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What is Sleep Apnea?

Excerpted from Wikipedia.com

Sleep apnea (or sleep apnoea in British English; English pronunciation: /æpˈniːə/) is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or “sleep study”.

There are three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (i.e., a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively. In CSA, breathing is interrupted by a lack of respiratory effort; in OSA, breathing is interrupted by a physical block to airflow despite respiratory effort, and snoring is common.

Regardless of type, an individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body (sequelae). Symptoms may be present for years (or even decades) without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

Signs and symptoms

Sleep apnea affects not only adults but some children as well. As stated by El-Ad, “patients complain about excessive daytime sleepiness (EDS) and impaired alertness.” In other words, common effects of sleep apnea include daytime fatigue, a slower reaction time, and vision problems. Moreover, patients are examined using “standard test batteries” in order to further identify parts of the brain that are affected by sleep apnea. Tests have shown that certain parts of the brain cause different effects. The “executive functioning” part of the brain affects the way the patient plans and initiates tasks. Second, the part of the brain that deals with attention causes difficulty in paying attention, working effectively and processing information when in a waking state. Thirdly, the part of the brain that uses memory and learning is also affected. Due to the disruption in daytime cognitive state, behavioral effects are also present. This includes moodiness, belligerence, as well as a decrease in attentiveness and drive. These effects become very difficult to deal with, thus the development of depression may transpire. Finally, because there are many factors that could lead to some of the effects previously listed, some patients are not aware that they suffer from sleep apnea and are either misdiagnosed, or just ignore the symptoms altogether.

Diagnosis

The diagnosis of sleep apnea is based on the conjoint evaluation of clinical symptoms (e.g. excessive daytime sleepiness and fatigue) and of the results of a formal sleep study (polysomnography, or reduced channels home based test). The latter aims at establishing an “objective” diagnosis indicator linked to the quantity of apneic events per hour of sleep (Apnea Hypopnea Index(AHI), or Respiratory Disturbance Index (RDI)), associated to a formal threshold, above which a patient is considered as suffering from sleep apnea, and the severity of his sleep apnea can be then quantified.

Nevertheless, due to the number and variability in the actual symptoms and nature of apneic events (e.g., hypopnea vs apnea, central vs obstructive), the variability of patients’ physiologies, and the intrinsic imperfections of the experimental setups and methods, this field is opened to debate. Within this context, the definition of an apneic event depends on several factors (e.g. patient’s age) and account for this variability through a multi-criteria decision rule described in several, sometimes conflicting, guidelines. One example of a commonly adopted definition of an apnea (for an adult) includes a minimum 10 second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation.

Oximetry

Oximetry, which may be performed overnight in a patient’s home, is an easier alternative to formal sleep study (polysomnography). In one study, normal overnight oximetry was very sensitive and so if normal, sleep apnea was unlikely.In addition, home oximetry may be equally effective in guiding prescription for automatically self-adjusting continuous positive airway pressure.

History

The clinical picture of this condition has long been recognized as a character trait, without an understanding of the disease process. The term “Pickwickian syndrome” that is sometimes used for the syndrome was coined by the famous early 20th century physician, William Osler, who must have been a reader of Charles Dickens. The description of Joe, “the fat boy” in Dickens’s novel The Pickwick Papers, is an accurate clinical picture of an adult with obstructive sleep apnea syndrome.

The early reports of obstructive sleep apnea in the medical literature described individuals who were very severely affected, often presenting with severe hypoxemia, hypercapnia and congestive heart failure.

The management of obstructive sleep apnea was revolutionized with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates in Sydney, Australia.The first models were bulky and noisy, but the design was rapidly improved and by the late 1980s CPAP was widely adopted. The availability of an effective treatment stimulated an aggressive search for affected individuals and led to the establishment of hundreds of specialized clinics dedicated to the diagnosis and treatment of sleep disorders. Though many types of sleep problems are recognized, the vast majority of patients attending these centers have sleep-disordered breathing.

See also

  • Deviated septum
  • Catathrenia
  • Marfan syndrome
  • Obesity hypoventilation syndrome
  • Ondine’s curse
  • Sleep medicine
  • Snoring

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