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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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polysomnography (PSG) (cont.)
https://t.me/medicina_free
monitoring 186–191
central vs obstructive apnoea 189
frequency and duration 186–187
performance 186, 189–190
professionals carrying out 186, 189
recurrent/persistent symptoms 187
repeat sleep monitoring tests 187–188
significant weight gain/loss 187–188
tracking systems (CPAP) 186, 187f, 188–189
NIV see NIV, positive pressure
in OSA 86, 166
PAP therapy modes 169–172
see also CPAP, in OSA
in OSA, evaluation of ecacy 192–197
AHI 194
BP and cardiovascular events 195–196, 195t
optimal measure 192
oxygen parameters 193, 194–195
physiological parameters 193–195
PSG and EEG 193–194
symptom evaluation 192, 193, 196
SARS-CoV-2 pandemic impact 343
telemonitoring 184, 186, 343, 345, 345t
in OSA 184, 186, 343
titration in OSA 171
at home 342, 345, 345t
in interstitial lung diseases 240
see also CPAP, in OSA
tracking system 186, 187f, 188–189
positive end expiratory pressure (PEEP), increased,
COPD 68
positive pressure ventilation
invasive see invasive mechanical ventilation
noninvasive see NIV, positive pressure
post-operative management 279
post-polio syndrome 265–266
power of attorney 307
Prader–Willi syndrome 273, 389, 397, 399, 400
pre-Bötzinger complex (PBC) 4f, 7, 63
pregabalin 323
pregnancy, hypoventilation and 278–281
anaesthetic/surgical considerations 280–281,
280t
contraindications 280
feasibility and assessment 280
labour and post-delivery management 281
physiological considerations 280–281, 280t
pregnancy, sleep and wakefulness in fetus 370, 390
pressure-targeted ventilation (PTV) 283, 284f
monitoring 289f
pressure–volume curve, lung
in COPD 68, 68f
normal 68f
preterm infants 371, 372, 384
apnoea of 396–397
productivity losses, of sleep disorders 338, 338t
proteonomics 30
PSG see polysomnography (PSG)
PSQI (questionnaire) 98–99
psychiatric conditions
non-respiratory sleep disorders comorbid 93t,
313, 316, 318
in OSA 79–80, 109
see also depression/depressive symptoms
psychosis, insomnia disorder increasing risk 316
psychosocial support 307
pulmonary artery wedge pressure 59
COPD 234
434
pulmonary capillary wedge pressure 85
pulmonary congestion 59
pulmonary disease, OSA comorbid 103, 106–107,
230–241
see also asthma, SDB in; chronic obstructive
pulmonary disease (COPD); interstitial lung
diseases (ILDs)
pulmonary disease, surgery 279
pulmonary embolism 298, 303
pulmonary fluid overload, in heart failure 59
pulmonary function test (PFT) impairment 237
pulmonary hypertension (PH)
central sleep apnoea prevalence 40
in obesity hypoventilation syndrome 258
OSA association 82, 103
in children 379
COPD overlap syndrome 107, 234
surgery risk 279
pulmonary oedema, in CSA 86
pulmonary system, assessment, in OSA 103
pulse arrival time (PAT) 27–28
dynamic PAT change approach 27
OSA-specific response 28
pulse oximetry see oximetry
pulse rate response, apnoea-specific 29
pulse transit time (PTT) 27–28, 196
pulse wave analysis 28
pulse wave parameters 28
Q
quality of life
assessment in PAP therapy for OSA 193
in idiopathic pulmonary fibrosis and OSA 237, 238
tracheostomy-delivered ventilation 294
questionnaires 33, 90, 92, 95–100
assessing sleepiness 95–96, 114
ESS see Epworth Sleepiness Scale (ESS)
Stanford Sleepiness Scale 95, 96
associated with sleep diary 312–313
circadian rhythm sleep-wake disorders 333
computerised algorithms 345
OSA-related quality of life 193
OSA screening 96–98, 148, 149, 152, 368
Berlin Questionnaire 97, 97t
driving risk and 115
evaluation of PAP therapy ecacy 193, 196
in interstitial lung diseases 238
Lausanne NoSAS score 98
OSA50 questionnaire 98
STOP-Bang questionnaire 97–98, 98t, 148
STOP questionnaire 97
paediatric 388
OSAS diagnosis 378
self-reported 95
sleep quality assessment 98–99
FOSQ 98, 99
PSQI 98–99
various other 99
quiet sleep (QS) in newborns 370, 372, 390, 391
R
rapid eye movement (REM) sleep see REM sleep
rapid maxillary expansion (RME) 401, 402
RBD see REM sleep behavioural disorder (RBD)
reactive oxygen species 86
