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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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CPAP long-term eects on 245
https://t.me/medicina_free
OSA and metabolic syndrome 243f, 244, 245
liraglutide 245–246
liver dysfunction, in OSA 244
locus coeruleus 2
loop gain 45f, 49–50, 51f, 57–58, 199, 224
circulatory delay and 50
controller gain 49, 50, 55, 57, 58
CSA in heart failure, prognosis 199, 205
definition/description 49, 57–58, 58f, 199, 224
feedback gain 57
high 44, 45f, 49, 58, 199, 225
CSA pathophysiology 57–59, 58f, 199, 205
CSA types mediated by 222, 223, 226, 227
definition 199, 224
instability and ventilatory overshoot 49, 58
OSA pathophysiology 44, 45f, 49–50, 51f, 77
OSA severity 46
in sleep vs wakefulness 50
TECSA 222, 223, 224, 225
see also ventilatory overshoot
low 49, 199–200
lowering, OSA treatment 50
measurement 50
mixing 49
non-hypercapnic CSA (hyperventilation) 57–59,
58f, 199, 205
plant gain 49, 50, 55, 57–58, 58f
acetazolamide decreasing 216
theophylline decreasing 217
during sleep vs wakefulness 50
lung
assessment 103
mechanoreceptors 49
lung mechanics
in COPD and OSA 232–233, 233f
in periodic breathing 61
lung pressure–volume curve see pressure–volume
curve, lung
lung volume
changes, upper airway calibre 47
in COPD, hypoventilation and 68, 68f
decreased
in kyphoscoliosis 69
in obesity 69, 101
respiratory muscle weakness and 270
in sleep 47
"trachea traction" theory in ILDs 236
recruitment, cough augmentation 299f
M
macroglossia 47, 102, 170f, 171, 252
MADs see mandibular advancement devices (MADs)
magnetic resonance imaging (MRI), diaphragm
weakness 271
maintenance of wakefulness test see MWT
(maintenance of wakefulness test)
Mallampati score 76, 77, 102, 387
modified grading 102, 103f
mandible
enlarged, in acromegaly 250, 251f
length, decreased OSA risk 46
mandibular advancement devices (MADs) 158–159,
158f
CPAP vs 158–159, 165
custom-made vs thermoplastic 158
mechanism of action 158
success factors 158, 159f
424
mandibular distraction osteogenesis 401
mandibular movements 29
detecting sleep stages 153, 351
detection/analysis, OSA diagnosis 29, 356–357
mandibular overgrowth 102
mandibular retroposition 401
mandibular retrusion 401, 401f
mask(s)
CPAP in OSA 164
air-leakage 174, 175f, 176, 178
in asthma 232
customised 176
dental or skeletal cranial changes 175f, 177
local pressure due to 175f, 176–177, 178
ocular irritation prevention 178
optimal, artificial intelligence and 365–366
oronasal masks 176
side-eects 175f, 176–177
skin marks/rashes, sores due to 175f, 176
inability to use 282
midface hypoplasia risk in infants 405
nasal 164, 178, 288, 402
NIPPV, in children 404
NIV interface 288
air leakage 283, 288
oronasal 164, 174, 176, 178, 288, 402
pressure, spontaneous breathing 284f
mattress, devices under 349f, 350t
maxilla
constriction 401, 401f
enlarged, in acromegaly 250, 251f
maximal expiratory pressure (P
maximal inspiratory pressure (P
McGill oximetry score 393, 394
mean sleep latency (MSL) 142, 145
in narcolepsy 312, 326
mechanical insuation-exsuation (MI-E) 297f,
299f, 300
mechanical ventilation see ventilation, mechanical
mechanoreceptors, lung 49
medical fitness 33
medications
CSA due to see central sleep apnoea (CSA)
EDS due to 93t, 94
improving sleep quality in COPD 234
sleep architecture interference 142, 143t
sleep-related hypoventilation due to 22
see also pharmacological therapy; specific drugs
and conditions
medico-legal implications, sleep disorders 336–337
OSA 336–337
melanin-concentrating hormone (MCH) 3f
melanoma, malignant 109
melatonin 2
circadian rhythm and 2, 332
therapy
delayed sleep-wake phase syndrome 333
irregular sleep–wake rhythm disorder 334
REM sleep behaviour disorder 329
men
CSA prevalence 39
OHS prevalence 41
OSA prevalence 38, 39, 46, 76, 78
menopause
hypoxic ventilatory response 7
peri- and post-, sleep changes 6
menstrual cycle
hypoxic ventilatory response 7
sleep changes across 6
Emax
Imax
) 271
) 271
mental capacity 307
https://t.me/medicina_free
metabolic syndrome 242–247
OSA associated 82, 108, 242
CPAP impact on glucose metabolism 244–245
new drugs 245–246
pathophysiological mechanisms 243f, 244
treatment (lifestyle and CPAP) 242, 244–245
prevalence and mortality 242
metabolism, disturbances, OSAS in children 379
metabolomics 30
metformin 245
methadone 40
methylphenidate 326t
micrognathia 102
microRNA 30, 195
microsleeps 145
middle-ear pressure 177
midface advancement 401
midface hypoplasia 177, 405
minute ventilation (V'E) 58f, 59
ASV devices measuring 205–206
decreased from wakefulness to sleep 10, 57
increase, hypoxic ventilatory response 10
in infants/children 371
loop gain (plant gain) and 57–58, 58f
as marker of ventilatory drive (ideal) 57, 72, 72f
P
determining 59, 60
aCO
2
in pregnancy 280
response to hypercapnia 9–10, 58f
mixed apnoea 16f, 373
