madman
Super Moderator
KEY POINTS
• Obstructive sleep apnea (OSA) leads to intermittent oxygen desaturations and hypercapnia, frequent arousals from sleep, sympathetic nervous system activation, cerebral hypoperfusion, neuroinflammation, fluctuations in blood pressure, endothelial dysfunction, hypercoagulability, white matter lesions, and gray matter loss.
• People with neurologic conditions may not present with classic OSA symptoms.
• Many neurologic conditions, such as stroke, Parkinson disease, Alzheimer disease, and myotonic dystrophy type 1 and 2, are associated with a higher risk of OSA.
• A negative home sleep apnea test does not rule out the diagnosis of OSA, and repeat testing with in-laboratory polysomnography should be pursued if concern for OSA persists.
• Home sleep apnea tests should only be used in people without significant insomnia who have a high risk of OSA but low risk of other types of sleep-disordered breathing.
• Although the apnea-hypopnea index determines the severity of OSA, other factors should also be considered to direct treatment.
ABSTRACT
OBJECTIVE
Obstructive sleep apnea (OSA) is a common disorder that can have a significant negative impact on quality of life and health, including many neurologic disorders. This article discusses the updates in the diagnosis, implications, and treatment of OSA.
LATEST DEVELOPMENTS
New recommended criteria for diagnosing OSA increase the recognition of the disorder. Although the apnea-hypopnea index has been the metric used to diagnose, stratify severity, and monitor treatment, it has limitations. A growing number of other metrics, including hypoxic burden, sleep quality, arousal index, respiratory event duration, and daytime sleepiness, are important to consider for comprehensive assessment and risk strati cation. Various endotypes and phenotypes of OSA may have certain risks and respond differently to treatment. Treatment of OSA may improve several neurologic symptoms and reduce the risk of neurologic comorbidities. Although positive airway pressure therapy remains the most efficacious treatment of OSA, several alternatives are available, and the list is rapidly expanding, including hypoglossal nerve stimulation and medications.
ESSENTIAL POINTS
Neurologists should screen for signs and symptoms of OSA as well as consider testing in patients at high risk who are asymptomatic. Treatment should be tailored based on the severity of OSA, objective data such as the arousal index and hypoxic burden, symptoms, comorbidities, and several patient factors, including morphologic characteristics and personal preferences. OSA is a treatable condition that, when well-managed, may lead to improvement of many neurologic conditions and quality of life.
• Obstructive sleep apnea (OSA) leads to intermittent oxygen desaturations and hypercapnia, frequent arousals from sleep, sympathetic nervous system activation, cerebral hypoperfusion, neuroinflammation, fluctuations in blood pressure, endothelial dysfunction, hypercoagulability, white matter lesions, and gray matter loss.
• People with neurologic conditions may not present with classic OSA symptoms.
• Many neurologic conditions, such as stroke, Parkinson disease, Alzheimer disease, and myotonic dystrophy type 1 and 2, are associated with a higher risk of OSA.
• A negative home sleep apnea test does not rule out the diagnosis of OSA, and repeat testing with in-laboratory polysomnography should be pursued if concern for OSA persists.
• Home sleep apnea tests should only be used in people without significant insomnia who have a high risk of OSA but low risk of other types of sleep-disordered breathing.
• Although the apnea-hypopnea index determines the severity of OSA, other factors should also be considered to direct treatment.
ABSTRACT
OBJECTIVE
Obstructive sleep apnea (OSA) is a common disorder that can have a significant negative impact on quality of life and health, including many neurologic disorders. This article discusses the updates in the diagnosis, implications, and treatment of OSA.
LATEST DEVELOPMENTS
New recommended criteria for diagnosing OSA increase the recognition of the disorder. Although the apnea-hypopnea index has been the metric used to diagnose, stratify severity, and monitor treatment, it has limitations. A growing number of other metrics, including hypoxic burden, sleep quality, arousal index, respiratory event duration, and daytime sleepiness, are important to consider for comprehensive assessment and risk strati cation. Various endotypes and phenotypes of OSA may have certain risks and respond differently to treatment. Treatment of OSA may improve several neurologic symptoms and reduce the risk of neurologic comorbidities. Although positive airway pressure therapy remains the most efficacious treatment of OSA, several alternatives are available, and the list is rapidly expanding, including hypoglossal nerve stimulation and medications.
ESSENTIAL POINTS
Neurologists should screen for signs and symptoms of OSA as well as consider testing in patients at high risk who are asymptomatic. Treatment should be tailored based on the severity of OSA, objective data such as the arousal index and hypoxic burden, symptoms, comorbidities, and several patient factors, including morphologic characteristics and personal preferences. OSA is a treatable condition that, when well-managed, may lead to improvement of many neurologic conditions and quality of life.