referral for further investigations 309–315
referral to sleep centre 95, 148, 149, 152
referral to sleep physicians, numbers 354
https://t.me/medicina_free
refusal of treatment 306–307
reimbursement of treatment, AHI grades and 33
relaxation therapy 318
REMOV%TST 29
REM parasomnia see parasomnia, REM
REM sleep 1, 2, 255
age aecting time spent 5
arousals, EEG scoring 121
atonia 2, 5, 255
persisting in wakefulness 329–330
blood pressure increase 2, 11, 13
breathing control 4f, 7, 9, 255
central apnoeas in infants 392
characteristics 2–3
in children (young) 371, 390, 392
core body temperature and 3
diaphragm paralysis eect 70
EEG 2, 5, 390
EEG scoring (stage R) 121, 123t, 125f, 390
hypoventilation 274
in neuromuscular conditions in children 380
in obesity hypoventilation syndrome 255, 256
hypoxic ventilatory response (HVR) 7
instability, in insomnia disorder 318
myocardial infarction and strokes 11
neurobiology 2, 4f
neuromuscular/chest wall disorders 264
in newborn infants 370, 392
NREM sleep cycle 2–5, 5f
see also NREM–REM sleep cycling
predominance later in night 3
reduced, in insomnia 318
threshold level of hypercapnia to provoke arousal
10
transition from slow-wave sleep, neurobiology 2
ventilatory response to hypoxia/hypercapnia 3, 9,
10
without atonia 329
REM sleep behavioural disorder (RBD) 311, 329
isolated (iRBD) 329
management 329
neurodegenerative processes and 314, 329
prevalence 309, 329
video-PSG 311–312, 329
REM sleep-related parasomnia see parasomnia, REM
renal disease
end-stage
CSA in 40
OSA in 40, 109, 110
OSA comorbidity 109–110
renal failure, CSA in 227
renal sympathetic activity 11
renin–angiotensin–aldosterone system (RAAS) 80,
86, 109
resistance–volume curve, in COPD 68, 68f
respiratory acidosis 256, 257
respiratory arousal threshold 27, 44, 45, 45f, 52–53
increasing to improve OSA severity 53
low, in OSA 27, 44, 45, 45f, 52–53, 77, 166
OSA exacerbation, reasons 52
OSA pathophysiology 44, 45, 45f, 52–53, 77
quantification 53
respiratory control, during sleep 4f, 7–8, 8f
in COPD and OSA 232–233, 233f
NREM sleep 7, 9
oversensitive in OSA, high loop gain 44, 45f,
49–50, 51f
REM sleep 4f, 7, 9, 255
respiratory control centres 66
ventilation drive reduced, in OHS 255
respiratory depressants 42
respiratory disturbance index (RDI) 193, 194
respiratory drive 10
"blunted", obesity 267
central, disorders 273
neural 263, 264
normal 263
see also ventilatory drive
respiratory eort 29, 351
associated with waking see respiratory arousal
threshold
in asthma 382
detection, mandibular movement detection 29,
351, 356, 357
increased in OSA 29
measurement, type III devices 129, 130, 389
in mixed apnoea, in infant/child 391
reduced in CSA 15, 55
upper airway resistance syndrome 376
respiratory eort burden 29
respiratory eort-related arousal (RERA) 18, 128f
CPAP tracking systems 189
in infants/children, definition 391–392
respiratory eort-related arousal (RERA) index
(RERA-I) 189
respiratory events
home sleep apnoea tests (type III) 129, 133
scoring (PSG) 124–125, 125f, 126f, 127
respiratory failure
acute-on-chronic hypercapnic 256
disorders causing 263–268
hypercapnic (type II) 65, 71
chest wall disorders 265t, 267
chronic 70
diseases causing 263, 264–267, 265t
excess oxygen, ventilatory failure 70, 71, 71f
load/capacity ratio 263–264, 264f
neuromuscular diseases associated 264–267,
265t
in obesity hypoventilation syndrome 254, 258,
260, 267
oxygen therapy controlled 65, 70, 71f, 302
treatment 267
hypoxic (type I) 65, 66
screening 66
stable chronic, P
types 65–66
monitoring 136, 139
tcCO
2
respiratory load 66, 67f, 263–264
increase, hypoventilation mechanism 67f
respiratory load/capacity ratio see under respiratory
muscles
respiratory monitoring 117
types see sleep tests
respiratory motor pools 7, 8f
respiratory muscles 7, 372
in COPD and OSA 233, 233f
EMG measurement 72–73
expiratory
strength assessment 271, 272
weakness 70
failure, in motor neurone disease 265
inspiratory
vital capacity and 270
weakness 69, 70, 270, 271
load/capacity ratio 67f, 263–264
in chest wall disorders 263–264, 264f, 265t,
267
435
respiratory muscles (cont.)