in infants/children 391, 392
Mobitz type 2, AV block 210
modafinil 326t
molecular correlation spectroscopy 138
monitoring of sleep 117–132
digital tools see digital technology
gold standard, PSG 117, 133, 147, 149, 355
nocturnal capnography 136–140
types 117
see also polysomnography (PSG); sleep tests
monoaminergic neurons 3f
monoamines, upper airway dilator muscle
stimulation 49
montelukast 400, 401
Morningness–Eveningness Questionnaire 313
motor neurone disease (MND/ALS) 70, 103–104,
265, 265t, 274
cough augmentation 298
emotional distress and psychosocial support 307
NIV adherence barriers 291
NIV titration 288
palliative care 305, 306
telemonitoring 306
tracheostomy-delivered ventilation outcome 294
ventilatory support 306
motor neurones, disorders 265–266, 265t
motor vehicle accidents (MVAs) 115, 145, 336, 337
death rates, WHO 337
EDS and 92, 115, 145, 336, 337
near-miss 92, 337
nonmedical costs 338, 338t
OSA associated 80, 96, 115, 336, 337, 340
risk assessment 337
mouth pressure, P
movement(s)
abdominal, measurement 120
abnormal during daytime 92
abnormal during sleep 92, 127
of body, EEG in children 390
72
0.1
EEG and PSG scoring 121
scoring and reporting 127
detection, digital tools 349, 349f, 351
watches 349f, 350t
jerking, apnoeas associated 91
leg see leg movements
rib cage, measurement 120
thoracic see thoracic movements
movement disorders, sleep-related see sleep-related
movement disorders
MrOS Sleep study 25
MSLT (Multiple Sleep Latency Test) 96, 114, 141, 142
adherence to therapy and 142
in children 389, 394
description and protocol 142
evaluation of PAP therapy response in OSA 193
in hypersomnias 312, 326
medication wash-out before 142
medications aecting 142, 144t
in non-respiratory sleep disorders 312
summary of procedure 142, 143t
multidisciplinary team (MDT)
surgery in hypoventilation syndromes 278
telemedicine for SDB management/diagnosis
344, 344f, 345
Multiple Sleep Latency Test see MSLT (Multiple Sleep
Latency Test)
muscle weakness 70
generalised 70, 103
respiratory muscles see respiratory muscles
skeletal muscles 269–270
muscular dystrophies 266–267
see also Duchenne muscular dystrophy (DMD)
MWT (maintenance of wakefulness test) 114, 141,
143–145
in children 394
description and use 143–144
evaluation of PAP therapy response in OSA 193
microsleeps, and drowsiness 145
motor vehicle accident risk in EDS 337
in non-respiratory sleep disorders 312
normal values 144–145
protocol and requirements 144
PSG before 144, 144t
summary of procedure 143t
myasthenia gravis 266
myocardial infarction 11
myofunctional therapy 161
myopathy, proximal 103
myotonic dystrophy 266, 274
type 2 266
N
napping see daytime naps/napping
narcolepsy 92, 93t, 325–328
aetiology and pathogenesis 326–327
clinical presentation 325
diagnosis 325–326
drug treatment 326t, 327
EDS in 313
type 1 310, 325
diagnostic criteria 312
type 2 310, 325
diagnostic criteria 312
nasal cannula 129, 304
nasal cavity, examination in children 387
nasal obstruction, CPAP side-eects in OSA 174, 183
nasal passages, examination 102
425
nasal pressure, RERA 18
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nasal prongs 120, 282
nasopharyngeal obstruction, in children 387
nasopharyngeal symptoms
in children 387
CPAP side-eects in OSA 175f, 177
nasopharyngeal tube 398
nasopharynx, malformation, management 401
National Heart, Lung, and Blood Institute (NHLBI)
216
National Institute for Health and Care Excellence
(NICE)
bicarbonate level, OHS 275
CPAP for moderate/severe OSAS 166
PAP therapy aim (AHI) in OSA 194
neck
examination 102, 104, 104f
fluid accumulation, overnight rostral shi 47, 79
so tissue, OSA and 47
negative pressure ventilation 282
neonates see newborn infants
neural stimulation, respiratory muscle strength
assessment 272
neural transmission 71–73, 72f, 263
neurobiology of sleep/breathing 1–14
neurocognitive dysfunction/deficits
in OSA 27, 32, 75, 79–80
in OSAS in children 379
sleep hypoventilation in children 403
management 403–404
neurodegenerative diseases
central sleep apnoea in 40
CSA in 227
isolated REM sleep behaviour disorder in 329
non-respiratory sleep disorders comorbid 314
neurological assessment 103–104
neurological disorders
CNS/brainstem 264, 265t, 274–275
CSA in 227
neuromechanical dissociation 72
neuromuscular diseases (NMDs) 102, 103, 263, 273
aetiology 264–267, 265t
BPAP therapy 171
CNS/brainstem involved 264, 265t
cough augmentation 298, 404
cough ecacy impaired 298, 303
disease types 264–265, 265t
general inspection 102
hypercapnic respiratory failure 265t
hypoventilation, pathophysiology 70
hypoventilation assessment, algorithm 274, 275f
NIV titration 286t, 288, 404
nocturnal hypoventilation 103, 274, 275f, 403,
404
palliative care 305, 306
pregnancy feasibility/assessment 280
SDB, aetiology 103
sleep hypoventilation syndromes in children
380–381
management 403–405
slowly progressive, T-IPPV for 294
