The sleep breathing disorders (SDB) include obstructive sleep apnea (OSA), central sleep apnea disorders, sleep related hypoventilation disorders, and sleep related hypoxemia disorder in international classification of sleep diseases 3rd edition (ICSD-3). Latest diagnosis criteria are introduced. Treatments, which target to Individual contributors, should be applied. Thus identification of the phenotype in patients with OSA is important. The methods of evaluation patients' arousal thresholds, loop gain as well as neuromyopathy in clinical setting are reported. Several new treatment strategies are developed and applied for OSA. Long term follow up and more data are needed for evaluation the outcomes of hypoglossal nerve stimulation, bariatric surgery as well as medicine as treatments for OSA.
Humans ; Sleep Apnea Syndromes ; diagnosis ; therapy ; Sleep Apnea, Central ; Sleep Apnea, Obstructive

Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Continuous Positive Airway Pressure ; Humans ; Lung ; Respiration ; Sleep Apnea, Central/therapy* ; Sleep Apnea, Obstructive

Humans ; Infant, Newborn ; Male ; Sleep Apnea, Central ; diagnosis ; therapy

Humans ; Sleep Apnea, Central/therapy* ; Hypoventilation/congenital* ; Homeodomain Proteins

OBJECTS: This study was conducted to investigate the effects of sleep apnea syndromes on the systemic blood pressure. METHODS: The subjects were 140 patients who were consulted to Yon-jung brain auction and sleep research center for polysomnography due to snoring and sleep apnea from Jan. 1st 1995 to Oct. 31st 1995. Twenty-four out of 140 were excluded due to cardiovascular diseases other than systemic hypertension, antihypertensive medication, inadequate data or diagnosis other than sleep apnea syndrome. The remaining 116 were accepted as proper subjects. Using Pearson's correlation and multiple regression analysis, we looked for the relationship between sleep and respiratory variables to systemic blood pressure. RESULTS: The results were as follows : 1) According to the correlation analysis, statistically significant variables to mean systolic and diastolic blood pressure were the total time and total number of sleep apnea, degree of oxygen saturation of total sleep time, apnea index, total time and total number of central apnea, and the total time of obstructive apnea. 2) According to the multiple regression analysis, only the total time of sleep apnea significantly affected mean systolic and diastolic blood pressure, and the degrees of affection were 7.9% and 6.2% respectively. CONCLUSION: These findings showed that sleep apnea syndrome had lower influence over systemic blood pressure than expected and regardless of the type, only the total time of sleep apnea influenced systemic blood pressure. In the case of central apnea, mechanisms other than hypoxemia and the increase of sympathetic activity during arousal may make it possible to increase systemic blood pressure.
Anoxia ; Apnea ; Arousal ; Blood Pressure* ; Brain ; Cardiovascular Diseases ; Diagnosis ; Humans ; Hypertension ; Oxygen ; Polysomnography ; Sleep Apnea Syndromes* ; Sleep Apnea, Central ; Snoring

OBJECTIVEThe aim of this study is to investigate the occurrence and mechanism of Cheyne-Stokes breathing pattern in patients with heart failure.

METHODSFifty-six patients who performed polusomnography sleep testing at National Center of Cardiovascular Diseases Fuwai Hospital from March to May in 2015. We divided them into chronic heart failure (CHF) group and non-CHF group.

RESULTSThe occurrences of sleep apnea in two groups were high. In CHF group (n = 11) , there were 10 patients with apnea hypopnea index (AHI) > 5; and their AHI was 23.93 ±14.63. In non-CHF group (n = 45), there were 33 patients whose AHI > 5; and their AHI was 16.20 ± 18.76. The ratio of center sleep apnea to all gross sleep apnea ratio in CHF group was higher than that in non-CHF group (80.21% ± 30.55% vs 27.16% ± 35.71%, P < 0.01 ).

CONCLUSIONBased upon the new theory of holistic integrative physiology and medicine, we explain the mechanism of circulatory dysfunction induce the oscillation breathing in patients with CHF. The sleep apnea and C-S respiration in CHF should be called circulatory sleep apnea, rather than central sleep apnea.

OBJECTIVES: Much attention has been paid to sleep apnea syndrome (SAS) in the elderly because of its high prevalence. It is expected that SAS in the elderly has both similarities and differences compared to SAS in the young or middle-aged populations. The aim of this study was to elucidate the characteristics and consequences of SAS in the elderly. METHODS: In this study we included 210 young or middle-aged adults between 23 and 59 years (20 women and 190 men) and 65 older adults between 60 and 83 years of age (16 women and 49 men). Respiratory disturbance indices (RDIs) of the study subjects were more than 5 in an overnight polysomnography. They completed the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Informations about body mass index (BMI), neck, waist, and hip measurements, and blood pressure were obtained. RESULTS: No difference was observed between older adults with SAS (older SAS) and adults aged under 60 with SAS (SAS aged under 60) in RDI, apnea index, % time of oxygen saturation less than 90%, and PSQI. Obstructive apnea index and oxygen desaturation index (ODI) were lower in older SAS. Compared to SAS aged under 60, lowest oxygen saturation and central apnea index were higher in older SAS, but they were statistically not significant. BMI and neck circumference were significantly lower in older SAS compared to SAS aged under 60. Diastolic blood pressure was lower in older SAS compared to SAS aged under 60 with no difference in systolic blood pressure. Older SAS showed lower scores in ESS than SAS aged under 60. Significant correlation was observed between RDI and BMI in SAS aged under 60, but not in the case of older SAS. The relationships between RDI and neck circumference, systolic and diastolic pressure, and ESS were similar. CONCLUSIONS: The elderly with SAS were not over-weight and there was no relationship between body weight and the severity of SAS. Also, the behavioral and cardiovascular effects of SAS were not marked in the elderly, which might be partly explained by decreased ODI and relatively higher lowest oxygen saturation in older SAS. The normal aging process, aside from increased body weight, might contribute to the development of SAS in the elderly with modest complications.
Adult ; Aged* ; Aging ; Apnea ; Blood Pressure ; Body Mass Index ; Body Weight ; Female ; Hip ; Humans ; Neck ; Oxygen ; Polysomnography ; Prevalence ; Sleep Apnea Syndromes* ; Sleep Apnea, Central

