Diagnosis Of Sleep-related Breathing Disorders Research Articles

Untreated Moderate-to-Severe Sleep-Related Breathing Disorders Are Associated with Increased Frequency of Episodes of Autonomic Dysreflexia during Sleep in Individuals with Subacute or Chronic Spinal Cord Injury: A Prospective Cross-Sectional Study. (P1-13.002)

<h3>Objective:</h3> This ongoing cross-sectional study is focused on the potential association between moderate-to-severe sleep-related breathing disorders (SRBDs) and more severe cardiovascular dysfunction following spinal cord injury (SCI). <h3>Background:</h3> Sleep-related breathing disorders (SRBDs) are common and under-recognized among individuals living with spinal cord injury (SCI). SRBDs can affect the sympathetic response, but the impact of untreated SRBDs on cardiovascular autonomic function after SCI remains incompletely understood. <h3>Design/Methods:</h3> This cross-sectional study included adults with subacute/chronic (≥1 month after SCI onset), cervical or high-thoracic (T6 or above) SCI. The diagnosis of SRBD was established using a home-based/hospital unattended sleep screening test that quantifies the apnea-hypopnea index (AHI). Moderate-to-severe SRBD was defined as an AHI ≥ 15 events per hour. Episodes of autonomic dysreflexia (AD) were defined as a sudden increase in systolic blood pressure (BP) ≥ 20 mmHg. <h3>Results:</h3> This study included 45 individuals (14 females, 31 males with ages from 20 to 84 years; mean age: 57.0 years) with motor complete (n=22) or incomplete (n=24) SCI at cervical (n=38), or high thoracic levels. Time from SCI onset varied from 1.5 months to 52 years (mean time: 49.4 months). Mean AHI was 16.0 events per hour (AHI range: 0.8–51.7). The AHI was not associated with systolic BP (mean+/−SEM: 122.0+/−2.2 mmHg; p=0.903), diastolic BP (72.6+/−3.0 mmHg; p=0.639), mean arterial pressure (90.1+/−2.4 mmHg; p=0.714), and heart rate (70.6+/−1.4 bpm; p=0.669) during sleep. However, the AHI was significantly, positively correlated with the number of silent episodes of AD (mean +/− SEM: 3.6+/−0.4; Rsqr=0.220, p=0.001) during sleep, after excluding other causes of AD. <h3>Conclusions:</h3> The results of this cross-sectional study suggest that more severe SBRBs are associated with frequent silent episodes of AD during sleep among individuals with SCI. Future research is needed to assess the effects of continuous positive airway pressure (CPAP) therapy on cardiovascular dysfunction following SCI. <b>Disclosure:</b> The institution of Dr. Furlan has received research support from Wings for Life Spinal Cord Research Foundation. The institution of Dr. Furlan has received research support from Craig H Neilsen Foundation. The institution of Dr. Furlan has received research support from Ontario Neurotrauma Foundation. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. The institution of Dr. Furlan has received research support from J P Bickell Foundation. The institution of Dr. Furlan has received research support from Praxis Spinal Cord Institute. The institution of Dr. Furlan has received research support from Cervical Spine Research Society. Dr. Loh has stock in Dara3D. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz Pharmaceuticals. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Paladin Labs. Dr. Boulos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Boulos has received research support from Interaxon. The institution of Dr. Boulos has received research support from The Mahaffy Family Research Fund. The institution of Dr. Boulos has received research support from Canadian Institutes of Health Research. The institution of Dr. Boulos has received research support from Slamen-Fast New Initiatives in Neurology Award. The institution of Dr. Boulos has received research support from Green Mountain . Dr. Boulos has received personal compensation in the range of $5,000-$9,999 for serving as a speaker with Jazz Pharmaceuticals.

