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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4566_Библиотеки_им_академика_М_И_Перельмана
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oestrogen exposure (HRT) timing 6
https://t.me/medicina_free
OSA 27, 32, 79–80
cognitive therapy, insomnia disorder treatment 318
COMISA see comorbid insomnia and sleep apnoea
(COMISA)
communication
advance care planning 306–307
aer bereavement 308
comorbid insomnia and sleep apnoea (COMISA) 75,
190, 313, 319
CBT, digital support 360
CPAP treatment, and CBT-I 319
compliance
CPAP, in OSA see CPAP, in OSA
definition 181
compound muscle action potential (CMAP) 272
confusional arousal 328
congenital central hypoventilation syndrome (CCHS)
21, 274, 380
definition, and criteria for 21
hypercapnia 21
incidence 380
management 403
PHOX2B mutation 21, 70, 380
presentation 264, 274, 380, 403
surgery 279
conjunctivitis, bacterial, CPAP side-eect 178
consultations, telemedicine see telemedicine,
e-consultations
continuous positive airway pressure see CPAP
controller gain 49, 50, 55, 57, 58
see also loop gain
COPD see chronic obstructive pulmonary disease
(COPD)
coping skills, CPAP adherence in OSA 182
corneo–retinal potential dierence, EOG 119
coronary artery disease
in idiopathic pulmonary fibrosis and OSA 237
in obesity hypoventilation syndrome 258
in OSA 81, 107
coronavirus pandemic see SARS-CoV-2 pandemic
cor pulmonale 103, 379
corticomuscular (CM) coupling 27
corticoperipheral neuromuscular disconnection 27
corticosteroids
inhaled, in asthma 232, 383
intranasal in OSAS in children 400–401, 400t
nasal topical, with CPAP therapy in OSA 177, 183
cortisol 6
costs of sleep disorders see economic cost
cough 296
eectiveness, deep breath 297f, 298
as a function 296
nocturnal, in IPF and OSA 236, 239f, 240
phases 296, 297f
weak, detection 296
cough assist devices 280
in neuromuscular weakness 70
T-IPPV in children and 294
cough assist techniques see cough augmentation
techniques
cough augmentation techniques 282, 296–301
air stacking technique 297f, 298, 299f
expiratory support 297f, 298
glossopharyngeal breathing 297f, 298, 299f
in hypoventilation syndromes 296, 298
in children 404
indications 296, 298
individualisation 300
414
inspiratory support 298
laryngeal visualisation during 298
lung volume recruitment 299f
manually assisted cough 297f, 298, 299f
mechanical insuation-exsuation 297f, 298,
299f, 300
in neuromuscular diseases 298
thoracoabdominal thrusts 297f, 298
titration 297f
cough peak flow (CPF) 271, 296, 380
cough reflex 296
Couzon syndrome 401
COVID-19 pandemic see SARS-CoV-2 pandemic
CPAP
advantages (cost/low complexity) 260
in bronchopulmonary dysplasia 384
in CSA
in chronic heart failure 204, 205, 206
data analysis, artificial intelligence 365
in opioid-induced SDB 210, 212
treatment-emergent CSA with 41
see also treatment-emergent CSA (TECSA)
in obesity hypoventilation syndrome 258–260
benefits 258–259
NIV vs, trials 259–260
CPAP, in OSA 164–197, 319
adherence/compliance 165, 174, 181–185, 188,
359
adaptations to improve 182–183, 239f, 240,
369
in asthma 232
barriers to, in IPF and OSA 239f, 240
behavioural interventions 184
in children 402
data analysis, artificial intelligence 365
determinants 182
digital technology and 184, 359, 360, 365, 369
documenting/determining 181–182, 188
early adoption and 182, 183
education/support 183–184, 359, 360
follow-up techniques 184
good, duration/definition 165
importance, protective eects 365
improved during SARS-CoV-2 pandemic 343
in insomnia comorbidity, CBT and 319
masks and see mask(s)
monitoring 184, 359
motor vehicle accident risk reduced 115, 337
non-adherence, estimates 181, 319
sedative-hypnotic drug use 183
strategies to improve in IPF 239f, 240
AHI reduction 165, 172t
aim 164
air leak (manufacturing) 188
assessment of endotypic traits 53
asthma and OSA coexisting 232
auto-adjusting see auto-adjusting PAP (APAP)
benefits/positive results 165, 232, 365
bilevel see bilevel positive airway pressure (BPAP)
in cardiovascular disease and OSA 108, 112, 165
in children 400t, 402
pressure level 402
clinical trials 165
comparisons of fixed-level CPAP 169, 170f
APAP trial to determine pressure level 171
APAP vs 171–172, 172t, 176
BPAP vs 172, 172t
CPAP with EPR vs 172, 172t
CPAP with humidification vs 172, 172t, 176,
CPAP, in OSA (cont.)
