Skip to main content
SpringerLink
Log in

Obstructive Sleep Apnea: Diagnosis with Polysomnography and Portable Monitors

  • Chapter
  • First Online:
Essentials of Sleep Medicine

Part of the book series: Respiratory Medicine ((RM))

Abstract

Obstructive sleep apnea (OSA) is the leading cause of referral to sleep laboratories worldwide, accounting for at least 75–80% of diagnoses. In the last few decades, there have been considerable advances in knowledge regarding the underlying mechanisms, diagnostic approaches, treatment options, and the impact of OSA on personal as well as public health of OSA. The current definitions of sleep apnea are not uniform, but most of them attempt to characterize the frequency of sleep-disordered breathing events (e.g., AHI “Apnea–Hypopnea Index” or RDI “Respiratory Disturbance Index”) along with the severity (e.g., oxygen desaturation) of each event (e.g., complete (apnea) and partial (hypopnea) cessation of breathing during sleep). Newer approaches using wearable technologies and novel analyses using signal processing may help to improve diagnostic and prognostic approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020;323(14):1389–400.

    Article  PubMed  Google Scholar 

  2. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–98.

    Article  PubMed  PubMed Central  Google Scholar 

  3. AASM. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in adults. Sleep. 1999;22(5):667–89.

    Article  Google Scholar 

  4. AASM. International classification of sleep disorders, Diagnostic and coding manual. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  5. Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: pathophysiology and treatment. Chest. 2007;131(2):595–607.

    Article  PubMed  Google Scholar 

  6. Morrell M, Arabi Y, Zahn B, Badr M. Progressive retropalatal narrowing preceding obstructive apnea. Am J Respir Crit Care Med. 1998;158:1974–81.

    Article  CAS  PubMed  Google Scholar 

  7. Badr MS, Dingell JD, Javaheri S. Central sleep apnea: a brief review. Curr Pulmonol Rep. 2019;8(1):14–21.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Javaheri S, Malik A, Smith J, Chung E. Adaptive pressure support servoventilation: a novel treatment for sleep apnea associated with use of opioids. J Clin Sleep Med. 2008;4(4):305–10.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Javaheri S, McKane SW, Cameron N, Germany RE, Malhotra A. In patients with heart failure the burden of central sleep apnea increases in the late sleep hours. Sleep. 2019;42(1):zsy195.

    Article  Google Scholar 

  10. Javaheri S, Somers VK. Cardiovascular diseases and sleep apnea. Handb Clin Neurol. 2011;98:327–45.

    Article  PubMed  Google Scholar 

  11. Punjabi N, Sorkin J, Katzel L, Goldberg A, Schwartz A, Smith P. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir and Crit Care Med. 2002;165:677–82.

    Article  Google Scholar 

  12. Punjabi NM, Ahmed MM, Polotsky VY, Beamer BA, O'Donnell CP. Sleep-disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol. 2003;136(2–3):167–78.

    Article  CAS  PubMed  Google Scholar 

  13. Punjabi NM, Beamer BA. Alterations in glucose disposal in sleep-disordered breathing. Am J Respir Crit Care Med. 2009;179(3):235–40.

    Article  CAS  PubMed  Google Scholar 

  14. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6(8):e1000132.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Punjabi NM, Newman AB, Young TB, Resnick HE, Sanders MH. Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas. Am J Respir Crit Care Med. 2008;177(10):1150–5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010;182(2):269–77.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122(4):352–60.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gottlieb JD, Schwartz AR, Marshall J, et al. Hypoxia, not the frequency of sleep apnea, induces acute hemodynamic stress in patients with chronic heart failure. J Am Coll Cardiol. 2009;54(18):1706–12.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.

    Article  CAS  PubMed  Google Scholar 

  20. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Arzt M, Young T, Peppard PE, et al. Dissociation of obstructive sleep apnea from hypersomnolence and obesity in patients with stroke. Stroke. 2010;41(3):e129–34.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Leung RS, Bradley TD. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med. 2001;164(12):2147–65.

    Article  CAS  PubMed  Google Scholar 

  23. Raphelson JR, Kreitinger KY, Malhotra A. Positive airway pressure therapy in sleep-disordered breathing. Neurotherapeutics. 2021;18(1):75–80.

    Article  PubMed  Google Scholar 

  24. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. New Engl J Med. 1993;32:1230–5.

    Article  Google Scholar 

  25. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.

    Article  PubMed  Google Scholar 

  26. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999;340(11):847–51.

