Index

ACE. See Angiotensin-Converting enzyme inhibitors Acetazolamide (Diamox), 239, 297, 298

nonhypercapnic CSA, 328 Acid maltase deficit

NIPPV, 176 Acoustic reflection upper airway, 67-68 Acromegaly, 237, 398

CSA, 326 Actigraphy, 29-30

ADA. See Americans with Disabilities Act Adaptive servo-ventilation, 125, 134. See also Bilevel pressure and adaptive servo-ventilation Adenotonsillectomy pediatric SDB, 272 ADHD. See Attention deficit/hyperactivity disorder Adherence adaptive servo-ventilation, 129-130 CPAP, 111-113 nasal CPAP, 255 oral appliances, 223 positive pressure therapy, 160, 161-164 dependent variable, 161-162 Aerophagia positive pressure therapy, 159 Aggressive disorders, 267 Aging, CSA, 324

AHI. See Apnea/hypopnea index (AHI) Air leakage positive airway pressure therapy, 159 Airway bypass surgery, 210

tracheotomy, 210 Alcohol, 233, 253, 300, 302 GER, 396 geriatric OSA, 282 OSA, 8-9 Alertness, 89-100 Allergies, 9 Almitrine, 239

Alprazolam (Xanax, Niravam), 301

ALS. See Amyotrophic lateral sclerosis Alveolar hypoventilation clinical features, 176 Alzheimer's disease, 285, 370-371 Ambien®, 234, 302 Ambulatory diagnostic system, 30 Americans with Disabilities Act (ADA), 414 Aminorex (Menocil), 236 Amlodipine (Norvasc), 299 Amyotrophic lateral sclerosis (ALS), 378-379 NIPPV, 176 Androgens, 234 Anesthetics, 301 Angina, nocturnal, OSA, 7 Angiotensin-converting enzyme inhibitors, 299 ANN. See Artificial neural networks Antacids, GER, 396 Antiepileptic drug side effects, 349 Antihypertensive medications, 296 Antipsychotics, 300 Anxiolytics, 300

APAP. See Auto-positive airway pressure (APAP) Apert's syndrome, 271-272 Apnea. See also specific apnea genioglossus, 63 tensor palatine, 63 Apnea/hypopnea index (AHI), 43, 66 epilepsy, 340 insomnia, 350-351 OSA portable monitoring, 51-53 pediatric OSA, 269-270 Apnea Positive Pressure Long-term Efficacy

Study (APPLES), 425 Apneas, 2-3. See also specific apnea pons, 368 APPLES. See Apnea Positive Pressure

Long-term Efficacy Study ARES Unicorder, 28 Arnold Chiari malformations, 377 Arousal disorders, 359 Arrhythmias, cardiac, diagnosis, 38-39 Artificial neural networks (ANN), 23

Asthma, 390-392 bronchial vs. OSA, 342-343 CPAP, 391-392 Ataxic breathing, medulla, 368 Ativan, 301

Attention deficit/hyperactivity disorder

(ADHD), 268 Australia

CPAP cost and reimbursement, 116-117 Auto-positive airway pressure (APAP), 137-150, 163 auto-titration, 140-144

technique, 142-144 BPAP, 140, 147

Cheyne-Stokes central apnea, 139 chronic treatment, 144-148

technique, 147-148 vs. CPAP, 145-146 device characteristics, 137-138 efficacy, 141-142 EPAP, 140 IPAP, 140

mask/mouth leak, 138 portable monitors, 144 potential uses, 138 reimbursement, 148 repetitive apneas, 139 statistics, 145 AutoSet T, 138

Baclofen (Kemstro), 234 Barbiturates, 301, 374 Bariatric surgery, 236, 256

upper airway, 80-81 Bedwetting, 267 Behavioral treatment OSA, 233-234, 241 UARS, 314

Benzodiazepines, 233-234, 300, 301, 372, 374 Beta-blockers, 299 Bi-Flex device, 129-130, 140 Bilevel PAP (BPAP), 125, 154 APAP, 140, 147 pediatric SDB, 274 Bilevel pressure and adaptive servo-ventilation, 125-136 adherence, 129-130 central apnea, 130 Cheyne-Stokes respiration, 130 complex sleep apnea, 130-131 historical, 125-126

[Bilevel pressure and adaptive servo-ventilation] hypercapnia, 128-129 patient selection, 127-128 reimbursement criteria, 131-133 severe obesity, 127-128 titration, 126-127 Bisphosphonates

GER, 396 Blood pressure CPAP, 115-116 OSA, 10 BMI. See Body mass index Body mass index (BMI), 22, 235

geriatric OSA, 282 Bötzinger complex, 369 BPAP. See Bilevel PAP Bromocriptine (Parlodel), 239 Bronchial asthma vs. OSA

quality of life, 342-343 Bronchiectasis, NIPPV, 176 Bullying, 267

Bupivacaine (Marcaine), 234 Bushnell v. Bushnell, 406-407 Butalbital, 301

CAD. See Coronary artery disease Caffeine, GER, 396 Calcium channel blockers, 299 GER, 396

Canadian CPAP Trial for Congestive Health Failure Patients with Central Apnea (CANPAP), 116, 328 Cardiac arrhythmia diagnosis, 38-39 Cardiac failure, CPAP, 116 Cardiac medications, 299 Cardiorespiratory monitoring, 35-60 Cardiovascular disease, 398-400 Cardiovascular outcomes, CPAP, 115-116

Cardiovascular risk factor reduction,

OSA, 235 Cataplexy, 4 Catapres, 299 Central hyperventilation, midbrain, 368 Central nervous system (CNS)

disorders, 368, 370-375 Central sleep apnea (CSA), 38, 301, 321-332 acromegaly, 326