surgery in see surgery
tracheostomy-delivered ventilation (T-IPPV) 293,
404
see also motor neurone disease (MND/ALS)
neuromuscular dysfunction, in children 377
neuromuscular junction diseases 265t, 266
neuromuscular weakness, hypoventilation 70
neuroprotective therapy 329
426
neurotransmitters
dysregulation, in restless legs syndrome 322
sleep promotion 3f
wakefulness, role 2, 3f
newborn infants
apnoea, pathophysiology 372
CCHS in 380
control of breathing, development 7, 371–373
REM sleep 392
sleep states (AS and QS) 370, 391–392
active sleep 370, 390, 391
quiet sleep 370, 372, 390, 391
see also infant(s)
"nightmare disorder" 330
nightmares 330
night terrors 328
night-time hypoxaemia 24–25
NIPPV see NIV, positive-pressure
NIV, negative pressure 282
NIV, positive pressure 282–292, 284f
adherence 282, 291
barriers to 291
adverse events 291
air leaks 283, 288, 289–290
automatic modes 283–284
characteristics 283
in children
cough assistance with 404
with neuromuscular conditions 381, 403–404
for OSA 400t, 402
in congenital central hypoventilation syndrome
403
in COPD 69, 235, 286t, 287
daytime use 288
duration per day 293
eectiveness 286
extubation onto, criteria 279
goals 286, 289
at home 282, 307
long-term, palliative care 307
titration 288
in hypoventilation with reduced ventilatory drive
71
increasing pressure/volume, eect 283
initiation 286, 287, 288
interface choice 288
invasive ventilation vs 282–283
in kyphoscoliosis 69
limitations 282
long-term 282, 293
adherence 282
monitoring 282
nocturnal, in COPD 235
palliative care 307
long-term goal 286
modes 283–284, 284f, 285t
elements, trigger and cycle 284, 285t
newer 283–284
pressure-targeted ventilation 283, 284f, 289f
terminology issues 284
volume-assured pressure support 283
volume-targeted ventilation 283, 284f
monitoring 282, 289–291
gas exchange 290
leaks and obstructions 289–290
nocturnal 290
optimal method, and PSG 290
telemonitoring 290–291
ventilator data, stepwise approach 289, 289f
NIV, positive pressure (cont.)
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in neuromuscular diseases 286t, 288, 293
in neuromuscular weakness 70
in obesity and OSA 69
in obesity hypoventilation syndrome 258–260
benefits 258–259
exercise training with 261
for OSA in children 400t, 402
for OSA in infancy 397–398, 398t
in pneumothorax 303
post-operative 279
in pregnancy, in hypoventilation 280
pressure-targeted ventilation (PTV) 283, 284f,
289f
pre-surgery 279
spontaneous mode 285t
titration 282, 286–288
COPD 286t, 287
NMD 286t, 288
OHS 286t, 287–288
site/place 288
during sleep 287
tracheostomy-delivered ventilation (T-IPPV) vs
294, 295
volume-assured pressure support (VAPS) 283
volume-targeted ventilation (VTV) 283, 284f
withdrawal in end-stage disease 307–308
nocturia, in CSA 84
nocturnal bruxism 311
nocturnal capnography 136–140
non-24-hr sleep–wake rhythm disorder (N24SWRD)
334
nonalcoholic fatty liver disease (NAFLD), OSA
associated 244, 245
nonalcoholic steatohepatitis (NASH) 244, 246
noninvasive ventilation (NIV) see NIV
non-rapid eye movement (NREM) sleep see NREM
sleep
non-respiratory sleep disorders 309–335
in children 382
classification 309–311, 310t
comorbidity 313
with other pathological conditions 313–314
with other sleep disorders 313
diagnostic approach 311–313
epidemiology 309–311
see also circadian rhythm sleep–wake disorders
(CRSWD); hypersomnia; insomnia; parasomnia
norepinephrine reuptake inhibitor 49, 162
nose, inspection 102
NREM parasomnia see parasomnia, NREM
NREM–REM sleep cycling 2–4
age aecting 5, 6
blood pressure and heart rate changes 11, 13
respiratory network activity 9
NREM sleep 1, 2
age aecting time spent 5, 6
arousals, EEG scoring 121
blood pressure 11
body temperature 2
breathing control 7, 9
breathing movements in foetus 7
characteristics 2
in children (young) 371
CSA during 57
EEG characteristics 2, 4–5
EEG scoring 121, 122t
in children 389–390, 391
hypoxic ventilatory response 7
in infants 371, 391
parasympathetic activity 11
stage N1 (NREM 1) 122t, 389–390
stage N2 (NREM 2) 122t, 124f, 390
stage N3 (NREM 3) 122t, 124f, 390
sympathetic activity fall 11
threshold level of hypercapnia to provoke arousal
10
ventilatory drive and V'E 57
ventilatory overshoot in 58
ventilatory response to hypoxia/hypercapnia 9,
10, 57
nucleus tractus solitarius 8f
O
obesity 101–102, 254
airway narrowing 47, 101
central, OSA and 39
chest wall compliance decrease 69
in children
management 402–403
oximetry and 394
clinical examination 101–102
CPAP side-eects in OSA 174
expiratory flow limitation 69
hypoventilation pathophysiology 69, 255, 256
see also obesity hypoventilation syndrome (OHS)
impact on mechanics of respiratory system 101,
255, 267
increased upper airway resistance 47, 69, 101
interstitial lung diseases and OSA 237
lung volume decrease 69, 101
management 69
in children 402–403
in obesity hypoventilation syndrome 261
