Yu Jin Lee

doi:10.4306/jknpa.2020.59.1.20

Journal List > J Korean Neuropsychiatr Assoc > v.59(1) > 1143425

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee: Updates of Diagnosis and Treatment of Sleep-Related Breathing Disorders–Focusing on Obstructive Sleep Apnea

Special Article

J Korean Neuropsychiatr Assoc 2020;59(1):20-24.

Published online: 17 January 2020

DOI: https://doi.org/10.4306/jknpa.2020.59.1.20

Updates of Diagnosis and Treatment of Sleep-Related Breathing Disorders–Focusing on Obstructive Sleep Apnea

Yu Jin Lee, MD, PhD

Department Psychiatry, Seoul National University College of Medicine, Seoul, Korea

Address for correspondence Yu Jin Lee, MD, PhD Department Psychiatry, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel +82-2-2072-2456 Fax +82-2-744-7241 E-mail ewpsyche@snu.ac.kr

Revised 20 January 202031 January 2020 Accepted 5 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This paper reviews the updated findings, including the current clinical guidelines and recent research trends, on the pathophysiology, diagnosis, and treatment of obstructive sleep apnea (OSA), a common sleep disorder associated with medical and mental disorders. The pathophysiology of OSA is believed to be related not only to the anatomical causes of the upper airway but also to the comparative anatomical mechanisms, such as the upper airway muscle function, arousal threshold, and loop gain. When OSA is suspected of being a clinical symptom or sign, a sleep study should be used for a diagnosis of OSA. Traditionally, continuous positive airway pressure has been the most effective first-line treatment for OSA. On the other hand, there could be a limitation of longterm compliance and new therapies that are suitable for the diverse mechanisms of OSA have been proposed or studied. In the future, the treatment of enhancing the effect through a more individualized consideration should be applied for OSA.

Keywords: Obstructive sleep apnea, Diagnosis, Treatment

REFERENCES

1). Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976; 27:465–484.

2). Kim J, In K, Kim J, You S, Kang K, Shim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004; 170:1108–1113.

3). Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328:1230–1235.

4). Chen YH, Keller JK, Kang JH, Hsieh HJ, Lin HC. Obstructive sleep apnea and the subsequent risk of depressive disorder: a population-based followup study. J Clin Sleep Med. 2013; 9:417–423.

5). Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012; 307:2169–2176.

6). Marshall NS, Wong KK, Phillips CL, Liu PY, Knuiman MW, Grunstein RR. Is sleep apnea an independent risk factor for prevalent and incident diabetes in the Busselton Health Study? J Clin Sleep Med. 2009; 5:15–20.

7). Choi JW, Song JS, Lee YJ, Won TB, Jeong DU. Increased mortality in relation to insomnia and obstructive sleep apnea in Korean patients studied with nocturnal polysomnography. J Clin Sleep Med. 2017; 13:49–56.

8). Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005; 353:2034–2041.

9). Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year followup of the Wisconsin sleep cohort. Sleep. 2008; 31:1071–1078.

10). Tasali E, Ip MS. Obstructive sleep apnea and metabolic syndrome: alterations in glucose metabolism and inflammation. Proc Am Thorac Soc. 2008; 5:207–217.

11). Kohler M, Stradling JR. CrossTalk proposal: most of the cardiovascular consequences of OSA are due to increased sympathetic activity. J Physiol. 2012; 590:2813–2815.

12). Schäfer H, Koehler U, Ploch T, Peter JH. Sleep-related myocardial ischemia and sleep structure in patients with obstructive sleep apnea and coronary heart disease. Chest. 1997; 111:387–393.

13). Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013; 188:996–1004.

14). Carberry JC, Amatoury J, Eckert DJ. Personalized management approach for OSA. Chest. 2018; 153:744–755.

15). Eckert DJ. Phenotypic approaches to obstructive sleep apnoea - new pathways for targeted therapy. Sleep Med Rev. 2018; 37:45–59.

16). Eckert DJ, Younes MK. Arousal from sleep: implications for obstructive sleep apnea pathogenesis and treatment. J Appl Physiol (1985). 2014; 116:302–313.

17). Tkacova R, Dorkova Z. Clinical presentations of OSA in adults. Eur Respir Monogr. 2010; 50:86–103.

