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Progress in Sleep Research
Ahmed S. BaHammam
MahadevappaHunasikattiEditors
Sleep
Apnea
Frontiers
Pathophysiology, Diagnosis, and
Treatment Strategies
Progress in Sleep Research
The book series provides an overview of the physiological processes involved in
sleep regulation and the essential role of sleep in various vital physiological pro-
cesses. It also summarizes the different stages of sleep and the clinical features
of common sleep disorders. The individual books discuss the neurological and
neuropsychological implications of sleep and highlight the relation between
sleep and brain structure-functions. It explores the impact of sle
ep on circadian
biology, neuroanatomy, neurophysiology, neuropharmacology, neuroendocrinol-
ogy, neuroimmunology, neuropathol ogy, basic neurology, biological psychiatry,
and the behavioral sciences. It reviews the genetic factors associated with normal
sleep and sleep disorders. It also describes the recent advances in research aiming to
elucidate the neurochemical mechanisms regulating sleep and wakefulness.
Ahmed S. BaHammam
•
Mahadevappa Hunasikatti
Editors
Sleep Apnea Frontiers
Pathophysiology, Diagnosis, and Treatment
Strategies
Editors
Ahmed S. BaHammam
The University Sleep Disorders Center,
Department of Medicine, College of
Medicine
King Saud University
Riyadh, Saudi Arabia
Mahadevappa H
unasikatti
Division o
f Respiratory, Sleep and
Anesthesiology (DSRA), OHT1, Food and Drug
Administration (FDA)
Silver Spring, MD, USA
ISSN 2730-5678 ISSN 2730-5686 (electronic)
Progress in Sleep Research
ISBN 978-981-99-7900-4 ISBN 978-981-99-7901-1 (eBook)
https://doi.org/10.1007/978-981-99-7901-1
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore
Pte Ltd. 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by
similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Paper in this product is recyclable.
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This article/speech/other publication reflects
the views of the author and should not be
construed to represent FDA’s views or
policies.
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Preface
“Sleep is the only medicine that gives ease.”
—Sophocles (496–406 B.C.E.)
Getting the right amount and quality of sleep is not a luxury but a necessity that no
one can ignore. Early, undifferentiated stages of a problem are much harder to
diagnose than later stages when symptoms have advanced to the point where the
diagnosis is clear. A ton of literature has been written about sleep apnea. In the
modern world, scientists and researchers have access to vast and expanding infor-
mational resources that offer in-depth knowledge, instruction, and training to
advance and improve research. This book differs from others in that it focuses on
a specific area of research rather than being a traditional volume on sleep medicine. It
embodies the authors’ seriousness, sincerity, and passion as they attempt to lead and
direct the reader in their pursuit of research to discover new information, recognize
issues, and offer solutions.
This specialty volume covers a wide range of important topics related to OSA and
sleep-disordered breathing, including OSA screening, the current clinical perspec-
tive of adult OSA, perioperative evaluation and management of patients with sleep-
disordered breathing, central sleep apnea, OSA co-occurring with insomnia, sleep
telemedicine during the COVID-19 pandemic, wearable technology, sleep disorders
and traffic safety, the current clinical perspective of adult OSA, recent developments
in surgical treatments for snoring and OSA, the use of neurostimulators in OSA,
advances in PAP and nonsurgical therapies, and the significance of REM on sleep
dysfunctions, and the impact of COVID-19 pandemic on OSA and other sleep
disorders.
The importance of the disorders is discussed, and the availability of new data was
considered while selecting the topics for this volume, though most authors empha-
size the need for more study. Additionally, the authors featured in this volume come
from different parts of the globe, each representing a specific area of expertise in
studying sleep and its disorders.
The title of this book makes clear that it is written with sleep specialists and other
healthcare professionals in mind. Therefore, this volume should be an excellent
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reference for sleep medicine practitioners and physicians-in-training, as well as
students, primary care and general physicians, and diverse medi cal specialty inter-
ested in the field of sleep medicine.
viii Preface
Although the chapters were written
and revised at the height of the COVID-19
pandemic, the planning for this edition started in 2020. We are, therefore, even more
appreciative than usual of the many contributors who made time to work on the book
despite the pandemic’s demands on their personal and professional lives.
