DECISION MAKING IN OBSTRUCTIVE SLEEP-DISORDERED BREATHING : Putting it all Together - 09/09/11

Doi : 10.1016/S0272-5231(05)70434-2

Ahmed Bahammam, MD, MRCP (UK) ^a,^b, Meir Kryger, MD, FRCPC ^b

^a Department of Internal Medicine (AB, MK)

^b Sleep Disorders Center (MK), University of Manitoba, Winnipeg, Manitoba

Résumé

Obstructive sleep-disordered breathing (OSDB) is a relatively common medical problem. It consists of a spectrum ranging from apnea to hypopnea to the upper airway resistance syndrome (UARS). Obstructive apnea refers to the temporary cessation of airflow during sleep for 10 seconds or more despite continuing ventilatory effort, whereas hypopnea means reduction of 30% to 50% in airflow for 10 seconds or more. The two findings often overlap each other in the same patient. On the other hand, UARS is characterized by frequent arousals in response to increased respiratory effort as a result of upper airway narrowing, without overt apnea or hypopnea. Patients with UARS are usually heavy snorers.

Obstructive sleep apnea (OSA), the most widely known disorder in the category, affects 2% to 4% of middle-aged adults.^{107 Young T., Palta M., Dempsey J. , et al. The occurrence of sleep-disordered breathing among middle-aged adults N Engl J Med 1993 ; 328 : 1230-1235 [cross-ref]

Cliquez ici pour aller à la section Références} UARS, on the other hand, appears to be under-recognized and under-reported,^{25 Downey R., Perkin R.M., Mac Quarrie J. Upper airway resistance syndrome: Sick symptomatic but underrecognized Sleep 1993 ; 16 : 620-623

Cliquez ici pour aller à la section Références} resulting in underestimation of the real incidence of the disorder.

This article focuses on the overall management of patients with OSDB, trying to use the best current evidence in making decisions regarding each step of management. We offer a general overview of the rationale for treating obstructive sleep disorders, then discuss the management approach for OSDB, covering its recognition, diagnosis, and treatment, trying to develop a systematic approach. The reader must understand, however, that there is no universal agreement on the best approach to management of OSDB. It is also important to realize that controversies do exist among experts about the significance of apnea and whether it should be treated.^{88 Stradling J. Sleep apnea and the misuse of evidence-based medicine Lancet 1997 ; 349 : 201-202 [cross-ref]

Cliquez ici pour aller à la section Références, 102 Wright J., Johns R., Watt I. , et al. Health effects of obstructive sleep apnea and the effectiveness of continuous positive airway pressure: A systematic review of the search evidence BMJ 1997 ; 314 : 851-860

Cliquez ici pour aller à la section Références}

Le texte complet de cet article est disponible en PDF.

Plan

WHY SLEEP APNEA SHOULD BE DIAGNOSED AND TREATED

RECOGNITION OF OBSTRUCTIVE SLEEP APNEA

Laboratory Investigation

WHO SHOULD RECEIVE TREATMENT FOR OBSTRUCTIVE SLEEP-DISORDERED BREATHING

TREATMENT

General Measures

Specific Therapy

SUMMARY AND APPROACH TO MANAGEMENT

Address reprint requests to Meir Kryger, MD, FRCPC, Sleep Disorders Center, St. Boniface General Hospital Research Center, R2034, 351 Tache Avenue, Winnipeg, Manitoba, R2H 2A6