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Obstructive
Sleep Apnea
A Multidisciplinary
Approach
Peter M. Baptista
Rodolfo Lugo Saldaña
Steve Amado
Editors
123

Obstructive Sleep Apnea

Peter M. Baptista
Rodolfo LugoSaldaña • Steve Amado
Editors
Obstructive Sleep Apnea
A Multidisciplinary Approach

Editors
Peter M. Baptista
Clinica Universidad de Navarra
Pamplona, Spain
Steve Amado
Sede Quinta de Mutis
Universidad del Rosario
Bogotá, Colombia
Rodolfo LugoSaldaña
Hospital Constitución
ISSSTE
Monterrey, Nuevo León, Mexico
ISBN 978-3-031-35224-9 ISBN 978-3-031-35225-6 (eBook)
https://doi.org/10.1007/978-3-031-35225-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

To my parents and sisters for their guidance
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and love.
To my wife, children, and grandchildren for
their unwavering love, support, patience,
and inspiration.
To all those patients and physicians with
whom I have learned so much.
Peter M. Baptista
Dedicated to my dear parents and brother.
Because I know they are always with me. My
wife and my children, they are my engine, and
lastly, all my former fellows, who are the fuel
of that engine.
Rodolfo LugoSaldaña
To my family for their constant warmth.
My fellow editors, Peter and Rodolfo, for
their great work and friendship.
Steve Amado

Foreword
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With almost a billion people suffering from obstructive sleep apnea (OSA) worldwide, the enormous scientic output on all aspects of OSA, published in sleep journals, general medical journals, and textbooks, is not surprising. Scientic papers
include original papers, systematic reviews, consensus documents, and guidelines.
Textbooks have covered all aspects of OSA that you can think of: epidemiology,
pathophysiology, medical history, general and OSA-specic examination, diagnosis, sleep studies both in a sleep lab and at home, drug-induced sleep endoscopy,
imaging, and all forms of nonsurgical and surgical treatment that are out there:
CPAP, MAD positional therapy, myofunctional therapy, upper airway surgery, maxillofacial surgery, and upper airway stimulation. The authors of this book have done
a great job by updating the current literature.
This book, however, offers much more. It is new and original by approaching
OSA from a completely new perspective. This is the reason that I am so enthusiastic
about it. It lls a gap, an unmet need. Allow me to explain.
OSA caregivers are increasingly confronted by patients and have patients referred
by primary care physicians and by specialists from other disciplines with questions
as to how far their other disease could be related to OSA.In addition, therefore,
would it be a good idea to screen for OSA and treat it?
For instance, an ophthalmologist might refer a patient with glaucoma with the
specic question: Is it useful to screen for sleep apnea in such a case? Similarly, a
cardiologist who sees a patient with difcult-to-treat high blood pressure or arrhythmia poses the question: Should this patient be screened for OSA? A neurologist who
has a patient who has suffered a cerebrovascular accident asks if this could be
related to OSA and whether the patient in that case needs to be treated, even if he/
she is asymptomatic. A general orthopedic surgeon who is seeing a patient for hip
surgery needs to know if this patient has OSA and, if so, is this OSA a risk for general anesthesia. Should the surgery be postponed, with a sleep study done rst
before the surgery is performed? It is a known fact that patients undergoing bariatric
surgery will suffer from OSA in up to 56% of cases. Is it needed to screen all the
patients in the bariatric population for OSA and treat those with severe OSA with
CPAP or not? In addition, should all patients with OSA who have had bariatric surgery have a repeated sleep study after their weight loss? In all these situations, is it
needed to perform the most comprehensive form of sleep study (polysomnography)
or are less comprehensive forms of sleep study (polygraphy) or even yet simpler
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Foreword
forms of screening sufcient? In this approach, one accepts that by using simpler
screening devices, early-stage OSA might be missed, but these are not the patients
who are at perioperative risk. Those are just examples; there are many relevant questions for doctors of other disciplines that we as OSA experts can help with.
The potential other manifestations of OSA in women are highlighted. The potential effect of OSA in urologic disease, in particular erectile dysfunction, is another
factor so far not sufciently studied. Should all men with erectile dysfunction be
screening for OSA? Many psychiatric patients suffer from sleep disturbances; here,
it might be difcult to distinguish between cause and effect. A recent theory for
instance is that Vincent van Gogh, who wrote in many letters to his brother Theo
about his sleep disturbances, suffered from sleep apnea, due to his retrognathia.
Another excellent chapter in this book deals with the role of OSA in metabolic
disturbances. The chicken or the egg question is: Are patients with OSA often obese
due to their disease or have they developed OSA because of their overweight? OSA
caregivers see increasingly frequently children with OSA.Should we as ENT doctors screen all kids with hypertrophic tonsils for OSA before we remove them?
In sum, I regard this book as a highlight and a valuable addition to what we
already have in OSA textbooks. We need to congratulate the editors Dr. Peter
Baptista J., Dr. Steve Amado, and Dr. Rodolfo Lugo for this hallmark. They are to
be congratulated for putting together a group of well-published international authors
from all relevant disciplines. Read this book!
Nicode Vries Amsterdam, The Netherlands