18). Liu L, Kang R, Zhao S, Zhang T, Zhu W, Li E, et al. Sexual dysfunction in patients with obstructive sleep apnea: a systematic review and metaanalysis. J Sex Med. 2015; 12:1992–2003.

19). Ustun B, Westover MB, Rudin C, Bianchi MT. Clinical prediction models for sleep apnea: the importance of medical history over symptoms. J Clin Sleep Med. 2016; 12:161–168.

20). Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope. 1999; 109:1901–1907.

21). Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002; 127:13–21.

22). Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999; 131:485–491.

23). Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016; 149:631–638.

24). Cho YW, Lee JH, Son HK, Lee SH, Shin C, Johns MW. The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath. 2011; 15:377–384.

25). Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for Diagnostic Testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017; 13:479–504.

26). American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed.Darien, IL: American Academy of Sleep Medicine;2014.

27). Sullivan CE, Issa FG, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981; 318:862–865.

28). Stepnowsky CJ Jr, Moore PJ. Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev. 2003; 7:445–446.

29). Rotenberg BW, Vicini C, Pang EB, Pang KP. Reconsidering first-line treatment for obstructive sleep apnea: a systematic review of the literature. J Otolaryngol Head Neck Surg. 2016; 45:23.

30). Marin JM, Carrizo SJ, Vicente E, Agusti AG. Longterm cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005; 365:1046–1053.

31). Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M, Martínez-Alonso M, Carmona C, Barceló A; A, et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA. 2012; 307:2161–2168.

32). McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016; 375:919–931.

33). Martinez-Garcia MA, Campos-Rodriguez F, Javaheri S, Gozal D. Pro: continuous positive airway pressure and cardiovascular prevention. Eur Respir J. 2018; 51:1702400.

34). McEvoy RD, Kohler M. Con: continuous positive airway pressure and cardiovascular prevention. Eur Respir J. 2018; 51:1702721.

35). Aurora RN, Casey KR, Kristo D, Auerbach S, Bista SR, Chowdhuri S, et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. Sleep. 2010; 33:1408–1413.

36). Camacho M, Nesbitt NB, Lambert E, Song SA, Chang ET, Liu SY, et al. Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and metaanalysis. Sleep. 2017; 40:zsx004.

37). Dorrity J, Wirtz N, Froymovich O, Hamlar D. Genioglossal advancement, hyoid suspension, tongue base radiofrequency, and endoscopic partial midline glossectomy for obstructive sleep apnea. Otolaryngol Clin North Am. 2016; 49:1399–1414.

38). Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol (1985). 2005; 99:1592–1599.

39). Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Permutt S, et al. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1991; 144:494–498.

40). Strollo PJ Jr, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, et al. Upper-airway stimulation for obstructive sleep apnea. N Engl J Med. 2014; 370:139–149.

41). Woodson BT, Soose RJ, Gillespie MB, Strohl KP, Maurer JT, de Vries N, et al. Three-year outcomes of cranial nerve stimulation for obstructive sleep apnea: the STAR trial. Otolaryngol Head Neck Surg. 2016; 154:181–188.

42). Gaisl T, Haile SR, Thiel S, Osswald M, Kohler M. Efficacy of pharmacotherapy for OSA in adults: a systematic review and network metaanalysis. Sleep Med Rev. 2019; 46:74–86.

43). Taranto-Montemurro L, Messineo L, Sands SA, Azarbarzin A, Marques M, Edwards BA, et al. The combination of atomoxetine and oxybutynin greatly reduces obstructive sleep apnea severity. A randomized, placebo-controlled, double-blind crossover trial. Am J Respir Crit Care Med. 2019; 199:1267–1276.

44). Carley DW, Prasad B, Reid KJ, Malkani R, Attarian H, Abbott SM, et al. Pharmacotherapy of apnea by cannabimimetic enhancement, the PACE clinical trial: effects of dronabinol in obstructive sleep apnea. Sleep. 2018; 41:zsx184.

45). Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ. Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 2006; 29:1036–1044.

46). Zinchuk A, Yaggi HK. Sleep apnea heterogeneity, phenotypes, and cardiovascular risk. Implications for trial design and precision sleep medicine. Am J Respir Crit Care Med. 2019; 200:412–413.

TOOLS

Similar articles