Adult Obstructive Sleep Apnea/Hypopnea Syndrome: Definitions, Risk Factors, and Pathogenesis
Section snippets
Definitions
The International Classification of Sleep Disorders, Second Edition (ICSD-2) classifies sleep-related breathing disorders into 3 basic categories: central sleep apnea syndrome, obstructive sleep apnea (OSA) syndrome, and sleep-related hypoventilation/hypoxic syndrome. In this classification, the term “upper airway resistance syndrome” is subsumed under the diagnosis of OSA because the pathophysiology is so similar to that of OSA. Sleep apnea is termed “obstructive” when respiratory effort is
Prevalence
According to the first major US population-based study conducted about 15 years ago, when AHI criteria based on thermistor measures of airflow are applied to a general population of middle-aged adults, 24% of men and 9% of women meet criteria for OSA.8 These prevalence figures are based on a cutoff AHI of 5 or higher. Most of these patients (>50%) had mild sleep apnea according to current criteria. If the symptom of sleepiness is included as part of a syndromic definition (OSA syndrome), 4% of
Pathogenesis
The upper airway in humans has a complex anatomic structure characterized by an elongated posterior pharyngeal space, a 90 degree bend in airflow, and lack of rigidity. This is in part due to its multipurpose function of phonation, swallowing, and breathing. With respect to breathing and the underlying pathogenesis of sleep apnea, the patency of the upper airway depends on a balance of forces: forces that promote airway collapse and opposing forces that maintain upper airway patency. Forces
References (52)
Obstructive sleep apnea: re-evaluating our index of severity
Sleep Med
(2006)- et al.
Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll
Chest
(2006) - et al.
Gender differences in sleep and sleep-disordered breathing
Clin Chest Med
(2004) - et al.
Rapid eye movement-related sleep-disordered breathing: influence of age and gender
Chest
(2008) Gender differences in the expression of sleep-disordered breathing: role of upper airway dimensions
Chest
(2001)- et al.
Body fat distribution and sleep apnea severity in women
Chest
(1995) - et al.
A community study of sleep-disordered breathing in middle-aged Chinese men in Hong Kong
Chest
(2001) - et al.
Genomic approaches to understanding obstructive sleep apnea
Respir Physiolo Neurobiol
(2003) - et al.
Lower body positive pressure increases upper airway collapsibility in healthy subjects
Respir Physiol Neurobiol
(2008) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force
Sleep
(1999)
Hypopnea in sleep-disordered breathing in adults
Sleep
Effects of varying approaches for identifying respiratory disturbances on sleep apnea assessment
Am J Respir Crit Care Med
Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study
Am J Respir Crit Care Med
Stress measures linking sleep apnea, hypertension and diabetes–AHI vs arousals vs hypoxemia
Sleep
Association of atrial fibrillation and obstructive sleep apnea
Circulation
The occurrence of sleep-disordered breathing among middle-aged adults
N Engl J Med
The epidemiology of adult obstructive sleep apnea
Proc Am Thorac Soc
Recognition of obstructive sleep apnea
Am J Respir Crit Care Med
Prevalence of sleep-disordered breathing in women: effects of gender
Am J Respir Crit Care Med
Gender differences in sleep disordered breathing in a community-based sample
Am J Respir Crit Care Med
Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study
Sleep
Influence of sex and age on duration and frequency of sleep apnea events
Sleep
The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms?
Arch Intern Med
Sex differences and sleep apnoea
Thorax
Influence of gender on waking genioglossal electromyogram and upper airway resistance
Am J Respir Crit Care Med
Longitudinal study of moderate weight change and sleep-disordered breathing
JAMA
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