[Central sleep apnea (CSA)] aging, 324

bilevel pressure and adaptive servo-ventilation, 130 cerebrovascular disease, 325 congestive heart failure, 325 continuous positive airway pressure therapy,

153-154 CPAP, 103 gender, 324-325 hypercapnic, 321 management, 327 NIPPV, 327 hypothyroidism, 326 idiopathic, 326 management, 327-328 metabolic disorders, 326 nonhypercapnic, 322 management, 327-329 pharmacological therapy, 328-329 supplemental oxygen, 328-329 NREM, 322

pathogenesis during sleep, 322-323 pathophysiologic classification, 321-322 REM, 322

risk factors, 323-326 sleep state, 324 Cephalometry mandibular advancement splints, 225 upper airway, 67, 194 Cerebral cortex

Cheyne-Stokes, 368 Cerebrovascular disease, CSA, 325 Certificate of need (CON) and licensure laws, 418-419 Charcot-Marie-Tooth (CMT), 379 Cheyne-Stokes respiration (CSR), 53, 324, 369 APAP, 139

bilevel pressure and adaptive servo-ventilation, 130 cerebral cortex, 368 continuous positive airway pressure therapy, 153-154 geriatric SDB, 284 NIPPV, 176 Child Behavioral Checklist, 267 Children. See Pediatric Choking, 2-3

Choline esterase inhibitor, 372 Chronic hypercapnic respiratory failure NIMV, 340

Chronic hypoxemia, 379 Chronic obstructive pulmonary disease (COPD), 333-337, 392-394 airflow limitation, 334 diagnosis and management, 339-340 diaphragm, 336

gas exchange during sleep, 333-334 hypertension, 393 long-term oxygen therapy, 334-335 NIPPV, 394

nocturnal desaturation, 335 nocturnal hypoxemia, 334

treatment, 340 nocturnal oximetry, 339-340 noninvasive mechanical ventilation

(NIMV), 340-341 physiological variables, 334 positive airway pressure therapy, 154 respiratory muscles, 336 SDB, 337-338 sleep quality, 338-339 sleep studies, 340 Claustrophobia positive airway pressure therapy, 159 Cleveland Family Study, 9 Clonazepam (Klonopin), 301, 372 Clonidine (Catapres), 299 CMT. See Charcot-Marie-Tooth CNS. See Central nervous system Cognition geriatric SDB, 284-285 pediatric SDB, 268 Computed tomography (CT)

upper airway imaging, 65-66 CON. See Certificate of need (CON) and licensure laws Congenital craniofacial syndromes, 14 Congestive heart failure CSA, 325 geriatric SDB, 284 Conners Parent Rating Scale-Revised:Long, 267 Continuous positive airway pressure (CPAP), 101-124, 255 adherence, 111-113 Alzheimer's disease, SRBD, 371 vs. APAP, 145-146 assessment, 104 asthma, 391-392 baseline indicators, 113 benefits, 151-152 blood pressure, 115-116 cardiac failure, 116

[Continuous positive airway pressure (CPAP)] cardiovascular disease, 399-400 cardiovascular outcomes, 115-116 central apnea, 103 Cheyne-Stokes respiration, 153-154 CHF, 400

cost and reimbursement, 116-117 CSA, 153-154

decompensated patients with cardiorespiratory failure, 106-107 ESRD, 397 failure, 114 first night, 104-106 geriatric SDB, 288 health outcomes, 114-115 home setting, 107-108 indications, 152-155 interface, 109

left-to-right cardiac shunt (LRS), 115-116 mode of action, 102-103 motivation, 113 MRI, 79

nasal congestion, 108-109 vs. oral appliances, 222-223 OSA, 101, 152-153

upper airway imaging, 77 vs. other treatments, 110-111 pediatric SDB, 272-275 practical aspects, 103-104 preeclampsia, 115-116 pressure level and airflow, 109-110 side effects, 108-109 split-night study, 107 UARS, 153, 314 COPD. See Chronic obstructive pulmonary disease Coronary artery disease

OSA, 8 Cortisol, 252 Cost effectiveness portable monitor, 55-56 CPAP. See Continuous positive airway pressure Craniofacial features

OSA, 11-12 Craniofacial morphology upper airway, 72-73 Craniofacial syndromes congenital, 14 Criminal responsibility recklessness, 407-408

Crouzon's syndrome, 271-272 CSA. See Central sleep apnea CSR. See Cheyne-Stokes respiration CT. See Computed tomography Cycrin, 238, 297 Cystic fibrosis NIPPV, 176

Daytime sleepiness, 53

ESRD, 397 Delta sleep, children, 264 Dementia geriatric SDB, 284-285 Lewy body, 371 Dementia Rating Scale (DRS), 285 Demerol, 301 Depression OSA, 8

sleep apnea, 352-354 Dermatomyositis, 382 Desyrel, 299

Dexfenfluramine (Fen-Phen®), 236 Diabetes mellitus, 379 Diamox, 239, 297, 298

nonhypercapnic CSA, 328 Diaphragm

COPD, 336 Diazepam (Valium), 301 Diet, weight loss, 235 DigiTrace Home Sleep System, 25 Dilaudid, 234 Disability laws, 414-415 DMD. See Duchenne muscular dystrophy DME. See Durable medical equipment providers

DMERC. See Durable medical equipment regional carrier Dolophine, 234 Donepezil, 372 Dougherty v. Gifford, 409 Down syndrome, 272, 372 Driving, impaired physicians duties, 412-413 DRS. See Dementia Rating Scale (DRS) Dry mouth positive airway pressure therapy, 159 Duchenne muscular dystrophy (DMD), 272, 381-382 NIPPV, 155, 176