https://t.me/medicina_free
177
CSA development see treatment-emergent CSA
(TECSA)
device/system 164, 165f
diabetes (type 2), impact on 242, 244–245, 246
dose–response association 181
driving risk reversal 115, 337
ecacy 170
end-expiratory lung volume increase 164
evaluation of ecacy see under positive airway
pressure (PAP) therapy
expiratory pressure relief (EPR) with 172, 172t,
183
as first-line treatment, severe OSA 164
flowchart for 166f
follow-up and monitoring 167, 184, 186–191,
187f, 190
digital technology and see telemonitoring
need for periodic control 367, 369
OSA outcome assessment 186, 187, 187f
repeat sleep monitoring tests 187–188
tracking systems see below
see also positive airway pressure (PAP) therapy,
monitoring
good response, description 192
humidification with 172, 172t, 176, 177, 183
in hypertension and OSA 107, 114
impact on glucose metabolism 244–245
indications 164–168, 166f
AHI limitations for assessing 166
diagnostic/treatment-orientating 167
excessive sleepiness in OSA 165
group D patients 166–167
mild OSA with symptoms 166
moderate OSA 166
severe OSA 164, 165, 166, 167
in infancy 397–398, 398t
initial period of (golden phase) 182, 186–187
in interstitial lung disease and OSA 239f, 240
intolerance 190
intolerance, alternative therapy
MADs for 161
muscle stimulation for 161
long-term, self-management 369
MADs vs 158–159
mechanism of action 164–165
metabolic syndrome, impact on 242, 244–245,
246
nasal interface/method 164, 165f
see also mask(s)
NICE recommendation 166
non-adherence, estimates 181, 319
nonalcoholic fatty liver disease, impact on 245
numbers treated in Netherlands 369
in obesity and OSA 108–109
hypoventilation, strategy 69
weight loss and 156
optimal (pressure, mask, support) 359
optimal eects, CPAP duration 165, 182
optimal pressure/titration 170f, 171
pressure, predictive equations for 171
pressure, tracking system 188
pressure profile 170, 170f, 171
side-eects 174–180
air leakage 174, 175f, 176, 178, 188
eect on adherence 183
factors contributing to 174
mask, due to local pressure 175f, 176–177,
CPAP, in OSA (cont.)
178
miscellaneous 175f, 179
nasal, aecting adherence 174, 183
ocular 175f, 178
pressurised air-related 175f, 177–178, 183
troubleshooting 175f, 176, 177, 183
split-night PSG study, trial 118
in systemic hypertension 195, 195t
TECSA development see treatment-emergent CSA
(TECSA)
telemonitoring role/eect see telemonitoring
titration 171, 342
auto- see auto-adjusting PAP (APAP)
at home 171, 342, 345, 345t
near-future model 345t
optimal pressure 170f, 171
traditional (current) model 171, 345t
tracking systems 186, 187f, 188–189
AHI on 188, 189
see also follow-up and monitoring (above)
trial period, remote monitoring 369
variable (automatic) see auto-adjusting PAP (APAP)
craniofacial abnormalities, OSA/OSAS in 102, 401f
in children 377
examination 76
management 398, 399, 400t, 401
craniofacial procedures, for OSAS in children 400t,
401
C-reactive protein 30, 87, 114
critical closing pressure (P
measurement 53
weight loss reducing 156
"critical window hypothesis" 6
crossbite 388, 402
CSA see central sleep apnoea (CSA)
CSR see Cheyne–Stokes respiration (CSR)
Cushing disease 102
Cushing syndrome 249f
cyclic alternating pattern (CAP) 26
cystic fibrosis 279, 302, 383–384
cytokines, inflammatory, and chronic intermittent
hypoxia 86, 244
) 44, 46
crit
D
dapagliflozin 246
data and data collection 365f
management 364
structure, dierences by source 364
unstructured to structured 365f
volume increase 364
databases 364, 365f
data protection issues 346
daytime hypoventilation see hypoventilation
daytime naps/napping
in children/infants 5, 371, 392, 394
narcolepsy management 327
daytime somnolence
assessment in children 394
in circadian disorders 333
in OSA 32, 74, 78–79
in OSAS in children/adolescents 377
paediatric 5, 377, 394
normative values 394
see also excessive daytime sleepiness (EDS)
daytime symptoms/signs 92, 92t
abnormal movements 92
hypercapnia see hypercapnia
415
hypocapnia 39
https://t.me/medicina_free
idiopathic hypersomnia 325
OSA 74, 75t
somnolence see daytime somnolence
see also excessive daytime sleepiness (EDS)
deadweight loss 338, 338t
decision-making
advance care planning in chronic lung disease 307
artificial intelligence 365
in MND/ALS, for NIV 306
on surgery
in hypoventilation syndromes 278
tracheostomy 306–307
deep vein thrombosis (DVT), OSA association 82
delayed sleep–wake phase syndrome (DSPS) 333
dental changes, mask side-eects in CPAP therapy
177
depression/depressive symptoms
in advanced COPD 307
CPAP adherence in OSA 182
in idiopathic pulmonary fibrosis 239f, 240
insomnia disorder relationship 316, 317, 318
in OSA 80, 109, 340
dexamphetamine 326t
diabetes mellitus, type 1 (T1DM), OSA associated
249f
diabetes mellitus, type 2 (T2DM) 102, 242–247
CSA associated 39–40, 226–227
OSA associated 82, 108, 242–243, 249f
AHI increase 244
bidirectional relationship 242–243
CPAP impact 242, 244–245
diabetes development risk in OSA 242
new drugs 245–246
pathophysiological mechanisms 243f, 244
T2DM complications aected 244
treatment (lifestyle and CPAP) 244–245
periodic breathing in 40
diabetic neuropathy 226, 266
diagnosis of SDB 147–154, 354