https://t.me/medicina_free
hypoventilation mechanism 67f, 263
imbalance 67f, 263–264, 264f
in neuromuscular disorders 263–264,
264–267, 264f, 265t
in obesity 255, 267
normal capacity 66, 67f, 263
secondary accessory 7
see also pharyngeal dilator muscles
strength assessment 269–272
clinical 269–270
invasive 270t, 271–272
noninvasive 270–271, 270t
non-volitional 272
physical examination 270
volitional, intact cortical function 271
weakness 263, 300
alveolar hypoventilation in 66, 67f, 70, 273
assessment see respiratory muscles, strength
assessment
expiratory muscles 70
inspiratory muscles 69, 70, 270, 271
in motor neurone disease 265
neuromuscular conditions in children 380
obesity hypoventilation syndrome 255
respiratory neurons 7, 8f
respiratory pacing
in children with neuromuscular disorders 404,
405
in congenital central hypoventilation syndrome
403
respiratory polygraphy see polygraphy (PG),
respiratory
respiratory pump
hypoventilation 66–67, 67f
in neuromuscular disease 263, 264f
normal 66, 67f
respiratory rate
normal 66
REM sleep 3
in respiratory failure 66
respiratory rhythm, in infants 372
respiratory system, obesity impact on mechanical
properties 255
restless legs syndrome (RLS) 311, 321–324
augmentation, treatment of 323
augmentation prevention 322–323
in cystic fibrosis 383
definition 321
diagnosis/diagnostic criteria 311, 321
disorders mimicking 321–322
economic costs 339
genetic factors 322
insomnia comorbidity 313
management 322–323
pathophysiology 322
dopaminergic dysregulation 322, 323f
periodic leg movements during sleep 322
prevalence 309, 321
restless sleep disorder, in childhood 311
retrognathia 102, 388, 401f
retrotrapezoid nucleus 8f, 9
rhinitis
allergic 231, 382, 383
CPAP side-eects in OSA 175f, 177
rib cage movements, measurement 120
rise time, NIV titration 286t
road trac accidents see motor vehicle accidents
(MVAs)
436
robotic surgery, transoral 157
ROMANCE RCT 246
rostral volume shi, OSA 47, 79
S
salmeterol 235
sarcoidosis 236, 238
SARS-CoV-2 pandemic (COVID-19) 346
e-consultations role 369
EEG headband device app use 351
impact on sleep clinic role 342, 343
SDB diagnosis since 355
SDB management since 343–346, 344f, 345t
sleep duration increased in 351
SAVE (Sleep Apnea cardioVascular Endpoints) trial
24, 114
scleroderma 236
scoliosis, pregnancy with hypoventilation 281
SCOPER (Sleep, Cardiovascular, Oxygen, Position,
Eort, and Respiration) system 129–130, 130t
SDB see sleep disordered breathing (SDB)
secondary (peripheral) oscillators 2
sedation, avoidance, OSA treatment 157
sedative-hypnotic drug, CPAP adherence in OSA 183
selective serotonin reuptake inhibitors (SSRIs) 313,
326t
semaglutide 246
serotonergic neurons, response to increase in
inspired CO2 8f
serotonin receptor antagonist 53
SERVE-HF trial 86–87, 198, 199, 200, 207–208
design/performance issues 207
mortality in 207–208, 215
sex dierences
CSA prevalence 39
OSA prevalence 38, 39, 77–78
sleep 6–7
sex hormones 6, 78
shi work disorder 334
shi workers, Multiple Sleep Latency Test (MSLT) 142
Short-Form Health Survey (SF-36) 193
shortness of breath 263
sinus tachycardia 127
skeletal cranial changes, CPAP masks causing 177
skeletal muscle weakness 269–270
sleep 348
active (AS) in newborns 370, 390, 391
advanced timing, with age 6
ageing and 5–6, 123t
architecture 2–5
evaluation 2
medications aecting 142, 144t
breathing control during 4f, 7–9, 8f, 57, 57f
cardiovascular function during 11–13
continuity, disruption in insomnia 317
control 1–2, 348
daytime
in idiopathic hypersomnia 325
see also daytime naps/napping; daytime
somnolence
definition 1
depth, arousal measurement, SDB grading 27
development in first years of life 7, 370–371,
390–391
duration
in children 5, 370, 383, 392
COVID-19 pandemic changing 351
infancy 370
insucient see sleep, insucient
https://t.me/medicina_free
reduced, with age 5, 6, 123t
short, habitual 93t
eciency
in idiopathic hypersomnia 325
impact on AHI 127
environment, insomnia 91
in fetus 370–371, 390
healthy nocturnal pattern 3, 5f
initiation, diculties in, dierential diagnosis 93t,
94
insucient 93t, 348
