Neurological Perspective on Obstructive and Nonobstructive Sleep Apnea

One of every 15 adults in the United States has at least moderate sleep apnea. The true prevalence is higher, as ∼0.3 to 5% of adults with sleep apnea are undiagnosed. Sleep apnea has major health consequences; therefore, neurologists must recognize and treat sleep apnea syndromes appropriately. There are three main categories of sleep apnea: obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea. OSA results from upper airway obstruction, and CSA is due to lack of inspiratory muscle effort; mixed apnea results from a combination of these factors. Sleep apnea syndromes can present within the spectrum of “typical” neurological complaints, including forgetfulness, headaches, sleepiness, fatigability, seizures, and muscle and nerve weakness. A good sleep history, a nocturnal polysomnogram, and multiple sleep latency test are important in elucidating the diagnosis and validating the complaints of sleepiness. The gold standard for treatment of OSA is positive airway pressure, although some patients may benefit from surgical interventions designed to bypass the site of airway obstruction. With CSA, treatment is directed toward the underlying disorder. Patients with CSA may also benefit from several types of nasal positive airway pressure treatment, while some require mechanical ventilation.

KEYWORDS

Neurological - perspective - sleep apnea

REFERENCES

• 1 Young T, Peppard P, Gottlieb D. Epidemiology of obstructive sleep apnea. A population health perspective.  Am J Respir Crit Care Med. 2002;  165 1217-1239
• 2 Lindberg E, Gislason T. Epidemiology of sleep-related obstructive breathing.  Sleep Med Rev. 2000;  4 411-433
• 3 American Academy of Sleep Medicine Task Force . Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.  Sleep. 1999;  22 667-689
• 4 Howard R S, Wiles R S, Hirsch R S, Spencer R S. Respiratory involvement in primary muscle disorders.  Q J Med. 1993;  86 175-189
• 5 Mellies U, Ragette R, Schwake C, Baethmann M, Voit T, Teschler H. Sleep-disordered breathing and respiratory failure in acid maltase deficiency.  Neurology. 2001;  57 1290-1295
• 6 Guilleminault C, Stoohs R, Quera-Salva M. Obstructive and non-obstructive apneas during sleep and neurological disorders.  Neurology. 1992;  42(suppl 6) 53-60
• 7 Rogette R, Mellies U, Schwake C, Voit T, Techsler H. Patterns and predictors of sleep disordered breathing in primary myopathies.  Thorax. 2002;  57 724-728
• 8 Quera-Salva R S, Guilleminault C, Chevret S et al.. Breathing disorders during sleep in myasthenia gravis.  Ann Neurol. 1992;  31 86-92
• 9 Stepansky R, Weber G, Zeitlhofer J. Sleep apnea and cognitive dysfunction in myasthenia gravis.  Acta Med Austriaca. 1997;  24 128-131
• 10 Guilleminault C, Robinson A. Central sleep apnea.  Otolaryngol Clin North Am. 1998;  31 1049-1065
• 11 Chokroverty S. Sleep breathing, and neurologic disorders. In: Chokroverty S Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects Woburn, MA; Butterworth-Heinemann 1999: 509-571
• 12 Krieger A J, Rosomoff H L. Sleep induced apnea: a respiratory and autonomic dysfunction syndrome following bilateral percutaneous cervical cordotomy.  J Neurosurg. 1974;  40 168-180
• 13 Nogues M, Gene R, Benarroch E, Leiguarda R, Calderon C, Encabo H. Respiratory disturbances during sleep in syringomyelia and syringobulbia.  Neurology. 1999;  52 1777-1783