Evaluation of a nasopharyngeal stent in patients with obstructive sleep-related breathing disorders

ObjectiveThis study was performed to evaluate the therapeutic effect and diagnostic value of a novel nasopharyngeal stent (Naśtent; Corinium Medical Equipment Ltd., Cirencester, UK). The Naśtent is designed to stent palatal collapse in patients with sleep-related breathing disorders.MethodsThe study was conducted from 2018 to 2019. Patients who did not qualify for continuous positive airway pressure therapy underwent split-night examination with an inserted Naśtent for the first half of the night. The next morning, drug-induced sleep endoscopy (DISE) was performed.ResultsOf the 122 enrolled patients, 21 were excluded because of Naśtent intolerance (n = 14) or technically invalid examinations (n = 7). Among the remaining 101 patients, in correlation with DISE, the apnea–hypopnea index was significantly reduced in patients with palatal obstructions, mainly in those with anteroposterior collapse patterns. The Naśtent did not influence retrolingual or multilevel obstructions. Using a 40% reduction of the apnea–hypopnea index by the Naśtent as a cut-off value, 85.7% of soft palate obstructions were detected compared with DISE.ConclusionsThe Naśtent is a viable tool to reduce palatal obstructions, although it is not readily tolerated. It may also be helpful for diagnosis of sleep-related breathing disorders when DISE is unavailable.

Role of esophageal manometry in polysomnography of patients with chronic respiratory failure.

Esophageal pressure (Pes) monitoring is performed during polysomnography (PSG) with a thin, water-filled catheter connected to a transducer. The resulting quantitative assessment of respiratory effort can aid in the accurate diagnosis of sleep-related breathing disorders. This was a prospective observational study using Pes in PSG for thirty patients with chronic respiratory failure (CRF) conducted in the Department of Pulmonary, Critical Care and Sleep Medicine at a tertiary care centre of North India. Sleep scoring was done by conventional method and using esophageal manometry and compared polysomnography normal without esophageal manometry recording (PSGN) and polysomnography with esophageal manometry scoring (PSGE). Apnea hypopnea index (AHI) index was similar in both groups. However, respiratory effort related arousals (RERAs) were diagnosed easily using Pes resulting in significant increase in respiratory disturbance index (RDI) and even reclassification in terms of severity of sleep apnea. Besides, Pes was also useful to distinguish obstructive from central hypopnea which cannot be distinguished by routine PSG which can help guide therapy particularly in chronic respiratory failure patients with hypoventilation. Such patients with hypoventilation often require bilevel positive airway pressure as ventilatory support. Central hypopneas and apneas with hypercapnia may require higher-pressure support, a backup rate or even advanced volume assured modes of ventilation. Thus, it can be concluded that Pes in PSG remains a safe and generally well-tolerated procedure. Use of Pes aids to detect RERA and thereby RDI; a better marker of sleep-related breathing disorder rather than AHI. It also helps in differentiating between obstructive and central hypopnea.

Apnea and heart rate detection from tracheal body sounds for the diagnosis of sleep-related breathing disorders.

Sleep apnea is one of the most common sleep disorders. Here, patients suffer from multiple breathing pauses longer than 10s during the night which are referred to as apneas. The standard method for the diagnosis of sleep apnea is the attended cardiorespiratory polysomnography (PSG). However, this method is expensive and the extensive recording equipment can have a significant impact on sleep quality falsifying the results. To overcome these problems, a comfortable and novel system for sleep monitoring based on the recording of tracheal sounds and movement data is developed. For apnea detection, a unique signal processing method utilizing both signals is introduced. Additionally, an algorithm for extracting the heart rate from body sounds is developed. For validation, ten subjects underwent a full-night PSG testing, using the developed sleep monitor in concurrence. Considering polysomnography as gold standard the developed instrumentation reached a sensitivity of 92.8% and a specificity of 99.7% for apnea detection. Heart rate measured with the proposed method was strongly correlated with heart rate derived from conventional ECG (r 2=0.8164). No significant signal losses are reported during the study. In conclusion, we demonstrate a novel approach to reliably and noninvasively detect both apneas and heart rate during sleep.

Predictive value of laryngoscopy with reference to the treatment of obstructive sleep apnea with mandibular advance device

Introduction The diagnosis of sleep-related breathing disorders is based primarily upon targeted history-taking and upon night- time polysomnography. Diagnostic measures should be completed by laryngopharyngoscopy (LPS). Frequently in cases of relevant obstructive sleep- related breathing disorders, a collapse of the pharyngeal lumen may be detected already in the waking state: either during spontaneous breathing or through adequate provocation (snoring manoeuvre). Materials and methods 34 patients with AHI mild to moderate (20.8) were selected to treatment with mandibular advance splint. To predict outcome, a special occlusal splint with 8 mm advance was placed and nasal laringoscopy was performed. Results 30 patients (88.23%) showed good response to advance with an increment of 6 mm on the diameter of upper airway. Conclusion Laringoscopy with mandibular advance splint shows changes in upper airway and predicts outcome in patients with mild to moderate sleep apnea candidates for treatment with mandibula advance device. Acknowledgements Instituto de Investigaciones del Sueno.