Contents
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1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Peter M. Baptista and Guillermo Plaza Mayor
2 Pathophysiology of Obstructive Sleep Apnea . . . . . . . . . . . . . . . . . . . . . 17
Sara Op de Beeck, Eli Van de Perck, and Olivier M. Vanderveken
3 Sleep Related Breathing Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Fausto Fernandes
4 Diagnosis: How Is Diagnosis Performed . . . . . . . . . . . . . . . . . . . . . . . . . 67
Edilson Zancanella, Bruno Bernardo Duarte,
Michel Burihan Cahali, and Carolina Ferraz de Paula Soares
5 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Claudio Vicini, Angelo Cannavicci, Eleonora Cioccioloni,
Giuseppe Meccariello, Giovanni Cammaroto, Riccardo Gobbi,
Antonio Sanna, Domenico Maurizio Toraldo,
Giulio Alessandri Bonetti, Francesco Maria Passali,
Arianna Alagna, Michele De Benedetto, Michele Arigliani,
Luana Conte, Fabrizio Salamanca, Giannicola Iannella,
and Ahmed Yassin Baghat
6 Orofacial Myofunctional Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Carlos O’Connor-Reina, Francisca Borrmann,
and Laura Rodriguez-Alcala
7 OSA in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Stacey Ishman
8 Obstructive Sleep Apnea and Systemic Autoimmune Diseases . . . . . . . 143
Philippe Chalem
9 OSA and Cardio vascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Caroline M. Van De Heyning, Lobke L. Pype, and Hielko Miljoen
10 Obstructive Sleep Apnea: A Neurological Approach . . . . . . . . . . . . . . . 169
Karem Josena Parejo
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Contents
11 Ear, Nose, and Throat (ENT) Aspects of Obstructive
Sleep Apnea (OSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Casale Manuele and Moffa Antonio
12 Dentistry in Obstructive Sleep Apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Luis D. Aneyba López, Antonio Luigi Gracco, S. R. Falardo,
Francesca Milano, Giovanni Bruno, Alberto De Stefani,
Francesca Zalunardo, Antonio Romero-Garcia,
Carlos A. Carrasco Rueda, Ilan Vinitzky Brener,
Miguel Meira e Cruz, Emma Patricia García Campos,
and Dominik Ettlin
13 Obstructive Sleep Apnea (OSA) and Gastroenterology. . . . . . . . . . . . . 251
Carlos A. Cortez-Hernández and Jose C. Cessa-Zanatta
14 Sleep-Disordered Breathing: An Expanding Spectrum
for the Pulmonologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Qanta A. A. Ahmed
15 OSA in Obstetrics and Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
René De León Salazar and Cesar F. Saldaña Solorzano
16 Urological Issues Related to Obstructive Sleep Apnea . . . . . . . . . . . . . 297
Hernan Alonso Aponte Varon, Daniela Camila Niño Vargas,
Daniel Mauricio Colmenares Leal,
and Byron Eduardo Lopez De Mesa Rodriguez
17 Dangerous Liaisons: Obstructive Sleep Apnea, Dysbiosis,
and Chronic Inflammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Silvia Sánchez-Ramón and María Guzmán-Fulgencio
18 General Practitioner, Sleep Disorder Breathing,
and Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Marta Marin-Oto, Eugenio Vicente, and José M. Marin
19 Ophthalmology: Neuro- Ophthalmological . . . . . . . . . . . . . . . . . . . . . . . 327
Araceli Nogueira, Gabriela Bosco, Nuria Pérez-Martín,
Marta Morato, Carlos S. Fernández-Escámez, Nicolás Toledano,
Carlos O’Connor-Reina, and Guillermo Plaza
20 Anesthesia Considerations in Obstructive Sleep Apnea . . . . . . . . . . . . 349
Abigail Almaguer Valadez, Belia Garduño, Lilia Mayorga Padilla,
and Daniela Alejandra Becerril Gaitan
21 Radiological Diagnosis in OSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Vijaya Krishnan Paramasivan, Srinivas Kishore, Vikas Agrawal,
and Mohan Kameswaran
22 Allergic Rhinitis and OSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
Alvaro Carvallo and Gabriel Gastaminza

Contents
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23 Psychiatric Illness and Obstructive Sleep Apnea . . . . . . . . . . . . . . . . . . 403
Hector Olivares Rodriguez
24 Psychologic Disturbances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Guadalupe Jovanna Teran, Débora Yoaly Arana Lechuga,
and Javier Velázquez Moctezuma
25 Endocrinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Camilo Silva Froján, Juana Karina Zapata Cárdenas,
Saioa Echeverría Andueza, and Patricia Andrada Álvarez
26 Dermatologic Changes Related to Patients with Obstructive
Sleep Apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Pedro Redondo
27 Laboratory Parameters Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Camilo Silva Froján, Juana Karina Zapata Cárdenas,
Saioa Echeverría Andueza, and Patricia Andrada Álvarez
28 Genetics of Obstructive Sleep Apnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . 479
Ana Patiño-García
29 Maxillofacial Surgery in OSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Stanley Yung-Chuan Liu and Kristoffer Schwartz
30 Obstructive Sleep Apnea and Hematology Manifestations . . . . . . . . . . 511
María Marcos-Jubilar
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31 Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
Christel A. L. de Raaff, Nico de Vries, and B. A. van Wagensveld
32 Burden of Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533
Marina Carrasco-Llatas, Mathias Wollny,
and Nelleke Bos
33 Sleep Apnea Syndrome in Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Fuccillo Emanuela, Passali Francesco Maria,
and Di Girolamo Stefano
34 Artificial Intelligence in Sleep Medicine: A New Epoch Dawns . . . . . . 551
Qanta A. A. Ahmed and Robson Capasso
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