In light of the fact that our population is inexorably sleep-deprived and that sleep
medicine must deal with an increasing number of patients with sleep disorders who
have multiple, complicated problems, we have been able to assemble the brightest
minds and industry pioneers to offer authoritative leadership.
The greatest strength of this volume is the representation of several authors’
personal experiences. It is encouraging to see how many people took the initiative to
use this platform to share their knowledge and breadth of experience regarding sleep
research. In addition, the book is easy to read and comprehend. The topic of sleep
health, in general, and sleep apnea, in particular, is discussed. This is a valuable book
that every sleep researcher, practitioner, and trainee will want to keep handy for
quick reference.
Chapters are written by eminent clinicians, educators, and researchers in the field
of sleep medicine. The volume’s text, tables, and illustrations are well balanced and
provide readers with useful information. The main objective of this volume is to
increase readers’ knowledge of sleep apnea, which will directly improve patient-
centered care across a range of clinical settings. Overall, our authors include a sizable
number of subspecialists from various sleep disciplines as well as many sleep
specialists. The authors also come from a wide range of medical specialties.
The editors of the book have more than two decades of experience in sleep
medicine practice and research. Furthermore, they have extensive experience con-
tributing, editing, and managing journals relevant to sleep medicine. Finally, we
hope this book will convey some of our joy at having been given a chance to work in
the quickly expanding field of sleep medicine. The field is dynamic, so this book
aims to provoke thought rather than provide a solution. As a result, we anticipate that
this volume will be even more educational and useful for the readers.
Riyadh, Saudi Arabia Ahmed S. BaHammam
Fairfax, VA, USA Mahadevappa Hunasikatti
09/01/2022
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Acknowledgments
A project like this represents the collective scholarship of an academic community,
not just one or two individuals, and this volume in particular. The majority of the
information is the contributions of other people. Hence, there are a few thanks that
must be given.
First and foremost, this volume’ s editing was made possible thanks in large part
to Prof. Seithikurippu R. Pandi-Perumal and Springer publishers’ trust and support.
We appreciate each and every one of our contributors for dedicating precious time
and lending their knowledge to the chapters they wrote. We appreciate Springer’s
staff for their strict publishing guidelines and commitment to excellence.
Ahmed S. BaHammam
Mahadevappa Hunasikatti
09/01/2022
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5
Contents
1 Neuro-Stimulator Use in Obstructive Sleep Apnea—Past,
Present and Future .. .... ..... .... ..... .... .... ..... .... 1
Christopher N. Schmickl, Andrew M. Vahabzadeh-Hagh,
and Atul Malhotra
2 Positive Airway Pressure Therapies: Advances of the Decade .. ... 19
Mashni Alsaeed, Yousef MohamedRabaa Hawsawi,
and Ahmed S. BaHammam
3 Advances in Alternate, Non-PAP, Non-surgical Therapies
in the Treatment of Obstructive Sleep Apnea . ...... ..... ..... 35
Mahadevappa Hunasikatti, Seithikurippu R. Pandi-Perumal,
and Ahmed S. BaHammam
4 Perioperative Assessment and Management of Patients
with Sleep Disorders . .... .... .... ... .... .... .... .... .... 49
Vinh Nguyen, Brian Freeman, and Kumudhini Hendrix
5 Central Sleep Apnea: Advances in the Last Decade ... ..... ..... 67
Ahmed S. BaHammam, Mahadevappa Hunasikatti,
and Seithikurippu R. Pandi-Perumal
6 Current Clinical Perspective of Adult Obstructive Sleep Apnea:
Symptomatology, Clinical Features, and Different Phenotypes . .. . 8
Ahmed S. BaHammam, Mahadevappa Hunasikatti,
and Seithikurippu R. Pandi-Perumal
7 Is Screening of Obstructive Sleep Apnea Necessary? Current
Perspectives on Screening/Diagnosis .. .. ... ... ... .. ... ... ... 101
Barry Krakow and Mahadevappa Hunasikatti
8 Diagnosis and Management of OSA Comorbid with Insomnia
(COMISA) ........ ................. ................ .. 107
Ravi Gupta and Lokesh Kumar Saini
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