Sleep-related groaning: Prevalence and characteristics in a cohort of patients with suspected obstructive sleep apnea

Conclusion: Nocturnal groaning has the same prevalence in patients referred for diagnosis of sleep-disordered breathing as among other populations referred for sleep studies. The respiratory tracings in these patients have a distinct appearance that is possible to recognize with a polygraphic recording and thereby prevent the pattern from being misdiagnosed as central apneas. Objectives: The aim of this study was first to estimate the prevalence of groaning in patients referred for diagnosis of sleep-related breathing disorders. Second, we wanted to describe the respiratory pattern in order to distinguish the patients from patients with sleep apnea. Methods: This was a prospective study in 1004 patients, performed in the Sleep Unit in our ENT Department, during a 12 month period. Results: Four patients were diagnosed with video polysomnography, and the diagnosis of nocturnal groaning was confirmed. The prevalence of groaning in our sleep laboratory was 0.4%. All the patients had a mild form of sleep-related disturbance, and all groaning episodes occurred during REM sleep. The groaning events appeared in clusters. The length of each groan varied between 4 and 38 s. The number of events in a period varied between 2 and 11, and the length of each groaning period ranged between 11 and 168 s.

Das Schlafapnoe-Syndrom in der Rehabilitation

Sleep-related breathing disorders are a common finding in patients undergoing cardiological rehabilitation. Sleep apnoea is recognized as a major risk factor for cardiovascular disorders. The diagnosis of sleep-related breathing disorders begins with taking a thorough sleep medicine-related patient history and answering dedicated questionnaires. The second step involves portable monitoring to assess oxygen saturation, heart rate, respiratory flow and effort. Portable monitoring is able to detect the severity of the breathing disorder and forms the basis on which to refer the patient for further sleep laboratory diagnosis or, in the case of positive results, to initiate appropriate treatment. In order to exclude a sleep-related breathing disorder, to distinguish between obstructive and central sleep apnoea, or to diagnose other sleep disorders a cardiorespiratory polysomnography in a sleep laboratory is required. Polysomnography is also needed if comorbidities are present. Appropriate and prompt treatment of sleep-related breathing disorders can shorten cardiological rehabilitation and improve outcomes in this patient group.

Perceived Stress, Depression, and Coping Strategies in Patients with Sleep-Related Breathing Disorder

Sleep-related breathing disorders (SRBDs), such as obstructive sleep apnea and upper airway resistance syndrome, are characterized by repetitive upper airway obstructions during sleep. These diseases’ main symptoms are loud snoring, disrupted nocturnal sleep, and excessive daytime sleepiness. The course is usually progressive, and profound functional impairment and/or life-threatening complications can occur.1 According to recent, extensive population-based surveys on SRBDs, SRBD prevalence is relatively high, especially among obese middle-aged and older adults,2,3 and SRBDs constitute a major public health problem.4,5 A diagnosis of SRBD is stressful because of the disorder’s progressive course and associated significant physical and psychological distress. Many studies have documented that patients with SRBD experience mood changes, psychological dysfunction,6,7 and an impaired quality of life.8 Coping has been defined as “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.”9 Researchers view coping as a response to perceived stress and considered it to be particularly important for mediating life stresses and the onset of a psychiatric illness, especially depression.9 It has two widely-recognized major functions: regulating emotions or distress (emotion-focused coping) and managing the problem causing the distress (problem-focused coping). In most stressful encounters, individuals use both forms of coping apportioning the Received: May 15, 2011 Revised: July 19, 2011 Accepted: July 21, 2011