algorithms 147–151, 150f
of CSA see central sleep apnoea (CSA)
new digital tools see digital technology
of OSA see OSA/OSA syndrome (OSAS)
prevalence of SDB and 354
sleep tests see sleep tests
timing 354
see also specific methods e.g. polysomnography
diaphragm 7, 66
in COPD 69
paralysis, bilateral 70, 270
sleep-related hypoventilation 139, 139f
phrenic nerve stimulation eect 219
strength, assessment, twitch Pdi 272
weakness 266, 270
noninvasive tests 270–271
digital artery, vasoconstriction 28
digital patient records 368
digital technology 348–369
CPAP adherence improvement 184, 359, 360,
365, 369
CPAP treatment monitoring see telemonitoring
diagnostic tools (new) 354–358, 368
approval and marketing authorisation 356, 357
data collection over several nights 357
mandibular movement detection 356–357
miniaturised sensors linked to digital server 356
multicaptor design, measurements 357
need for investment and importance 357
416
tracheal sound recording 357
for follow-up of therapy 359–363
remote consultations and 361–362
telemonitoring, CPAP see telemonitoring
health tools, feedback on treatment 360
for optimisation of therapy 359–363
continuous support during 359, 360
digital health media 360
long-term support needed 360
patient engagement 360
remote consultation 361–362
specific medical interventions 360
telemonitoring from CPAP machines 360–361,
361f, 362f
see also telemonitoring
OSA diagnosis
impact on, Netherlands information 367, 368
underdiagnosis and 367, 368
screening solutions 356, 357
sleep/circadian rhythm monitoring 91, 154,
349–351
accuracy concerns 91, 352
devices 154, 349, 349f, 350t
devices compared with PSG 349f, 350t
electrophysiological signals 349, 351–352
movement detection 349, 349f, 351
principles 349
sensitivity and specificity 352
sleep stages 349, 351, 352
ventilation monitoring 349, 351
see also telemedicine
dipping phenomenon see under blood pressure (BP)
disability-adjusted life years (DALYs) 339
dissociated sleep 328
dobutamine 61
dopamine, circadian changes 322, 323f
dopaminergic dysregulation, restless legs syndrome
322, 323f
dopaminergic treatment, of restless legs syndrome
322–323
dorsal respiratory group (DRG) 7, 8, 8f
Down syndrome 102, 393, 394
dreams 312, 329, 330
driving
ability to, AHI to assess 33, 115
accidents see motor vehicle accidents (MVAs)
commercial, OSA and 80, 336, 337, 340
EDS and 115, 336, 337
high-risk OSA patient identification 115, 337
OSA as risk factor 80, 115, 336, 337
sleepiness at the wheel 92, 145, 336, 337
driving licences, EU Directive, OSA inclusion 115,
336–337
drowsiness 145
MWT (maintenance of wakefulness test) 145
see also daytime somnolence
drug-induced sleep endoscopy (DISE) 157
in children 399
Duchenne muscular dystrophy (DMD) 266–267,
274, 275, 380, 403
anaesthetic/surgical risks 279
hypoventilation (nocturnal) 274, 275, 380, 403
NIV titration 288
palliative care 306
ventilatory support 306
dulaglutide 246
Dutch Apnea Association 368
dyspnoea, nocturnal 91
E
https://t.me/medicina_free
economic burden of OSA 339–340, 339f, 368
Australia 339, 339f
Italy 340
USA 339
economic costs 338–339, 338t, 339–340, 339f
deadweight loss 338, 338t, 339f
estimating in OSA 338–339
financial 338, 338t
health system 338, 338t, 339f
informal care costs 338, 338t, 339f
non-financial 338t, 339, 339f
nonmedical costs of accidents 338, 338t, 339f
of OSA, and its secondary outcomes 338–339,
338t
productivity losses 338, 338t, 339f
untreated OSA 368
e-consultations 344, 369
requirements 361–362
education, CPAP adherence in OSA 183–184, 360
e-interventions see digital technology; telemedicine
elderly people
advanced sleep-wake phase syndrome 333
OSA and driving 337
see also ageing
electrocardiography (ECG) 120
oximetry with, in children 394
during PSG, evaluating 127
pulse arrival time 27
electroencephalography (EEG), sleep 118–119, 119f,
120
24hr, in hypersomnia, insomnia and circadian
changes 312
absent from type III devices/tests 133
"activité moyenne" (active sleep) 390
alpha waves 123f
central apnoea 126f
in children, scoring, sleep stages 389–391
delta waves 122t, 123f
dyschronisation 2
electrode placements 118–119, 119f
AASM 119, 119f, 121
epochs 121, 389, 390
headband device 349f, 350t, 351
hypopnoeas 126f
insomnia 318
K complexes 122t, 124f
major body movement 390
NREM sleep, characteristics 2, 4–5
OSA, evaluation of PAP therapy ecacy 193
portable monitoring devices 193, 194
REM sleep, characteristics 2, 5
"rules"/guidelines 118, 121
sawtooth waves 123t, 124f
scoring 121
of arousals 121, 125f, 390
in children/infants 389–391
sleep development in infants 391
sleep staging 118–119, 119f, 121, 122t,
123f–125f, 123t
in children/infants 389–390
normative data across lifespan 123t
quiet and active sleep, newborns 370, 390, 391
stage N1 (NREM 1) 122t, 389–390
stage N2 (NREM 2) 122t, 124f, 390
stage N3 (NREM 3) 122t, 124f, 390
stage R (REM) 123t, 125f, 390
stage W 122t, 123f, 389
sleep states in newborn infants 370, 390, 391
synchronisation, NREM sleep 2
theta waves 122t
electromyography (EMG) 117, 120
electrode placement 120
mentalis and submentalis 120
respiratory muscles 72–73, 272
sleep staging 122t, 123f, 123t, 124f, 125f
surface, NIV monitoring 290