adverse outcomes 348
EDS due to 93t, 94
insomnia vs 94
maintenance
diculties in, dierential diagnosis 93t, 94
in OSA 75
problems 91
menstrual cycle, changes with 6
misperception 317, 318
monitoring see monitoring of sleep
neurobiology and physiology 1–14
NREM see NREM sleep
promotion, neurotransmitter systems 3f
quality see sleep quality
quantity and quality measurement 355
quiet (QS) in newborns 370, 372, 390, 391
REM see REM sleep
requirements, time 5–6, 370
scoring, AASM 2
sex dierences 6–7
slow-wave see slow-wave sleep (SWS)
stages 2–5, 5f
in children 389–390
digital technology monitoring 351, 352
normative data across lifespan 123t, 128
stage N1 (NREM 1) 122t
stage N2 (NREM 2) 122t, 124f
stage N3 (NREM 3) 122t, 124f
stage R (REM) 123t, 125f
stage W (Wakefulness) 122t, 123f
staging
digital tools, headband EEG 351
EEG 121, 122t, 123t
EEG electrode placement 118–119, 119f
mandibular movement 153, 351
PSG hypnogram 127, 128, 128f, 129f
states in newborn infants 370, 390
time spent during life 1
time spent with respiratory eort 29
sleep apnoea see apnoea, sleep
sleep apnoea–hypopnoea syndrome 129
"sleep attacks" 312
Sleep Clinical Record 388
sleep clinics 342–347
accredited, standard procedures 342
demand for OSA diagnosis 354, 355, 367, 368
number in Netherlands 368
organisational aspects 342–347
changes during SARS-CoV-2 pandemic 343
changes post-SARS-CoV-2 pandemic 343–346,
344f, 345t
current mixed model 346
SARS-CoV-2 pandemic impact 342, 343
traditional 342
patient-centred approach 346, 346f
personnel, more needed 346
referral 95, 148, 149, 152
telemonitoring of CPAP in OSA and 369
role 342
shi from PSG to ambulatory polygraphy 368
telemedicine role 342, 343–344, 368
telemedicine strategy for sleep disorders 344,
344f, 345–346
current mixed model 346
diagnostic strategy 344, 344f, 345
near-future model/role and goals 345, 345t
problems outstanding 345–346
protocols needed 345–346
see also telemedicine
sleep diary 90, 312–313, 334
sleep disorder(s)/disturbances 93t, 94
ageing eect 5–6
non-respiratory see non-respiratory sleep disorders
post-menopause 6
prevalence 337
respiratory see sleep disordered breathing (SDB)
sex dierences 6
symptoms in sleep history 91–92, 92t
see also specific disorders
sleep disordered breathing (SDB) 15–43, 309
categories in ICSD-3 15–17, 309
in children see children
comorbid with other disorders 230–253
see also individual disorders
CSA see central sleep apnoea (CSA)
definitions 15–22
economic costs 338–339, 338t
evaluation/diagnosis see sleep tests
events (apnoeas/hypopnoeas) 32
grading, specific see grading of SDB
in heart failure 199
hypoventilation syndromes see hypoventilation
syndromes
management
changes during SARS-CoV-2 pandemic 343
telemedicine see telemedicine
traditional to near-future model evolution 345t
OSA see OSA/OSA syndrome (OSAS)
pathophysiology 44–73
sleep quality (poor) 98
sleep fragmentation 348
in CSA 84
detection, mandibular movement detection 357
improved by CPAP in OSA 165
inflammatory cytokine release 244
markers, OSA severity grading 34
metabolic disorders in OSA and 108
in narcolepsy 325
ventilatory drive blunting 69
Sleep Heart Health Study (SHHS) 23–24, 25, 39, 41,
81
smoking and OSA 156
sleep history 90–94
children 387–388
collateral (partners) 75, 90, 91
daytime symptoms 92, 92t
description/definition 90
EDS see excessive daytime sleepiness (EDS)
in infants 386–387
initiating/maintaining sleep diculties 93t, 94
latency of sleep 91
obtaining 90–91
see also questionnaires
onset of sleep 91
OSA, evaluation of PAP therapy response 192, 193
sleep-related symptoms 91–92, 92t
437
sleep termination, events 91
https://t.me/medicina_free
sleep hygiene 157, 318
infants 387
OSA treatment 157
psycho-education on 318
sleep hypoventilation syndromes see hypoventilation
syndromes
sleepiness
assessment 141–146, 142t
excessive see excessive daytime sleepiness (EDS)
see also daytime somnolence
sleepiness at the wheel (SW) 92, 115, 336
non-OSA subjects 336
in OSA 336
prevalence 337
sleepiness state, assessment of sleepiness by 142t
sleepiness trait, assessment of sleepiness by 142t
