Diagnosis Of Obstructive Sleep Apnea

According to the International Classification of Sleep Disorders (second edition) (ICSD-2) (2), the diagnosis is based on PSG and clinical criteria in adults and children. The following is a brief overview of the diagnostic criteria.

In adults, the patient complains of daytime sleepiness, unrefreshing sleep, fatigue, insomnia, awaking with breath holding, gasping, or choking, or there is a bed partner that notes loud snoring or breathing pauses during sleep. If the patient is not symptomatic, for example the patient has only snoring during sleep, then a PSG showing > 15 obstructive apneas, obstructive hypopneas, and/or RERAs per hour of sleep can be confirmatory. If the patient is symptomatic, for example the patient has daytime sleepiness, OSA is confirmed by a PSG showing > 5 obstructive apneas, obstructive hypopneas, and/or RERAs per hour of sleep.

A child may not be able to give a history and the parent or other caregiver may note snoring, labored or obstructed breathing, or both during the child's sleep. There are a number of witnessed sleep events that may indicate OSA, which include paradoxical inward rib cage motion during inspiration, movement arousals, sweating, or neck hyperextension. In addition, the parent or caregiver may note that the child is excessive sleepy during the day, has hyperactivity or aggressive behavior, has a slow rate of growth, has morning headaches and/or enuresis. This is confirmed by a PSG

FIGURE 5 An obstructive apnea with a crescendo increase in esophageal pressure (Pes). Snoring intensity, observed in the Mic channel, parallels the changes in esophageal pressure until the start of the apnea. The apnea ends in an arousal, noted by an increase in chin and leg electromyogram tone and an increase in the electroencephalogram signal frequency. There is a paradox of the abdominal and thoracic movement (respiratory excursions are out of phase) and an arterial oxygen desaturation to 87%. The apnea occurs in rapid eye movement sleep, and the epoch is two minutes in duration. Abbreviations: C4A1, O1A2, electroencephalogram electrodes placed centrally or occipitally and referenced to the left (A1) and right (A2) ear, respectively; Chin EMG, electromyogram recorded from chin muscles; ROCA1, right eye electro-oculogram referenced to the left (A1) ear; LOCA2, left eye electro-oculogram referenced to the right (A2) ear; PULSE, pulse rate; EKG, electrocardiogram; LAT and RAT, leg movements measured from left and right anterior tibialis, respectively; Mic, snoring intensity by microphone; Nasal and Oral, airflow assessed by pressure transducer and thermistor, respectively; Chest and Abdomen, thoracic and abdominal movement, respectively, measured by impedance bands; Pes, esophageal pressure measurements; SaO2, pulse oximetry from a finger sensor. Source: Courtesy of Clete A. Kushida, M.D., Ph.D.

FIGURE 5 An obstructive apnea with a crescendo increase in esophageal pressure (Pes). Snoring intensity, observed in the Mic channel, parallels the changes in esophageal pressure until the start of the apnea. The apnea ends in an arousal, noted by an increase in chin and leg electromyogram tone and an increase in the electroencephalogram signal frequency. There is a paradox of the abdominal and thoracic movement (respiratory excursions are out of phase) and an arterial oxygen desaturation to 87%. The apnea occurs in rapid eye movement sleep, and the epoch is two minutes in duration. Abbreviations: C4A1, O1A2, electroencephalogram electrodes placed centrally or occipitally and referenced to the left (A1) and right (A2) ear, respectively; Chin EMG, electromyogram recorded from chin muscles; ROCA1, right eye electro-oculogram referenced to the left (A1) ear; LOCA2, left eye electro-oculogram referenced to the right (A2) ear; PULSE, pulse rate; EKG, electrocardiogram; LAT and RAT, leg movements measured from left and right anterior tibialis, respectively; Mic, snoring intensity by microphone; Nasal and Oral, airflow assessed by pressure transducer and thermistor, respectively; Chest and Abdomen, thoracic and abdominal movement, respectively, measured by impedance bands; Pes, esophageal pressure measurements; SaO2, pulse oximetry from a finger sensor. Source: Courtesy of Clete A. Kushida, M.D., Ph.D.

that demonstrates during sleep one or more apneas or hypopneas of at least two respiratory cycles in duration, or frequent RERAs, arterial oxygen desaturation with apnea, or hypercapnia, or frequent arousals and snoring associated with periods of hypercapnia and/or arterial oxygen desaturation or frequent arousals associated with paradoxical breathing (abdominal and thoracic movement out of phase).

Sleep Apnea

Sleep Apnea

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