Sleep Disorders Introduction to Poly - Lec 2 PDF

SLEEP DISORDERS Zahra B. Macabada, RTRP HISTORY OF SLEEP DISORDERS HISTORY OF SLEEP DISORDERS ❖ 1836 – Charles Dickens: In "Posthumous Papers of the Pickwick Club," Dickens described a boy named Joe, who was overweight and extremely tired and who snored heavily. From this “Pickwickian syndro...

SLEEP DISORDERS Zahra B. Macabada, RTRP HISTORY OF SLEEP DISORDERS HISTORY OF SLEEP DISORDERS ❖ 1836 – Charles Dickens: In "Posthumous Papers of the Pickwick Club," Dickens described a boy named Joe, who was overweight and extremely tired and who snored heavily. From this “Pickwickian syndrome” was coined and is now called obesity hypoventilation syndrome. ❖ 1950s and 1960s: Researchers like Nathaniel Kleitman and William Dement identified different sleep stages, paving the way for modern sleep studies. ❖ 1961: Sleep Research Society formed with pioneers like Doctors Kleitman, Dement, Rechtschaffen, Aserinsky and Jouvet. ❖ 1968: Doctors Rechtschaffen and Kales developed standardized scoring techniques for sleep studies and produced A Manual of Standardized Technology Techniques and Scoring Sytems for Sleep Stages of Human HISTORY OF SLEEP DISORDERS ❖ 1970: First sleep-disorders lab established by William Dement, growing to four centers in five years. ❖ 1975: The American Academy of Sleep Medicine (AASM) was founded, initially known as the Association of Sleep Disorders Centers (ASDC). ❖ 1990:AASM developed the International Classification of Sleep Disorders (ICSD) which categorized and described all known sleeping disorders. The second edition of (ICSD-2) was published in 2005, third edition (ICSD-3) was published in 2014. INSOMNIA can be defined as a complaint of a lack of sleep or of nonrestorative sleep and can occur in all age groups. The ICSD-3 defines insomnia as “persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment.” CHRONIC INSOMNIA DISORDER is associated with sleep disturbances and daytime symptoms as previously described that occur at least three times a week for at least 3 months. TYPES OF INSOMNIA Psychophysiological Idiopathic Paradoxical Insomnia Insomnia Insomnia Caused by anxiety about first identified at infancy or early Formerly termed sleep state sleep and learned sleep- childhood and persists misperception. prevention habits. throughout the patient’s life. Patient reports insomnia Lifelong insomnia with no despite normal sleep identifiable external causes. patterns. Inadequate Sleep Behavioral Insomnia Insomnia Due to a Hygiene of Childhood Mental Disorder Also called limit-setting Caused by a diagnosed Poor habits leading to sleep disorder, behavioral mental illness and persists for difficulties. insomnia of childhood at least 1 month. Limit-setting disorder in Linked to mental health children, associated with conditions like depression or inconsistent bedtime anxiety. practices. TYPES OF INSOMNIA Insomnia Due to Prescription and illegal drugs with insomnia Medical Conditions as a side effect include, but are not limited Chronic pain and other to, the following: medical issues can cause insomnia. Beta blockers Thyroid hormones Corticosteroids Oral contraceptives Adrenocorticotropic hormones Antimetabolites Insomnia Due to Monoamine oxidase inhibitors Decongestants Substance Use Diphenylhydantoin Thiazides Calcium blockers Another form of insomnia is Alpha methyldopa secondary to substance abuse or substance Bronchodilators withdrawal. Stimulating tricyclics Drugs and alcohol can disturb Stimulants sleep patterns. TYPES OF INSOMNIA Short-term Insomnia Other Insomnia Isolated Symptoms Disorder Disorder and Normal Variants Also called adjustment This diagnosis is used Individuals who routinely allot insomnia or acute insomnia. sparingly for individuals who time in bed in excess of their is often associated with a experience difficulty sleep need and those who specific stressor that can initiating or maintaining routinely obtain less than 6 include work, school, or sleep but do not meet the hours of sleep per night marital stress; excitement; full criteria for chronic or without daytime impairments anticipation; financial short term insomnia. (short sleepers) fall into this hardship; illness; and the category death of a loved one or a natural disaster. INSOMNIA TREATMENT OPTIONS Therapies: Group Therapy: Helps explore psychological causes of insomnia. Light Therapy: Regulates circadian rhythms. Biofeedback: Helps control physiological responses related to sleep. Self-Control Techniques: Useful for patients feeling a lack of control in their lives. Sleep Restriction: Limits time in bed to improve sleep quality. Medical/Condition-Specific