapies, 520 521 surgical therapies, 518 520 Occupational safety, OSA in pilots, railroad engineers, and merchant Ocular complications, and mask interfaces for OSA treatment, 480 481 Opioid antagonists, in OSA therapy, 532 Opioids, to avoid or monitor in OSA patients, 536 537 Oral appliance therapy, for OSA, 487, 505 516, 561 562 bite registration, 509 classification and mechanism of action, 506 clinical evaluation, 509 512 maxillomandibular shape, 510 musculoskeletal, 511 512 nasal obstruction, 509 510 oropharyngeal, 510 cost-effectiveness of, 561 versus CPAP, 561 562 efficacy and side effects, 506 in children, 487 occlusal symptoms, 508 509 symptoms of TMJ disorder, 506 508 Oral pressure therapy, cost of, 567 Oronasal mask, 478 479 Oropharynx, surgery of, in therapy of OSA, 498 OSA. See Obstructive sleep apnea. Oxidative stress, in OSA, as instigator of altered metabolic function, 436 437 Oxygen, in treatment of complex OSA, 472 supplemental, to treat OSA in children, 488 P Pathophysiology, of complex OSA, 464 467 primary, 467 treatment-emergent, 464 467 of OSA, 427 428 arousal response, 428 effect of lung volumes, 427 pharyngeal neuropathy, 428 upper airway collapsibility, 427 upper airway dilator muscle activity, 427 428 ventilatory control stability, 428 Pediatrics, mask interfaces in, 480 OSA in children, 483 493 diagnosis in, 483 483 special populations, 488 490 Down syndrome, 489 infants, 488 489 obese, 489 Prader-Willi syndrome, 489 490 with craniofacial abnormalities, 489 specific therapies, 483 488 adenotonsillectomy, 484 486 bariatric surgery, 488 oral appliances, 487
612 Pediatrics (continued ) partial tonsillectomy, 486 pharmacologic therapies, 487 positional therapy, 487 488 positive airway pressure, 486 rapid maxillary expansion, 487 supplemental oxygen, 488 tracheostomy, 488 uvulopalatopharyngoplasty, 488 weight loss, 488 Periodic leg movements in sleep, as cause of EDS in OSA patients, 575 Pharmacotherapy, for OSA, 527 542 for comorbid conditions, for endocrinologic disorders with, 534 535 medications to avoid in patients with OSA, 536 537 anesthetic agents, 537 benzodiazepines and barbiturates, 536 opioids, 536 537 to promote alertness, 528 530 to reduce nasal air resistance and congestion, 530 531 to stimulate ventilation, 531 534 for OSA in children, 487 leukotriene receptor antagonists, 487 nasal steroids, 487 for weight loss in management of OSA, 520 521 treatment of complex OSA with, 471 Pharyngeal closing pressure, in OSA pathophysiology, 427 428 Pharyngeal neuropathy, in OSA pathophysiology, 428 Pharynx, surgery of, in therapy of OSA, 498 499 Pillows, snore, for OSA therapy, 547 Polypectomy, for OSA therapy, 496 497 Polysomnography, in diagnosis of OSA in children, 483 484 Positional therapy, for OSA, 545 547 to treat OSA in children, 487 488 Positive airway pressure (PAP) therapy, for OSA therapy, effects on cardiovascular disease, 453 461 for complex OSA, 470 471 hypersomnia in OSA patients despite, 586 587 possible causes of, 587 treatments for, 588 in children, 486 mask interfaces for, 477 481 Prader-Willi syndrome, OSA therapy in children with, 489 490 Progesterone, in OSA therapy, 535 R Rapid maxillary expansion, to treat OSA in children, 487 REM suppressants, in OSA therapy, 533 534 Residual sleepiness, in OSA, 571 582 causes of, 573 578 biomarkers, cytokines, and hormones, 576 578 chronic intermittent hypoxia theory, 573 574 depression, 574 inadequate CPAP treatment, 575 576 insufficient sleep, 574 narcolepsy, 574 575 restless legs syndrome and periodic leg movements, 575 definition of EDS, 571 572 measuring EDS, 572 573 treatment of EDS in patients with, 578 579 stimulant use in CPAP users with, 528 530 Restless legs syndrome, as cause of EDS in OSA patients, 575 Rhinoplasty, for OSA therapy, 496 497 Risk factors, effect on OSA, 428 429 age, 429 male gender, 429 obesity, 428 429 S Septoplasty, for OSA therapy, 496 497 Serotonergic agents, in OSA therapy, 533 534 Servoventilation, adaptive (ASV), treatment of complex OSA with, 470 471 Simulators, driving, in assessment of excessive sleepiness, 596 597 Sleep apnea. See Obstructive sleep apnea. Sleep fragmentation, in OSA, impact on metabolic regulation, 436 Sleep loss, due to OSA, consequences and perceptions of, 592 594 Sleep physician, role in medicolegal issues with OSA and driving, 602 Snore pillows, for OSA therapy, 547 Soft palate, uvulopalatopharyngoplasty for therapy of OSA, 497 Speech exercises, for OSA therapy, 550 Stimulant therapy, in CPAP users with residual Stroke, effects of OSA therapy on, 458 460 Surgical therapy, for OSA, 488, 495 503 costs associated with, 562 563 craniofacial, 499 500 epiglottis, 499 hard palate, 497 498 hypopharynx, 498 499 in children, 488 adenotonsillectomy, 484 486 bariatric surgery, 488 partial tonsillectomy, 486 tracheostomy, 488
613 T uvulopalatopharyngoplasty, 488 larynx, 499 neck, 500 501 nose, nasal cavity, and nasopharynx, 496 497 oropharynx, 498 soft palate, 497 for weight loss in management of OSA, 518 520 Temporomandibular joint (TMJ) disorder, as side effect of oral appliance therapy for OSA, 506 508 Tongue surgeries, in therapy of OSA, 498 Tonsillectomy, partial, for OSA therapy in children, 486, 498 Tracheostomy, to treat OSA, 500 501 in children, 488 Transpalatal advancement pharyngoplasty, for therapy of OSA, 498 Transportation, and OSA, medicolegal issues, 591 605 assessment of excessive sleepiness and alertness, 594 effects on neurocognitive performance, 592 594 neurocognitive function, 592 sleep loss, consequences and perception of, 592 594 laws and regulations regarding OSA screening, 599 602 motor vehicle accidents and, 599 effects of therapy for OSA on accidents, 599 role of the sleep physician, 602 Turbinoplasty, for OSA therapy, 496 497 U Uvulopalatopharyngoplasty, for therapy of OSA, 497 to treat OSA in children, 488 V Ventilation, drugs that stimulate, use in OSA therapy, 531 532 acetazolamide, 531 acetylcholinesterase inhibitors, 532 533 doxapram, 532 glutamate antagonists, 532 methylxanthine derivatives, 531 nicotinic agents, 531 532 opioid antagonists, 532 serotonergic agents and REM suppressants, 533 534 Ventilatory control stability, in OSA pathophysiology, 428 Visceral adiposity, effect of OSA treatment on, 438 439 W Weight loss, in management of OSA, 488, 517 525 CPAP, 522 in children, 488 lifestyle interventions, 521 522 pharmacologic therapies, 520 521 surgical therapies, 518 520