sleep laboratory 342
see also sleep clinics
sleep latency (sleep-onset latency) 91
age and 6
in children 371
in insomnia 317
measurements, MWT 143, 144–145
motor vehicle accident risk in EDS 337
postmenopausal women 6
sleep-onset REM periods (SOREMPs) 142, 312, 326
in children 394
sleep paralysis 329–330
sleep physician 186, 190
sleep quality
asthma treatment impact 232
in COPD 233–234
measurement 355
poor, in SDB 98
in CSA 84
eect/impact 348
in type 2 diabetes and OSA 242
questionnaires see questionnaires
sleep questionnaires see questionnaires, sleep
sleep-related breathing disturbances (SRBD), in heart
failure 199
sleep-related hallucinations 312, 330
sleep-related hypoventilation disorders 15, 17, 392
due to a medical disorder 22, 42
due to medication/substance 22, 42
in infants/children see children
see also hypoventilation, nocturnal/sleep-related
sleep-related hypoxaemia disorder 15, 17
sleep-related movement disorders 93t, 310t
ICSD-3 criteria and types 310t, 311
insomnia comorbidity 313
prevalence 309
sleep restriction therapy (SRT) 318, 319
sleep spindles 5, 6–7
sleep tests 117–132
capnography 136–140
in hypoventilation 275
in neuromuscular conditions in children 380–381
out-of-centre (OCST), in OSA 18
portable monitoring (PM) 149, 193, 194
telemedicine and future model 344f, 345, 345t
type I/II monitoring see polysomnography (PSG)
type III devices/limited channel/home testing
129–131, 133–134, 149, 342
acceptability and sensitivity/specificity 130,
131, 133
accuracy 130, 131, 133, 134
actigraphy (built-in) 130
438
sleep tests (cont.)
advantages 130, 131, 133, 153
home sleep apnoea tests (HSAT) 129–131, 149
limitations 130, 133–134, 153, 154
minimum number of signals 130, 152
polygraphy see polygraphy (PG), respiratory
reporting, and AHI 130, 131, 134
SCOPER system 129–130, 130t
scoring, and standards 130
screening for OSA and CSA 152–154, 153f
sensor/two signals/two channels 129, 152
signal number, minimum 130
type IV studies 131–132, 152, 153
actigraphy (built-in) 130
limitations 132, 134–135, 154
for screening OSA 153
two sensors 131
see also oximetry
sleep-trackers, wearable 91, 154
sleep–wake cycle 1–2, 332
in children 371
disturbances see circadian rhythm sleep–wake
disorders (CRSWD)
in fetus and infants 370–371, 390–391
models 2
neural regulation 1–2, 3f
regularity, in sleep history 91
see also NREM–REM sleep cycling
sleepwalking 328
slow-wave sleep (SWS) 2, 3
age aecting time spent 5, 6
homeostatic function 318
menstrual cycle, changes with 6
reduced, in insomnia 318
transition to REM sleep, neurobiology 2
smartphones and smartphone apps 91, 345, 349
EEG headband device app 351
mandibular movement detection 357
movement detection 349f, 350t
optimising OSA treatment and 362
patient support in CPAP treatment 184, 339, 359,
360, 362
tracheal sound recording 357
see also telemonitoring
smoking cessation 156, 278
sni nasal inspiratory pressure (SNIP) 271
snoring 91
asthma and OSA 231
by children 376, 377, 378, 383, 387
idiopathic pulmonary fibrosis and OSA 236
improvement, tongue muscle stimulation 161
monitoring, PSG 120
in OSA/OSAS 32, 74, 75, 78, 148
in children 377
primary 376
"simple" vs in OSA 91, 92t
socioeconomic impact, sleep disorders 337–340
economic burden of OSA 339–340, 339f
economic costs see economic costs
OSA 339–340, 339f
estimating costs 338–339, 338t
underdiagnosis eects 367–368
sodium/glucose cotransporter (SGLT)-2 inhibitors
246
sodium oxybate 326t
solriamfetol 162, 326t
somatostatin analogue treatment 252
Somfit system 350t, 351
spinal and bulbar muscular atrophy 265
spinal cord injury 59
https://t.me/medicina_free
spinal motor activity, REM sleep 4f
spinal muscular atrophy (SMA) 265, 274, 306, 380,
403
spirometry, in breathlessness 270, 270t
split-night studies
polysomnography, in OSA 118
TECSA 223–224
stages of sleep see sleep, stages
staging of sleep see sleep, staging
Stanford Sleepiness Scale (SSS) 95, 96, 141
STAR (Stimulation Therapy for Apnea Reduction) trial
161
Stensen"s duct 178
stimulus control therapy 318
STOP-Bang questionnaire 97–98, 98t, 148, 239t
