Obstructive Sleep Apnea Pathophysiology Comorbidities and Consequences Sleep Disorders 1st Edition by Clete Kushida 9781040200162 1040200168

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ISBN 10: 1040200168
ISBN 13: 9781040200162
Author: Clete Kushida

Responding to the growing recognition of Obstructive Sleep Apnea (OSA) as a major medical condition and the emergence of exciting new therapies, this source analyzes the clinical features, characteristics, comorbidities, and impact of OSA on patient biological systems and quality-of-life. Edited by the Director of the Center for Human Sleep Researc

Obstructive Sleep Apnea Pathophysiology Comorbidities and Consequences Sleep Disorders 1st Table of contents:

1 Perspectives

References

Section I: Features, Factors, and Characteristics

2 History

• Pretwentieth Century Literature
• Burwell Et Al.’S Poker Player And The First Sleep Recordings Of Pickwickian Patients
• First Treatment Attempts
• Sleep Apnea In Thin Persons
• First Major International Conference Of Respiratory Sleep Disorders
• Sleep Apnea Over The Past Twenty-Five Years
• Sleep Apnea In Children
• Cornerstones Of Modern Treatment For Obstructive Sleep Apnea
• Conclusions
• References

3 Epidemiology

• Introduction
• Snoring
• Obstructive Sleep Apnea Prevalence
• Gender
• Menopause
• Pre-eclampsia
• Ethnicity
• Children
• New Directions
• Metabolic Syndrome
• Conclusions
• References

4 Ontogeny

• Introduction
• Infancy
• Childhood And Adolescence
• Adulthood And Old Age
• Clinical Manifestations
• Age Dependence
• Risk Factors for Osa During Adulthood
• Pathophysiology of Osa in Adults and the Elderly
• Outcomes and Comorbidities of Osa in Adults and the Elderly
• Conclusions
• References

5 Phylogeny and Animal Models: An Uninhibited Survey

• Introduction
• Terrestriality And Evolution Of The Pharynx
• Evolutionary Pressures Influence The Pharynx
• Walking, Talking, and Breathing: What Is the Problem?
• Changes in the Craniofacial Relationships
• Changes in the Maxilla
• Oropharyngeal Compression
• Language, Speech, And Brain Growth
• Altricial Brain Growth in Mammals
• Cerebral Control Over Pharynx
• Acquisition of Speech Predisposes to Obstructive Sleep Apnea
• Life History and Emergence of Obstructive Sleep Apnea
• Animal Models Of Obstructive Sleep Apnea
• Obesity and Bony Abnormalities
• Rhesus Monkey Model of Nasal Constriction
• Descent of Hyoid: Chimpanzees Mirror Human Ontogeny
• Conclusions
• References

6 Upper Airway Anatomy

• Introduction
• Anatomy Of The Upper Airway
• Overview
• Nose
• Anterior Nasal Cavity
• Posterior Nasal Cavity/Nasopharynx
• Mouth
• Anterior Oral Cavity and Tongue
• Posterior Oral Cavity/Oropharynx
• Pharynx
• Oropharynx: Retropalatal Region
• Oropharynx: Retroglossal Region
• Hypopharynx
• Larynx
• Conclusions
• References

7 Physiology and Dynamics of the Upper Airway

• Introduction
• Embryology
• Nonrespiratory Functions Of The Upper Airway
• Speech
• Swallowing
• Physiologic Functions Of Selected Regions Of The Upper Airway
• Physiology of the Nose
• Upper Airway Muscles
• Physiology of the Larynx
• Dynamics Of The Upper Airway During Sleep
• The Starling Resistor Model
• Measurements in the Static Upper Airway
• Limitations of Studies on Upper Airway Collapsibility
• Determinants of Upper Airway Neuromotor Tone
• Sleep State
• Ventilatory Drive
• Subatmospheric (Negative) Pressure
• Lung Volume
• Posture and Neck Position
• Gender
• Airway Length
• Upper Airway Sensation
• Development
• Upper Airway Collapsibility in Osa
• Conclusions
• References

8 Upper Airway Pathology

• Introduction
• Nasal Obstruction
• Choanal Atresia
• Laryngomalacia
• Tracheomalacia And Tracheal Stenosis
• Congenital Pharyngeal Stenosis
• Hurler’S And Hunter’S Syndromes
• Hurler’s Syndrome
• Hunter’s Syndrome
• Maxillary Hypoplasia
• Crouzon’s Syndrome
• Apert’s Syndrome
• Pfeiffer’s Syndrome
• Antley-Bixler’s Syndrome
• Stickler’s Syndrome
• Down Syndrome
• Cleft Palate Repair
• Mandibular Hypoplasia
• Pierre Robin Syndrome
• Treacher Collins Syndrome
• Goldenhar’s Syndrome
• Tongue Enlargement
• Beckwith-Wiedeman Syndrome
• Conclusions
• References

