Skip to main content

Sleep-Disordered Breathing: An Expanding Spectrum for the Pulmonologist

  • Chapter
  • First Online:
Obstructive Sleep Apnea
  • 332 Accesses


Sleep-disordered breathing has long been the provenance of pulmonologists, particularly in the United States because much of the field of clinical sleep medicine has been defined by highly prevalent disorders of breathing in sleep, including obstructive sleep apnea syndrome. While clinical sleep medicine was first formalized at Stanford university in the 1970s, the field remains in relative infancy as it rapidly evolves. Physicians with a deep focus in sleep disorders medicine often care for patients with both lung disease and sleep disorders. Pulmonologists that take care of complex lung disease—whether primary disorders of the respiratory system, or systemic manifestations in the respiratory system of other disease processes—need to understand how sleep disorders impact the patient population. This chapter places the evolution of our field into context while refreshing understanding of coexistent challenges including sleep deprivation and the burden of sleep disorders on public health which will present to the pulmonologist caring for a wide spectrum of patients. Special attention is placed on central sleep apnea syndrome which is increasingly being recognized and can be treated with transvenous phrenic nerve stimulation.

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

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
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

Similar content being viewed by others


  1. Roffwarg HP, Dement WC, Muzio JN, Fisher C. Dream imagery: relationship to rapid eye movements of sleep. Arch Gen Psychiatry. 1962;7:235–58.

    Article  CAS  PubMed  Google Scholar 

  2. Lugaresi E, Coccagna G, Mantovani M, Brignani F. Effects of tracheostomy in two cases of hypersomnia with periodic breathing. J Neurol Neurosurg Psychiatry. 1973;36(1):15–26. PMID: 4691688; PMCID: PMC494270

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Sullivan CE, Berthon-Jones M, Issa FG, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;317:862–5.

    Article  Google Scholar 

  4. Uehata T. Karoshi, death by overwork. Nihon Rinsho. 2005;63(7):1249–53. Japanese PMID: 16001791

    PubMed  Google Scholar 

  5. Rechtschaffen A, Bergmann BM, Everson CA, Kushida CA, Gilliland MA. Sleep deprivation in the rat: I. Conceptual issues. Sleep. 1989;12(1):1–4. PMID: 2648532

    Article  CAS  PubMed  Google Scholar 

  6. Chu Y, Yang J, Shi J, Zhang P, Wang X. Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis. Eur J Med Res. 2020;25(1):64. PMID: 33267871; PMCID: PMC7708895

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tefft BC. Acute sleep deprivation and culpable motor vehicle crash involvement. Sleep. 2018;41(10) PMID: 30239905

  8. Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep. 1996;19(4):318–26. PMID: 8776790

    Article  CAS  PubMed  Google Scholar 

  9. Ioachimescu OC, Janocko NJ, Ciavatta MM, Howard M, Warnock MV. Obstructive lung disease and obstructive sleep apnea (OLDOSA) cohort study: 10-year assessment. J Clin Sleep Med. 2020;16(2):267–77. Epub 2020 Jan 13. PMID: 31992433; PMCID: PMC7053033

    Article  PubMed  PubMed Central  Google Scholar 

  10. Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2018;38:39–49. Epub 2017 Mar 30. PMID: 28760549

    Article  PubMed  Google Scholar 

  11. McNicholas WT, Hansson D, Schiza S, Grote L. Sleep in chronic respiratory disease: COPD and hypoventilation disorders. Eur Respir Rev. 2019;28(153):190064. PMID: 31554703

    Article  PubMed  PubMed Central  Google Scholar 

  12. Grote L, Sommermeyer D, Ficker J, Randerath W, Penzel T, Fietze I, Sanner B, Hedner J, Schneider H. REM sleep imposes a vascular load in COPD patients independent of sleep apnea. COPD. 2017;14(6):565–72. Epub 2017 Sep 26. PMID: 28949781

    Article  PubMed  Google Scholar 

  13. Poh TY, Mac Aogáin M, Chan AK, Yii AC, Yong VF, Tiew PY, Koh MS, Chotirmall SH. Understanding COPD-overlap syndromes. Expert Rev Respir Med. 2017;11(4):285–98. Epub 2017 Mar 24. PMID: 28282995

    Article  CAS  PubMed  Google Scholar 

  14. Murphy PB, Rehal S, Arbane G, Bourke S, Calverley PMA, Crook AM, Dowson L, Duffy N, Gibson GJ, Hughes PD, Hurst JR, Lewis KE, Mukherjee R, Nickol A, Oscroft N, Patout M, Pepperell J, Smith I, Stradling JR, Wedzicha JA, Polkey MI, Elliott MW, Hart N. Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. JAMA. 2017;317(21):2177–86. PMID: 28528348; PMCID: PMC5710342

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wang D, Yee BJ, Grunstein RR. Does sleep apnea worsen the adverse effects of opioids and benzodiazepines on chronic obstructive pulmonary disease? Ann Am Thorac Soc. 2019;16(10):1237–8. PMID: 31573347

    Article  PubMed  Google Scholar 

  16. Adler D, Bailly S, Soccal PM, Janssens JP, Sapène M, Grillet Y, Stach B, Tamisier R, Pépin JL. Symptomatic response to CPAP in obstructive sleep apnea versus COPD- obstructive sleep apnea overlap syndrome: insights from a large national registry. PLoS One. 2021;16(8):e0256230. PMID: 34383866; PMCID: PMC8360593

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Suri TM, Suri JC. A review of therapies for the overlap syndrome of obstructive sleep apnea and chronic obstructive pulmonary disease. FASEB Bioadv. 2021;3(9):683–93. PMID: 34485837; PMCID: PMC8409567