Treatments: Focus on treating underlying conditions (e.g., pain management in arthritis). SLEEP-RELATED BREATHING DISORDERS are divided into those of central origin and those caused by an obstruction. Central breathing disorders are characterized by a lack of respiratory effort caused by either a central nervous disorder or a cardiac dysfunction. Obstructive respiratory events are caused by partial or complete collapse of the upper airway. OBSTRUCTIVE SLEEP APNEA Adult ❖ is one of the most common sleep disorders, characterized by repeated episodes of obstructive apneas and hypopneas during sleep. ❖ respiratory events classified by a complete cessation (defined as a decrease in amplitude of at least 90%) of airflow and continued respiratory effort. ❖ APNEA: Complete cessation of airflow for at least 10 seconds with continued respiratory effort. ❖ HYPOPNEA: Partial reduction of airflow (by 30%-90%), with an oxygen desaturation of ≥3% or an EEG arousal lasting at least 10 seconds. OBSTRUCTIVE SLEEP APNEA Adult ❖ APNEA: Complete cessation of airflow for at least 10 Often these events are seconds with continued associated with body respiratory effort. jerks, limb movements, ❖ HYPOPNEA: Partial paradoxical breathing reduction of airflow (by (chest and abdominal 30%-90%), with an oxygen effort asynchrony), and desaturation of ≥3% or an snoring. EEG arousal lasting at least 10 seconds. OBSTRUCTIVE SLEEP APNEA Adult ❖ RISK FACTORS: ❖ SYMPTOMS: ❖ Obesity ❖ snoring ❖ Advanced age ❖ gasping or choking during sleep ❖ Male gender ❖ witnessed pauses in breathing ❖ Smoking ❖ restless sleep ❖ Structural airway anomalies (e.g., ❖ Sweating enlarged tonsils, adenoids or ❖ Waking with the bed in disarray tongue, high-arched (narrow) ❖ morning headaches palate, micrognathia (small jaw), or retrognathia (recessed jaw) ❖ Craniofacial abnormalities ❖ Large neck size OBSTRUCTIVE SLEEP APNEA Adult DIAGNOSTIC CRITERIA: ❖ APNEA-HYPOPNEA INDEX (AHI): Total number of apneas and hypopneas per hour of sleep with complaints of daytime sleepiness as well as gasping, choking, or snoring. ❖AHI = (no. of apneas + no. of hypopneas) / sleep hours ❖AHI < 5: Normal ❖AHI 5-15: Mild ❖AHI 15-30: Moderate ❖AHI >30: Severe OBSTRUCTIVE SLEEP APNEA Adult DIAGNOSTIC CRITERIA: ❖ RESPIRATORY DISTURBANCE INDEX (RDI): Total number of apneas, hypopneas, and respiratory effort–related arousals (RERAs) per hour. ❖RDI = (no. of apneas + no. of hypopneas + no. of RERAs)/ sleep hours ❖ RERA - is an EEG arousal that is associated with a marked decrease in airflow and continued or increasing respiratory effort. ❖ UPPER-AIRWAY RESISTANCE SYNDROME is characterized by frequent RERAs during sleep and results in symptoms similar to those of OSA ✓The airflow is absent despite the persistence of respiratory effort. ✓An airway obstruction exists when the chest and abdomen expand and contract but no air flows through the nose or mouth. ✓ also an obstructive respiratory event. ✓Like obstructive apneas, effort persists; however, airflow is not completely absent but rather decreased. OBSTRUCTIVE SLEEP APNEA Adult HEALTH IMPLICATIONS OF OSA: ❖ Cardiovascular Risks: OSA is associated with hypertension, coronary artery disease, atrial fibrillation, heart failure, and stroke. ❖ Metabolic Impacts: Increased insulin resistance, metabolic syndrome, and difficult control of diabetes. ❖ Cognitive and Psychosocial Effects: Excessive daytime sleepiness (EDS), memory loss, concentration difficulties, depression, and higher risk of accidents. OBSTRUCTIVE SLEEP APNEA Pediatric ❖ presents similarly to adult OSA but is characterized by shorter respiratory events (based on a two-breath criteria). ❖ SYMPTOMS: Snoring, labored or paradoxical breathing, morning headaches, oxygen desaturation, and hypercapnia. ❖ RISK FACTORS: Obesity, Down syndrome, and craniofacial abnormalities. ❖ Even mild OSA in children can lead to growth impairments, cognitive issues, and is associated with sudden infant death syndrome (SIDS). CENTRAL SLEEP APNEA ❖ there are eight different central sleep apnea syndromes ❖ characterized by cessation of airflow with a concurrent cessation of respiratory effort ❖ are often seen in older patients, those with congestive heart failure, neurological conditions, or on opioid medications, as well as in patients using continuous positive airway pressure (CPAP) for the first time or those with high CPAP pressures CENTRAL SLEEP APNEA ❖ Characterized by a lack of respiratory effort due to a central nervous system disorder or cardiac dysfunction. ❖ Cessation of airflow coincides with a lack of respiratory effort, often seen in older patients, those with heart failure, neurological