Duobloc mandibular advancement splints, 218, 227

Durable medical equipment (DME)

providers, 148 Durable medical equipment regional carrier

(DMERC), 131-132 Dynacirc, 299

Edema, upper airway, 71 Eden Trace II Recording System, 25 EDS. See Excessive daytime sleepiness Elderly. See Geriatric Embletta Recording System, 26 Employer legal obligations, 413-418 Enbrel, 239-240, 241

End-stage renal disease (ESRD), 396-398 CPAP, 397

daytime sleepiness, 397 PLMD, 397 RLS, 397 Enuresis, 267 EPAP. See Expiratory PAP Epilepsy, 373-375

sleep apnea treatment, 349-350 Epworth Sleepiness Scale (ESS), 91-92 Esophageal motility agents, 396 Esophageal reflux, 379 ESRD. See End-stage renal disease ESS. See Epworth Sleepiness Scale Estrogen, 251, 252, 296, 299 Etanercept (Enbrel), 239-240, 241 Ethnicity geriatric OSA, 282 upper airway, 72-73 Examination. See Physical examination Excessive daytime sleepiness (EDS), 2, 281, 307 Exercise, weight loss, 235 Expiratory PAP (EPAP), 126

APAP, 140 Eye irritation positive airway pressure therapy, 159

Family history geriatric OSA, 282 OSA, 9

Federal Aviation Administration Guide for

Aviation Medical Examiners, 418 Federal Motor Carrier Safety Administration, 417-418

Federal Railroad Administration (FRA), 417 Fen-Phen®, 236

Fiberoptic nasopharyngolaryngoscopy upper airway surgery, 193-194 Fluoxetine (Prozac, Sarafem), 298 FRA. See Federal Railroad Administration Fujita classification, 198 Functional Outcomes of Sleep Questionnaire, 222

Gasping, 2-3

Gastroesophageal reflux (GER), 394-396

OSA vs. bronchial asthma, 342-343 GBAT. See Genial bone advancement trephine system Gender CSA, 324-325 OSA, 247-260, 253-255 upper airway, 71-72 Genetics, upper airway, 72-73 Genial bone advancement trephine system (GBAT), 208 Genioglossus, apnea, 63 Genioglossus advancement hyoid myotomy, 208-209 GER. See Gastroesophageal reflux Geriatric obstructive sleep apnea, 281-295 epidemiology, 281-282 risk factors, 282-283 upper airway, 282 Geriatric sleep-disordered breathing Alzheimer's disease, 285 Cheyne-Stokes respiration, 284 clinical assessment and management, 287-288 clinical features, 283-284 cognition, 284-285 CPAP, 288 dementia, 284-285 diagnosis, 287-288 hypertension, 283 mortality, 286-287 oral appliances, 288 Parkinson's disease, 285-286 snoring, 283 surgery, 289 treatment, 288-289 Glaucoma, OSA, 8 Glossectomy, midline, 209 Growth hormone, 252 Guillain-Barré syndrome, 368, 379-380

Halcion, 234

Hallucinations, hypnagogic, 4

Headaches, 375-376

Health Insurance Portability and Accountability

Act of 1996 (HIPAA), 413 Health outcomes CPAP, 114-115 HIPAA. See Health Insurance Portability and Accountability Act of 1996 Histamine H2 receptor antagonists

GER, 396 History OSA, 1-20, 6-7, 7-8, 9 pediatric OSA, 13-14, 264-265 Hormone replacement therapy, 254-255, 296, 299

Hydromorphone (Dilaudid, Palladone), 234 Hyoid myotomy and suspension, 201-202 Hypercapnia bilevel pressure and adaptive servo-ventilation, 128-129 Hypercapnic central sleep apnea, 321 management, 327 NIPPV, 327 Hypercapnic respiratory failure chronic, NIMV, 340 Hypersomnolence oral appliances, 220 Hypertension, 299, 373 COPD, 393 geriatric SDB, 283 OSA, 8 Hyperventilation central, midbrain, 368 Hypnagogic hallucinations, 4 Hypnotics sedative, 233-234, 301 Hypoglossal nerve, 239 Hypopharynx anatomy and physiology, 61-62 obstruction, 208-209 Hypotension, 299

orthostatic, UARS, 313 Hypothyroidism, 237, 398 CSA, 326 OSA, 8 Hypoventilation alveolar, clinical features, 176 neuromuscular junction, 368 Hypoxemia chronic, 379 nocturnal COPD, 334 treatment, 340

ICAM-1. See Intracellular adhesion molecule-1

IL-6. See Interleukin-6 (IL-6)

IL-8. See Interleukin-8 (IL-8)

ILD. See Interstitial lung disease

Imipramine (Tofranil), 297

Imovane, 234

Impaired driving physician duties, 412-413 Inflammation, 389-390, 392, 399 Informed consent physicians duties, 411-412 Inhibace, 299 Injection snoreplasty, 207 Insomnia, 3, 6-7 defined, 350 prevalence, 350 sleep apnea, 350-352 Inspiratory PAP (IPAP), 126

APAP, 140 Institute of Medicine, 426 Interleukin-6 (IL-6), 389, 392 Interleukin-8 (IL-8), 389, 392, 399 Interstitial lung disease (ILD)

PAP, 155 Intracellular adhesion molecule-1

(ICAM-1), 389, 392, 399 Introspective sleepiness, 91-92 IPAP. See Inspiratory PAP (IPAP) Isradipine (Dynacirc), 299

K-ABC. See Kaufman Assessment Battery for Children (K-ABC) Karolinska sleepiness scale, 91, 92 Kaufman Assessment Battery for