electrooculography (EOG) 119–120
sleep staging 122t, 123f, 123t, 124f, 125f
electrophysiological signals, digital technology
monitoring 349, 351–352
empagliflozin 246
end-expiratory lung volume (EELV) 61
CPAP therapy in OSA 164
CSA prognostic impact 200
positive/negative patterns, in CSA 200
positive vs negative 61, 62f
end-expiratory pressure, ASV devices 206
end-of-life phase 305
NIV withdrawal 307–308
endogram, with/without OSA 51f
endoscopy, drug-induced sleep see drug-induced
sleep endoscopy (DISE)
endothelial dysfunction, oxidative stress and 86
endothelial function, peripheral arterial tonometry 28
endotypes, OSA see OSA/OSA syndrome (OSAS),
pathophysiological
end-stage renal disease (ESRD) 40, 109
ENT interventions, OSA treatment 157–158
in children 399–400
enuresis 330
primary vs secondary 330
epidemiology
craniofacial indices, racial dierences 46
CSA 39–41
hypoventilation syndromes 41–42
non-respiratory sleep disorders 309–311
OSA see OSA/OSA syndrome (OSAS)
sleep disordered breathing 38–43
Epworth Sleepiness Scale (ESS) 33, 75, 95, 96, 114,
141
cautions over interpretation 75, 96
evaluation of sleepiness with PAP therapy 193
modified for children 378
situations assessed by 96t
sleep diary associated with 313
studies evaluating 96
ESADA cohort see European Sleep Apnoea Database
(ESADA)
eszopiclone 183
ethnic dierences
CPAP adherence in OSA 182
OSA phenotype 78f, 79
OSA prevalence 46, 78f, 79
European Respiratory Society (ERS)
CPAP therapy in OSA 165
CSA and chronic HF, approach 202, 203f, 208
hypoventilation in obesity, staging 257, 257t
non-CPAP therapy 161
OSA definition using PSG in children 393
OSA treatment in children 399, 402
OSA treatment in infancy 397
PSG or PG in children with OSA 388–389
task force, driving and OSA 115
European Sleep Apnoea Database (ESADA) 24, 172
asthma 231
OSA and metabolic syndrome 244, 245
417
event duration
https://t.me/medicina_free
OSA severity 23–24, 24t
AHI see apnoea–hypopnoea index (AHI)
alternative parameters to AHI 23–24, 24t, 32,
36, 112, 113, 166
hypoxic load, integration 25–26, 26t
see also apnoea; hypopnoea
excessive daytime sleepiness (EDS) 92, 92t, 93–94
absent in SDB with HF 84
assessment 95, 141–146
laboratory tests 141
motor vehicle accident risk 337
OSLER test 143t, 145
subjective measurement 141
tools 141, 142t
see also MSLT (Multiple Sleep Latency Test);
MWT (maintenance of wakefulness test)
in asthma 231
causes 93–94, 190, 193, 314
definition/description 93, 95, 141
dierential diagnosis 93–94, 93t
driving risk 115, 336, 337
evaluation, questionnaire 193
failure to improve aer PAP 190
in hypersomnias 309, 310
impact on daily living activities, questionnaire 99
motor vehicle accidents and 92, 115, 145, 336,
337
myotonic dystrophy 266
in non-respiratory sleep disorders 309, 310, 313
occupational accidents and 80, 149, 336, 340
in OSA 74, 75, 77, 80
comorbidity risk prediction 114, 148
CPAP adherence linked to 182
CPAP recommendation 165
evaluation of therapy ecacy 193
high-risk patient identification 114
increased risks associated 115, 149
initial severity, enhanced CPAP usage 182
OSA phenotype based on 77, 78f, 82
residual, aer therapy 162, 193
in OSA and idiopathic pulmonary fibrosis 236
persistent, in narcolepsy type 1 312
quantification 95
severity, assessment 92
see also daytime somnolence
exercise oscillatory ventilation 200
exercise training
obesity hypoventilation syndrome treatment 261
OSA treatment 156
expiration
upper airway collapse in OSA 170–171
upper airway muscles 372
expiratory muscles 372
strength assessment 271, 272
weakness, hypoventilation 70
expiratory positive airway pressure (EPAP) 286t, 303
auto-titrating 283, 284, 288
COPD 287
management of children with neuromuscular
disorders 404
OHS 287
expiratory pressure relief (EPR), PAP with 172, 172t
exploding head syndrome 330
Extreme Gradient Boosting classifier 351
F
FACE trial 199, 200, 208
418
failure to thrive 379
family, involvement, CPAP adherence in OSA 182
family carers, support for 308
fat deposition
men vs women 78
obesity 255, 256
fatigue
in CSA 84
in OSA 75, 78
premature, advanced sleep-wake phase syndrome
333
feedback system, circadian sleep rhythm 1–2
fibreoptic nasopharyngoscopy, in OSA 77
"first night eect" 118
floppy eyelid syndrome 178
flow see airflow
fluid, overnight rostral shi 47, 79
fluid balance, surgery and 279
forced expiration, cough augmentation techniques
297f
forced vital capacity (FVC)
cough augmentation 299f
in neuromuscular conditions in children 380
forehead patches 349f, 350t, 351
FOSQ (questionnaire) 98, 99
FOSQ-10 99
Friedman scoring/classification 76–77, 103
Functional Outcomes of Sleep Questionnaire (FOSQ)
98, 99
functional residual capacity (FRC)
decreased, in ILDs and OSA 236
lung mechanics in CSA 200
PAP therapy eect 204
periodic breathing patterns 61, 62f
G
GABA (g-aminobutyric acid) 2
release, REM sleep 4f
GABAergic neurons 2
decreased brain arousability 8
REM sleep 4f
respiratory control during sleep 8
gabapentin 323
gas exchange 66
in COPD and OSA 233
NIV monitoring 290
gasping, nocturnal 92t
gas trapping
COPD 68
obesity 255
gastro-oesophageal reflux disease (GORD) 236, 382,
386, 387