9 Control of Breathing in Sleep

• Introduction
• Hallmarks Of Sleep Apnea
• Changes In The Control Of Breathing In Sleep
• Reduced Respiratory Motor Output
• Sleep Unmasks a Highly Sensitive Apneic Threshold
• Importance of Reflex Inputs—Reduced Gain of Chemoreflexes
• Concept of Loop Gain (See Also Chapter 11)
• The Co2 Reserve and Apnea
• The Co2 Reserve Is Labile
• Which Chemoreceptors Are Responsible for Apnea?
• Reduced Gain of Mechanoreflexes
• Alterations in Cerebral Blood Flow and Vascular Responsiveness
• The Special Problem Of Rem Sleep
• Skeletal Muscle Atonia
• Excitation of Central Rhythm Generator
• Sleep Effects On Ventilatory Control And Sleep Apnea In Special Circumstances
• Obstructive Sleep Apnea
• Neurodegenerative Disease
• Congestive Heart Failure
• Hypoxia
• Elderly
• Conclusions
• Acknowledgments
• References

10 Arousal from Sleep

• Introduction
• What Is A Micro-Arousal And How Is It Related To The Course Of Sleep?
• The Concept Of Cortical And Subcortical (Autonomic) Arousal
• Arousals Preceded By Synchronization (Slow Waves, K-Complexes) Eeg Changes
• Influence Of Sensory Stimulation On The Formation Of Both Types Of Arousals
• State-Specific Reactivity In Sleep
• Hierarchy Of Arousals—The Concept Of A Continuum
• Pathologic Arousals, With Special Emphasis On Sleep-Related Breathing Disorders
• Arousals Gating Pathological Events
• Functions Of Arousal During Sleep
• Conclusions
• Acknowledgment
• References

11 Pathogenesis

• Introduction
• Anatomy (See Also Chapter 6) Function
• Structure
• Upper Airway Lumen
• Upper Airway Soft Tissue
• Other Anatomical Factors
• Upper Airway Shape
• Upper Airway Length
• Nasal Obstruction
• Upper Airway Collapse
• Sites of Collapse
• Collapsibility in Obstructive Sleep Apnea
• Mechanisms
• Balance of Forces
• Neuromuscular Compensation
• Background
• Awake
• The Effect of Sleep
• Theory Of Upper Airway Collapse
• Newer Theories Of Upper Airway Collapse (Fig. 2)
• Lung Volume
• Ventilatory Control Instability
• Respiratory Drive and Upper Airway Patency
• Loop Gain
• Loop Gain in Obstructive Sleep Apnea
• Co2 Reserve and Loop Gain
• Neuromuscular Compensation During Sleep
• Arousal Threshold
• Motor and Sensory Deficits
• Other Mechanisms
• Neurotransmitters And Sleep (Fig. 5)
• Conclusions
• References

12 Risk Factors

• Introduction
• Obesity (See Also Chapter 20)
• Weight Gain and Obstructive Sleep Apnea
• Weight Loss and Obstructive Sleep Apnea
• Effect of Obesity on Obstructive Sleep Apnea
• Fat Distribution
• Neck Circumference
• Summary on Obesity and Obstructive Sleep Apnea
• Craniofacial Features (See Also Chapter 8)
• Upper Airway Soft Tissues and Skeletal Features
• Soft Tissues of the Pharynx
• Nose
• Gender
• Weight and Gender
• Upper Airway Mechanics and Gender
• Control of Breathing and Gender
• Menopause
• Ethnicity
• Age (See Also Chapter 4)
• Smoking
• Alcohol
• Specific Diseases
• Polycystic Ovarian Syndrome
• Stroke
• Other Neurologic Conditions
• Snoring
• Body Position
• Conclusions
• References

13 Familial and Genetic Factors

• Introduction
• Intermediate Phenotypes
• Obesity (See Also Chapter 20)
• Craniofacial Structure (See Also Chapter 12)
• Ventilatory Control (See Also Chapters 7 and 9)
• Disorders That Affect Sleep And Breathing
• Sudden Infant Death Syndrome
• Congenital Central Alveolar Hypoventilation Syndrome
• Prader-Willi Syndrome
• Other Congenital Syndromes
• Obstructive

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