Evaluation of ApneaGraph in the diagnosis of sleep-related breathing disorders

ApneaGraph relies on measuring pressure and airflow simultaneously at different levels in the pharynx identifying the segment of airway obstruction and providing baseline respiratory parameters. This study aims to evaluate ApneaGraph and correlate results with both sleep nasendoscopy and polysomnography. This was a prospective study of 49 patients with snoring and/or obstructive sleep apnoea. Thirty of the these patients underwent a PSG and an ApneaGraph study simultaneously in the Sleep Lab. Nineteen patients attended the day surgery unit and had a sleep nasendoscopy with a 10-min ApneaGraph analysis. Polysomnography was used to validate the ApneaGraph system. There are no significant differences (independent t test, P > 0.15) between ApneaGraph compared to Polysomnography based on the apnoea-hypopnoea index, total number of apnoeic events, average oxygen saturations and maximum desaturation. This suggests that the ApneaGraph can be used to assess OSA. Statistically, there is poor correlation between the two groups (Spearman's rho 0.29). In the cases of discordance, ApneaGraph places greater emphasis on a lower pharyngeal contribution. This unique study analyses the ApneaGraph system in the diagnosis of obstructive sleep apnoea and snoring. It demonstrates the benefits of this new system and highlights certain limitations in localizing the site and level of pharyngeal obstruction in patients with sleep disorders.

Report of an EFNS task force on management of sleep disorders in neurologic disease (degenerative neurologic disorders and stroke)

A task force to develop guidelines for diagnostic evaluation and treatment of sleep disorders in degenerative neurologic disorders and stroke was initiated by the European Federation of Neurological Societies (EFNS). The aims were to provide evidence-based recommendations in the management of sleep disorders associated with degenerative neurologic disorders and stroke. Neurological patients often have significant sleep disorders like sleep-related breathing disorders (SBD), insomnia, sleep-related motor and rapid eye movement behavioral disorders affecting nocturnal sleep and daytime function. A polysomnography (PSG) is usually a diagnostic minimum for the diagnoses of the most commonly reported sleep disorders in patients with neurologic diseases. A full video-PSG/video-EEG-PSG should be considered in patients with nocturnal motor and/behavior manifestations. Respiratory polygraphy has a moderate sensitivity and specificity in the diagnosis of SBD without neurologic diseases, but its value in patients with neurologic diseases has not been evaluated. Oximetry has a poor sensitivity-specificity for the identification of SDB. Continuous and bi-level positive airway pressure devices are the most effective treatment of SDB in patients with neurologic diseases. There is a need for further studies focusing on the diagnostic procedures and treatment modalities in patients with sleep disorders and degenerative neurologic diseases and stroke.

Letter Regarding Article by Scharf et al, “Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers”

To the Editor: We congratulate Scharf et al on their innovative and stimulating article about the feasibility of detecting apnea/hypopnea events by analyzing transthoracic impedance signals in pacemaker patients.1 There are some questions we would like the authors to address. The pacemaker lower rate was programmed to 70 bpm in 50% of patients. It would be of interest to know the percentage of atrial and ventricular pacing during the study because pacing may influence sleep apnea syndrome in selected patients.2 Were there any changes in the apnea-hypopnea index before and during pacing? The differentiation between the obstructive and central type of sleep-related breathing disorders was based on thoracic and abdominal excursions …

Diagnosis of Sleep-Related Breathing Disorders by Visual Analysis of Transthoracic Impedance Signals in Pacemakers

Minute ventilation sensors of cardiac pacemakers measure ventilation by means of transthoracic impedance changes between the pacemaker case and the electrode tip. We investigated whether this technique might detect sleep-related breathing disorders. In 22 patients, analog waveforms of the transthoracic impedance signal measured by the pacemaker minute ventilation sensor over the course of a night were visualized, scored for apnea/hypopnea events, and compared with simultaneous polysomnography. Analysis of transthoracic impedance signals correctly identified the presence or absence of moderate to severe sleep apnea (apnea/hypopnea index, AHI >20 h(-1)) in all patients (receiver operating characteristics, ROC=1.0). The ROC for AHI scores of > or =5 h(-1) and > or =10 h(-1) showed an area under the curve of 0.95, P<0.005, and 0.97, P<0.0001, respectively. Accuracy over time assessed by comparing events per 5-minute epochs was high (Cronbach alpha reliability coefficient, 0.85; intraclass correlation, 0.73). Event-by-event comparison within +/-15 seconds revealed agreement in 81% (kappa, 0.77; P<0.001). Detection of apnea/hypopnea events by pacemaker minute ventilation sensors is feasible and accurate compared with laboratory polysomnography. This technique might be useful to screen and monitor sleep-related breathing disorders in pacemaker patients.