general data protection regulation (GDPR) 365f, 366
gene therapy/editing 306
genetic factors
grading of SDB and OSA 29
high-risk OSA patient identification 114–115
idiopathic hypersomnia 327
insomnia predisposition 317
narcolepsy 326
OSAS in children 377
restless legs syndrome 322
genioglossus 47
hypoglossal nerve stimulating device 49
responsiveness during sleep in OSA 48–49,
48f
gliflozins 246
glossopexy 398
glossopharyngeal breathing 297f, 298, 299f
https://t.me/medicina_free
glucagon-like peptide (GLP)-1 108
glucagon-like peptide (GLP)-1 receptor agonists
245–246
glucose metabolism
CPAP impact 242, 244–245
type 2 diabetes and metabolic syndrome 243f,
244
glue ear 388
glutamate 2
glutamatergic dysregulation, in restless legs
syndrome 322
glutamatergic neurons 2
REM sleep 4f
glycaemic control, in diabetes and OSA 244, 245,
246
glycine 4f
goitre 248, 250
grading of SDB 23–31
AHI 23, 32, 33–34, 127
alternatives to, event duration 23–24, 24t, 32,
112, 113, 166
see also apnoea–hypopnoea index (AHI)
arousals, measurement 26–27
see also arousal(s), measurement
autonomic parameter measurement 27–29, 34
see also autonomic parameters, SDB severity
based on integrative disease model 34–35, 35f,
36f
biomarkers 30, 32
dierent oxygen parameters 24–26, 25t, 26t
see also oxygen
event duration 23–24, 24t, 32, 112, 113, 166
hypoxic load, integrating parameters 25–26,
26t
genetics 29
multicomponent system 35, 36f
of OSA see OSA/OSA syndrome (OSAS), severity
evaluation
respiratory events frequency 34–35
sleep depth 27
sleep study parameters 33–34
three-dimensional model 34–35, 35f
growth disturbances, OSAS in children 379
growth hormone (GH) 39, 251, 252
OSAS in children 379
persistent hypersecretion 250
Guillain–Barré syndrome 266
H
Haldane eect 302
hallucinations 312
daytime 92
sleep-related 312, 330
Hashimoto disease 248
hazard ratio (HR) 365
HbA1c 244, 245
headache, morning 92, 92t
in CSA 84
in OSA 75
head and neck examination 102
headbands, digital monitoring 154, 349f, 350t, 351
health-related data see data and data collection
health-related quality of life (HRQoL), tracheostomydelivered ventilation 294
health system costs, sleep disorders 338, 338t, 339f
heart failure (HF)
chronic see chronic heart failure (CHF)
CSA (non-hypercapnic) and 57, 57t
pathophysiology, chemoreceptors 60
screening for CSA 87
symptoms 202
CSA and CSR impact on HF outcome 85–87, 85f,
198, 199, 202
pathophysiology 85–86, 85f
predictors 87
screening 87
CSA prognostic impact on 198, 199, 204, 215
ERS therapeutic approach 202, 203f, 208
FACE trial 199, 200, 208
mortality risk 199
see also chronic heart failure (CHF)
CSA treatment
acetazolamide 216–217
buspirone 217
nocturnal low flow O2 therapy 215, 216, 216f
optimising 204
theophylline 217
CSR in 19, 85
excessive daytime sleepiness absent 84
HCVR 60
irritant receptor stimulation, AHI increase 59
in obesity hypoventilation syndrome 258
OSA associated 82, 107, 112, 199
in children 379
positive airway pressure (PAP), eect 86–87
pulmonary fluid overload 59
with reduced ejection fraction (HFrEF) 215–216,
216f, 217
severity, in CSA/CSR 85
subgroups 199
systolic, severity and LVEF 199
treatment, optimising, in CSA 204
heart rate
arousal intensity related to 26
in hypoventilation 275f
in NREM sleep 11
OSA-related response (∆HR) 29
variability, SDB severity grading 28–29
hemidiaphragm, raised 271
hereditary sensory motor neuropathy 266
high altitude, CSA in see central sleep apnoea (CSA)
high-altitude periodic breathing (HAPB) 19, 226, 227
treatment 226
high-flow nasal cannula oxygen therapy 304
HIPARCO study 195
history taking 90
collateral (by partners) 75, 90, 91
on infants 386–387
insomnia (insomnia disorder) 91
in OSA 75, 76, 91
see also sleep history
home
blood pressure levels 195, 195t
CPAP titration in OSA 171, 342, 345, 345t
NIV at 282, 288, 290–291, 307
oximetry, in children 378, 393–394
PAP titration 345, 345t
polysomnography 345, 345t, 393
respiratory polygraphy 342, 393
screening tests 356
SDB management, telemedicine 345t, 346
sleep apnoea tests (HSAT) 129–131, 149
sleep tests see sleep tests, type III devices
tracheostomy-delivered ventilation 293
see also telemonitoring
Homeostatic Model Assessment Index 245
419
home sleep apnoea tests (HSAT) 129–131, 149
https://t.me/medicina_free
see also sleep tests, type III devices
hormone replacement therapy (HRT) 6
hot flushes 6
5-HT1A receptor agonist, buspirone 217, 219
"hub-spoke model" 344
humidification, CPAP with 172, 172t, 176, 177, 183
hyoid bone 46
hyperactivity, OSAS in children and 379
hyperarousal, insomnia disorder pathophysiology
317
hypercapnia 9, 57, 65
chemosensitivity to, CSA outcome 200
in COPD 72, 73, 233, 233f
oxygen therapy 235
CSA with see central sleep apnoea (CSA),
hypercapnic
daytime
obesity hypoventilation syndrome 254, 255,
256, 257
oxygen not first-line therapy 302
diurnal, in obesity hypoventilation syndrome 256,
257
in OSA 44, 48
threshold level to provoke arousal 10
ventilatory response see hypercapnic ventilatory
response (HCVR)
hypercapnic CSA see central sleep apnoea (CSA),
hypercapnic
hypercapnic respiratory failure see respiratory failure
hypercapnic ventilatory response (HCVR) 9–10, 57,
58f, 59–60, 67f
in CSA