Children (K-ABC), 268 Kemstro, 234 Klonopin, 301, 372 Kyphoscoliosis NIPPV, 176 PAP, 155

Lambert-Eaton syndrome, 380-381 Laser-assisted uvulopalatoplasty (LAUP), 68, 207

LAUP. See Laser-assisted uvulopalatoplasty Laws disability, 414-415 self-referral, 419 Left-to-right cardiac shunt (LRS)

CPAP, 115-116 Legal duties physicians, 408-409

Legal implications

OSA, 405-424 Legal obligations employers, 413-418 Leptin, 252

LES. See Lower esophageal sphincter (LES) Lewy body dementia, 371 Liability for employee's negligence employers, 416-417 Lingualplasty, 209 Lorazepam (Ativan), 301 Lower esophageal sphincter (LES), 395 LRS. See Left-to-right cardiac shunt (LRS)

Magnetic resonance imaging (MRI) CPAP, 79

upper airway, 64-65, 73 Maintenance of wakefulness test (MWT), 96, 97

Mallampati classification system, 12 Mandibles bite depth, 227 Mandibular advancement splints (MAS), 217-218 cephalometric radiograph, 225 duobloc, 218, 227 monobloc, 218 MRI, 219

Mandibular osteotomy with genioglossus advancement, 200-201 Manifest sleepiness, 95-97 observation scales, 96-97 Marcaine, 234

MAS. See Mandibular advancement splints (MAS) Mask leak APAP, 138

positive pressure therapy, 159 Maxillary osteogenic distraction device children, 275 Maxillomandibular advancement osteotomy

(MMO), 203-205 MCP-1. See Monocyte chemoattractant protein-1 (MCP-1) MD. See Myotonic dystrophy (MD) Mebaral, 301

Medical disorders, 389-404 Medications effects, 295-304 side effect checklists, 91, 92 Medroxyprogesterone (Cycrin, Provera), 238, 297

Medulla ataxic breathing, 368 Men

OSA, 247-248 Menocil, 236 Menopause, 254-255 Mentally handicapped individuals, 372 Meperidine hydrochloride (Demerol), 301 Mephobarbital (Mebaral), 301 Meridia, 236 MESAM IV, 27

Methadone (Dolophine, Methadose), 234

Methadose, 234

Metoclopramide

GER, 396 Metoprolol (Inhibace), 299 MG. See Myasthenia gravis Mibefradil (Posicor), 299 Micrognathia, 13 Midazolam (Versed), 301 Midbrain central hyperventilation, 368 Midline glossectomy (MLG), 209 Mirtazapine (remeron), 299 MLG. See Midline glossectomy MMO. See Maxillomandibular advancement osteotomy (MMO) Modafinil (Provigil), 240, 241-242, 295-297 adverse effects, 297 mechanism of action, 296 pharmacokinetics, 296-297 Monobloc mandibular advancement splints, 218 Monocyte chemoattractant protein-1

(MCP-1), 389, 392, 399 Morbidity clinical features, 283-284 Mortality clinical features, 283-284 Motivation CPAP, 113 Mouth leak APAP, 138 MRI. See Magnetic resonance imaging MSLT. See Multiple sleep latency test Muller maneuver, 68, 80 Multiple sclerosis, 376-377 Multiple sleep latency test (MSLT), 92, 94 pediatric OSA, 269 Muscular dysfunction/sensory neuropathy upper airway, 71

MWT. See Maintenance of wakefulness test Myasthenia gravis (MG), 370, 380-381 Myopathies, 381-382 myotonic NIPPV, 176 Myotonic dystrophy (MD), 382-384 Myotonic myopathy NIPPV, 176

Naloxone (Narcan), 239 Napping patterns children, 263-264 Narcan, 239 Narcolepsy sleep apnea, 354-355 Narcotics, 234 Nasal congestion, 237 CPAP, 108-109

positive airway pressure therapy, 159 Nasal continuous positive airway pressure. See also continuous positive airway pressure Nasal function

OSA, 11 Nasal reconstruction upper airway surgery, 197 Nasal rim bilateral collapse, 11 Nasopharyngolaryngoscopy fiberoptic upper airway surgery, 193-194 Nasopharyngoscopy upper airway, 68-69 Nasopharynx anatomy and physiology, 61-62 National Commission on Sleep

Disorders, 426 National Transportation Safety Board

(NTSB), 417 Neck circumference

OSA, 11 Nefazodone (Serzone), 299 Nembutal, 301

Neurological disorders, 367-388 Neuromuscular function disorders,

380-381 Neuromuscular junction hypoventilation, 368 Neuropathy peripheral, 379-380 Nicotine, 239 GER, 396

NIMV. See Noninvasive mechanical ventilation NIPPV. See Noninvasive positive pressure ventilation Niravam, 301 Nitric oxide (NO), 392, 399 NO. See Nitric oxide (NO) Nocturnal angina

OSA, 7 Nocturnal hypoxemia COPD, 334 treatment, 340 Nocturnal oximetry

COPD, 339-340 Non-rapid eye movement sleep (NREM), 5, 51 children, 264 CSA, 322 definitions, 22 Nonhypercapnic central sleep apnea, 322 management, 327-329 pharmacological therapy, 328-329 positive pressure therapy, 327-328 supplemental oxygen, 328-329 Noninvasive mechanical ventilation (NIMV) chronic hypercapnic respiratory failure, 340 COPD, 340-341 Noninvasive positive pressure ventilation (NIPPV), 154, 173-190 acid maltase deficit, 176 aerophagia, 181 air leaks, 180-181 amyotrophic lateral sclerosis, 176 bronchiectasis, 176 Cheyne-Stokes respiration, 176 complications, 180-181 congestion, 181 continuous, 180 COPD, 394 cystic fibrosis, 176 DMD, 155, 176 effects, 181-182

after ventilation, 181-182 during ventilatory assistance, 181 follow-up, 180

hypercapnic central apnea, 327 hypoventilation signs and symptoms, 175 indications, 177-178 interfaces, 173-174 kyphoscoliosis, 176 management, 178-181 nocturnal, 178-179