Patient discomfort in polysomnography with esophageal pressure measurements

The reference method for measuring respiratory effort and for differentiating between obstructive and central apneas in the diagnosis of sleep-related breathing disorders is overnight monitoring of esophageal pressure. Despite this being the reference method, it is not widely used because it is considered invasive and uncomfortable for the patients. The aim of this study was to assess patient discomfort and insertion difficulty when using an esophageal catheter during polysomnography. We have performed a prospective questionnaire-based clinical study in 799 consecutive patients where polysomnography with an esophageal catheter was routinely performed in the diagnosis of sleep-related breathing disorders. The main outcome measures were the catheter-related discomfort experienced by the patient and difficulty of catheter insertion reported by the sleep technician. Ninety-six percent of the patients accepted the insertion of the catheter, and most of the patients considered it acceptable to sleep with the catheter. Correspondingly, in most of the patients, the catheter was easily inserted, and there were difficulties in only a few patients. Specifically, no complications or side effects were reported when using the catheter. To optimize the diagnosis of sleep-related breathing disorders, an esophageal sensor catheter can be used during polysomnography, without causing major patient discomfort.

Diagnosis of sleep apnea by automatic analysis of nasal pressure and forced oscillation impedance.

Detecting and differentiating central and obstructive respiratory events is an important aspect of the diagnosis of sleep-related breathing disorders with respect to the choice of an appropriate treatment. The purpose of this study was to evaluate the performance of a new algorithm for automated detection and classification of apneas and hypopneas, compared with visual analysis of standard polysomnographic signals. The algorithm is based on time series analysis of nasal mask pressure and a forced oscillation signal related to mechanical respiratory input impedance, measured at a frequency of 20 Hz throughout the night. The method was applied to all-night measurements on 19 subjects. Two experts in sleep medicine independently scored the corresponding simultaneously recorded polysomnographic signals. Evaluating the agreement between two scorers by a weighted kappa statistic on a second-by-second basis, we found that inter-expert variability and the discrepancy between automatic analysis and visual analysis performed by an expert were not significantly different. Implementation of this algorithm in a device for home monitoring of breathing during sleep might aid in the differential diagnosis of sleep-related breathing disorders and/or as a means for follow-up and treatment control.

Technical protocol for the use of esophageal manometry in the diagnosis of sleep-related breathing disorders

A time-tested protocol for intrathoracic pressure monitoring during sleep is described. This method of esophageal manometry uses a fluid-filled catheter to measure variations in transmitted intrathoracic pressure with respiration. Esophageal manometry is an invaluable tool for the sleep specialist in the diagnosis of sleep-related breathing disorders, especially for detecting cases of upper airway resistance syndrome and for distinguishing subtle central apneas from obstructive events. The methods for scoring esophageal pressure, the indications and contraindications for esophageal manometry, the use of esophageal manometry as the ‘gold standard’ for the measurement of respiratory effort, and directions for future research are also discussed.

Validierung einer 7kanaligen ambulanten Polygraphieeinheit

For some time, the ambulatory diagnosis of sleep-related breathing disorders has included the use of seven-channel recording units. One such unit is the POLY-MESAM (MAP, Martinsried, FRG). The first part of the present study prospectively investigated the handling of the system for physicians and patients, its technical reliability, reliability of the software used and the results in comparison to handscoring. In all, 104 patients (95 males, 9 females) were studied for different severities of obstructive sleep-related breathing disorders. The first 51 patients were connected to the POLY-MESAM in the evening within the clinic. The patients then slept at home and returned the next day. Another 53 patients received only a short briefing in the clinic and connected themselves at home to the POLY-MESAM System. Each patient's status was monitored by means of a visual analogue scale. Automatic evaluation of the data was compared with the results of manual scoring. From the data recorded only 6% of the results were not usable. Patients acceptances of the system were very high (94.3%). On average each patient required 21 minutes for attaching and detaching the device. Scoring and instructing the patients required an average of 23 min. Regarding the apnea-hypopnea index (AHI), the correlation between automatic (AHI = 11.1) and manual (AHI = 11.3) evaluations was high. Analysis of snoring turned out to be insufficient. The POLY-MESAM proved to be reliable and user-friendly. Our findings show that the system can be recommended for outpatient screening of sleep-related breathing disorders, with patients able to manage the system without help. Validation by using simultaneous polysomnography is the subject of part two of the study.