STOP questionnaire 97
Stow–Severinghaus electrode 138
stroke 227
acute, hypercapnic respiratory failure 264, 265t
CSA impact on 88
CSA in 39, 62, 227
CSR in/aer 19, 39, 55, 84
in early morning hours 11
OSA association 18, 76t, 80, 81, 149
subcoeruleus region 2
substance abuse
CSA due to 19–20, 40
parasomnias associated 331
see also opioids, chronic use
sudden cardiac death, SERVE-HF trial 207
sudden infant death syndrome (SIDS) 374
sulthiame 50, 162
supine apnoea index 159
support
for family carers/caregivers 308
OSA treatment 183–184, 359, 360
psychosocial, palliative medicine 307
suprachiasmatic nucleus (SCN) 1–2, 12, 12f, 332
supraglottoplasty 398
surgery
anaesthetic considerations 279
decision-making, in hypoventilation syndromes
278
in neuromuscular/chest wall conditions 278–281
anaesthesia 279
post-operative management 279
pre-operative assessment 278–279
OSA treatment 157–158
in pregnancy with hypoventilation 280–281
suxamethonium 279
sympathetic activity
arousals in CSA, HF outcome 85f, 86
decrease, nocturnal low flow O2 therapy 216
fall in NREM sleep 11
glycaemic control in diabetes 244
intermittent hypoxaemia causing 44
markers, OSA severity grading 34
OSA-associated type 2 diabetes 244
in REM sleep 11, 244
a-synucleinopathies 227, 314, 329
T
T88 (88% oxygen saturation) 24
T90 (90% oxygen saturation) 24–25, 113
tachycardia 127
TECSA see treatment-emergent CSA (TECSA)
telemedicine 343–344
current/future SDB management 343–346
current limitations/problems 345–346
current mixed model 346
diagnosis 344, 345, 345t
future goals and model 345, 345t
PAP monitoring see telemonitoring
proposed model/strategies 344, 344f
see also sleep clinics
data protection issues 346
e-consultations/remote consultations 344, 369
requirements 361–362
SDB management evolution 345t
since SARS-CoV-2 pandemic 342, 343–346, 344f,
345t
technologies, and future use 345, 345t
see also digital technology
telemonitoring 184, 344
CPAP in OSA 184, 186, 343, 345t, 360–361, 365
alerts generated 360–361, 362
artificial intelligence and data 365
decision tree 361, 362f
long-term programmes 360
mandatory for remote consultations 362
multimodal 360
in the Netherlands 369
remote consultations, requirements 361–362
residual AHI (rAHI) destabilising 361f
trial period of CPAP 369
impact of SARS-CoV-2 pandemic 342, 343–346,
344f, 345t
increase in, post-pandemic 343
motor neurone disease (MND/ALS) 306
NIV 290–291
PAP therapy 184, 186, 343, 345, 345t
commercial platform issue 345
problems to be solved 345–346
records, keeping 345
see also digital technology
temperature, body
NREM sleep 2
REM sleep 3
TESLA trial 161
tests, sleep see sleep tests
theophylline 217
thermistors 120
thoracic movements
apnoea 16f
hypopnoea 17f
thoracic spine, evaluation 103
thromboembolism, OSA association 82, 196
thyroid hormones 248
deficiency 248–250
replacement therapy 250
thyroiditis, chronic autoimmune 248
thyroid-stimulating hormone (TSH) 249t, 250
thyroxine (T4) 248, 249t, 250
ticagrelor 63
tidal volume
average (normal) 66
NIV titration 286t
pressure-targeted ventilation 283
respiratory failure 66
tiotropium 235
tongue
increased size, OSA risk 47
muscle stimulation 161
point-of-care ultrasound in OSA 104
volume, hyoid bone displacement 46
tongue base collapse 158
439
tongue-stabilising device 159
https://t.me/medicina_free
tonometry, peripheral arterial 28
tonsillectomy 379, 383, 399–400
tonsils, enlarged 47, 377, 379, 387, 393
topical steroids, nasal 177, 183, 401
total apnoea duration (TAD) 24t
total apnoea–hypopnoea duration (TAHD) 25–26, 26t
total hypoponea duration (THD) 24t
trachea, displacement 47
tracheal cannula 282
tracheal pressure 72
tracheal sounds, recording, OSA diagnosis 357
"trachea traction" theory 236
tracheostomy 224, 282–283
advance care planning 306
elective or semi-elective 293, 294
indications 293–295, 294t
congenital central hypoventilation syndrome
403
hypoventilation syndromes in children 404
management in children 400t, 404
OSAS management in children 400t
in Pierre Robin sequence 398
tracheostomy-delivered ventilation (T-IPPV) 282,