in type 2 diabetes, metabolic syndrome 244
OSA and 38–39, 76, 101, 108, 155–156, 237,
249f
asthma comorbidity in children 382
CPAP in 108–109
ventilatory strategy 69
as OSA risk factor 38–39, 76, 101
pharyngeal collapsibility 47, 101, 155–156
SDB association 101–102
visceral, in metabolic syndrome and OSA 242
obesity hypoventilation syndrome (OHS) 15, 17,
254–262, 267, 287
bicarbonate levels 257, 275
clinical consequences 256, 258
clinical presentation 256
comorbidities 257, 258
CPAP and NIV 69, 258–260, 267
benefits 258–259
clinical implications/choice 260, 261f
CPAP as initial treatment 260, 287
CPAP compared to NIV, trials 259–260
indications 258
long-term ecacy 260
NIV and automatic titration 284
NIV in mild hypercapnia 259
NIV titration 286t, 287–288
Pickwick study 260
short-term ecacy 259
definition and criteria for 21, 254–255
diagnosis 256–257, 256t
epidemiology 255
hypoventilation staging 257t
intensive care units and 258
427
lifestyle interventions 259, 261
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mortality, and cause of death 258
non-PAP treatment 261
pathophysiology 69, 255–256, 261, 267
phenotypes 255–256
prevalence 41, 254, 255
prominent REM hypoventilation 255
surgery in 279
obstructive apnoea 15, 16f
in infants/children 391, 392
see also apnoea, sleep; OSA/OSA syndrome (OSAS)
obstructive breathing events 18
see also apnoea, sleep; hypopnoea; respiratory
eort-related arousal (RERA)
"obstructive hypoventilation", infants/toddlers 378
obstructive sleep apnoea (OSA) see OSA/OSA
syndrome (OSAS)
occlusion pressure (P
occupational accidents, OSA and 80, 149, 336, 340
ocular irritation, CPAP side-eect 175f, 178
odds ratio product (ORP) 27
ODI see oxygen desaturation index (ODI)
oesophageal manometry 389
oesophageal monitoring 120
oesophageal pressure (P
measurement 271, 389
oestrogen 6
OHS see obesity hypoventilation syndrome (OHS)
older people see elderly people
oligonucleotide therapy 306
Ondine"s curse see congenital central hypoventilation
syndrome (CCHS)
opiates
breathlessness reduction in advanced disease 306
NIV withdrawal in end-stage disease 307–308
in renal impairment, reduced ventilatory drive 70,
71
opioids, chronic use
CSA due to 19, 40, 63, 88, 210–214
admissions and mortality 88
ASV therapy 210, 212–213
BPAP therapy 212
central apnoea duration variation 210
CPAP therapy 210, 212
detoxification impact 210
prevalence of CSA 210, 211f, 211t
PSG in 210, 211f
terminal apnoea, mortality 210
obstructive disordered breathing 210
oral contraceptives 7
orexin 12, 312
deficiency 325, 326, 327
function 327
orexin peptides, dual antagonists 12
organisation, sleep clinics see sleep clinics
orlistat 244
oronasal flow
apnoea 16f
hypopnoea 17f
oropharyngeal exercise 161
in OSAS in children 402
oropharynx
evaluation techniques in OSA 76–77
examination 102
narrowing, evaluation 102, 103f
orosomucoid-1 30
orthodontic procedures, for OSAS in children 400t,
401–402
orthopnoea 270
428
0.1
) 72
oes
) 18, 72
NIV for, in neuromuscular weakness 70
OSA50 questionnaire 98
OSA/OSA syndrome (OSAS) 15, 32, 34, 74–83
A, B, and C criteria 17–18
accidents associated
motor vehicle 80, 96, 115, 336, 337, 340
occupational 80, 149, 336, 340
adverse neurocognitive outcome 32, 79–80
susceptibility measure 27
age, prevalence increase with 39, 46, 76, 78f, 79
AHI in see apnoea–hypopnoea index (AHI)
arterial stiness and 27
asymptomatic 75, 77, 148, 354
diagnosis 355
autonomic function impairment 28–29
biomarkers 30
cardioprotective eects 81
in children/infants see children; infant(s)
classification
by clinical phenotypes 77, 78f
ICSD-3 17–18
severity evaluation, Baveno 23, 166
clinical consequences of 32, 33, 79–82, 96, 147,
337
arrhythmias 81
cancer 82, 109
cardiovascular 32, 80–81, 80f, 107–108, 195,
196
coronary artery disease 81
heart failure 82
liver dysfunction 244
metabolic syndrome 82, 108
neurobehavioural (cognitive, psychiatric) 79–80,
109
pathophysiological mechanisms 80f, 81, 82
pulmonary hypertension 82, 107
pulse wave analysis for 28
sleepiness 79–80, 82
stroke 81
systemic hypertension 80–81, 195
thromboembolism 82
type 2 diabetes 82
see also the individual conditions
clinical criteria/parameters 17–18, 148
clinical examination 76–77, 76t, 101, 102, 103,
112
of neck 104, 104f
clinical phenotypes 74, 77–79, 78f, 148, 194
BP response to PAP therapy 195
classification by 77, 78f
dynamic, positional OSA 160
EDS-based 77, 78f, 82
elderly 78f, 79
ethnic 78f, 79
multiple-feature/complex 79
sex-specific 77–78
symptom-based 77, 78f, 82
clinical symptoms 32, 74–75, 75t, 148
in chronic disease, pauci-symptomatic 354
CPAP adherence linked to 182
daytime 74, 75t
evaluation of PAP therapy response 192, 193
excessive daytime sleepiness 74, 75, 77, 78f,
115
men vs women 77–78
nocturnal 74, 75t
recurrent/persistent aer PAP 187
snoring 32, 74, 75, 78, 148
comorbidities/conditions associated 76, 76t,
OSA/OSA syndrome (OSAS) (cont.)