[Noninvasive positive pressure ventilation (NIPPV)] methods, 173-175 myotonic myopathy, 176 nasal dryness, 181 OHS, 176

Ondine's curse, 176 OSA, 176 Pierre Robin, 176 poliomyelitis, 155 potential use, 176 rhinitis, 181

spinal muscular atrophy, 176 survival, 176-177 tuberculosis, 155, 176 ventilator and mode, 174-175 Norvasc, 299 Novel flow sensor with amplifier, 309 pneumotachograph, 310 NREM. See Non-rapid eye movement sleep NTSB. See National Transportation Safety Board (NTSB)

Obesity adaptive servo-ventilation, 127-128 bilevel pressure, 127-128 OSA, 10, 250 severe, 127-128 upper airway, 70-71 Obesity hypoventilation syndrome (OHS) NIPPV, 176 PAP, 154

positive airway pressure therapy titration techniques, 157 regulatory screening in safety-sensitive positions, 417 Observation scales manifest sleepiness, 96-97 Obstructive sleep apnea (OSA). See also Geriatric obstructive sleep apnea; Pediatric obstructive sleep apnea adjunctive and alternative therapies,

233-246, 241 alcohol, 8-9 allergies, 9

behavioral therapies, 233-234, 241 blood pressure, 10 body habitus, 250 bronchial asthma, 341-345 vs. bronchial asthma quality of life, 342-343

[Obstructive sleep apnea (OSA)] cardiac arrhythmias, 38 cardiovascular risk factor reduction, 235 central ventilatory control, 251-252 clinical prediction models, 22-23 congenital craniofacial syndromes, 14 continuous positive airway pressure upper airway imaging, 77 continuous positive airway pressure therapy, 152-153 contributing factors, 248-253 physical, 249-250 physiologic, 250-251 coronary artery disease (CAD), 8 CPAP, 101

craniofacial features, 11-12

crescendo increases, 40

demographics, 5-6

depression, 8

diagnosis, 21

epidemiology, 247-248

family history, 9

future directions, 425-426

gender differences, 247-260

gender-specific conditions, 253-255

glaucoma, 8

history and physical examination, 1-20

history of present illness, 6-7

hormonal effects, 251-252

hypertension, 8

hypothyroidism, 8

laboratory diagnosis, 24-25

laws regulating diagnosis and treatment,

418-419 legal implications, 405-424 legal obligations, 406 main cues, 2-3

medical disorders correction, 237-238, 241

medication history, 9, 10

medications worsening, 300-301

men, 247-248

nasal function, 11

neck circumference, 11

neuromuscular reflexes, 250-251

NIPPV, 176

nocturnal angina, 7

obesity, 10, 250

oral appliances upper airway imaging, 77-79 oxygen, 237-238, 241 past medical history, 7-8 pathogenesis, 69-70

[Obstructive sleep apnea (OSA)] pathophysiology, 36—38 pharmacologic therapy, 238-240, 241 pharynx, 11-12 physical examination, 9-10 portable monitoring, 25-26 positional therapy, 236-237, 241 pregnancy, 8 pulmonary disease, 8 screening, 21-34 sleep arousal, 252-253 smoking, 9 social history, 8-9 treatment, 255-256 upper airway anatomy, 249 upper airway compliance, 249-250 upper airway imaging, 75-81 weight gain, 7 weight loss upper airway imaging, 76-77 women, 247-248 Obstructive sleep apnea-hypopnea

(OSAH), 305 Obstructive sleep apnea-hypopnea syndrome (OSAHS), 305 Octreotide (Sandostatin), 237 ODI. See Oxygen desaturation index OHS. See Obesity hypoventilation syndrome Ondine's curse

NIPPV, 176 Opioids, 300, 301 Optical coherence tomography upper airway imaging, 64 Oral appliances, 217-232, 255-256 adherence, 223 adverse effects, 224-225 cardiovascular, 220-221 clinical evaluation and management, 226-227 clinical outcomes, 219-222 clinical practice issues, 226-230 vs. CPAP, 222-223 follow-up procedures, 228 geriatric SDB, 288 hypersomnolence, 220 indications and contraindications, 226 mechanisms of action, 218-219 neuropsychological, 220 OSA, 77-79

polysomnography, 219-220 quality of life, 222 selection, 227

[Oral appliances] snoring, 222 titration protocol, 228 TMJ discomfort, 226 treatment outcome prediction, 223-224 types, 217-218 UARS, 314-315 upper airway imaging, 77-79 Orlistat (Xenical), 236 Orthostatic hypotension

UARS, 313 OSA. See Obstructive sleep apnea OSAH. See Obstructive sleep apnea-hypopnea OSAHS. See Obstructive sleep apnea-

hypopnea syndrome OSLER. See Osler sleep resistance (OSLER) test Osler sleep resistance (OSLER) test, 97 Osteogenic distraction device maxillary, children, 275 Osteotomy genioglossus advancement, 200-201 mandibular, 200-201

maxillomandibular advancement, 203-205 Outcomes CPAP cardiovascular, 115-116 health, 114-115 oral appliances, 219-222, 223-224 SDB surgery, 196-197 upper airway surgery, 196-197 Overbite, 13

