Talk:Sleep apnea

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Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/sleep_apnea/sleep_apnea.htm (public domain)

Contents

[edit] Image

I added an image of myself wired up for a sleep study. If anyone feels that it is inappropriate to use an image of myself, believe me, I have no particular need to have my picture here. Hardly an ego-stroking picture. We lacked any image of this at all; I went in for a sleep study last night and arranged the picture for the specific purpose of having an image of this for the Commons. - Jmabel | Talk 05:11, 17 July 2009 (UTC)

[edit] 4-month old vandalism

FYI. Just removed four month old vandalism. Perhaps some bot should watch for the word crap? - Hordaland (talk) 11:58, 31 October 2009 (UTC)

Hi I am not sure if this is the right place to post this, but... I just read the article and I think there is some more vandalism on it. I am not one of the writers, so I don't think I am qualified to make this change myself. But there seems to be a joke on the article. Under Epidemiology heading, it says: "Also tickling of the abdomen, buttock and sole of the foot have been found to be affective alternative treatments for sleep apnea." Obviously a joke. — Preceding unsigned comment added by AmyRosenberg1 (talk • contribs) 14:46, 19 October 2011 (UTC)

[edit] Citation Verification

(Part of the WikiProject Medicine effort)
I hope that these sources will be of assistance in the efforts to improve this wiki.

[edit] Introduction Section

ICD9|327.2

  • broken link: the link doesn’t work, although the second link (780.57) does

“Sleep apnea (or sleep apnoea in British English) is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea (Greek: ἄπνοια (ápnoia), from α- (a-), privative, πνέειν (pnéein), to breathe), lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep.”

“The standard definition of any apneic event includes a minimum 10-second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation.”

  • Citation needed. I could find no source that verified these exact numbers.
I believe this comes from the AASM guidelines; I'll try to confirm if I can find a copy around.--MarmotteiNoZ 08:37, 11 December 2010 (UTC)

“Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or a "sleep study".”

“Clinically significant levels of sleep apnea are defined as five or more episodes per hour of any type of apnea”

“(from the polysomnogram)”

  • I suggest rewording to “(as measured by a polysomnogram)” or removing this parenthetical statement

“Breathing is interrupted by the lack of respiratory effort in central sleep apnea; in obstructive sleep apnea, breathing is interrupted by a physical block to airflow despite respiratory effort. In complex (or "mixed") sleep apnea, there is a transition from central to obstructive features during the events themselves.”

“Regardless of type, the individual”

  • Suggest “an individual” rather than “the individual”

“the individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening”

What is this "apnoea in BRITSH English"? What you call 'British English' is English. Otherwise it is Jamaican English, Australian English, American English or some other off-shoot. —Preceding unsigned comment added by 182.53.148.86 (talk) 12:14, 10 January 2011 (UTC)

[edit] Classification section

[edit] Obstructive sleep apnea section

Note: this section was checked for accuracy, but the main article on obstructive sleep apnea was not. Many of these suggestions may apply to the main article as well.

“Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing”

“The muscle tone of the body ordinarily relaxes during sleep”

  • Suggest “The residual muscle tension of the body (muscle tone) ordinarily relaxes during sleep” to avoid confusion with the more colloquial use of the term “muscle tone”

“may not be important”

  • Suggest “may not have long-term deleterious effects”, because “important” is vague

“but chronic severe obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), sleep deprivation, and other complications. The most serious complication is a severe form of congestive heart failure called cor pulmonale.”

“Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more likely to have OSA than young people. Men are more likely to suffer sleep apnea than women and children are, though it is not uncommon in the latter two population groups.”

“Many people benefit from sleeping at a 30-degree elevation of the upper body”. This citation for this statement is a primary source. I suggest this review article instead: https://ckm.osu.edu/sitetool/sites/intmedpulmpublic/documents/Standards%20of%20practice%20review.pdf.

The 3 citations following “…are also recommended as a treatment for sleep apnea,” are also all primary sources. Again, recommend the above review article instead, which has good summarizes of all the possible treatments for OSA, including discussions of CPAP and surgery.