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106–111, 148, 337, 354, 367
acromegaly see acromegaly
asthma see asthma, SDB in
bidirectional relationship 106, 107, 108, 110,
112
cancer 82, 109
cardiovascular disease 107–108, 148, 164
cerebrovascular disease 164
in children 382, 402
COPD see chronic obstructive pulmonary
disease (COPD)
COPD overlap syndrome 103, 106–107, 232–
233, 234, 275
depression 78, 80, 109, 340
diabetes see diabetes mellitus, type 2 (T2DM)
diagnosis and 354, 355, 368
economic impact 340
endocrine disorders 78, 248–253, 249f
heart failure 82, 107, 112, 199
high-risk, assessment see high-risk patient
identification (below)
hypertension see hypertension, systemic
hypothyroidism see hypothyroidism
ILDs see interstitial lung diseases (ILDs)
insomnia see comorbid insomnia and sleep
apnoea (COMISA)
metabolic diseases 82, 108–109, 112, 164,
242–247
metabolic syndrome see metabolic syndrome
obesity see obesity
pulmonary disease 103, 106–107, 230–240,
231f
pulmonary hypertension see pulmonary
hypertension (PH)
renal disease 40, 109–110
socioeconomic impact of 337
thyroid disease 78
at time of OSA diagnosis 368
CSA coexisting 204
treatment flowchart 203f
CSA comparison 15
CSA developing during treatment 61, 62
see also treatment-emergent CSA (TECSA)
definition 15, 17–18, 32
of OSAS vs OSA 32
diagnosis 148, 150f, 354, 355f, 357
challenging problems 367
in children 178, 388–389, 393
data collection over several nights 357
delays 147
gold standard test (PSG) 147, 149, 355
high demand for 354, 355, 357
by high medical consumption 368
high probability OSA 149
home respiratory polygraphy 342, 355, 356
mandibular movement detection 29, 356–357
mild OSA 149, 356f
moderate-to-severe OSA 149, 356f
multicaptor design digital tool 357
need for simple alternative to PSG 355, 356,
357
new digital tools see digital technology
overdiagnosis 34, 368
oximetry, in children/infants 393–394
polygraphy 188, 355
pre-test probability, improving 368
PSG see polysomnography (PSG)
screening, pre-test probability see below
OSA/OSA syndrome (OSAS) (cont.)
sleep testing 148, 152–154, 153f
telemedicine and 344, 344f, 345t
time until 368
tracheal sound recording 357
two-step approach 152–154, 153f
type III devices 152
ultrasound, neck 104, 104f
underdiagnosis see underdiagnosis (below)
waiting times, increased 367
diagnostic algorithms, individualised 147–151,
150f
driving risks 80, 115, 336–337
economic burden 339–340, 339f
endogram 51f
endotypes see pathophysiological traits (below)
epidemiology 38–39
children/infants 376–377
exacerbation
low respiratory arousal threshold 52
ventilatory instability causing 50
false-positives, digital technology and 368
follow-up/monitoring 186, 187f, 190, 367
patient engagement and digital tools 360
see also telemonitoring
as frequency-oriented metric 23
genetic factors 29
heart rate response (∆HR) 29
as heterogeneous condition 36, 194
high-risk patient identification 112–116
AHI 112, 113
biomarkers 114
driving risk 115
elevated BP 114
genetic factors 114–115
hypoxia, measures 113
sleepiness 114
history taking 75, 76, 91
HVR, time of day and 11
hypoventilation pathophysiology 69
increased risk, definition 149
in infants see infant(s)
instability and evolving over time 148
intermittent hypoxia, acute HVR 11
lifestyle interventions see lifestyle interventions, in
OSA
lifetime impacts 367, 369
management 155–197
see also therapeutic interventions (below)
medico-legal implications 336–337
see also driving; motor vehicle accidents (MVAs)
mild
asthma with, treatment 232
in children 399
CPAP therapy 166
diagnostic tests 149
screening tests 356f
moderate-to-severe
in children 399
CPAP therapy 165, 166
diagnostic tests 149
in interstitial lung diseases 236
muscle stimulation, therapy 161
obesity in, weight loss intervention 245
pre-test probability, screening 152–154, 153f
as risk factor for metabolic syndrome 242
neurocognitive dysfunction in 27, 32, 75
normal state continuum with OSAS 376
obesity and see obesity
429
OSA/OSA syndrome (OSAS) (cont.)
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in obesity hypoventilation syndrome 254, 256
occupational accidents 80, 149, 336, 340
outcome assessment 186, 187f
overdiagnosis 34, 368
pathogenesis see pathophysiological traits (below)
pathophysiological traits (endotypes) 44–54, 45f,
62, 74, 77
airway dilator muscle response inadequate 44,
45, 45f, 47–49, 48f, 77, 166
assessment of traits 53–54
chemical drive withdrawal 50, 51
chronic intermittent hypoxia 230
clinical phenotype relationship 77–79, 78f
genioglossus responsiveness 45f, 47, 48–49,
48f, 166
high loop gain 44, 45f, 49–50, 51f, 77
high positive P
interactions of endotypes 44–45, 45f
44, 46
crit
interventions based on 45, 48–49, 53
low respiratory arousal threshold 27, 44, 45, 45f,
52–53, 77, 166
lung volume 47
in MAD responders 158
overnight rostral fluid shi 47
quantification 45–46
respiratory eort increased 18, 29
small collapsible upper airway 15, 44, 45f,
46–49, 53, 62, 77, 166
upper airway anatomy 46–47
ventilatory drive 44, 49–50, 51f, 53, 62
see also upper airway; upper airway muscles
personalised approach to evaluating 148–151
phenotypes see OSA/OSA syndrome (OSAS), clinical
phenotypes
physical examination 76–77, 76t, 101, 102, 103
point-of-care ultrasound 104, 104f
positional (POSA) 159–161
pre-test probability, limited sleep tests 152, 153f,
154
prevalence 38, 46, 112, 147, 231, 309, 354
age-related 39, 46, 76, 78f, 79
control, and decrease in societal costs 340
global 38
peri-/post-menopause 6
racial/ethnic dierences 46, 78f, 79
sex (male/female) 38, 39, 77–78
recurrence, despite weight loss 156
REM-predominant 50
respiratory events, residual with CPAP 188–189
risk factors 38–39, 44, 76, 76t, 106, 147–148,
230
asthma and 231
screening 354–355, 355f, 356f
screening tools 76–77, 96, 148, 149
digital tools 356–357
limited sleep tests 152–154, 153f
questionnaires see questionnaires
see also sleep tests, type III devices
severe
CPAP vs MAD therapy 165
OHS phenotype 256
screening tests 356f
treatment-emergent CSA risk 224, 227
severity evaluation 23, 24, 32–37, 112
AHI 24, 32, 33–34, 36, 38, 112, 166, 194
AHI alternatives, event duration 23–24, 24t, 32,
36, 112, 113, 166
AHI model limitations 23, 32, 33–34, 36
430
OSA/OSA syndrome (OSAS) (cont.)