due to hyperventilation, pathophysiology 57,
59–60
HCVR as predisposing factor 41
prognostic impact 200
in CSA with HF 60, 215
description 9–10, 59–60
heart failure subgroups 60
reduced, in congenital central hypoventilation
syndrome 380
hypercholesterolaemia 102
hyperpyrexia, malignant 279
hypersomnia/hypersomnolence, disorders 310, 310t
assessment in children 377
clinical features 310, 313
diagnostic approach 311, 312
disorder types 310, 310t
EDS in see excessive daytime sleepiness (EDS)
ICSD-3 criteria defining 310
idiopathic see idiopathic hypersomnia (IH)
prevalence 309
see also narcolepsy
hypertension, systemic
assessment 103
definitions/BP levels 195, 195t
evaluation of PAP therapy ecacy in OSA 195,
195t
in OSA 29, 80–81, 80f, 107
BP levels 195, 195t
CPAP therapy 107, 114, 195
high-risk patient identification 114
oxygen desaturation index as predictor 24
in OSAS in children 379
resistant, in OSA 81, 195
hyperventilation
cyclical, in infants 372
in hypoxaemia, carotid body (CB) and 9f, 10
420
in non-hypercapnic CSA 56f, 57, 57t, 59, 61
P
and apnoea threshold 59
aCO
2
see also central sleep apnoea (CSA), non-
hypercapnic
in respiratory cycle with periodic breathing 56f
treatment-emergent CSA 224
hypnogram 127, 128, 128f, 129f
digital technology 351
HypnoLaus study 28, 38
hypnotic agents, contraindication in COPD 235
hypocapnia 57, 57f
daytime 39
hypoglossal nerve, stimulation, device 49, 161
hypopharyngeal surgery 157
hypopnoea 32
in asthma 231
causes/pathophysiology 8
definition 15, 17f, 32, 391
detection 120
duration, OSA severity 23–24
in idiopathic pulmonary fibrosis 238
in infants/children, definition 391
obstructive 15, 391
oxygen desaturation 113
portable monitoring device underestimation 194
presentations 17f
PSG 125, 126f
total time 24t
hypopnoea event duration (HypDur) 23–24, 24t
hypothalamic–pituitary axis, metabolic syndrome and
OSA 243f
hypothalamus, suprachiasmatic nucleus (SCN) 1–2,
12, 12f, 332
hypothyroidism 248–250
clinical/biological characteristics 249t
OSA in
pathophysiological mechanism 248, 250
prevalence 249–250
severity 250
treatment 250
overt (OH), OSA and 248, 249f, 249t, 250
subclinical (SCH), OSA and 248, 249t, 250
hypoventilation 65–66, 273–277
aetiology 65, 66–67, 273–274, 380
assessment 274, 275f
ASV device action 205–206
central, management in children 403
in central respiratory drive disorders 273
in chest wall disorders 263, 264, 265t, 267, 273,
274
clinical features, signs 274, 275–276
controlled oxygen, principles 70–71, 71f
in COPD 67–69, 68f, 233, 233f
cyclical, in infants 372
daytime 264, 273
in motor neurone disease 265
in neuromuscular/chest wall disorders 264
in obesity hypoventilation syndrome 254, 255,
256, 257, 257t
oxygen not first-line therapy 302
definition 17, 65–66, 273
diagnosis 257, 275–276, 276f
high-risk patient identification 274–275
in hypercapnic CSA 56, 57t
in hypercapnic (type 2) respiratory failure 65, 263
see also respiratory failure
hypoxaemia in, oxygen therapy indication 302
investigations 275–276
in kyphoscoliosis 69, 266, 274
hypoventilation (cont.)
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management 275
mechanical ventilation see NIV; ventilation,
mechanical
oxygen therapy, principles 70–71, 71f
mechanisms 66–67, 67f
neural transmission 71–73, 72f
in neuromuscular diseases 263, 264–267, 265t,
273, 274
see also neuromuscular diseases (NMDs)
in neuromuscular weakness 70, 263–264, 264f,
273
nocturnal/sleep-related 264, 273–274
capnometry 136, 137–138
in CCHS 21
children with neuromuscular conditions 380–
381, 403–404
clinical features 274, 275
in daytime normocapnia, NIV monitoring 290
definitions 136, 273, 274b
detection 136–140
detection, AASM recommendation 136
high-risk patient identification 274–275
investigations 271, 274, 275–276, 276f
management 275
in neuromuscular diseases 265, 266, 274,
275f, 403, 404
NIV before surgery 279
in OHS 255, 256, 257t
P
levels 17
aCO
2
P
symptoms 273, 274
assessment 138–139, 140
tcCO
2
timing of onset 274–275
see also sleep-related hypoventilation disorders
in obesity and OSA 69
in obesity hypoventilation syndrome 254, 255,
256, 257, 257t, 260
"obstructive" in infants/toddlers 378
pathophysiology of 65–73, 67f
in COPD 67–69, 68f, 233, 233f
in kyphoscoliosis 69, 266, 274
in neuromuscular weakness 70, 263–264, 264f
in obesity and OSA 69
respiratory pump and 66–67, 67f
pregnancy assessment 280
pregnancy feasibility 280
progression from REM sleep, to NREM sleep, to
daytime 264, 274
in REM sleep 255, 256, 264, 274
respiratory failure types 65–66, 263
screening/suspecting 66
surgery and 278
timing of onset 274–275
ventilatory drive reduced, controlled oxygen
70–71, 71f
ventilatory impairment before 273
V'/Q' mismatching coexisting 65
see also respiratory failure; ventilatory failure
hypoventilation syndromes 17, 21–22, 56
CCHS see congenital central hypoventilation
syndrome (CCHS)
in children see children
cough in and ineective cough 296, 298
disease types 21–22, 56
epidemiology 41–42
idiopathic central alveolar hypoventilation 21–22
late-onset central hypoventilation 21
OHS see obesity hypoventilation syndrome (OHS)
sleep-related hypoventilation due to medical
hypoventilation (cont.)