The paragraph on snoring is only supported by one primary source. This textbook may be a better general source for the entire discussion of snoring and sleep apnea: Snoring and obstructive sleep apnea; http://books.google.com/books?id=jUEFn5RfqqoC&printsec=frontcover#v=onepage&q&f=false

The following two sources:

  • Yan-fang S, Yu-ping W (August 2009). "Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients"
  • Bixler EO, Vgontzas AN, Lin HM, et al. (November 2008). "Blood pressure associated with sleep-disordered breathing in a population sample of children"

are primary sources that could be removed because the immediately follow references are both review article that nicely summarize the effects of sleep-disordered breathing:

  • Leung RS (2009). "Sleep-disordered breathing: autonomic mechanisms and arrhythmias"
  • Silverberg DS, Iaina A, Oksenberg A (January 2002). "Treating obstructive sleep apnea improves essential hypertension and life"

Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (November 2005). "Obstructive sleep apnea as a risk factor for stroke and death".

  • Primary source claim: This article is a primary source. I suggest the following, freely-available review article: “The effect of obstructive sleep apnea on chronic medical disorders”; http://www.ncbi.nlm.nih.gov/pubmed/17373350.

“Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those unaffected”.

Kumar R, Birrer BV, Macey PM, et al. (June 2008). "Reduced mammillary body volume in patients with obstructive sleep apnea".

  • Primary source claim: Both this citation and the one immediately following it, which is the lay summary of the same article, are primary source references. However, I wasn’t able to find any reviews that cite this finding.

[edit] Central sleep apnea section

This entire section is unreferenced. I suggest the following general sources:

“Even in severe cases of central sleep apnea, the effects almost always result in pauses that make breathing irregular, rather than cause the total cessation of breathing.”

  • Citation needed: This whole section is in need of citations, but this particular paragraph, which discusses the effects of hypoxia, may want to reference this review article: http://www.ncbi.nlm.nih.gov/pubmed/19506312, which summarizes many of the effects on hypoxia on rodent models.

“In people with epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications”.

[edit] Mixed apnea and complex sleep apnea section

“The presence of central sleep apnea without an obstructive component is a common result of chronic opiate use (or abuse) owing to the characteristic respiratory depression caused by large doses of narcotics” *Incorrect positioning in the article – this sentence would fit better in the “central sleep apnea” section. This statement also requires a citation. One source that suggest a link between depressive drug use and sleep apnea is the Merck Manual of Health and Aging, page 438, though it is far from conclusive and actually suggests that drug use contributes to obstructive sleep apnea more than it does to central sleep apnea: http://books.google.com/books?id=dqU68DdZ8poC&printsec=frontcover#v=onepage&q&f=false

“Complex sleep apnea has recently been described by researchers as a novel presentation of sleep apnea.”

“As of July 2007, there has been no alternate convincing evidence produced that these central sleep apnea events associated with CPAP therapy for obstructive sleep apnea are of any significant pathophysiologic importance.”

  • Dated info: see the above two reviews for a more recent discussion of complex sleep apnea, its causes, and its status as a real disease. The subsequent paragraph, “Research is ongoing, however, at the Harvard Medical School, including adding dead space to positive airway pressure for treatment of complex sleep-disordered breathing” is also dated, and references only a single, limited case study.

[edit] Treatment section

“The CPAP machine assists only inhaling, whereas a BiPAP machine assists with both inhaling and exhaling and is used in more severe cases.”

‘Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF (December 2007). "Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option?”

  • Primary source claim: This is a primary source article. I suggest either this excellent review - http://www.ncbi.nlm.nih.gov/pubmed/17136406, or the Chan et al. reference immediately following this one, which is listed below and now has a PMID nmber.

“Chan A, Lee R, Cistulli PA. Oral Appliances for Obstructive Sleep Apnea [Review]. Chest (In Press). 2007 Aug; 132(2):693-9”

“CPAP and OAT are generally effective only for obstructive and mixed sleep apnea which have a mechanical rather than a neurological cause.”

“In mild cases of obstructive sleep apnea, use of a specially shaped pillow or shirt may reduce sleep apnea episodes, usually by causing users to sleep on the side instead of on the back or in a reclining position instead of flat.”