arousals, measurement 26–27
autonomic parameters 27–29
Baveno classification 23, 166
biomarkers 30, 32
cardiometabolic risk assessment 112, 113f
end-organ impact 34–35, 35f
features suitable for 32–33
future trends 36
genetics 29
high-risk patients see high-risk patients (above)
hypoxic burden 25
importance and implications 33
integrative disease model basis 34–35, 35f, 36f
intermittent hypoxia markers 34
multicomponent grading system 35, 36f
oxygen parameters 24–26, 25t, 26t, 113
respiratory events, systemic eects 34–35, 36
sleep fragmentation markers 34
sleep questionnaires 33
from sleep study parameters 33–34
snoring intensity and 75
S
value decrease 25
pO
2
sympathetic activation markers 34
symptoms and manifestations 32–33, 36, 38
three-dimensional model 34–35, 35f
type III devices/limited channel 130, 131
see also grading of SDB
socioeconomic impact see socioeconomic impact,
sleep disorders
subjective manifestations 33
symptom phenotypes 77, 78f, 82
telemedicine, proposed use 344, 344f
see also telemedicine; telemonitoring
therapeutic interventions 155–197
adherence see CPAP, in OSA
APAP see auto-adjusting PAP (APAP)
assessment of ecacy of 192–197
behavioural 155–157
BPAP 171
in children see children
continuous support role 183, 359, 360
cost-benefit ratio 340
CPAP see CPAP, in OSA
CSA development see treatment-emergent CSA
(TECSA)
ecacy, dependent on pharyngeal collapsibility
45
ENT interventions 157–158
hypoglossal nerve stimulation 161
improvement of quality 359–360
increasing arousal threshold 45, 53
in infants 397–398, 398t
intraoral devices 158
lifelong, impact 367, 369
lifestyle see lifestyle interventions, in OSA
MADs see mandibular advancement devices
(MADs)
medical 155
monitoring see follow-up (above)
muscle stimulation 161
myofunctional therapy 161
non-CPAP 155–162, 190
numbers treated in the Netherlands 369
oxygen 50
PAP see positive airway pressure (PAP) therapy
pathophysiological aims/basis 45–46, 48–49,
53
patient preference 164
OSA/OSA syndrome (OSAS) (cont.)
https://t.me/medicina_free
pharmacological 162
positional devices 160–161
preventing chemical drive dips 50
successful, criteria 359
surgical 155, 157–158
telemonitoring see telemonitoring
underdiagnosis 337, 367
digital health and 367, 368
eects 367–368
upper airway obstruction, causes 15
ventilation strategy 69
OSAS see OSA/OSA syndrome (OSAS)
oscillators 5
secondary (peripheral) 2
OSLER test 145
procedure, summary 143t
out-of-centre sleep testing (OCST), OSA 18
ovarian hormones 6
overbite 388
"overlap syndrome", COPD and OSA 103, 106–107,
232–233, 234, 275
overnight sleep study 112
overweight
obesity hypoventilation syndrome 41
OSA risk and prevalence 38–39
see also obesity
oxidative stress 86, 236, 244
oximetry (pulse oximetry) 121
abnormal, McGill criteria 393, 394
in children 389, 393–394
with neuromuscular conditions 381
evidence-based specification in SDB 132
in hypoventilation 275–276, 276f
interpretation of trace 134f, 135, 135f
methods and parameters, in SDB 131t
NIV monitoring 290
nocturnal home, in children 393–394
OSAS diagnosis 378
obesity hypoventilation syndrome 257
overnight
in breathlessness 271
in children 389
problems associated 134
in PSG and type III study 153
in SCOPER categorisation system 130t
sensitivity/specificity, sleep apnoea diagnosis 132
sleep apnoea, trace 134f
type IV studies 131, 134–135, 153
interpretation 132, 134–135
limitations 131, 134–135
as screening tool 132, 133, 134
oxybutynine 162
oxygen
alveolar–arterial oxygen tension gradient (PAaO2)
65, 66
alveolar oxygen tension (P
desaturation 113, 200
) 66
AO
2
apnoea and bradycardia, sequence 373, 374f
in children/infants 393
in COPD 233, 234
events (dips), number, ODI 24
high-risk OSA patient identification 113
intermittent, in COPD and OSA 107
parameters integrating 24–25, 25t
influence on ventilation 57
monitoring, in infants 371
P
9
aO
2
carotid sinus nerve threshold to hypoxia 10
oxygen (cont.)
