Sleep disordered breathing

Sleep disordered breathing (SDB) refers to a spectrum of respiratory disturbances that occur during sleep, including conditions such as snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA).

Characterized by recurrent arousals from sleep and intermittent hypoxemia.

SDB includes spectrum of disorders ranging from habitual snoring to frequent episodes of obstructive breathing during sleep.

2 of the main characteristics include sleep fragmentation and hypoxia, both of which may have negative effects on cognitive function.

A worldwide epidemic with an estimated prevalence of 26%

Common among older populations and can affect to 60% of elderly (Ancoll-Israel S et al).

SDB, affects 6-7% of children, with a higher prevalence among children of racial minorities or low income backgrounds

Associated with adverse health outcomes including: Hypertension, cardiovascular disease, and diabetes.

Consequences of untreated SDB in childhood include behavior problems, daytime sleepiness, impairment of growth, neurodevelopment, and quality of life, along with an increased prevalence of cardiovascular and metabolic diseases.

Sleep disordered breathing in hospitalized patients is associated with greater morbidity and mortality.

Associated with congestive heart failure, atrial fibrillation and stroke.

A risk factor for premature mortality.

Under diagnosed and undertreated.

Among older women, compared to those without sleep disordered breathing, there is an increased risk developing cognitive impairment (Yaffe K et al).

The above study was a prospective and cognition study of 298 women without dementia with overnight polysomnography findings of sleep disorder, and demonstrated elevated oxygen desaturation and high percentage of sleep time in apnea or hypopnea were associated with the risk of development of mild cognitive impairment or dementia.

Adenotonsillar hypertrophy is the most recognized risk factor for pediatric SDB.

In children with mild, STB, early tonsillectomy resulting in improved outcomes of symptoms, behavior and blood pressure.

Treatment for SDB depends on the underlying cause and severity of the condition.

Some lifestyle changes may help improve SDB, including maintaining a healthy weight, avoiding alcohol and sedatives before bedtime, sleeping on a  side instead of the back, and keeping a regular sleep schedule.

CPAP is a common treatment for moderate to severe sleep apnea.

Some individuals with mild to moderate SDB may benefit from oral appliances that help position the tongue and jaw to keep the airway open.

Surgical options may include procedures to remove excess tissue from the throat or reshape the jaw or palate.

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