• 14 Devereaux M W, Keane J R, Davis R L. Automatic respiratory failure associated with infarction of the medulla. Report of two cases with pathologic study of one.  Arch Neurol. 1973;  29 46-52
• 15 Nakajima M, Katsura K, Hashimoto Y, Terasaki T, Uchino M. A case of Ondine curse associated with a medullary tumor.  Rinsho Shinkeigaku. 2000;  40 811-815
• 16 Martin R, Roessmann U, Fanaroff A. Massive intracerebellar hemorrhage in low-birth-weight infants.  J Pediatr. 1976;  89 290-293
• 17 Kemp A M, Stoodley N, Cobley C, Coles L, Kemp K W. Apnoea and brain swelling in non-accidental head injury.  Arch Dis Child. 2003;  88 472-476
• 18 Clay A, Behnia M, Brown K. Mitochondrial disease: a pulmonary and critical-care medicine perspective.  Chest. 2001;  120 634-648
• 19 Arnulf I, Similowski T, Salachas F et al.. Sleep disorders and diaphragmatic function in patients with amyotrophic lateral sclerosis.  Am J Respir Crit Care Med. 2000;  161 849-856
• 20 Gozal D. Congenital central hypoventilation syndrome: an update.  Pediatr Pulmonol. 1998;  26 273-282
• 21 Weese-Mayer D E, Silvestri J M, Marazita M L, Hoo J J. Congenital central hypoventilation syndrome: inheritance and relation to sudden infant death syndrome.  Am J Med Genet. 1993;  47 360-367
• 22 Shahar E, Shinawi M. Neurocristopathies presenting with neurologic abnormalities associated with Hirschsprung's disease.  Pediatr Neurol. 2003;  28 385-391
• 23 Guilleminault C, Tilkian A, Lehrman K et al.. Sleep apnea syndrome: states of sleep autonomic dysfunction.  J Neurol Neurosurg Psychiatry. 1977;  40 718-725
• 24 Chesson A, Berry R, Pack A. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults.  Sleep. 2003;  26 907-913
• 25 Poyares D, Guilleminault C, Rosa A, Ohayon M, Koester U. Arousal, EEG spectral power and pulse transit time in UARS and mild OSAS subjects.  Clin Neurophysiol. 2002;  113 1598-1606
• 26 Loube D, Gay P, Strohl K, Pack A, White D, Collop N. Indications for positive airway pressure treatment of adult obstructive sleep apnea patients.  Chest. 1999;  115 863-866
• 27 Lowe A, Schmidt-Nowara W. Oral appliance therapy for snoring and sleep apnea. In: Pack A Sleep Apnea Pathogenesis Diagnosis and Treatment New York; Marcel Dekker Inc 2002: 555-573
• 28 Grunstein R, Sullivan C. Continuous positive airway pressure for sleep breathing disorders. In: Kryger M, Roth T, Dement W Principles and Practice of Sleep Medicine. 3rd ed Philadelphia; WB Saunders 2000: 894-912
• 29 Sher A, Goldberg A. Upper airway surgery for obstructive sleep apnea. In: Pack A Sleep Apnea Pathogenesis Diagnosis and Treatment New York; Marcel Dekker Inc 2002: 575-605
• 30 Riley R, Powell N, Li K, Guilleminault C. Surgical therapy for obstructive sleep apnea-hypopnea syndrome. In: Kryger M, Roth T, Dement W Principles and Practice of Sleep Medicine. 3rd ed Philadelphia; WB Saunders 2000: 913-928
• 31 Li K K. Surgical management of obstructive sleep apnea.  Clin Chest Med. 2003;  24 365-370
• 32 Guilleminault C, Philip P, Robinson A. Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease.  J Neurol Neurosurg Psychiatry. 1998;  65 225-232
• 33 Krachman S, Criner G. Sleep disorders.  Clin Chest Med. 1998;  19 139-154
• 34 Elefteriades J A, Quin J A. Diaphragm pacing.  Chest Surg Clin N Am. 1998;  8 331-357
• 35 Chervin R D, Guilleminault C. Diaphragm pacing for respiratory insufficiency.  J Clin Neurophysiol. 1997;  14 369-377