chemoreceptor sensitivity 9, 9f, 10
CSA due to high altitude 63
hypoxic respiratory failure 65
V'E change and 9
in wakefulness, eect in sleep 10
S
aO
2
ecacy of PAP therapy in OSA 194–195
monitoring in oxygen therapy 302
nocturnal hypoventilation definition 274t
obesity hypoventilation syndrome 257
saturation 233
apnoea types, presentations 16f
in COPD 233, 234
high-risk OSA patient identification 113
hypopnoea, presentations 17f
hypoxia, as biomarker of CSA outcome 200
measurement 121
ventilatory failure screening 66
SDB severity parameters 24–26, 34
event duration and hypoxic load 25–26, 26t
hypoxic burden 25, 34
night-time hypoxaemia 24–25
S
24, 25, 25t
pO
2
in children with neuromuscular conditions 381
decrease, OSA severity 25
monitoring, sleep-related hypoventilation 139,
139f
oxygen therapy in central hypoventilation 403
T88 (88% threshold) 24
T90 (90% threshold) 24–25, 113
oxygen desaturation index (ODI) 24, 25, 25t,
113, 131
in children 394
ecacy of PAP therapy in OSA 193, 194–195,
196
intermittent hypoxaemia 131t
oximetry/type IV measuring 131, 134
type III devices, use in 133
oxygen therapy/supplementation
acute indications 302, 303, 303b
chronic indications 303
in congenital central hypoventilation syndrome
403
controlled, principles in hypoventilation 70–71,
71f, 302, 403
in COPD, during sleep 234–235, 303
in CSA in heart failure 204
daytime 303
excess 70–71, 71f
ventilatory failure due to 70–71, 71f, 302, 403
flow rates 303
high-altitude periodic breathing 226
high-flow nasal cannula 304
indications 302–304
monitoring 302, 303
nocturnal low flow, in CSA 215–216, 216f
in OSA 50
target S
uncontrolled 70–71, 71f, 302
302, 303
aO
2
oxyhaemoglobin dissociation curve 10, 70, 71f, 302
in COPD 233
P
paediatric respiratory sleep medicine 370–405
control of breathing, development 371–372
sleep development 370–371
see also children; infant(s)
431
palatal collapse 158
https://t.me/medicina_free
palatal surgery 157
palliative medicine 305–308
COPD 305, 306
in long-term NIV users 307
MND/ALS 305, 306
neuromuscular diseases 305, 306
psychosocial support 307
parabrachial nucleus 2
paralysis, sleep 329–330
parasomnia 310t, 328–331
comorbid with other neurodegenerative process
314
comorbid with other sleep disorders 313
ICSD-3 definition 311
NREM 310t, 311, 328–329, 331
forms of 328
pathophysiology 328–329
video-PSG 311, 328–329
prevalence 309
rare types 330–331
REM 310t, 311, 328, 329–330
isolated sleep paralysis 329–330
nightmares 330
RBD see REM sleep behavioural disorder
scoring and reporting 127
substance abuse/diseases associated 331
types 310t, 311
parasomnia overlap disorders 310t
parasympathetic activity, in NREM sleep 11
Parkinson disease 40
parotitis 178
partners
collateral sleep history 75, 90, 91
CPAP adherence in OSA 182
patient-centred approach, SDB management 346,
346f
patient empowerment/participation 367–369
patient records, digital 368
Patient-Reported Apnea Questionnaire (PRAQ) 33
patient-reported outcome measures (PROMs)
OSA 33
PAP therapy response in OSA 193
patient–ventilator asynchrony (PVA) 287
peak cough flow 279, 280
peak expiratory flow, cough 271
Pediatric Sleep Questionnaire 378
pedunculopontine nucleus 2
peptidergic neurons 3f
perimenopausal women, sleep disturbances 6
periodic breathing (PB) 55, 60f
ASV therapy action 206, 206f
CSA in, prognostic outcome 198, 200
description 55, 392
detection, in HF patients 87
in diabetes mellitus 40
in heart failure, CSA and 86–87
high-altitude 19
in infants/children 372, 373, 392
definition 392
le ventricular impairment predisposing to 204
lung mechanics 61
patterns (negative/positive) 61, 62f
respiratory cycle length 56, 56f
periodic limb movement disorder (PLMD) 310t, 311
comorbid with other sleep disorders 313
diagnostic criteria 311
periodic limb movements during sleep (PLMS) 311,
322
432
diagnostic criteria 311
prevalence 309
peripheral arterial tonometry 28, 130t
peripheral neuropathies 266
personality, CPAP adherence in OSA 182
Pfeier syndrome 401
PG see polygraphy (PG), respiratory
pharmacological therapy
COPD 235
insomnia disorder 319
OSA 162
see also medications
pharyngeal airway
collapse/collapsibility 44, 45f, 46, 53
in children, management 401
definition and V'
MADs reducing 158
obesity and 47, 101, 155–156
critical closing pressure (P
measurement 53
weight loss reducing 156
functional anatomy 46–47
length, men vs women 78
narrow, evaluation 102
OSAS in children 377
see also upper airway
pharyngeal dilator muscles 44, 45, 47
activation during wakefulness in OSA 47
arousal threshold and 45, 52
in hypothyroidism and OSA 250
OSA pathophysiology 44, 45, 47–49, 48f, 77
reactivation, airway patency 45, 47, 48
relaxation in sleep 44, 45, 47–48, 49
monoamine therapy reducing 49
preventing, OSA treatment 48–49
stimulation, OSA therapy 161
see also genioglossus; upper airway muscles
pharynx, CPAP side-eects in OSA 175f, 177
Philips Sleep Apnea Quiz 368
PHOX2B gene mutation 21, 70, 380
phrenic nerve