conditions, or those taking opioid medications. ❖ CSA events are common during sleep-wake transitions due to unstable ventilatory control and low levels of carbon dioxide (CO₂). CENTRAL SLEEP APNEA WITH CHEYNE-STOKES BREATHING ❖ Cheyne–Stokes breathing is characterized by a pattern of central apnea or hypopnea alternating with a distinct waning and waxing breathing pattern. This pattern is typically seen during nonrapid eye movement (NREM) sleep and is corrected during REM. ❖ Most patients with Cheyne–Stokes breathing are males over age 60. ❖ The diagnostic criteria for Cheyne–Stokes breathing is five or more central apneas or hypopneas per hour of sleep, greater than 50% of the total respiratory events being central in origin, and a crescendo–decrescendo pattern. CENTRAL SLEEP APNEA DUE TO A MEDICAL DISORDER WITHOUT CHEYNE–STOKES BREATHING ❖ Occurs secondary to conditions like brainstem lesions, with central apneas and hypopneas. ❖ five or more central apneas or hypopneas per hour of sleep, greater than 50% of the total respiratory events being central in origin, and the absence of a crescendo–decrescendo pattern is diagnostic. CENTRAL SLEEP APNEA DUE TO HIGH-ALTITUDE PERIODIC BREATHING ❖ High-altitude periodic breathing disorder is characterized by central apneas and hypopneas occurring during a recent ascent to at least 4,000 meters (approximately 12,000 feet). ❖ The events occur at least five times per hour of sleep. ❖ Central apneas/hypopneas occurring at high altitudes (>4,000 meters), typically resolving upon returning to lower altitudes. CENTRAL SLEEP APNEA DUE TO A MEDICATION OR SUBSTANCE ❖ Central respiratory events triggered by drugs like methadone or hydrocodone. CENTRAL SLEEP APNEA PRIMARY CENTRAL SLEEP APNEA ❖ Idiopathic and cannot be explained by the use of a medication, substance, or the presence of a medical illness. ❖ Diagnostic criteria include five or more central apneas or hypopneas per hour of sleep, greater than 50% of the total respiratory events being central in origin ❖ Absence of a crescendo–decrescendo pattern. CENTRAL SLEEP APNEA PRIMARY CENTRAL SLEEP APNEA OF INFANCY ❖ Life-threatening disorder, occurs in infants who are at least 37 weeks conceptional age ❖ Characterized by prolonged central apnea, lasting at least 20 seconds (or a periodic breathing pattern at least 5% of the sleep time), ❖ Desaturation ❖ Apnea ❖ Cyanosis. ❖ Is usually attributed to a developmental issue or secondary to another medical condition. CENTRAL SLEEP APNEA PRIMARY CENTRAL SLEEP APNEA OF PREMATURITY ❖ DIAGNOSTIC CRITERIA: ❖ conceptional age of less than 37 weeks ❖ either recurrent central apneas of at least 20 seconds in duration or periodic breathing for at least 5% of the duration of sleep study monitoring. ❖ The condition usually improves with maturation of the ventilatory control centers. CENTRAL SLEEP APNEA TREATMENT-EMERGENT CENTRAL SLEEP APNEA ❖ often referred to as complex sleep apnea ❖ Is diagnosed after the patient has been diagnosed with OSA and has had a subsequent PAP titration. ❖ After resolution of obstructive events during the titration, central events emerge and persist with at least five central events per hour of sleep. ❖ These patients are often placed on bi-level PAP therapy, sometimes with a backup rate to help resolve the central events. SLEEP-RELATED HYPOVENTILATION DISORDERS Characterized by abnormally elevated arterial carbon dioxide levels (PCO2 > 45 mmHg) during sleep, leading to hypercapnia. TYPES OF DISORDERS OBESITY HYPOVENTILATION SYNDROME (OHS) ❖ Also known as hypercapnic sleep apnea. ❖ Affects obese individuals. ❖ Diagnostic criteria: ❖ PaCO2 > 45 mm Hg during wakefulness. ❖ Body Mass Index (BMI) > 30. ❖ No other medical conditions or medications causing hypoventilation. ❖ Symptoms include worsening hypoventilation during sleep, especially in REM sleep, and may also present obstructive sleep apnea. TYPES OF DISORDERS CONGENITAL CENTRAL ALVEOLAR HYPOVENTILATION SYNDROME (CCHS) ❖ A rare genetic disorder due to a mutation in the PHOX2B gene. ❖ Characterized by failure of automatic breathing control. ❖ Symptoms: ❖ Sleep-related hypoventilation and hypercapnia. ❖ Oxygen desaturation during sleep. ❖ May also experience hypoventilation while awake. ❖ Typically presents at birth but can appear later in life. ❖ Requires lifelong treatment with ventilatory support. TYPES OF DISORDERS SLEEP-RELATED HYPOVENTILATION DUE TO MEDICAL DISORDER ❖ Hypoventilation during sleep attributed to underlying medical conditions (e.g., airway disease, muscular disorders). THANKS CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon and Slidesgo Flaticon infographics & images by Freepik Freepik