Presentation
Strategies to increase effective management in patients presenting for gynecologic surgery are needed. [ncbi.nlm.nih.gov]
Entire Body System
- Fatigue
However, the effect on fatigue as major complaint in chronic fatigue patients without excessive daytime sleepiness, is not fully understood nor explored. [ncbi.nlm.nih.gov]
RSIA requires a railroad to consider the need to include in its fatigue management plan “opportunities for identification, diagnosis, and treatment of any medical condition that may affect alertness or fatigue, including sleep disorders.” ( Id. at section [federalregister.gov]
However, it is important to acknowledge the difference between daytime sleepiness and fatigue. [docsopinion.com]
“We strongly believe that DOT should immediately reconsider the decision in order to help avoid future fatigue-related tragedies,” the letter states. [safetyandhealthmagazine.com]
Complications may include: Daytime fatigue and sleepiness. The repeated awakenings associated with obstructive sleep apnea make normal, restorative sleep impossible. [mayoclinic.org]
- Weight Gain
We report a patient with anti-muscle kinase receptor MG with severe OSA and hypoventilation that resolved upon successful treatment of MG despite a 60-lb weight gain. [ncbi.nlm.nih.gov]
This may be due to allergies and seasonal weight gain (many people get heavier in the winter). [tuck.com]
[…] loss or poor weight gain) Excessive daytime sleepiness [stanfordhealthcare.org]
Symptoms of OSA include: Odd positions during sleep with head propped up or off the bed Loud and continuous snoring Weight loss or poor weight gain Stopping breathing at night for a short period − followed by snorting and gasping or completely waking [cincinnatichildrens.org]
- Enuresis
Clinicians should routinely ask about enuresis in patients suspected of having OSA. A systematic study of the association between enuresis and OSA in adults is warranted. [ncbi.nlm.nih.gov]
Children five years and older commonly exhibit enuresis, behavior problems, deficient attention span, and failure to thrive, in addition to snoring. [aafp.org]
- Problems at School
These behavioral problems may manifest themselves as irritability, lack of concentration, easy distractibility, and acting out which can lead to problems at school. [stanfordhealthcare.org]
As a result of their extreme sleepiness, they often show behavioral problems during the day. If left undiagnosed, OSA can lead to problems at school, and delayed growth. [cincinnatichildrens.org]
They may include: Bed-wetting Choking or drooling Sweating a lot at night Ribcage moves inward when they breathe out Learning and behavior problems Problems at school Sluggishness or sleepiness (often seen as laziness) Snoring Teeth grinding Restlessness [webmd.com]
Obstructive Sleep Apnea in Special Populations • Children Prevalence-2%, equal in boys and girls Adenotonsillar hypertrophy is the major etiology EDS is not a common symptom but problems with school work Tonsillectomy is the major treatment. • Pregnancy [slideshare.net]
- Infectious Mononucleosis
Independently, obstructive sleep apnea (OSA) and infectious mononucleosis are not uncommon in the pediatric population, but acute onset of OSA, as a respiratory complication in the setting of acute EBV infection is extremely uncommon. [ncbi.nlm.nih.gov]
The Epstein-Barr virus, for example, is known to be able to dramatically increase the size of lymphoid tissue during acute infection, and obstructive sleep apnea is fairly common in acute cases of severe infectious mononucleosis. [sciencedaily.com]
While systemic steroids are used to decrease upper airway obstruction in patients with infectious mononucleosis (because of anti-inflammatory and lympholytic effects), one study of systemic steroids demonstrated no effect on the size of tonsils or adenoids [aafp.org]
The Epstein-Barr virus, for example, is known to be able to dramatically increase the size of lymphoid tissue during acute infection, and OSA is fairly common in acute cases of severe infectious mononucleosis. [en.wikipedia.org]
Respiratoric
- Sleep Apnea
The cardinal symptoms of sleep apnea include the "3 S ’s": S noring, S leepiness, and S ignificant-other report of sleep apnea episodes. [emedicine.medscape.com]