disorder 22, 42
sleep-related hypoventilation due to medication/
substance 22, 42
therapy 282–308
BPAP 171
cough augmentation see cough augmentation
techniques
NIV see NIV
oxygen see oxygen therapy/supplementation
palliative see palliative medicine
tracheostomy see tracheostomy
hypoxaemia 10
acute, oxygen therapy 302, 303, 303b
acute-on-chronic, oxygen therapy 302, 303
causes 302
chronic, oxygen therapy 302
in COPD and OSA 233, 233f
consequences 234
in CSA due to high altitude 63
hypobaric 40
intermittent 44
oximetry 131t
measures/metrics, for OSA severity 24–25,
131–132
neurocognitive deficits in children with OSAS 379
nocturnal 24–25
children"s interstitial lung disease 384
in obesity hypoventilation syndrome 257
oxygen therapy indications 302, 303b
persistent, oximetry 131t
prolonged low-frequency, pulmonary disease 24
short intermittent high-frequency 24
ventilatory response 9–11, 9f
hypoxia
asphyxial 10
BRUEs causing 374
cancer associated with OSA and 82, 109
carotid sinus nerve P
chemosensitivity to, CSA outcome 200
threshold 10
aO
2
chronic, sustained 10–11
chronic intermittent (CIH), eect on
cardiovascular system 86
CSA prognostic outcome marker 200
depressant actions on brain, newborns 371
high-risk OSA patient identification 113
intermittent 11, 44, 82
eect on HVR 10, 11
inflammatory cytokine secretion 244
in interstitial lung diseases and OSA 236
markers, OSA severity 11, 34
OSA and cancer 82, 109
OSA and cardiovascular disease 81, 82, 108
OSA and metabolic conditions associated 82,
108
OSA and thromboembolism 82
pro-inflammatory 108
isocapnic 10
microenvironment, cancer and 109
in newborns and infants 371
renal 109
ventilatory acclimatisation 11
ventilatory response 3, 9–11, 9f, 44, 58f, 70, 71
hypoxia-reoxygenation cycle, in CSR/CSA, heart
failure outcome 85f, 86
hypoxic burden 25, 34, 194, 200
calculation 25
CSA prognostic outcome 199t, 200
ecacy of PAP therapy in OSA 194–195
421
markers of 199t
https://t.me/medicina_free
hypoxic load, event duration integration 25–26, 26t
hypoxic ventilatory decline 10
hypoxic ventilatory response (HVR) 9f, 10, 58f
acute (AHVR) 10, 11
chemosensitivity measured by 10, 58f, 60
in CSA, prognostic impact 200
in CSA due to hyperventilation 57, 58f
in CSA with HF 60, 215
description 10
factors aecting 10–11
fall during sleep (NREM and REM) 7
isocapnic, phases 10
menstrual cycle and 7
in OSA, morning vs evening 11
sex dierences 7
during wakefulness, men vs women 7
see also hypoventilation
I
ICSD-3 15, 309
abnormal movements in sleep 127
central apnoeas, subgroups 16
circadian rhythm disorders 310–311, 310t, 332,
333t
CSA definition 18–21
hypersomnias 310, 310t
hypoventilation syndromes 21–22
insomnias 309–310, 310t
OSA definition, criteria 17–18
parasomnias 310t, 311
SDB categories 15–17, 309
sleep disorder classification 309, 310t
nonrespiratory 309, 310t
respiratory 15–17, 309
sleep hypoventilation, definition 136
idiopathic central alveolar hypoventilation 17, 41
definition 21–22
idiopathic central hypoventilation syndrome 17
idiopathic hypersomnia (IH) 93t, 310, 325–328
clinical presentation 325
diagnosis/diagnostic criteria 312, 325–326
genetic factors 327
management 327
idiopathic pulmonary fibrosis (IPF) 235–236
OSA in 236
clinical consequences 237–238
clinical presentation 236–237, 238t
management 238, 239f, 240
pathophysiological relationship 236, 237f
polysomnography 238, 239, 239f
prevalence 236, 238, 384
screening and diagnosis 238, 239f
see also interstitial lung diseases (ILDs)
IH see hypoxia, intermittent
imagery rehearsal therapy (IRT) 330
in-bed sensors 154, 349f, 350t
indomethacin 61
indwelling catheter 136–137
infant(s)
apnoea
pathophysiology 372
secondary causes 397
types, definitions 391, 396–397
asphyxia and hypoxia sensitivity 371, 372
behavioural insomnia 386
breathing and sleep 372
breathing control, development 7, 371–373
422
breathing irregularities 372, 373
BRUEs 370, 373–374, 386, 387
clinical assessment 386–387
insomnia in 386–387
due to medical condition 386–387
normative data, PSG 392
"obstructive hypoventilation", PSG 378
OSA/OSAS 377, 397
causes, associated conditions 397
diagnosis 393
indications for management 397
management 397–398, 398t
periodic breathing 372, 373, 392
positions during sleep 377, 387
PSG see polysomnography (PSG)
sleep development 370–371, 390–391
sleep duration 370, 392
sleep problems 377, 386–387
sleep requirements 5, 370
sleep states 370, 392
sleep variability, EEG 391
upper airway, muscles 372
see also children; newborn infants
inflammation, neutrophilic, in asthma and OSA 230
inflammatory cytokines, chronic intermittent hypoxia
86, 244
inflammatory processes
irritant receptors, AHI increase 59
