Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring. A choking or snorting sound may occur as breathing resumes. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children, it may cause hyperactivity or problems in school.
A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.
Apnea, BrE: apnoea, is the temporal cessation of breathing. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are, there may or may not be a flow of gas between the lungs and the environment. If there is sufficient flow, gas exchange within the lungs and cellular respiration would not be severely affected. Voluntarily doing this is called holding one's breath. Apnea may first be diagnosed in childhood, and it is recommended to consult an ENT specialist, allergist or sleep physician to discuss symptoms when noticed; malformation and/or malfunctioning of the upper airways may be observed by an orthodontist.
Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.
A mandibi splint or mandibi advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards.
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.
The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.
Hypopnea is overly shallow breathing or an abnormally low respiratory rate. Hypopnea is defined by some to be less severe than apnea, while other researchers have discovered hypopnea to have a "similar if not indistinguishable impact" on the negative outcomes of sleep breathing disorders. In sleep clinics, obstructive sleep apnea syndrome or obstructive sleep apnea–hypopnea syndrome is normally diagnosed based on the frequent presence of apneas and/or hypopneas rather than differentiating between the two phenomena. Hypopnea is typically defined by a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It commonly is due to partial obstruction of the upper airway.
Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure. CPAP therapy is highly effective for managing obstructive sleep apnea. Compliance and acceptance of use of CPAP therapy can be a limiting factor, with 8% of people stopping use after the first night and 50% within the first year.
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.
The Apnea–Hypopnea Index or Apnoea–Hypopnoea Index (AHI) is an index used to indicate the severity of sleep apnea. It is represented by the number of apnea and hypopnea events per hour of sleep. Apnea is the complete absence of airflow through your nose and mouth. Hypoapnea is a partial collapse of your airway, limiting breathing. Apneas must last for at least 10 seconds and be associated with a decrease in blood oxygenation to be considered. Combining AHI and oxygen desaturation gives an overall sleep apnea severity score that evaluates both the number of sleep breathing disruptions and the degree of oxygen desaturation during said disruptions.
Christian Guilleminault was a French physician and researcher in the field of sleep medicine who played a central role in the early discovery of obstructive sleep apnea and made seminal discoveries in many other areas of sleep medicine.
Sabeluzole (R-58,735) is a nootropic and neuroprotective drug which was originally developed for the treatment of Alzheimer's disease, and has subsequently been researched for other applications such as sleep apnoea. It acts primarily as an NMDA antagonist, but other mechanisms of action may also be important.
Central sleep apnea (CSA) or central sleep apnea syndrome (CSAS) is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds either intermittently or in cycles, and is usually associated with a reduction in blood oxygen saturation. CSA is usually due to an instability in the body's feedback mechanisms that control respiration. Central sleep apnea can also be an indicator of Arnold–Chiari malformation.
Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.
The British Sleep Society (BSS) was established in 1988 to support clinicians, researchers, nurses, technologists, scientists and students with an interest in sleep and sleep disorders. It acts as an umbrella organisation, with a number of roles and activities. The Society advises health services policy through submitting evidence for consideration by the National Institute for Health and Care Excellence (NICE). It organises an influential scientific meeting each year dedicated to sleep disorders and sleep research and jointly hosts an annual international education course for sleep technologists and clinicians. The Society has charitable status, and operates throughout England, Wales, Northern Ireland and Scotland. It serves the media, fund raisers, commerce and concerned members of the public with support and advice.
Classification of sleep disorders, as developed in the 19th century, used primarily three categories: insomnia, hypersomnia and nightmare. In the 20th century, increasingly in the last half of it, technological discoveries led to rapid advances in the understanding of sleep and recognition of sleep disorders. Major sleep disorders were defined following the development of electroencephalography (EEG) in 1924 by Hans Berger.
Magdy Kherallah Younes is a Canadian physician and researcher specializing in respirology and sleep medicine. His major areas of focus include reflex control of breathing during exercise, sleep and mechanical ventilation; pathogenesis of respiratory failure; patient-ventilator interactions; hemodynamics of pulmonary circulation; pathogenesis of obstructive sleep apnea; and determination of novel biomarkers in the electroencephalogram (EEG). He is the inventor of several novel approaches to diagnosis and treatment, including Proportional Assist Ventilation (PAV), methods for non-invasive determination of passive respiratory mechanics during assisted ventilation, and Odds Ratio Product of sleep (ORP). These approaches have led to the development of several medical devices, including the Winnipeg Ventilator.
Human jaw shrinkage is the phenomenon of continued size reduction of the human mandible and maxilla over the past 12,000 to 15,000 years. Modern human lifestyles and diets are vastly different now from what they were for most of human evolutionary history. Human jaws, as well as oral cavities, have been shrinking ever since the Neolithic agricultural revolution. This has been confirmed by bone remains dated to this time period. Researchers are able to infer the basic lifestyle practices of past cultures, enabling them to link jaw size with lifestyle practice/behaviors. Bones from burial sites of past hunter-gatherer societies are associated with larger jaws and mouths, while bones retrieved from former farming cultures have decreased jaw size. Bones from farming societies also indicate the presence of dental malocclusions, commonly known as non-straight teeth. Within recent centuries, as food has become more processed and soft in form, a rapid increase in non-straight teeth, smaller jaws, and mouths; a lack of space for wisdom teeth; and associated health conditions have been observed. Such conditions include sleep apnea, constricted airways, and decreased respiratory fitness. Medical professionals have been making similar observations and documenting them for hundreds of years. Changes in diet, lifestyle, and breathing patterns have led to maladaptive phenotypic expression in terms of morphological craniofacial development that starts in childhood but persists throughout the lifespan.
Atul Malhotra is the director of research for pulmonary, critical care, sleep medicine, and physiology at the University of California, San Diego's Medical School. In addition, he is the Peter C. Farrell Presidential Chair and tenured professor of medicine at the same university. He is the author of almost 800 research publications, reviews, and book chapters.