Obstructive Sleep Apnea in Children Menu What is obstructive sleep apnea? Obstructive sleep apnea (OSA) is a condition in which there are brief pauses in your child's breathing pattern during sleep. [my.clevelandclinic.org]
Obstructive sleep apnea Other names Obstructive sleep apnoea Obstructive sleep apnea: As soft tissue falls to the back of the throat, it impedes the passage of air (blue arrows) through the trachea. [en.wikipedia.org]
- Snoring
Eligibility: (1) Patients: controls, snoring or OSA patients (2) Intervention: neuromuscular evaluation of the palate and/or uvula (3) Comparison: differences between controls, snoring and OSA patients (4) Outcomes: neuromuscular outcomes (5) Study design [ncbi.nlm.nih.gov]
Snoring Snoring is a common feature of OSA. However, although 80 to 90 percent of people with OSA report snoring, many people who snore don’t have OSA. [docsopinion.com]
Generally all people with obstructive sleep apnoea snore. 2 But not all people who snore have sleep apnoea (see "Snoring alone is not a good predictor"). [bpac.org.nz]
Be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence. [mayoclinic.org]
Some scientific evidence suggests that snoring for years at a time can lead to the development of lesions in the throat, just as the vibrations from snoring can lead to nerve or neuron lesions all around the body. [sleepassociation.org]
- Loud Snoring
SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA) a condition involving repeated episodes of partial or complete blockage of the airway during sleep. [bmc.org]
Be sure to talk to your doctor if you experience loud snoring, especially snoring that's punctuated by periods of silence. [mayoclinic.org]
Loud snoring is a telltale symptom of OSA. Snoring is caused by air squeezing through the narrowed or blocked airway. Not everyone who snores has sleep apnea though. [nlm.nih.gov]
OSA related symptoms included loud snoring, apneas, awakenings with gasping breaths, enuresis, and daytime sleepiness. [ncbi.nlm.nih.gov]
- Nasal Congestion
Chronic nasal congestion. Obstructive sleep apnea occurs twice as often in those who have consistent nasal congestion at night, regardless of the cause. This may be due to narrowed airways. Smoking. [mayoclinic.org]
Have a deviated septum or other nasal congestion issues. Prognosis Prognosis for those who have sleep apnea is positive. [baptisthealth.com]
General measures in treating obstructive sleep apnea include losing excessive weight, avoiding alcohol and sedatives, sleeping on one side, and medications to relieve nasal congestion. [medicinenet.com]
Jaw & Teeth
- Mouth Breathing
Subjective assessments of clinical symptoms/signs, including snoring visual analog scale (VAS), nasal obstruction, and mouth breathing, were recorded. [ncbi.nlm.nih.gov]
Loud or noisy breathing, snoring, or mouth breathing during sleep Brief pauses in breathing during sleep or difficulty breathing during sleep Restless sleep (i.e., lots of tossing and turning) Sweating heavily during sleep Bedwetting Sleeping in odd positions [my.clevelandclinic.org]
Common symptoms of obstructive sleep apnea in children may include: Snoring Daytime cognitive and behavior problems, including problems paying attention, easy distractibility, aggressive behavior and hyperactivity Mouth breathing Enlarged tonsils and [stanfordhealthcare.org]
Symptoms of Obstructive Sleep Apnea (OSA) are: snoring, restless/disturbed sleep, frequent partial or total wakenings and daytime mouth breathing. [ds-health.com]
Cardiovascular
- Hypertension
Hypertension Systemic hypertension is observed in 50-70% of patients with OSA. [emedicine.medscape.com]
Odds ratios for apnoea-hypopnoea index, body mass index, sex, age, and hypertension Fig 1. [doi.org]
Any diabetes-related complications (retinopathy, neuropathy, nephropathy, or coronary artery disease) were present in 55.5%, and 70.2% of the participants had hypertension. [ncbi.nlm.nih.gov]
- Tachycardia
The combination of hypoxaemia and partial arousal with each apnoea or hypopnoea is accompanied by a surge of adrenergic activity with consequent tachycardia and transient systemic hypertension. [academic.oup.com]
Activation of the sympathetic nervous system, by both hypoxia and arousal, may induce tachycardia and peripheral vasoconstriction, further increasing ventricular afterload (67). [onlinejacc.org]
