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Article

Obstructive sleep apnea basics

Jessica Vensel Rundo, MD, MS
Cleveland Clinic Journal of Medicine September 2019, 86 (9 suppl 1) 2-9; DOI: https://doi.org/10.3949/ccjm.86.s1.02
Jessica Vensel Rundo
Sleep Disorders Center, Neurological Institute, Cleveland Clinic
Roles: Sleep Fellowship Program Director
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  • For correspondence: [email protected]
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Figures

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  • Figure 1
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    Figure 1

    Friedman palate positions (classes 1, 2, 3, and 4).

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    Figure 2

    Polysomnogram excerpts with normal sleep, obstructive apnea, obstructive hypopnea, and respiratory event-related arousal waveform findings.

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    Figure 3

    A hypnogram depicts the recorded levels of sleep over time.

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    Figure 4

    Apneas can be obstructive, mixed, or central.

Tables

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    TABLE 1

    Obstructive sleep apnea symptoms

    SleepDaytime
    SnoringExcessive sleepiness
    GaspingFatigue
    SnortingMorning headaches
    Not breathingMemory or concentration issues
    Fragmented sleepMood disturbances or irritability
    Sleep maintenance insomnia (inability to stay asleep or waking and not returning to sleep)Decreased libido
    Nocturia
    Bedwetting
    Night sweats
    • Data from reference 5.

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    TABLE 2

    Screening for asymptomatic populations

    • Sleep history
    • Epworth Sleepiness Scale
    • Upper airway examination
    • STOP-BANG
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    TABLE 3

    Polysomnogram parameters and associated leads

    ParameterLead(s)
    Heart rate and rhythm (EKG/ECG)EKG2
    Brain waves (EEG)F3-M2, F4-M1, C3-M2, C4-M1, O1-M2, O2-M2
    Eye movement (EOG)E1-M2 and E2-M1
    Awake/asleep, REM sleep, chin and leg movement (EMG)CHIN1, R-LEG, L-LEG
    Nasal-oral airflowNASAL-TRANS, AIRFLOW
    Thoraco-abdominal effortCHEST, ABDOMEN
    Oxygen saturationSAO2
    SnoreSNORE
    Body positionSUPINE (watermark)
    • EEG = electroencephalogram; EKG/ECG = electrocardiogram; EMG = electromyogram; EOG = electrooculography; REM = rapid eye movement

    • View popup
    TABLE 4

    Obstructive sleep apnea diagnostic criteria

    Polysomnogram or home sleep apnea test reveals
    • ≥ 15 predominantly obstructive respiratory events per hour of sleep OR
    • ≥ 5 predominantly obstructive respiratory events per hour of sleep and at least 1 of following:
     – Daytime sleepiness, nonrestorative sleep, fatigue, or insomnia
     – Waking with breath holding, gasping, or choking
     – Observed loud snoring, breathing interruption, or both
     – Hypertension, mood disorder, cognitive dysfunction, ischemic heart disease, stroke, congestive heart failure, atrial fibrillation, or diabetes type 2
    • Data from reference 28.

    • View popup
    TABLE 5

    Obstructive sleep apnea severity

    IndexCalculation
    Apnea–hypopnea index (AHI)Embedded Image
    Respiratory disturbance indexEmbedded Image
    Respiratory event indexEmbedded Image
    • Respiratory event index is typically used for home sleep apnea testing as it is based on monitoring time as distinct from actual sleep time.

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Cleveland Clinic Journal of Medicine: 86 (9 suppl 1)
Cleveland Clinic Journal of Medicine
Vol. 86, Issue 9 suppl 1
1 Sep 2019
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Obstructive sleep apnea basics
Jessica Vensel Rundo
Cleveland Clinic Journal of Medicine Sep 2019, 86 (9 suppl 1) 2-9; DOI: 10.3949/ccjm.86.s1.02

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Obstructive sleep apnea basics
Jessica Vensel Rundo
Cleveland Clinic Journal of Medicine Sep 2019, 86 (9 suppl 1) 2-9; DOI: 10.3949/ccjm.86.s1.02
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  • Article
    • ABSTRACT
    • DEFINITION
    • PREVALENCE
    • SYMPTOMS
    • RISK FACTORS
    • COMORBIDITIES
    • SCREENING
    • SLEEP STUDIES
    • DIAGNOSTIC CRITERIA
    • Severity
    • SUMMARY
    • Footnotes
    • REFERENCES
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