293, 307
at home 293
indications 293–294, 294t
infants/children 293–294, 400t
NIV vs 294, 295
outcome 294
planning for, discharge home 294, 294t, 295
tracking systems, CPAP 186, 188–189
training
CPAP in OSA, for adherence 183–184
NIV adherence and 291
transdiaphragmatic pressure (Pdi)
measurement 271
twitch Pdi 272
transvenous phrenic nerve stimulation (TPNS) 219
treatment-emergent CSA (TECSA) 20–21, 57, 222–
225, 227, 343
ASV use 225–226
clinical features 84
CPAP therapy associated in OSA 179, 188, 222,
223–224, 225, 227
CPAP treatment continued 225, 227
CSA in HF and 226
definition 20, 222–223
first observation of 222–223
ICSD-3 criteria 20–21
in OSA aer non-positive pressure therapy 225
pathophysiology 61–62, 222, 223–224, 226
patterns, data analysis 365
phenotypes 224
prevalence 41, 223–224, 223t
resolution over time 224, 225, 227
risk factors 224
trisomy 21 397, 399, 400
type I/II devices see polysomnography (PSG)
type III devices see under sleep tests
type IV devices see under sleep tests
upper airway 46–47
adiposity in obesity hypoventilation syndrome
255, 256
collapse/collapsibility
inspiration vs expiration in OSA 170
interstitial lung diseases and OSA 236
obesity hypoventilation syndrome 256
OSA pathophysiology 44, 45f, 46, 77, 169
susceptibility to 46, 47
variations in OSA (within single night) 169
compromise, degree estimation 102, 103f
critical closing pressure (P
evaluation 102–103
functional anatomy 46–47
in infants/young children 372
inspiratory/expiratory size change 47
length, pharyngeal collapsibility and 46
lung volume changes and 47
motor suppression, REM sleep 4f
narrowing 102
in obesity 101, 255, 256
in OSA 44, 77, 102
obstruction 15, 44
ASV therapy eect 206, 207
bony structure role 46
causes, in OSA 15
hypothyroidism and OSA 250
infants/children 372, 377, 397
OSA pathophysiology 44, 46, 62
pathophysiological concept 44–54
see also upper airway, collapse/collapsibility
OSA pathophysiology 44, 45f, 46–49, 53, 62, 77,
102
overnight rostral fluid shi aecting 47, 79
patency, factors aecting 102
reduced patency, OSAS in children 377
resistance
APAP therapy and 160
COPD 67
decreased with lung volume increase 68, 68f
decreased with pharyngeal muscle activation 45
increased, in COPD, hypoventilation 67, 68f, 69
NIV management 69, 283
obesity 69, 174, 255
obesity and OSA, hypoventilation and 69
see also upper airway resistance syndrome
(UARS)
so tissue characteristics 46, 47
structural factors (bony), OSA and 46
surgery, OSA treatment 157
see also pharyngeal airway
upper airway muscles 47–49
medical interventions targeting 49
OSA pathophysiology 47–49
relaxation in sleep 47, 48
see also pharyngeal dilator muscles
upper airway resistance syndrome (UARS) 376
diagnosis in children 378
urocortin-3 30
uromodulin 30
uvulopalatopharyngoplasty 157, 400
) 44, 46, 53, 156
crit
U
ultrasound
diaphragm 271
point-of-care, in OSA 104, 104f
underdiagnosis of OSA see OSA/OSA syndrome
(OSAS)
440
V
vagal nerve mechanisms, apnoea and bradycardia
374f
vasodilation, cerebral 61
V'E see minute ventilation (V"E)
venlafaxine 326t
ventilation (alveolar ventilation) 66
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cessation in CSA 15, 56
impairment, before hypoventilation development
273
increased see hyperventilation
loop gain of see loop gain
monitoring, digital technology 349, 351
normal 66, 67f
overshooting see ventilatory overshoot
periodic breathing 55, 61
reduced see hypoventilation
regulation 57, 58f
undershooting 60, 224
see also ventilatory drive
ventilation, mechanical 282–283
approaches 282–283
CPAP see CPAP
at home 282
invasive see invasive mechanical ventilation
long-term 282, 293
modes, trigger and cycle 283–284, 285t
noninvasive see NIV
PAP see positive airway pressure (PAP) therapy
tracheostomy delivering see tracheostomy;
tracheostomy-delivered ventilation (T-IPPV)
see also specific conditions
ventilation–perfusion (V'/Q') mismatch
in COPD and OSA 233
hypoventilation with 65
hypoxic respiratory failure 65
PAP therapy eect, in CSA 204
ventilatory acclimatisation to hypoxia 11