    Article  CAS  PubMed  Google Scholar 

  27. Kreitinger KY, Lui MMS, Owens RL, et al. Screening for obstructive sleep apnea in a diverse bariatric surgery population. Obesity (Silver Spring). 2020;28(11):2028–34.

    Article  Google Scholar 

  28. Young T, Peppard P, Gottlieb D. The epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.

    Article  PubMed  Google Scholar 

  29. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Edwards BA, O’Driscoll DM, Ali A, Jordan AS, Trinder J, Malhotra A. Aging and sleep: physiology and pathophysiology. Semin Respir Crit Care Med. 2010;31(5):618–33.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Edwards BA, Wellman A, Sands SA, et al. Obstructive sleep apnea in older adults is a distinctly different physiological phenotype. Sleep. 2014;37(7):1227–36.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Malhotra A, Huang Y, Fogel R, et al. Aging influences on pharyngeal anatomy and physiology: the predisposition to pharyngeal collapse. Am J Med. 2006;119(1):72 e79–14.

    Article  Google Scholar 

  33. Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2003;167:1181–5.

    Article  PubMed  Google Scholar 

  34. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.

    Article  CAS  PubMed  Google Scholar 

  35. Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the sleep AHEAD study. Arch Intern Med. 2009;169(17):1619–26.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Foster GD, Sanders MH, Millman R, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Malhotra A, Huang Y, Fogel R, et al. The male predisposition to pharyngeal collapse: the importance of airway length. Am J Resp Crit Care Med. 2002;166:1388–95.

    Article  PubMed  Google Scholar 

  38. Malhotra A, Mesarwi O, Pepin JL, Owens RL. Endotypes and phenotypes in obstructive sleep apnea. Curr Opin Pulm Med. 2020;26(6):609–14.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Badr MS. Pathophysiology of upper airway obstruction during sleep. Clin Chest Med. 1998;19(1):21–32.

    Article  CAS  PubMed  Google Scholar 

  40. Badr MS. Pathogenesis of obstructive sleep apnea. Prog Cardiovasc Dis. 1999;41(5):323–30.

    Article  CAS  PubMed  Google Scholar 

  41. Rowley JA, Sanders CS, Zahn BR, Badr MS. Gender differences in upper airway compliance during NREM sleep: role of neck circumference. J Appl Physiol. 2002;92(6):2535–41.

    Article  PubMed  Google Scholar 

  42. Rowley JA, Zhou X, Vergine I, Shkoukani MA, Badr MS. Influence of gender on upper airway mechanics: upper airway resistance and Pcrit. J Appl Physiol. 2001;91(5):2248–54.

    Article  CAS  PubMed  Google Scholar 

  43. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C. Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med. 2009;10(2):226–32.

    Article  PubMed  Google Scholar 

  44. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

    Article  CAS  PubMed  Google Scholar 

  45. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT. Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med. 2003;163(5):565–71.

    Article  PubMed  Google Scholar 

  46. Jenkinson C, Davies RJ, Mullins R, Stradling JR. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet. 1999;353(9170):2100–5.

    Article  CAS  PubMed  Google Scholar 

  47. Pack AI. Obstructive sleep apnea. Adv Intern Med. 1994;39:517–67.

    CAS  PubMed  Google Scholar 

  48. Pack AI. Further development of P4 approach to obstructive sleep apnea. Sleep Med Clin. 2019;14(3):379–89.

    Article  PubMed  Google Scholar 

  49. Dagan Y, Doljansky JT, Green A, Weiner A. Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers. Traffic Inj Prev. 2006;7(1):44–8.

    Article  PubMed  Google Scholar 

  50. Hartenbaum N, Collop N, Rosen IM, et al. Sleep apnea and commercial motor vehicle operators: statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest. 2006;130(3):902–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of California, San Diego, Department of Medicine, Internal Medicine, La Jolla, CA, USA

    Janna Raphelson & Erica Feldman

  2. Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego Health, La Jolla, CA, USA

    Atul Malhotra

Authors
  1. Janna Raphelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erica Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Atul Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Atul Malhotra .

Editor information

Editors and Affiliations

  1. Department of Internal Medicine Wayne State University School of Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA

    M. Safwan Badr

  2. Geriatric Research Education and Clinical Center, Veteran Affairs Greater Los Angeles Healthcare System, Department of Medicine David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Jennifer L. Martin

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Raphelson, J., Feldman, E., Malhotra, A. (2022). Obstructive Sleep Apnea: Diagnosis with Polysomnography and Portable Monitors. In: Badr, M.S., Martin, J.L. (eds) Essentials of Sleep Medicine. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-93739-3_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-93739-3_6

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-93738-6

  • Online ISBN: 978-3-030-93739-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation