Diagnostic approach to sleep-disordered breathing

Abstract

Respiratory disorders in sleep are highly prevalent and increasingly recognized. Among these, obstructive sleep apnea, resulting in daytime fatigue and somnolence, increased risk of workplace and traffic accidents but also psychosocial dysfunction, is most often diagnosed. As an independent risk factor for cardiovascular and metabolic disease, obstructive sleep apnea has recently attracted even more attention. Apart from continuous positive airway pressure, only a few alternative treatment options are available. Individual history is still most important for selecting patients for sleep studies. Fatigue and a high subjective propensity to fall asleep during the daytime, a history of snoring and breathing pauses during sleep combined with anthropometric risk factors make a diagnosis very likely. Other night-time respiratory disorders include central sleep apnea, Cheyne–Stokes respiration, obesity hypoventilation syndrome and mixed sleep apnea syndromes. The diagnosis of sleep-disordered breathing can be made by comprehensive sleep studies in a sleep laboratory, but also using portable equipment for cardiorespiratory monitoring and measurement of oxygen desaturation at home, according to pretest probabilities, individual experience and local preferences.

Keywords::

• cardiorespiratory monitoring
• diagnosis
• polysomnography
• sleep apnea
• sleep-disordered breathing
• sleepiness
• vigilance

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

^†A sequence of breaths characterized by increasing respiratory effort leading to an arousal from sleep, but that does not meet criteria for an apnea or hyperpnea. The event must last 10 s or more and demonstrate a pattern of progressively negative esophageal pressure, terminated by a sudden change in pressure to a less negative level and an arousal.

OSAS: Obstructive sleep apnea syndrome.

Data taken from [28].