Sleep and breathing are both controlled by the brain. A wide range of neurological disorders has significant impact on sleep-related breathing. Features of hypoventilation, obstructive, and central apneas may all be manifestations of neurological disorders and these disorders may impact on the individual's neurological function. The dynamic relationship of the nervous system to sleep-related breathing is most striking in individuals who have lesions in their central nervous system (CNS) and sleep apnea. For some of these individuals, disruption of breathing in sleep results in worsening of their overall condition and improvement in breathing results in a global benefit. In others, however, the sleep-related breathing issue appears to parallel their neurological condition and treatment may result in little benefit. Unfortunately for the clinician, the distinction between these two groups is not always clear.
Although obstructive sleep apnea (OSA) may be one of the more common sleep-related breathing disorders (SRBDs), clinicians must also be aware that other respiratory issues may impact patients with neurological disorders. Treatment of any SRBD offers an opportunity to improve quality of life. In this chapter, we will explore the relationship of sleep and breathing to a variety of neurological conditions and describe some of the therapeutic approaches and pitfalls.
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