The Comorbidity of Periodic Limb Movements Disorder in Patients with Sleep-Related Breathing Disorder

Background: Sleep-related breathing disorders(SRBD) and periodic leg movements disorder(PLMD) are both common, and are considered as separate sleep disorders. However, both disorders show high comorbidity. SRBD and PLMD can result in excessive daytime sleepiness and insomnia due to frequent sleep fragmentation. So, it is very important to consider the presence of PLMD, when we are dealing with the diagnosis and management of SRBD. The objectives of this study were to determine the incidence of PLMD in patients with SRBD, and to describe any differences between patients with and without PLMD. Method: The authors reviewed the sleep recordings of 106 patients with a final diagnosis of SRBD(obstructive sleep apnea or upper airway resistance syndrome), who underwent full nocturnal polysomnography, including the monitoring of the anterior tibialis electromyogram. All sleep records were recorded and scored using the standard criteria. The data was analyzed by the student t-test. Result: 106 patients(M=76, F=30) were included in the analysis. Data revealed a mean age of years, a respiratory disturbance index(RDI) of /hour sleep, a lowest oxygen saturation of , a maximal esophageal pressure of , and PLM index(PLMI) of movements/hour sleep. Forty four percent(47 of 106 patients) had a PLMI of greater than 5 on this study. The mean age of the patients with PLMD was significantly higher than that of the patients without PLMD(p

Diagnosis and Treatment of Sleep Apnea Within the Community

Patients with sleep disorders are common in primary care, yet most physicians lack training in the diagnosis and treatment of such patients. To enhance recognition of sleep disorders by community physicians and transfer the diagnostic testing and care of such patients from tertiary care centers to the local community. To present our polysomnogram experience relevant to sleep apnea. Sleep disorders specialists provided a community with education, diagnostic equipment, and ongoing support as sleep disorders expertise was established locally. Outcomes for a 2-year period were assessed by chart review, patient questionnaire, tabulation of polysomnographic data, and comparison with published reports from specialized centers. Referral for sleep testing increased by almost 8-fold in patients at the Walla Walla Clinic in Walla Walla, Wash, from 0.27% (2 of 752 cases reviewed) to 2.1% (294 of 14330 internal medicine patients). Data were collected from all community physicians for a 2-year period on 360 new patients who underwent polysomnogram testing. This resulted in the diagnosis of sleep-related breathing disorders in 81% and periodic leg movements of sleep in 18%. Nasal continuous positive airway pressure treatment was given to 228 patients (average baseline apnea index of 19.1), representing a higher volume of patients than at many traditional sleep centers, yet compliance with continuous positive airway pressure was comparable. Sleep apnea is significantly underrecognized by primary care physicians. As a result of the intervention, local sleep expertise was established and large numbers of patients were discovered and treated in the community. Thus, a significant public health problem is identified and a solution established.

Ambulatory diagnosis of sleep-related breathing disorders.

Ambulatory diagnosis of sleep-related breathing disorders (SRBD) is necessary due to their high prevalence and to the limited capacities of sleep centers. Categories of SRBD which must be diagnosed and differentiated are defined. Indications for ambulatory diagnosis are given. A selection of systems on the market in Europe are given and described in terms of their parameters. The correct system for diagnosis in a specific patient must be selected according to the specific question. The issue of ambulatory diagnosis of SRBD has gained importance in Germany because beginning in spring 1992 physicians will be reimbursed if they continuously record respiratory signals, heart rate, oxygen saturation and movement in their patients and if they qualify by attending a one-week training course.

The Diagnosis of Sleep-Related Breathing Disorders

Information regarding sleep apnea syndromes and primary alveolar hypoventilation has been widely disseminated in both medical and lay publications. As a result, the pulmonary physician is confronted with a growing number of patients referred for evaluation of sleep-related breathing disorders. In addition, many pulmonary diseases may become worse during sleep. A wide variety of diagnostic options is available. The method chosen will depend on availability, cost, and the strength of the clinical impression. Screening studies, from the most simple (night-time Holter monitor or ear oximetry) to either a carefully performed nap study or a home recording may aid in deciding which patients require a formal polysomnogram. Centers with full all-night study capability may not use preliminary recordings at all. Because many therapeutic modalities exist, their intelligent use requires an accurate assessment of the type and severity of the breathing disorder.