Heart rates often change during apneic episodes, with relative bradycardia occurring during airway obstruction followed by tachycardia during arousals. Specific cranio-facial and oropharyngeal features also predispose a person to develop OSA. [todaysgeriatricmedicine.com]
Cardiovascular Disease in Obstructive Sleep Apnea • Vagal stimulation causes bradycardia • Bradycardia and hypoxia provoke serious cardiac rhythm disturbances i.e. premature beats asystole, ventricular tachycardia, cardiac arrest. 26. [slideshare.net]
[…] suggested an increased risk for coronary artery disease/myocardial ischemia, 13, 14 cerebrovascular accidents, 15, 16 and cardiomyopathy. 15, 17 Brady- and tachyarrhythmias may occur with increased frequency in patients with SDB, 18, 19 and ventricular tachycardia [clinical.diabetesjournals.org]
Musculoskeletal
- Muscular Atrophy
Children with some types of neuromuscular disease (eg, Duchenne muscular dystrophy, spinal muscular atrophy, cerebral palsy) may also have a higher risk of developing sleep apnea. [emedicine.com]
Face, Head & Neck
- Pierre Robin Syndrome
Less common causes include a tumor or growth in the airway, and birth defects such as Down syndrome and Pierre-Robin syndrome. [webmd.com]
Certain syndromes or birth defects, such as Down syndrome and Pierre-Robin syndrome, can also cause obstructive sleep apnea. What are the symptoms of obstructive sleep apnea? The following are the most common symptoms of obstructive sleep apnea. [stanfordchildrens.org]
Major risk factors for OSAS in children include adeno-tonsillar hypertrophy, neuromuscular disease and syndromes such as Down's or Pierre-Robin's syndrome. [analesdepediatria.org]
Children with syndromes that involve micrognathia, such as Treacher Collins syndrome, Pierre Robin syndrome, and Goldenhar's syndrome, become obstructed at the hypopharyngeal level. [aafp.org]
Psychiatrical
- Mood Swings
“We're talking about car accidents in the daytime, lost productivity at work, mood swings, waking up feeling groggy and falling asleep in class.” [hopkinsmedicine.org]
People with obstructive sleep apnea may also complain of memory problems, morning headaches, mood swings or feelings of depression, and a need to urinate frequently at night (nocturia). [mayoclinic.org]
They include: breathing stopping and starting making gasping, snorting or choking noises waking up a lot loud snoring During the day, you may also: feel very tired find it hard to concentrate have mood swings have a headache when you wake up Information [nhs.uk]
These include: Excess sweating Heat intolerance Warm skin Excessive hunger Weight loss Mood swings Panic attack Irritability Hyperactivity Restlessness Nervousness Abnormal heart rhythm Fast heart rate Palpitations Fatigue Insomnia Irregular menstruation [verywell.com]
- Anxiety Disorder
There were no significant differences among instrument types in self-report of psychiatric disorders (e.g., anxiety, ADHD, bipolar, depression), neurological disorders (e.g., seizure, stroke), cardiovascular disorders (e.g., heart disease, hypertension [doi.org]
Urogenital
- Sexual Dysfunction
There are many sexual dysfunctions in men that seem to be linked such as erectile dysfunction (ED), low dyadic, and solitary sexual desire, which share many risk factors. [transbiomedicine.com]
dysfunction Headaches People with central sleep apnea more often report recurrent awakenings or insomnia, although they may also experience a choking or gasping sensation upon awakening. [my.clevelandclinic.org]
Since people with sleep apnea tend to be sleep deprived, they may suffer from sleeplessness and a wide range of other symptoms such as difficulty concentrating, depression, irritability, sexual dysfunction, learning and memory difficulties, and falling [sleepfoundation.org]
These include: Sensitivity to cold Constipation Dry skin Brittle nails Hair loss Unexplained weight gain High cholesterol Irritability Sexual dysfunction Slow heart rate Irregular uterine bleeding It is important to note that not all of these symptoms [verywell.com]
- Nocturnal Enuresis
In the present study, enuresis in pediatric OSA patients significantly decreased after surgery. Also, Epworth scores decreased significantly after surgery. In children with nocturnal enuresis, the presence of OSA symptoms should be questioned. [ncbi.nlm.nih.gov]
