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POSTGRADUATE EDUCATION CORNERCONTEMPORARY REVIEWS IN SLEEP MEDICINEAdult Obstructive Sleep Apnea: Pathophysiology and Diagnosis
Section snippets
Pathophysiology of Upper Airway Obstruction in OSA
The pharynx is a complex structure that serves several purposes including speech, swallowing, and respiration. The human pharynx is composed of > 20 muscles and divided into four sections that include the nasopharynx (from the nasal turbinates to the start of the soft palate), velopharynx (from the start of the soft palate to the tip of the uvula), oropharynx (from the tip of the uvula to the tip of the epiglottis), and hypopharynx (from the tip of the epiglottis to the level of the vocal
Clinical Presentation
The classic signs and symptoms for OSA include signs of upper airway obstruction during sleep, insomnia, and daytime hypersomnolence in the setting of obesity; however, a broad range of symptoms can be reported (Table 1). Generally, these symptoms develop over years and progress in association with increases in weight, aging, or transition to menopause. A detailed longitudinal sleep history and physical examination are essential in identifying at-risk individuals because as many as 90% of cases
Risk Stratification for Appropriate Referral for Polysomnography
Appropriate referral by the physician for a sleep study begins with the history and physical examination. Clinical impression using a combination of symptoms, physical examination findings, and other objective data has been used to risk stratify patients for appropriate referral to a sleep laboratory. Obesity, in a population of middle-aged men from the community resulted in an OSA prevalence of > 50%.88 Snoring, while associated with a higher prevalence of OSA, only has a positive predictive
Summary
OSA is a common sleep disorder that can present in a variety of ways in the pulmonary physician's office. With a fundamental understanding of the pathophysiology of OSA, the pulmonary physician can routinely integrate questions into their review of system that will assist in appropriate referral for polysomnography and diagnosis of the disorder. Understanding nuances in the spectrum of presenting complaints and polysomnography correlates are important for diagnostic and therapeutic purposes.
References (101)
- et al.
Gender differences in sleep apnea: epidemiology, clinical presentation and pathogenic mechanisms
Sleep Med Rev
(2003) - et al.
Upper airway collapsibility during sleep in upper airway resistance syndrome
Chest
(2002) - et al.
The pharyngeal critical pressure: the whys and hows of using nasal continuous positive airway pressure diagnostically
Chest
(1996) - et al.
A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong
Chest
(2001) - et al.
Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing
Chest
(2000) Gender differences in the expression of sleep-disordered breathing: role of upper airway dimensions
Chest
(2001)- et al.
Two-point palatal discrimination in patients with upper airway resistance syndrome, obstructive sleep apnea syndrome, and normal control subjects
Chest
(2002) - et al.
Abnormal afferent nerve endings in the soft palatal mucosa of sleep apneics and habitual snorers
Regul Pept
(1997) - et al.
Abnormal palatopharyngeal muscle morphology in sleep-disordered breathing
J Neurol Sci
(2002) - et al.
Effect of induced hypocapnic hypopnea on upper airway patency in humans during NREM sleep
Respir Physiol
(1997)
Central sleep apnea: pathophysiology and treatment
Chest
The symptoms and signs of upper airway resistance syndrome: a link to the functional somatic syndromes
Chest
Prevalence of insomnia symptoms in patients with sleep-disordered breathing
Chest
A cause of excessive daytime sleepiness: the upper airway resistance syndrome
Chest
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
Pathogenesis of upper airway occlusion during sleep
J Appl Physiol
The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep
Sleep
Modeling hypersomnolence in sleep-disordered breathing: a novel approach using survival analysis
Am J Respir Crit Care Med
Relation of measures of sleep-disordered breathing to neuropsychological functioning
Am J Respir Crit Care Med
Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: sleep Heart Health Study
JAMA
Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study
Am J Respir Crit Care Med
Obstructive sleep apnea is independently associated with insulin resistance
Am J Respir Crit Care Med
Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study
Am J Epidemiol
Association of sleep apnea and type II diabetes: a population-based study
Am J Respir Crit Care Med
Extreme obesity associated with alveolar hypoventilation: a Pickwickian syndrome
Am J Med
Epidemiology of obstructive sleep apnea: a population health perspective
Am J Respir Crit Care Med
Pathogenesis of obstructive sleep apnea
J Appl Physiol
Prevalence of overweight and obesity in the United States, 1999–2004
JAMA
Upper airway pressure-flow relationships in obstructive sleep apnea
J Appl Physiol
Induction of upper airway occlusion in sleeping individuals with subatmospheric nasal pressure
J Appl Physiol
Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea
Am Rev Respir Dis
Obstructive sleep apnea in adults with tonsillar hypertrophy
Arch Intern Med
Cephalometric analysis in patients with obstructive sleep apnoea syndrome: i. Skeletal morphology
J Laryngol Otol
Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing
Am J Respir Crit Care Med
The relationship between craniofacial morphology and obstructive sleep apnea in whites and in African-Americans
Am J Respir Crit Care Med
Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness
Am Rev Respir Dis
Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing: significance of the lateral pharyngeal walls
Am J Respir Crit Care Med
State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects
Am J Respir Crit Care Med
Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects
J Appl Physiol
Pro: sleep apnea is an anatomic disorder
Am J Respir Crit Care Med
Family aggregation of upper airway soft tissue structures in normal subjects and patients with sleep apnea
Am J Respir Crit Care Med
Advancement of the mandible improves velopharyngeal airway patency
J Appl Physiol
Site of pharyngeal narrowing predicts outcome of surgery for obstructive sleep apnea
Am Rev Respir Dis
Pharyngeal patency in response to advancement of the mandible in obese anesthetized persons
Anesthesiology
Collapsibility of passive pharynx in patients with acromegaly
Am J Respir Crit Care Med
The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls
J Physiol
Do patients with obstructive sleep apnea have thick necks?
Am Rev Respir Dis
The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome
Eur Respir J
Pharyngeal fat in obstructive sleep apnea
Am Rev Respir Dis
Morphology of the uvula in obstructive sleep apnea
Am Rev Respir Dis
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The manuscript was supported by grants HL50381, HL37379, and HL77137 from the National Heart, Lung, Blood Institute, National Institutes of Health.
No financial or other potential conflicts of interest exist for all the authors.