“For patients who do not tolerate or fail nonsurgical measures, surgical treatment to anatomically alter the airway is available”

“For patients who fail these operations, the facial skeletal may be advanced by means of a technique called maxillomandibular advancement, or two-jaw surgery (upper and lower jaws)”

“Technically, this is accomplished by a surgery similar to orthognathic surgeries addressing an abnormal bite. The surgery involves a Lefort type one osteotomy and bilateral sagittal split mandibular osteotomies.”

  • I think these two sentences might be more detailed than a general audience requires or wants.

“Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with Cheyne-Stokes respiration (CSA-CSR).” Primary source claim: Just like in the introduction, this source is primary, and this review might be better - https://ckm.osu.edu/sitetool/sites/intmedpulmpublic/documents/Standards%20of%20practice%20review.pdf.

‘"Sleep Apnea". Diagnosis Dictionary. Psychology Today. http://www.psychologytoday.com/conditions/sleep-apnea.”

  • Failed verification – this source doesn’t talk about Acetazolamide

“Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects”

  • Failed verification – the Psychology today source doesn’t mention hypoxia and the other two references are in Spanish and German.
  • Dubious - Additionally, hypoxia is the absence of oxygen, so treating with low doses of oxygen is probably not used as a treatment for it.

[edit] Surgery section

The long term efficacy of surgery (except Tracheostomy) is known to be awful and the available surgerys are known to be some of the most painful peformed. Worse surgery can make CPAP less effective afterwards if it fails or apneas recur. http://www.health.com/health/condition-article/0,,20188724,00.html http://www.umm.edu/patiented/articles/what_surgical_procedures_sleep_apnea_000065_10.htm I've added such information and better sources than above throughout the years and they are always removed. It is often very biased sites offering the surgery that are positive about outcomes. The current state of this articlei s abysmal. Syousef1975 (talk) 04:48, 14 January 2011 (UTC)

“In contrast, although not well known, surgery is more expensive and can treat directly the causes of sleep apnea”

  • Citation needed: almost all of the sources listed in this paragraph from this sentence on are primary sources, and the paragraph itself discusses the results of the studies in too much detail. I suggest removing most of the details and summarizing the following excellent review - http://www.ncbi.nlm.nih.gov/pubmed/19950024

“Individuals with sleep apnea generally require more intensive monitoring after surgery for these reasons.”

  • Citation needed: This review, while not freely available, offers an excellent discussion of the needs of apnea patients after surgery and can be used as a citation for this entire paragraph: http://www.ncbi.nlm.nih.gov/pubmed/19944343

[edit] Alternative treatments section

“Ojay, Alise. "About Singing for Snorers"”

  • Verify credibility: it’s not clear that the paragraphs about “singing for snorers” contains any reliable information, as all the references are self-published or are articles written by the subject of the paragraph. However, the paragraphs are clear that the claims are unproven, so I don’t consider them particularly damaging.

[edit] Epidemiology section

“It is estimated that 20 million Americans are affected by sleep apnea”

“The Wisconsin Sleep Cohort Study found that, among the middle-aged, nine percent of women and 24 percent of men had sleep apnea.”

  • Citation needed: this text is both a primary source and is probably outdated. I suggest citing the other references in this section, which are both more current and are reviews.

[edit] History section

“The first reports in the medical literature of what is now called obstructive sleep apnea date only from 1965, when it was independently described by French and German investigators”

Tracheostomy was the recommended treatment and, though it could be life-saving, postoperative complications in the stoma were frequent in these very obese and short-necked individual.

“The management of obstructive sleep apnea was revolutionized with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates”


AMFEditor (talk) 23:53, 3 May 2010 (UTC)

[edit] Nasopharyngeal stent

The following was moved here from the article page for discussion. (I corrected the link in ref #1 and the date in ref #2.) Similar material has been removed from the article several times before, but it seems that the editor who has been restoring it has been making an effort to improve it. Unfortunately it may have fundamental problems that are not correctable. In any case, the editor should get consensus before restoring similar material again.