Overlap syndrome, 8, 394 Oximetry, 26-27 COPD, 339-340 flow, 29

nocturnal, 339-340 peripheral arterial tonometry, 28-29 snoring, 27-28 Oxycodone (Oxycontin, Roxicodone), 301 Oxycontin, 301 Oxygen OSA, 237-238, 241

supplemental, nonhypercapnic CSA, 328-329 Oxygen desaturation index (ODI), 28-29

P-Series PS2, 25

PAH. See Pulmonary arterial hypertension Palladone, 234

PAP. See Positive airway pressure Parasomnias, 4, 5 children, 269 sleep apnea, 358-361

Parkinson's disease, 376 geriatric SDB, 285-286 Parks v. Harris, 405 Parlodel, 239

Paroxetine (Paxil, Pexeva), 239, 298 Paxil, 239, 298 Pediatric delta sleep, 264 Pediatric maxillary osteogenic distraction device, 275 Pediatric napping patterns, 263-264 Pediatric non-REM sleep, 264 Pediatric normal sleep, 263-264 Pediatric obstructive sleep apnea, 261-280 cultural background, 264 diagnosis, 269-271 examination, 13-14 history taking, 13-14 medical history, 264-265 MSLT, 269

pharmacological guidelines, 264-265 physical examination, 14 polysomnogram (PSG), 269 RDI, 269-270 RERA, 269-270 Pediatric positive airway pressure therapy, 160 Pediatric rapid eye movement sleep, 264 Pediatric sleep-disordered breathing, 266-267 adenotonsillectomy, 272 vs. adults, 267 BPAP, 274

clinical signs, 268-269 cognition, 268 CPAP, 272-275 treatment, 272-276 Pentobarbital (Nembutal), 301 Performance tests, 97

Periodic limb movement disorders (PLMD), 4-5

sleep apnea, 356-358 Periodic limb movements during sleep (PLMS), 5-6 ESRD, 397 Periodontal disease oral appliances, 226 Peripheral arterial tonometry laboratory vs. home, 51 oximetry, 28-29 polysomnography, 50 Peripheral nervous system disorders, 368, 379-380 respiratory cycle, 368 Peripheral neuropathy, 379-380 Pexeva, 239, 298

Pharynx lateral narrowing, 12 OSA, 11-12 reconstruction treatment alternatives, 205-207 upper airway surgery, 205-207 Phenobarbital, 301 Phrenic nerve dysfunction, 379 Physical examination OSA, 1-20

pediatric OSA, 13-14 UARS, 313-314 upper airway surgery, 193 Physician-patient relationship, 408-409

telemedicine, 409-410 Physicians legal duties, 408-409, 410-413 Physiological sleepiness, 92-95 Pictorial sleepiness scale, 91, 92 Pierre Robin, 271-272

NIPPV, 176 Pillar palatal implant system, 206-207 PLMD. See Periodic limb movement disorders PLMS. See Periodic limb movements during sleep Pneumotachograph novel flow sensor, 310 Poliomyelitis NIPPV, 155 Polymyositis, 382 Polysomnography (PSG), 35-60

diagnostic criteria and measurement,

308-309 oral appliances, 219-220 pediatric OSA, 269, 270 peripheral arterial tonometry, 50 vs. portable monitor, 42-43 reference standard limitations, 48-52 RERA, 308-309 upper airway surgery, 193 Pompe's disease, 384 POMS. See Profile of mood states (POMS) Pons apneustic, 368 Pontine respiratory group, 369 Portable monitoring APAP, 144

cost effectiveness, 55-56 differential diagnosis, 53-54 evidence, 43-44, 54-55 OSA, 25-26

[Portable monitor] vs. polysomnography, 42-43 sleep staging, 51 studies, 46-47, 49 study design, 41-43 technical considerations, 54-55 Posicor, 299 Positional therapy

OSA, 236-237, 241 Positive airway pressure (PAP) ILD, 155

kyphoscoliosis, 155

obesity hypoventilation syndrome (OHS), 154 Positive airway pressure therapy, 151-172 adherence, 160, 161-164

dependent variable, 161-162 improving, 162-163 predictors, 162 psychological/educational interventions, 163 aerophagia, 159 air leakage, 159 children, 160 claustrophobia, 159 COPD, 154 dry mouth, 159 eye irritation, 159 mask leak, 159 nasal congestion, 159 nonhypercapnic central apnea, 327-328 preoperative management, 160-161 pulmonary arterial hypertension (PAH), 154 restrictive lung disease, 154-155 side effects, 158-160 skin breakdown, 159 titration techniques, 155-158 Powell-Riley protocol, 204

upper airway surgery, 195-196 PreBotzinger neurons, 369 Preeclampsia

CPAP, 115-116 Pregnancy, 253-254

OSA, 8 Preoperative evaluation upper airway surgery, 192-193 Pressure supportive ventilation (PSV), 125 Profile of mood states (POMS), 91, 92 Progesterone, 238, 251, 252, 254, 296, 299 Prostaglandins

GER, 396 Proton pump inhibitors GER, 396

Protriptyline (Vivactil), 238, 297 Provera, 238, 297 Provigil, 240, 241-242, 295-297 adverse effects, 297 mechanism of action, 296 pharmacokinetics, 296-297 Prozac, 298

PSG. See Polysomnography

PSV. See Pressure supportive ventilation

PTT. See Pulse transit time

Puberty, 253

Public awareness, 426

Pulmonary arterial hypertension (PAH)

positive pressure therapy, 154 Pulmonary disease

OSA, 8 Pulse transit time (PTT), 311 Pupillometry, 94-95

Quality of life oral appliances, 222 OSA vs. bronchial asthma, 342-343 Quantitative electroencephalographic analysis, 95