[…] of nocturnal enuresis as the treatment of the sleep disorder might have a favourable therapeutic effect on the enuresis.[46][43][45] For example, an adenotonsillectomy performed to reduce OSA has a positive impact on nocturnal enuresis.[46][39] A study [en.wikipedia.org]
Bed wetting — also known as nocturnal enuresis, although there are many causes for bedwetting besides sleep apnea. Frequent infections — may include a history of chronic problems with tonsils, adenoids, and/or ear infections. [chop.edu]
Neurologic
- Headache
A 36-year-old active duty male with migraine headaches presented for evaluation of poorly controlled hypertension. [ncbi.nlm.nih.gov]
There is a strong association between OSA and headache. In particular, there is a “sleep apnea headache” described as a recurrent morning headache, with resolution after effective treatment of sleep apnea. [link.springer.com]
[…] odd positions (e.g. neck hyperextended) Inattentiveness and lack of focus at school Excessive daytime sleepiness (e.g., child regularly falls asleep in school) Poor academic performance Irritable mood, aggressiveness, other behavioral problems Morning headaches [my.clevelandclinic.org]
If left untreated, OSA can cause daytime sleepiness, poor sleep quality, high blood pressure, increased blood sugar levels (as in diabetes), heart disease, cerebrovascular disease, depression, memory problems, sexual difficulties, weight gain and headaches [hospitals.jefferson.edu]
- Irritability
OSA can cause children to be tired, irritable or hyperactive during the day and to perform below their potential at school. [childrenshospital.org]
Ask your doctor about any sleep problem that leaves you chronically fatigued, sleepy and irritable. Excessive daytime drowsiness may be due to other disorders, such as narcolepsy. [mayoclinic.org]
[…] and turning) Sweating heavily during sleep Bedwetting Sleeping in odd positions (e.g. neck hyperextended) Inattentiveness and lack of focus at school Excessive daytime sleepiness (e.g., child regularly falls asleep in school) Poor academic performance Irritable [my.clevelandclinic.org]
Irritability/personality change. Nocturia. Decreased libido. Symptoms such as personality change, episodes of apnoea, irritability and restlessness at night may be better elicited by taking a history from a partner. [patient.info]
The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible, making severe daytime drowsiness, fatigue and irritability likely. [mayoclinic.com]
- Morning Headache
headaches Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]
A 64-year-old woman was referred to the department of otolaryngology because of daytime sleepiness and morning headaches. The patient refused polysomnographic evaluation because of claustrophobia. [ncbi.nlm.nih.gov]
Typical symptoms include snoring, not feeling refreshed on waking, day-time sleepiness, altered mood and morning headaches. [southerncross.co.nz]
In many cases it leads to debilitating daytime sleepiness, morning headaches, depression, and a general sense of unwellness. [sleepapnea.org]
- Somnolence
Neither patient exhibited daytime somnolence, although both were subsequently found to have severe obstructive sleep apnea. [ncbi.nlm.nih.gov]
- Sleep Disturbance
Daytime sleepiness (Epworth scale from 0 (no daytime sleepiness) to 24), sleep quality (Pittsburgh quality of sleep index from 0 (excellent sleep quality) to 21), partner rating of sleep disturbance (visual analogue scale from 0 (not disturbed) to 10) [ncbi.nlm.nih.gov]
In addition, the partners of participants in the didgeridoo group were much less disturbed in their sleep. [doi.org]
The combination of sleep disturbance and oxygen starvation can result in multiple problems, including automobile accidents, hypertension, heart disease, and mood and memory problems. OSA affects approximately 20 million Americans. [holyname.org]
Workup
Side effects of prolonged tongue-lip adhesion and optimal workup and treatment of persistent OSA in the setting of a tongue-lip adhesion. Pierre Robin sequence (PRS), persistent obstructive sleep apnea (OSA), and tongue-lip adhesion (TLA). [ncbi.nlm.nih.gov]