A new conservative therapy, especially for those patients being incompliant with CPAP therapy, is the nasopharyngeal stent,[1]. This concept of mechanically splinting the throat and thereby preventing collapse of the airway passage has already been successfully clinically tested[2] in the 1980ies in the U.S. before advent of CPAP by inserting latex tubes through the nose into the throat. Therapeutic efficacy was very good, yet long-term use led to mucosal irritation and patient incompliance. The new nasopharyngeal stent is a mesh made from thin nitinol wires, therefore very open-porous avoiding the disadvantages of the nasopharyngeal tube. Therapeutic efficacy and good patient compliance compared to CPAP have been proven in a clinical trial [3].
1. "Nasopharyngeal stent". http://alaxo.com/page12.html. 
2. Nahmias JS, Karetzky MS (1988). "Treatment of the obstructive sleep apnea syndrome using a nasopharyngeal tube..". Chest 94: 1142-7.. http://chestjournal.chestpubs.org/content/94/6/1142.long. 
3. Hartl M, Göderer L, Schick B, Iro H (2009). "Vergleich des pharyngealen Stents mit konventioneller nCPAP Therapie in der Behandlung des obstruktiven Schlaf-Apnoe-Syndroms.". EGMS. http://www.egms.de/static/de/meetings/hnod2009/09hnod632.shtml. 
(Babelfish translation of ref #3.)


Comments:

1) Reference #1 is a manufacturer's website that is promoting the product and is not a reliable source, in my opinion.

2) Reference #3 is an abstract for a talk given at a conference and does not have a corresponding full text journal article. It briefly describes a study and doesn't go into much detail. For example, it does not mention the number of patients, which may be a very small number. The study appears to be only preliminary since a translation of the abstract says, "Conclusion: In further investigations it must be examined whether the positive results of this study are confirmed. If this applies, the nasopharyngeale Stent in selected cases represents an alternative to the CPAP therapy."

Note that this contradicts the manufacturer's website of reference #1 which claims that the "results from the clinical study demonstrate therapeutic efficacy" of their device, which apparently isn't true according to the above conclusion from the abstract which says that confirmation is required before the stent can be used as an alternative to CPAP. If it were demonstrated already, confirmation wouldn't be needed. The edit appears to be promoting the product in a manner similar to the manufacturer. Presumably this was unintentional. The edit makes a claim at the end that "Therapeutic efficacy and good patient compliance compared to CPAP have been proven in a clinical trial.[3]" Reference #3 didn't give any results for patient compliance in the study.
--Bob K31416 (talk) 03:34, 20 September 2010 (UTC)

My two bits: one small scale clinical trial isn't sufficiently notable for mention in this article. Rklawton (talk) 03:39, 20 September 2010 (UTC)

[edit] Surgery Costs and Prevalence

While the article mentions success rates there is no indication of the costs of the surgery options for Maxillomandibular advancement (MMA), ie whether it is expensive or an affordable option for the average person and how often this option is used (ie how many such procedures are done annually). I'm not sure if this is true (perhaps someone who knows more about it can clarify at least a ballpark in this article). --EvenGreenerFish (talk) 23:57, 9 January 2011 (UTC)

[edit] Apnea vera

When I type in apnea vera, I get redirected to sleep apnea. My teacher in physiology has the following question for homework: "After a brief period of hyperventilation, 'apnea vera' occurs. Define apnea vera, and describe the feedback loop causing apnea vera."

That really doesn't sound like sleep apnea to me. I suggest a new page should be created for apnea vera; short of that, it should be mentioned in this article and/or the automatic reroute should be removed. Being rerouted to sleep apnea makes my brain muddle up in trying to figure out if it's the same thing, or another version of sleep apnea somehow, or what. Jojojlj (talk) 03:29, 3 March 2011 (UTC)

[edit] Hypoxic Pulmonary Vasoconstriction

I know obstructive sleep apnoea can induce hypoxic pulmonary vasoconstriction. I do not feel qualified or have the knowledge to make the necessary amendments, if someone is an expert, your modifications would be appreciated. Also overall, i think the page looks a little messy in comparison to some of the others (ie its in essay format, adding pictures/diagrams/bullet points might help improve the page). Not complaining, appreciate where it is at, just suggesting some possibly refinements to take it from good to excellent :) User:Tmoney 21:36, 8 October 2011 (AEDST) — Preceding unsigned comment added by 49.2.10.223 (talk)


Cite error: There are <ref> tags on this page, but the references will not show without a {{Reflist}} template or a <references /> tag; see the help page.

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