ventilatory drive 44, 49–50, 51f, 53
chemical drive see chemical drive
control 57, 58f, 66, 67f, 71–72, 72f
controlled oxygen, principles 70–71, 71f
in COPD 72
CSA pathophysiology 56, 57, 59, 61, 62, 63
definition/explanation 49, 67f
drugs reducing 50, 67f, 70
opiates 70, 71
eupnoeic 51f, 52, 53
hypercapnia, response 3, 9–10, 57, 58f
see also hypercapnic ventilatory response
(HCVR)
hypoventilation mechanism 66–67, 67f, 71
hypoxic 3, 9–10, 9f, 44, 57, 58f, 70, 71
removal, by uncontrolled oxygen 67f, 70–71,
71f
see also hypoxic ventilatory response (HVR)
increased
arousal and 51f, 52, 53
carbonic anhydrase inhibitors 50
hypoventilation response 44–45
loop gain and see loop gain
markers, neural transmission 71–72, 72f
measurement 50
mechanical-behavioural (wake) drive 49, 50
mechanoreceptors influencing 49, 66
normal 66, 67f
in obesity and OSA 69
OSA pathophysiology 44, 49–50, 51f, 52, 53
oxygen therapy eect on 50, 67f, 71, 71f, 80–81,
302
reduced 67f, 70
brainstem event or Ondine"s curse 67f, 70
cerebral alkalosis 61
drug-induced, hypoventilation in 50, 67f,
70–71
hypoventilation treatment 71
by uncontrolled oxygen 67f, 70–71, 71f
respiratory arousal threshold and 51f, 52, 53
in sleep, normal 3, 4f, 50
treatment-emergent CSA 62
V'
and V'
passive
wake drive 44, 49, 50
see also respiratory drive
ventilatory failure
acute, oxygen therapy 302, 303b
acute-on-chronic 302
chronic, oxygen therapy 304
see also hypercapnia; hypoventilation
ventilatory overshoot 11, 58, 58f, 60, 61, 62, 199,
224
volume overload inducing 204
ventilatory response (VR)
hypercapnic see hypercapnic ventilatory response
(HCVR)
hypoxic see hypoxic ventilatory response (HVR)
infants 371
ventilatory undershoot 60, 224
ventral respiratory group (VRG) 7–8, 8f
ventricular arrhythmias, in CSA and CSR 85
ventricular contractions, premature, in COPD 234
vibration alarm, positional therapy 160, 160f
video-PSG 127
in children 389
non-respiratory sleep disorders 311–312, 314
NREM parasomnia 311, 328–329
REM parasomnias 311–312, 329
video recordings
during PSG see video-PSG
sleep-related symptoms 91
vigilance tests, in hypersomnias 312
vital capacity (VC)
nocturnal hypoventilation and 274
in pregnancy and hypoventilation 280
respiratory muscle weakness and 270
surgery risk 278–279
vocal cord problems, CPAP side-eects in OSA 175f,
177
volatile organic compounds, exhaled 30
volume-assured pressure support (VAPS) 283
volume overload 204
volume-targeted ventilation (VTV) 283, 284f
V'/Q' mismatching see ventilation–perfusion
mismatch
active
51f, 53
W
wake (wakefulness) drive 44, 49, 50
wakefulness
breathing control during 7–9, 8f
low level, in idiopathic hypersomnia 325
neurotransmitter systems 3f
stage W, EEG 389
states, digital technology monitoring 351
upper airway dilators activated in OSA 47
waking
aer sleep onset, age and 5, 6
see also arousal(s)
watches, movement detection 349f, 350t
wearable sleep respiratory monitors 91, 154, 349f,
350t
weight gain
CPAP in OSA associated 179
OSA risk factor 38–39
significant, PAP monitoring in 187–188
441
weight loss
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antidiabetic drug eect 245–246
obesity hypoventilation syndrome treatment 261
OSA therapeutic strategy 155–156
in children 402–403
in diabetes/metabolic syndrome 242, 244, 245
positional OSA and 160
significant, PAP monitoring in 187–188
skeletal muscle weakness and 270
weight-reducing agents/drugs 156
women
CSA prevalence 39
hypoxic ventilatory response 7
OHS prevalence 41
OSA prevalence 38, 39, 77–78
sleep disorder post-menopause 6
work accidents 80, 149, 336, 340
work of breathing
COPD 68, 68f
increased, hypoventilation development 273
in obesity and OSA 69
obesity hypoventilation syndrome 255
World Health Organization (WHO)
death rates from motor vehicle accidents 337
telemedicine 343–344
treatment adherence, definition 181
X
XENDOS trial 244
Y
years of healthy life lost due to disability (YLDs) 339
years of life lost due to premature death (YLLs) 339
Z
Z-hypnotics 183
zolpidem 61, 226, 235
Zulewski score 250
442
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