activity, tracheal pressure and 72
conduction studies 272
lesions, bilateral 274–275
pacing, in children with neuromuscular disorders
405
stimulation, CSA treatment 218f, 219
physiology of sleep/breathing 1–14
Pickwick study 260
Pierre Robin sequence 377, 394, 397, 398
treatment options for OSA 398
pimavanserin 53
pineal body, melatonin secretion 2, 332
pitolisant 162, 326t
Pittsburgh Sleep Quality Index (PSQI) 33, 98–99, 313
pituitary adenoma 250, 252
plant gain see under loop gain
plasminogen activator inhibitor-1 12f, 13
platelets, activation, circadian clock and 12f, 13
PM (portable monitoring) see portable monitoring
(PM)
pneumocephalus 178
pneumothorax 177, 303
point-of-care ultrasound (POCUS), in OSA 104, 104f
poliomyelitis, acute 265–266
polygraphy (PG), respiratory 129–131, 133–134, 356
ambulatory, shi from PSG to 368
bronchopulmonary dysplasia 384
in children/infants, home studies 393
passive
53
) 44, 46
crit
diculties for patients/carers 356
https://t.me/medicina_free
high pre-test probability of OSG 149
at home 342, 393
in hypoventilation 275, 275f
OSA diagnosis 355
in children 378–379
repeat, aer weight loss 188
pre-operative assessment 279
see also sleep tests, type III devices
polyneuropathies, acquired 266
polysomnography (PSG) 2, 117–129, 348–349
abnormal movements, scoring/reporting 127
ageing eect on sleep 5
alternatives to
digital technology 355, 357
polygraphy 355, 356
simple diagnostic test 355
arousal threshold calculation 27
artificial nature of surroundings 118
benefits 118
carbon dioxide monitoring 121
in children/infants 388–389, 397
breathing, scoring 391–392
EEG scoring 389–391
gold standard, in-hospital PSG 386
home studies 393
indications 386, 388–389
interpretation 392–393
with neuromuscular conditions 381
normative data 392
OSA definitions 393
reporting 392–393
sensors 389
single night, sleep apnoea diagnosis 392
sleep variability in infants 391
see also electroencephalography (EEG)
CSA diagnosis 87, 149
CSA due to medical disorder without CSR 19
CSA due to medication or substance 20
CSA with CSR 18
primary CSA 20
digital devices tested against 349, 349f, 350t,
351
ECG evaluation 127
EEG see electroencephalography (EEG), sleep
EMG see electromyography (EMG)
EOG see electrooculography (EOG)
"first night eect" 118
full, sensors 2, 120–121, 389
full attended (type I) 117
full unattended (type II) 117
as gold standard test 117, 133, 147, 149, 355
at home
children 393
future SDB management 345, 345t
hypopnoeas, scoring 125, 126f
in hypoventilation 136, 275
insomnia diagnosis 317
interpretation, and reporting 127–128, 128f, 129f
limitations 118, 149
before MSLT 142
before MWT 144, 144t
negative, OSAS suspicion 118
NIV monitoring and 290
in non-respiratory sleep disorders 311–312
normal 128, 128f
opioid-induced SDB 210, 211f
OSA, evaluation of PAP therapy ecacy 193, 194,
196
polysomnography (PSG) (cont.)
OSA definition 18
OSA diagnosis 147, 149, 355
diagnostic algorithms (individualised) before
147–151
PSG alternatives 355, 356–357
repeat, aer weight loss 188
severe sleep apnoea 128, 129f
shi to ambulatory polygraphy 368
OSAS in children 378, 393
OSA with idiopathic pulmonary fibrosis 238, 238t,
239, 239f, 240
oximetry 153
parasomnias scoring/reporting 127
pharyngeal collapsibility measures 53
physiological signals monitored 117
portable monitoring devices 193, 194
reporting 127, 128, 128f, 129f
children/infants 392–393
residual respiratory events with CPAP 188–189
respiratory event scoring 124–125, 125f, 126f,
127
in restless legs syndrome 311
scoring rules 118, 121
SDB diagnosis or exclusion 128
self-applied 346
sensitivity, checking 121
sensors and associated monitoring 2, 120–121
in children/infants 389
severe sleep apnoea 128, 129f
signal acquisition/measurement 121
signal identification and collection 118
sleep staging 121, 122t, 123t
split-night studies 118, 223–224
TECSA prevalence 21, 223–224
as type I/II (attended/unattended) monitoring
117
video-PSG see video-PSG
pontomedullary pacemaker 222
portable monitoring (PM) 149
devices 193, 194
shortcomings 194
OSA diagnosis 149
PAP therapy ecacy in OSA 193, 194–195, 196
positional devices 160–161, 160f
positional obstructive sleep apnoea (POSA) 159–161
positional therapy 160–161, 160f
positive airway pressure (PAP) devices 169
commercial telemonitoring platforms 345
CPAP 164, 165f
positive airway pressure (PAP) therapy 169–173
adherence 181–182, 186
auto-adjusting see auto-adjusting PAP (APAP)
bilevel see bilevel positive airway pressure (BPAP)
central apnoea emergence see treatmentemergent CSA (TECSA)
in COPD 68
in CSA in chronic heart failure 86–87, 204–205,
206
in CSA with idiopathic pulmonary fibrosis 239f,
240
eectiveness 186
with expiratory pressure relief (EPR) 172
fixed-level CPAP see CPAP
in heart failure, eects 86–87, 204–205
initiation 186–187
intolerance 190
invasive see invasive mechanical ventilation
mechanism of action 204
433
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