Race geriatric OSA, 282 upper airway, 72-73 Radiofrequency ablation (RF) temperature-controlled, 205 Rapid eye movement (REM) sleep, 5 children, 264 CSA, 322 definitions, 22 Rapid eye movement sleep behavior disorder (RBD), 359 RDI. See Respiratory disturbance index Reactive oxygen species, 389, 392, 399 Reasonable care, 406-307 Recklessness criminal responsibility, 407-408 Reimbursement APAP, 148

bilevel pressure and adaptive servo-ventilation, 131-133 REM. See Rapid eye movement sleep Remeron, 299 Renal failure

CSA, 326 Repetitive apneas APAP, 139

RERA. See Respiratory effort-related arousals (RERA) Respiration neurological localization, 367-368 Respiratory cycle peripheral nerves, 368 Respiratory disturbance index (RDI), 43

pediatric OSA, 269-270 Respiratory drive drugs increasing, 238-239 Respiratory effort-related arousals (RERA), 37 crescendo increase, 41 defined, 309 frequency, 310 pediatric OSA, 269-270 polysomnography diagnostic criteria and measurement, 308-309 UARS, 306-307 Respiratory muscles

COPD, 336 Respiratory stimulants, 238 Restless legs syndrome (RLS), 4-5 ESRD, 397

sleep apnea, 356-357 Restoril, 301, 372 Restrictive lung disease positive airway pressure therapy, 154-155 Retrognathia, 13

RF. See Radiofrequency ablation (RF) Rivastigmine, 372

RLS. See Restless legs syndrome (RLS) Roxicodone, 301

Sandostatin, 237 Sarafem, 298 Screening

OSA, 21-34 SDB. See Sleep-disordered breathing Secobarbital (Seconal), 301 Seconal, 301

Secondary sleep apnea, 237 Sedative hypnotics, 233-234, 301 Selective serotonin reuptake inhibitors

(SSRI), 239, 296, 298-299 Self-referral laws, 419 Serotonin sleep apnea, 239 Serzone, 299 Severe obesity bilevel pressure and adaptive servo-ventilation, 127-128

Short Form-36 (SF-36), 222 Short-term potentiation (STP), 322 Sibutramine (Meridia), 236 SIDS. See Sudden infant death syndrome Skin breakdown positive airway pressure therapy, 159 Sleep children, 264 COPD, 338-339 CSA, 324 delta, 264 movements, 4-5 paralysis, 4 portable monitor, 51 quality, 338-339 staging, 51 upper airway, 73-74 Sleep apnea cues, 5-6

depression, 352-354 treatment, 353-354 epilepsy, 347-350

treatment, 349-350 insomnia, 350-352

treatment, 351-352 narcolepsy, 354-355 parasomnias, 358-361 PLM3, 356-358 RLS, 356-357 testing, 42 Sleep arousal

OSA, 252-253 Sleep-disordered breathing (SDB), 191, 261, 305. See also Geriatric sleep-disordered breathing; Pediatric sleep-disordered breathing children, 266-267 children vs. adults, 267 COPD, 337-338 definitions, 21-22 diagnosis, 40

special populations, 271-272 surgery alternative techniques, 196 cephalometric analysis, 194 contraindications, 193 fiberoptic nasopharyngolaryngoscopy,

193-194 indications, 192 outcomes, 196-197 physical examination, 193 polysomnogram (PSG), 193

[Sleep-disordered breathing (SDB) surgery]

Powell-Riley protocol, 195-196 preoperative evaluation, 192-193 preparation, 197 procedures, 197-205 rationale, 192 Sleep Heart Health Study, 8, 25, 282, 283,

284, 299, 337 Sleep hygiene, 3

Sleep-onset REM period (SOREMP), 355 Sleep-related breathing disorder (SRBD), 305

Alzheimer's disease, 370-371 Sleep-related eating disorder (SRED), 359-360 Sleep-related oxyhemoglobin desaturation, 333 Sleep-wake schedule, 3 Sleepiness assessment, 89-100 daytime, 53

excessive daytime, 2, 281, 307 introspective, 91-92

introspective, manifest, physiological, 90 manifest, 95-97 physiological, 92-95 UARS, 312-313 Sleepwalking, 360 Smoking, 234, 253 GER, 396 geriatric OSA, 282 OSA, 9 Snoring, 2, 6, 305-320 geriatric SDB, 283 increasing, 42 oral appliances, 222 oximetry, 27-28 Social history

OSA, 8-9 SomnoMed MAS, 218 Sonata, 302

SOREMP. See Sleep-onset REM period

(SOREMP) Speech defects, 267 Spinal cord, 368

injuries, 377-378 Spinal muscular atrophy

NIPPV, 176 Split-night study, 158 CPAP, 107

SRBD. See Sleep-related breathing disorder SRED. See Sleep-related eating disorder

SSRI. See Selective serotonin reuptake inhibitors Stanford Sleepiness Scale, 91, 92 Stardust Sleep Recorder, 26 Stark law, 419

State certificate of need and licensure laws, 418-419

STP. See Short-term potentiation Stroke

SRBD, 372-373 Sudden blackout doctrine, 406-407 Sudden infant death syndrome (SIDS), 271 Supplemental oxygen nonhypercapnic CSA, 328-329 Swallowing difficulties, 267

