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Obstructive Sleep Apnea Syndrome

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Sleep Disorders Medicine

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Abstract

Obstructive sleep apnea syndrome (OSAS) is a common, often under recognized, medical disorder characterized by repeated episodes of upper airway closure during sleep. The course is a slowly progressive one. The patient’s daytime performance becomes insidiously more impaired, until the patient eventually decompensates and presents to the healthcare system, either volitionally or as a result of one of the complications of sleep apnea. OSAS lies along a continuum of sleep-disordered breathing (SDB). There are controversies about the linearity of this continuum: It appears from recent data that there could be a point of “no return” where lesions in the upper airway leave permanent traces that may continuously impact on upper airway motor control during inspiration. A subdivision in this reported “continuum” in two segments can be made: first stage of chronic snoring and upper airway resistance (and there is no clear demonstration that chronic snorers do not always present some degree of upper airway resistance) with flow limitation, limited symptoms, and usually no daytime sleepiness; and second stage with an increasing clinical severity, with progressive degrees of obstructive apnea based on respiratory disturbance index (RDI) and oxyhemoglobin desaturations with clear sympathetic activation. Epidemiology and pathophysiology are part of the presentation. Comorbidities secondary to SDB (particularly cardio and cerebrovascular) are emphasized. The diagnosis should be strongly suspected on clinical evaluation confirmed by tests including imaging studies. Treatments should be guided by findings, avoiding approaches with limited chances of success. Advances in awareness of the presence and pathophysiology of pediatric SDB along with new understanding of reasons for incomplete or transient treatment success give hope that routine screening, early recognition, and aggressive treatment early in life will be performed.

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    Rachel Korson & Christian Guilleminault

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    Sudhansu Chokroverty

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Korson, R., Guilleminault, C. (2017). Obstructive Sleep Apnea Syndrome. In: Chokroverty, S. (eds) Sleep Disorders Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6578-6_32

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