    Article  PubMed  PubMed Central  Google Scholar 

  18. Khor YH, Ryerson CJ, Landry SA, Howard ME, Churchward TJ, Edwards BA, Hamilton GS, Joosten SA. Interstitial lung disease and obstructive sleep apnea. Sleep Med Rev. 2021;58:101442. Epub 2021 Jan 22. PMID: 33561604

    Article  PubMed  Google Scholar 

  19. Schiza SE, Bouloukaki I, Bolaki M, Antoniou KM. Obstructive sleep apnea in pulmonary fibrosis. Curr Opin Pulm Med. 2020;26(5):443–8. PMID: 32701670

    Article  PubMed  Google Scholar 

  20. Baranchuk A. Sleep apnea, cardiac arrhythmias, and conduction disorders. J Electrocardiol. 2012;45(5):508–12. Epub 2012 Apr 20. PMID: 22520295

    Article  PubMed  Google Scholar 

  21. Somers VK. Sleep—a new cardiovascular frontier. N Engl J Med. 2005;353(19):2070–3. Erratum in: N Engl J Med 2005;353(23):2523. PMID: 16282183

    Article  CAS  PubMed  Google Scholar 

  22. Naughton MT. PRO: persistent central sleep apnea/Hunter-Cheyne-Stokes breathing, despite best guideline-based therapy of heart failure with reduced ejection fraction, is a compensatory mechanism and should not be suppressed. J Clin Sleep Med. 2018;14(6):909–14. PMID: 29860966; PMCID: PMC5991963

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rosenberg R, Van Hout S. The American academy of sleep medicine inter-scorer reliability program: respiratory events. J Clin Sleep Med. 2014;10:447–54.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dupuy-McCauley KL, Mudrakola HV, Colaco B, Arunthari V, Slota KA, Morgenthaler TI. A comparison of 2 visual methods for classifying obstructive vs central hypopneas. J Clin Sleep Med. 2021;17:1157–65.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Goldstein CA, Berry RB, Kent DT, Kristo DA, Seixas AA, Redline S, et al. Artificial intelligence in sleep medicine: an American Academy of sleep medicine position statement. J Clin Sleep Med. 2020;16:605–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Costanzo MR. Central sleep apnea in patients with heart failure-how to screen, how to treat. Curr Heart Fail Rep. 2020;17(5):277–87. PMID: 32803641

    Article  PubMed  Google Scholar 

  27. Herkenrath SD, Randerath WJ. More than heart failure: central sleep apnea and sleep-related hypoventilation. Respiration. 2019;98(2):95–110. Epub 2019 Jul 10. PMID: 31291632

    Article  PubMed  Google Scholar 

  28. Joseph S, Costanzo MR. A novel therapeutic approach for central sleep apnea: phrenic nerve stimulation by the remedē® system. Int J Cardiol. 2016;206(Suppl):S28–34. Epub 2016 Feb 23. PMID: 26964705

    Article  PubMed  Google Scholar 

  29. Denfeld QE, Winters-Stone K, Mudd JO, Gelow JM, Kurdi S, Lee CS. The prevalence of frailty in heart failure: a systematic review and meta-analysis. Int J Cardiol. 2017;236:283–9. Epub 2017 Feb 10. PMID: 28215466; PMCID: PMC5392144

    Article  PubMed  PubMed Central  Google Scholar 

  30. Billings ME, Hale L, Johnson DA. Physical and social environment relationship with sleep health and disorders. Chest. 2020;157(5):1304–12. Epub 2019 Dec 21. PMID: 31870910; PMCID: PMC7268445

    Article  PubMed  Google Scholar 

  31. Gulotta G, Iannella G, Vicini C, Polimeni A, Greco A, de Vincentiis M, Visconti IC, Meccariello G, Cammaroto G, De Vito A, Gobbi R, Bellini C, Firinu E, Pace A, Colizza A, Pelucchi S, Magliulo G. Risk factors for obstructive sleep apnea syndrome in children: state of the art. Int J Environ Res Public Health. 2019;16(18):3235. PMID: 31487798; PMCID: PMC6765844

    Article  PubMed  PubMed Central  Google Scholar 

  32. Olmos SR. Comorbidities of chronic facial pain and obstructive sleep apnea. Curr Opin Pulm Med. 2016;22(6):570–5. PMID: 27662470

    Article  PubMed  Google Scholar 

  33. Shaeran TAT, Samsudin AR. Temporomandibular joint ankylosis leading to obstructive sleep apnea. J Craniofac Surg. 2019;30(8):e714–7. PMID: 31261319

    Article  PubMed  Google Scholar 

  34. Beddis H, Pemberton M, Davies S. Sleep bruxism: an overview for clinicians. Br Dent J. 2018;225(6):497–501. Epub 2018 Sep 21. PMID: 30237554.

    Article  CAS  PubMed  Google Scholar 

Download references


The authors acknowledge Dr. Robin Germany and Dr. Tim Meyer at Zoll-Respicardia for permission in reproducing images of the Zoll-Respicardia REMEDE system, digital clips of central sleep apnea syndrome, and expertise on central sleep apnea syndrome.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Qanta A. A. Ahmed .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ahmed, Q.A.A. (2023). Sleep-Disordered Breathing: An Expanding Spectrum for the Pulmonologist. In: Baptista, P.M., Lugo Saldaña, R., Amado, S. (eds) Obstructive Sleep Apnea. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-35224-9

  • Online ISBN: 978-3-031-35225-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics