Apneas, hypopneas, and respiratory effort-related arousals: Moving closer to a standard

Current Opinion in Pulmonary Medicine

Volumn 8, Issue 6, 2002, Pages 493-497

  Lewis, Kevin L ^a   Phillips, Barbara A ^a  

^a UNIVERSITY OF KENTUCKY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

APNEA; AROUSAL; BREATHING DISORDER; HUMAN; HYPOPNEA; HYPOVENTILATION; OBESITY; PATIENT MONITORING; POSITIVE END EXPIRATORY PRESSURE; PROGNOSIS; REIMBURSEMENT; REVIEW; SLEEP APNEA SYNDROME; SLEEP DISORDER; SNORING; STANDARD; SYNDROME DELINEATION;

APNEA; HUMANS; PROGNOSIS; RESPIRATION DISORDERS; RISK FACTORS; SEVERITY OF ILLNESS INDEX; SLEEP APNEA SYNDROMES; SNORING; WORK OF BREATHING;

EID: 0036838802     PISSN: 10705287     EISSN: None     Source Type: Journal    
DOI: 10.1097/00063198-200211000-00001     Document Type: Review

References (26)

1. 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. Classic epidemiologic cohort quoted often for its prevalence estimates of sleep disordered breathing in middle aged adults.
2. Young T, Peppard PE, Gottlieb DJ: Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med 2002, 165:1217-1239. This is the most recent and one of the most comprehensive reviews of the epidemiology of sleep apnea. The reference section alone is a must have for sleep specialists, and the article is a must read for anyone taking care of patients with sleep apnea, especially pulmonologists.
3. American Academy of Sleep Medicine Task Force: Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999, 22:667-689. Clinical activity and research activity relating to sleep apnea should all be referencing this new standard.
4. Tsai WH, Flemons WW, Whitelaw WA, et al.: A comparison of apneahypopnea indices derived from different definitions of hypopnea. Am J Respir Crit Care Med 1999, 159:43-48.
5. Redline S, Kapur VK, Sanders MH, et al.: Effects of varying approached for identifying respiratory disturbances on sleep apnea assessment. Am J Respir Crit Care Med 2000, 161:369-374.
6. Manser RL, Rochford P, Pierce RJ, et al.: Impact of different criteria for defining hypopneas in the apnea-hypopnea index. Chest 2001, 120:909-914.
7. Meoli AL, Casey KR, Clark RW, and the Clinical Practice Review Committee of the American Academy of Sleep Medicine: Hypopnea in sleep disordered breathing in adults. Sleep 2001, 24:469-470. The most recent proposed definition for hypopnea that represents a further refinement from the 1999 guidelines found in [3··].
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9. Ayappa I, Norman RG, Krieger AC, et al.: Non-invasive detection of respiratory effort related arousals (RERAs) by a nasal cannula/pressure transducer system. Sleep 2000, 23:763-771. This article explains how the use of this device can assess respiratory effort giving us a viable alternative to esophageal manometry for the assessment of patients with UARS.
10. Epstein MD, Chicoine SA, Hanumaura RC: Detection of upper airways resistance syndrome using a nasal cannula/pressure transducer. Chest 2000, 117:1073-1077.
11. Thurnheer R, Xie X, Bloch KE: Accuracy of nasal cannula pressure recordings for assessment of ventilation during sleep. Am J Respir Crit Care Ed 2001, 164:1914-1919.
12. Monasterio C, Vidal S, Duran J, et al.: Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001, 164:939-943. The largest number of patients randomized so far in the mild to moderate severity category. The follow up length was longer than prior studies of this group as well. This study added more weight to the argument that symptoms improve with CPAP in mild sleep apnea.
13. Barnes M, Houston D, Worsnop CJ, et al.: A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med 2002, 165:773-780.
14. Redline S, Adams N, Strauss ME, et al.: Improvement of mild sleep disordered breathing with CPAP compared with conservative therapy. Am J Respir Crit Care Med 1998, 157:858-865.
15. Engleman HM, Kingshott RN, Wraith PK, et al.: Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 1999, 159:461-467.
16. Barbe F, Mayoralas LR, Duran J, et al.: Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. Ann Intern Med 2001, 134:1015-1023. Despite the controversy it has generated, this paper carries significant importance for several reasons. First, the control group used "sham" CPAP, which is the best design for answering questions related to the effectiveness of CPAP in these patients. Second, it reminds us that sleep apnea is more than just a respiratory disturbance index, but a true syndrome. Finally, it will spur us to more intense investigation with asymptomatic patients. It is important to remember that non-sleepy patients with sleep apnea do not escape the well-established consequences to the cardiovascular and cerebrovascular system. Therefore, treatment decisions should not be based solely on the presence or absence of sleepiness.
17. Pack AI: Who should get treated for sleep apnea? Ann Intern Med 2001, 134:1065-1067.
18. Randerath WJ, Galetke W, Davis M, et al.: Prospective randomized comparison of impedance-controlled auto-continuous positive airway pressure with constant CPAP. Sleep Medicine 2001, 2:115-124.
19. Berry RB, Parish JM, Hartse KM: The use of auto-titrating continuous positive airway pressure for treatment of adult obstructive sleep apnea. Sleep 2002, 25:148-159.
20. Standards of Practice Committee of the American Academy of Sleep Medicine: Practice parameters for the use of auto-titrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. Sleep 2002, 25:143-147. References 19 and 20 are found together in the same issue of Sleep and provide the reader with an up to date review and practice guideline for the use of this exciting technology. As auto-titrating devices become more and more common, any clinician who provides care to sleep apnea patients will need to understand the technology in some detail. These articles area good starting point.
21. Yoshida K: Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. Sleep 2001, 24:538-544.
22. American Sleep Disorders Association Standards of Practice Committee: Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep 1995, 18:511-513.
23. Rose EC, Barthlen GM, Staats R, et al.: Therapeutic efficacy of an oral appliance in the treatment of obstructive sleep apnea: A 2-year follow up. Am J Orthod Dentofacial Orthop 2002, 121:273-279.
24. Wlaker-Engstrom ML, Tegelberg A, Wilhelmsson B, et al.: 4-Year follow up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Chest 2002, 121:739-746.
25. Marklund M, Sahlin C, Stenlund H, et al.: Mandibular advancement device in patients with obstructive sleep apnea. Chest 2001, 120:162-169. This study is highlighted simply because of the 5-year follow-up period.
26. Tunis S, Shuren J, Spencer FC, et al.: Medicare Coverage Policy: Continuous Positive Airway Pressure Therapy Used in the Treatment of Obstructive Sleep Apnea. October 30, 2001. Available at: http://www.hcfa.gov/coverage/8b3-bbb2.htm. The memorandum is actually a great review article as well. This coverage decision is an example of what can occur when there is effective communication of standard definitions and available research.