Workup • An overnight sleep study,or polysomnography: In-laboratory measurement of sleep architecture and electroencephalographic (EEG) arousals, eye movements, chin movements, airflow, respiratory effort, oximetry, electrocardiographic (ECG) tracings [slideshare.net]
It is necessary for this kind of nystagmus to perform a complete neurological and endocrinological workup. [intechopen.com]
Serum
- Hypercapnia
Six months later, severe hypoxemia without hypercapnia was noted. Contrast transthoracic echocardiography showed right-to-left shunt through a patent foramen ovale. [ncbi.nlm.nih.gov]
Neural responses to hypoxia and hypercapnia have not been well studied in children with obstructive sleep apnea and underlying syndromes. [emedicine.com]
References: [5] [3] Pathophysiology Obstruction of the upper airways → apnea → ↓ partial pressure of oxygen in arterial blood ( PaO 2 ), ↑ partial pressure of carbon dioxide in arterial blood ( PaCO 2, also known as hypercapnia ) → ↑ Hypoxic pulmonary [amboss.com]
The respiratory pauses may induce hypercapnia or hypoxia. Cardiac arrhythmias and elevation of systemic and pulmonary arterial pressures may occur. [icd9data.com]
This is called “hypercapnia.” Adults with OSA often have fragmented sleep. They tend to wake up briefly after their breathing stops. Children with OSA often do not wake up in response to pauses in breathing. [sleepeducation.org]
Treatment
Treatment of OSA usually improves well-being and reduces the risk of associated disorders. However, many people with OSA don’t receive treatment because they are not properly diagnosed. [docsopinion.com]
Patients should be encouraged to persevere with treatment for at least four weeks, as treatment acceptance often improves over time. [bpac.org.nz]
and for treatment of OSA should be low. [emedicine.medscape.com]
Prognosis
We discuss the pathophysiology of obstructive sleep apnea, as well as its prevalence, treatment outcomes with continuous positive airway pressure, and prognosis in these 2 distinct types of heart failure. [ncbi.nlm.nih.gov]
Prognosis Prognosis for those who have sleep apnea is positive. There are treatments that can alleviate symptoms and lead to better sleep, including, dental appliances, therapies and CPAP machines. [baptisthealth.com]
For patients who respond to CPAP, the short-term prognosis is excellent. [patient.info]
Etiology
KEYWORDS: Continuous positive airway pressure/methods; heart diseases/epidemiology/etiology; heart failure/complications/therapy; prevalence; risk factors; sleep apnea syndromes/classification/physiopathology; sleep apnea, obstructive/complications/prevention [ncbi.nlm.nih.gov]
Etiology Obstruction of the upper airways due to the collapse of the pharyngeal muscles during sleep Risk factors Obesity, especially around the neck (short, wide “ bull neck ”) Structural abnormalities that impair respiratory flow : tonsillar hyperplasia [amboss.com]
This finding suggests that the etiology of OSA in children may result from a complex interplay between adenotonsillar hypertrophy and loss of neuromuscular tone. [aafp.org]
Epidemiology
The primary objective of this article is to review some of the epidemiologic aspects of obstructive sleep apnea in adults. Correspondence and requests for reprints should be addressed to Naresh M. [doi.org]
The prevalence of OSA has increased in epidemiological studies over time. [ncbi.nlm.nih.gov]
Pathophysiology
We believe that this case exemplifies the relevant pathophysiological interdependence between obesity, metabolic syndrome and OSAS. [ncbi.nlm.nih.gov]
The potential for some of the specific pathophysiological causes of OSA to drive some of the key symptoms and consequences of OSA is also highlighted. [dovepress.com]
Prevention
A ‘Positioner’ preventing sleeping on the back can effectively reduce obstructive sleep apnea (OSA), but not always snoring for patients with long-term OSA. [doi.org]
KEYWORDS: Continuous positive airway pressure/methods; heart diseases/epidemiology/etiology; heart failure/complications/therapy; prevalence; risk factors; sleep apnea syndromes/classification/physiopathology; sleep apnea, obstructive/complications/prevention [ncbi.nlm.nih.gov]
CPAP machines increase air pressure in the throat to prevent sleep apnea's effect of closing off the upper airway and interrupting breathing. [hub.jhu.edu]