TCA. See Tricyclic antidepressants TCRF. See Temperature-controlled radiofrequency Temazepam (Restoril), 301, 372 Temperature-controlled radiofrequency (TCRF), 205-206 tongue, 209 Temporomandibular (TMJ) discomfort, 224 Tensor palatine apnea, 63 Testosterone, 234, 251-252, 252, 324 Theophylline (Theolair Uniphyl), 239, 297, 298 GER, 396 Third parties physicians duties, 412-413 Thyroxine, 252

TMJ. See Temporomandibular discomfort

TNF-alpha. See Tumor necrosis factor-alpha Tobacco, 253 Tofranil, 297 Tongue enlarged, 12 TCRF, 209

Tongue retaining devices (TRD), 217-219

Tracheal sound analysis, 29

Tracheal sound-respiratory disturbance index

(TS-RDI), 29 Tracheotomy airway bypass surgery, 210 Trans-nasal insufflation

UARS, 314 Trauma upper airway, 71

Trazodone (Desyrel), 299

TRD. See Tongue retaining devices

Triazolam (Halcion), 234

Tricyclic antidepressants (TCA), 238, 297, 299

TS-RDI. See Tracheal sound-respiratory disturbance index Tuberculosis

NIPPV, 155, 176 Tumor necrosis factor-alpha (TNF-alpha), 389

UARS. See Upper airway resistance syndrome UPF. See Uvulopalatal flap Upper airway acoustic reflection, 67-68 anatomy, 249

anatomy and physiology, 61-62 bariatric surgery, 80-81 cephalometry, 67 craniofacial morphology, 72-73 edema/trauma, 71 gender, 71-72 genetics/race, 72-73 geriatric OSA, 282 imaging, 61-88

muscular dysfunction/sensory neuropathy, 71 nasopharyngoscopy, 68-69 obesity, 70-71 OSA, 249 respiration, 74-75 sleep, 73-74

surgery, 80-81, 191-216, 256 alternative techniques, 196 cephalometric analysis, 194 contraindications, 193 indications, 192 nasal reconstruction, 197 outcomes, 196-197 pharyngeal reconstruction treatment alternatives, 205-207 physical examination, 193 Powell-Riley protocol, 195-196 preoperative evaluation, 192-193 preparation, 197 procedures, 197-205 rationale, 192

uvulopalatal flap (UPF), 197-198 uvulopalatopharyngo-glossoplasty, 197-198 wakefulness, 69-70

Upper airway resistance syndrome (UARS), 37, 261, 305-320 adaptive mechanisms, 306 clinical features, 312-313 continuous positive pressure therapy, 153 electroencephalographic arousal,

307-308 epidemiology, 311-312 insomnia symptoms, 312 noninvasive measures of respiratory effort, 310-311 vs. OSA, 311

pathophysiology, 306-308 peripheral component, 306 physical examination, 313-314 polysomnographic diagnostic criteria and measurement, 308-309 RERA, 306-307

respiratory event types, 306-307 sleepiness, 312-313 surgery, 315 treatment, 314-317 UPPGP. See Uvulopalatopharyngo-

glossoplasty UPPP. See Uvulopalatopharyngoplasty Uvulopalatal flap (UPF)

upper airway surgery, 197-198 Uvulopalatopharyngo-glossoplasty (UPPGP), 80-81 upper airway surgery, 197-198 Uvulopalatopharyngoplasty (UPPP), 66, 68

Vagal nerve stimulation (VNS), 374

side effects, 349 Valium, 301

Ventral respiratory group, 369 Versed, 301

Veterans Health Care System, 148

Vigilance tests, 97

Visual analog scales, 91, 92

Vivactil, 238, 297

VNS. See Vagal nerve stimulation

Wakefulness upper airway, 69-70 Walter Reed experiments, 96 Watch-PAT 100 System, 28-29 Weight gain OSA, 7

Weight loss, 235-236, 241, 256 diet, 235

[Weight loss] exercise, 235 OSA, 76-77

pharmacological therapy, 236 upper airway imaging, 76-77 Wisconsin Sleep Cohort Study, 9,

149, 235 Women

OSA, 247-248 Wright v. Yackley, 410

Xanax, 301 Xenical, 236

Yawning, 96

Z-hypnotics, 300, 302 Zaleplon (Sonata), 302 Zolpidem (Ambien), 234, 302 Zopiclone (Imovane), 234 Zurich Longitudinal Studies, 263

FIGURE 1.1 Bilateral collapse of the nasal rim that is frequently observed during inspiration in patients with obstructive sleep apnea-associated nasal resistance. (See p. 11)

Lateral Narrowing

FIGURE 1.3 Lateral narrowing of the pharyngeal wall. Source: Photograph courtesy of Kannan Ramar, M.D.

Tongue Mandible Soft Palate

Airway

Tongue Mandible Soft Palate

Airway

FIGURE 4.5 Volumetric reconstruction of axial magnetic resonance images in a normal subject (top panel) and a patient with sleep apnea (bottom panel). (See p. 66)

FIGURE 4.7 Volumetric state-dependent airway imaging in a normal subject using magnetic resonance imaging. (See p. 74)

Pre-Weight Loss - Normal

FIGURE 4.10 Upper airway soft tissue [soft palate (purple), the tongue (orange/rust), the lateral pharyngeal walls (green), parapharyngeal fat pads (yellow)] and craniofacial [mandible (gray)] magnetic resonance imaging reconstructions before and after a 17% weight loss in a normal woman. (See p. 77)

Post-Weight loss - Normal

FIGURE 4.10 Upper airway soft tissue [soft palate (purple), the tongue (orange/rust), the lateral pharyngeal walls (green), parapharyngeal fat pads (yellow)] and craniofacial [mandible (gray)] magnetic resonance imaging reconstructions before and after a 17% weight loss in a normal woman. (See p. 77)

Normal Subject

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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