The prevalence of sleep disorders increases with age. Sleep apnea is one of the most important diseases in the field of sleep disorders and is also highly prevalent in the elderly. It affects older men and women similarly and excessive daytime sleepiness, cognitive impairment, nocturia, cardiovascular diseases, traffic accidents and repeated falls are common manifestations of sleep apnea in the elderly. Polysomnography is the gold standard for the diagnosis of sleep apnea and reliable markers of respiratory efforts and a tibial EMG should be included because central sleep apneas and periodic leg movements are common in the elderly patients. Although cardiovascular morbidity and mortality seem to be lower in the elderly than in middle-aged adults, these may not be as low as commonly believed. Treatment should not be withheld on the basis of age, as symptoms such as excessive daytime sleepiness, cognitive dysfunction and nocturia can be improved by effective treatment with continuous positive airway pressure (CPAP) and compliance to CPAP use is not different from that in younger patients. Further clinical studies are warranted.
Accidents, Traffic ; Adult ; Aged ; Cardiovascular Diseases ; Compliance ; Continuous Positive Airway Pressure ; Female ; Humans ; Leg ; Male ; Nocturia ; Polysomnography ; Prevalence ; Sleep Apnea Syndromes ; Sleep Apnea, Central ; Sleep Wake Disorders

BACKGROUND: The cardiovascular dysfunction frequently accompanies sleep apnea syndrome, but the exact pathophysiology of cardiovascular dysfunction still remains uncertain. Moreover, most studies are concerned with obstructive sleep apnea syndrome and the studies of central sleep apnea syndrome are rare. METHODS: We studied with sixteen dogs which were anesthetized with intravenous pancuronium bromide. We created nonobstructive breath hold (apnea) in anesthetized dogs by means of alternating fixed duration (30s) of apnea and mechanical ventilation (breathing). After five or seven repetitions of this apnea-breathing cycle, we measured arterial oxygen pressure, arterial carbon dioxide pressure, heart rate, cardiac output, mean femoral artery pressure and mean pulmonary artery pressure separately before apnea (baseline), 25s after apnea (apneic period), 10s (early phase of postapneic period) and 25s (late phase of postapneic period) after resumption of breathing. We analysed the impact of oxygen trial on the hemodynamic changes by comparing measures of the eight 30% oxygen breathing dogs with the other eight room air breathing dogs. RESULTS: Heart rate decreased significantly at apneic period compared to baseline (p<0.05), and increased significantly at early and late phase of postapneic period compared to apneic period (p<0.05). After oxygen trial, this change of heart rate showed significant difference (p<0.05). Cardiac output only tended to decrease during late phase of postapneic period by comparison with baseline and apneic period. Mean femoral artery pressure of apneic period increased more than that of baseline (p<0.05), and persisted until late phase of postapneic period (p<0.05). When oxygen was supplied, this change of increase disappeared, but did not show statistical significance. Mean pulmonary artery pressure did not change according to apnea-breathing cycle and oxygen trial. CONCLUSION: In anesthetized dogs with periodic nonobstructive apnea, the changes of heart rate, cardiac output, mean femoral artery pressure were noted and the change of heart rate was closely related with hypoxia. Through this study, indirectly, we were able to understand partially the changes of cardiovascular function in patients with central sleep apnea syndrome.
Animals ; Anoxia ; Apnea* ; Arterial Pressure ; Carbon Dioxide ; Cardiac Output ; Dogs* ; Femoral Artery ; Heart Rate ; Hemodynamics* ; Humans ; Oxygen ; Pancuronium ; Pulmonary Artery ; Respiration ; Respiration, Artificial ; Sleep Apnea Syndromes ; Sleep Apnea, Central ; Sleep Apnea, Obstructive

Two children with late-onset congenital central hypoventilation syndrome were reported, one of whom was male and had no abnormal manifestations after birth, respiratory failure occurs at the age of 1 year and 6 months. After being hospitalized, he was treated with oxygen inhalation and non-invasive ventilation, but carbon dioxide retention could not be corrected. After one month of tracheal intubation, he was failure to wean from ventilator, so tracheostomy was performed. He needs a ventilator to help breath while sleeping, and can breath autonomously during the day without ventilator. The other case was a female, with no abnormalities after birth. At the age of 11 months, she developed respiratory failure. During sleep, the child needs non-invasive assisted ventilation through a nasal mask, and during the day, she breathed autonomously.Two patients were followed up forever 2 years and their growth and development were normal.
Humans ; Child ; Male ; Female ; Infant ; Sleep Apnea, Central/therapy* ; Respiration, Artificial ; Hypoventilation/congenital* ; Oxygen