Sleep

Abstract

Sleep has a profound influence on breathing, and the recognition and management of common apnoeic and non-apnoeic sleep disorders is increasingly relevant to the clinical practice of the modern chest physician. Sleep, its effect on the upper airway, and how this can lead to apnoeic events is described, as are the wider consequences of recurrent apnoeas on the cardiovascular system and normal daytime function. Abnormal numbers of apnoeic events (sleep-disordered breathing) are common and increasingly recognised, but should be distinguished from the obstructive sleep apnoea syndrome which requires sleep fragmentation and where treatment is known to be helpful. The diagnosis and stratification of sleep apnoea is defined and available treatments detailed. The benefits and drawbacks of each modality are described, with clinical pointers as to how to manage problems with CPAP (continuous positive airway pressure) and dealing with persistent symptoms. Central sleep apnoea, particularly in association with cardiac disease, is less commonly diagnosed than obstructive sleep apnoea, but its recognition is important although the optimal treatment is less well established. Non-apnoeic sleep disorders can present in the respiratory clinic with excessive daytime somnolence, and awareness of their clinical features can lead to onward referral and treatment.

This chapter will address not just sleep-disordered breathing, but also the non-apnoeic sleep disorders which may present to the respiratory physician who sees patients with excessive daytime somnolence or for “exclusion of sleep apnoea.”