metabolic disorders in OSA and 108
in obesity, SDB and 101–102
informal care costs, of sleep disorders 338, 338t,
339f
insomnia (insomnia disorder) 316–320
as 24-hr disorder 317
acute 93t
behavioural in infants 386
chronic 93t, 94, 309–310, 316–318
CBT-I for 318, 319
classification 316
definition and features 316
diagnosis, patient subjective report 317–318
ICSD-3 diagnostic criteria 316, 317t
pathophysiology 317
pharmacological treatment 319
prevalence 316
primary and secondary 316
treatment 318–319
in circadian disorders 310–311, 333
classification by total sleep time 318
comorbid with OSA see comorbid insomnia and
sleep apnoea (COMISA)
comorbid with other sleep disorders 93t, 313
comorbid with physical conditions 93t, 318
comorbid with psychiatric conditions 93t, 313,
316, 318
in COPD 233
definition 309–310
diagnostic approach 311, 312, 317–318
due to medical disorders 93t, 318
in infants 386–387
due to psychiatric disorders 93t, 313, 316, 318
due to substance abuse 93t
in early childhood 310
economic costs 339
EDS due to 93t, 94
genetic predisposition 317
history taking 91
ICSD-3 classification 309–310, 310t, 316, 317t
in infancy 386–387
maintenance, in OSA 75
https://t.me/medicina_free
idiopathic pulmonary fibrosis and 236, 239f,
240
middle, age and 6
in OSA 75
perimenopausal women 6
prevalence 309, 316
sleep duration 318
sleep environment 91
sleep insuciency vs 94
slow-wave sleep 318
therapy, dural orexin peptides antagonists 12
types 310, 310t
inspiration
upper airway collapse in OSA 170–171
upper airway muscles 372
inspiratory muscle weakness 69, 70, 270, 271
inspiratory positive airway pressure (IPAP) 286t, 303
children with neuromuscular disorders 404
COPD 287
OHS 287
inspiratory time, NIV titration 286t
insucient sleep syndrome 94, 310
insulin-like growth factor-1 (IGF-1) 39, 227, 250,
251, 252
insulin resistance 243f, 244
OSA associated 108
intercostal muscles 7
interleukin (IL)-6 30
interleukin (IL)-10 30
International Classification of Sleep Disorders see
ICSD-3
International RLS Study Group (IRLSSG) 321, 322,
323
interstitial lung diseases (ILDs) 235–240
in children 384
CSA in 40
idiopathic 235
OSA in 107, 235–240, 384
bidirectional pathophysiology 236
clinical consequences 237–238
clinical features 40, 236–237, 237t
management 238, 239f, 240
pathophysiology/pathogenesis 107, 236
prevalence 236, 238
risk factors 237
screening and diagnosis 238, 239f
oxygen therapy 302, 303
see also idiopathic pulmonary fibrosis (IPF)
intraocular pressure, elevated, CPAP and 178
intrathoracic pressure 200
CPAP elevating 178
TECSA and 225
increased, ASV-associated 215
negative 26, 82
adverse HF outcomes in CSA 86
SERVE-HF trial mortality 215
intubation diculties 281
invasive mechanical ventilation 282
indications 282–283
noninvasive ventilation vs 282–283
see also tracheostomy; tracheostomy-delivered
ventilation (T-IPPV)
iodine deficiency 248–249
IPF see idiopathic pulmonary fibrosis (IPF)
ipratropium, in COPD 235
iron deficiency, brain 322
irregular sleep–wake rhythm disorder (ISWRD)
333–334
ischaemic heart disease
in IPF and OSA 237
see also coronary artery disease
ischaemic stroke 11
see also stroke
isolated sleep paralysis 329–330
J
jerking movements, apnoeas associated 91
jet lag disorder 334
K
kallikrein-1 30
Kennedy disease 265
Kleine–Levin syndrome 310, 313
kyphoscoliosis 69, 267
cough augmentation 298
hypoventilation 267
pathophysiology 69
NIV strategy 69
L
Lambert-Eaton syndrome 266
laryngomalacia 398
late-onset central hypoventilation 264
with hypothalamic dysfunction 21, 41
lateral reticular formation, premotorneurons 4f
laterodorsal tegmental nucleus 2
Lausanne cohort study 113
Lausanne NoSAS score 98
learning problems 379, 386, 396, 398
le ventricular ejection fraction (LVEF) 199, 200
impaired
arrhythmia risk 207
CSA and CSR in HF 85, 87
CSA and periodic breathing with 202, 204
severity, CSA prognostic outcome 199, 202
systolic HF 199
leg movements
EMG 120
frequent, in sleep 91, 92t
restless legs syndrome 321
see also restless legs syndrome (RLS)
leptin 114, 255
resistance 69, 108, 255, 267
lifestyle, delayed sleep-wake phase syndrome and
333
lifestyle interventions
in obesity hypoventilation syndrome 259, 261
in OSA 155–157, 166
alcohol reduction 157
asthma coexisting 232
in children 402–403
exercise 156
metabolic syndrome management 244
night sedation avoidance 157
patient engagement 360
sleep hygiene measures 157
smoking cessation 156
type 2 diabetes management 244
weight loss 155–156
pre-operative assessment and 278
limited channel studies see sleep tests, type III
devices
lingual arteries, distance between (DLA) 104
lipid levels/profile
423
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