Skip to main content

Clinical Aspects in Sleep Disorders and Apnea

  • Reference work entry
  • First Online:
Drug Discovery and Evaluation: Methods in Clinical Pharmacology
  • 929 Accesses

Abstract

Sleep disorders are frequently reported complaints. Insomnia and hypersomnolence are symptoms often reported by patients and study participants. Sleep disorders with clinical consequences are not as common as complaints and symptoms might suggest. Sleep medicine is a new discipline which has developed its own curricula and physician specialization. Sleep medicine has developed a classification of sleep disorders with a manual with definitions and severity criteria. This classification will become part of the ICD-11 currently developed. The classification defines insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, sleep-related movement disorders, and other sleep disorders.

Diagnostic procedures include validated questionnaires; daytime testing of alertness and sleepiness; home recording of sleep-wake behavior, activity, and physiological signals; and finally a sleep laboratory investigation, cardiorespiratory polysomnography, with all signals recorded which change during normal and pathological sleep. Quantitative assessment of sleep, sleep stages, arousals from sleep, and vegetative functions during sleep is well-established, and normative values including age as modifier are well described.

Sleep disorders are recognized as risk factors for many other medical and mental disorders. Sleep disorders impair performance and may be perceived as early aging. Untreated sleep disorders cause costs at all levels of health care and need to be recognized and treated as appropriate.

Sleep disorders are a target to clinical pharmacology by being recognized and potentially excluded in any pharmacological trial. And sleep disorders are subject to drug discovery and development.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 699.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 999.99
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 and Further Reading

  • AASM (2014) International classification of sleep disorders. Third edition (ICSD-3). American Academy of Sleep Medicine, Darien

    Google Scholar 

  • Abrishami A, Khajehdehi A, Chung FA (2010) Systemic review of screening questionnaires for obstructive sleep apnea. Can J Anesth 85:423–438

    Google Scholar 

  • Berry RB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, Vaughn BV, for the American Academy of Sleep Medicine (2016) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.3. American Academy of Sleep Medicine, Darien

    Google Scholar 

  • Bonnet MH, Doghramji K, Roehrs T, Stepanski EJ, Sheldon SH, Walters AS, Wise M, Chesson AL Jr (2007) The scoring of arousal in sleep: reliability, validity, and alternatives. J Clin Sleep Med 3:133–145

    PubMed  Google Scholar 

  • Buysse DJ, Reynolds ICF, Monk TH et al (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    CAS  PubMed  Google Scholar 

  • Chung F, Yegneswaran B, Liao P, Vairavanathan S, lslam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire a tool to screen patients for obstructive sleep apnea. Anesthesiology 108:812–821

    PubMed  Google Scholar 

  • Collop NA, Tracy SL, Kapur V, Mehra R, Kuhlmann D, Fleishman SA, Ojile JM (2011) Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J Clin Sleep Med 7:531–548

    PubMed  PubMed Central  Google Scholar 

  • Eckert DJ, Younes MK (2014) Arousal from sleep: implications for obstructive sleep apnea pathogenesis and treatment. J Appl Physiol 116:302–313

    CAS  PubMed  Google Scholar 

  • El Shayeb M, Toper LA, Stafinski T, Pawluk L, Menon D (2014) Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. Canad Med Assoc J 186:E25–E51. https://doi.org/10.1503/cmaj.130952

    Article  Google Scholar 

  • Flemons WW, Whitelaw WA, Brant R, Remmers JE (1994) Likelihood ratios for a sleep apnea clinical prediction rule. Am J Respir Crit Care Med 150:1279–1285

    CAS  PubMed  Google Scholar 

  • Flemons WW, Littner MR, Rowley JA et al (2003) Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American Thoracic Society. Chest 124:1543–1579

    PubMed  Google Scholar 

  • Gautier-Veyret E, Pépin JL, Stanke-Labesque F (2017) Which place of pharmacological approaches beyond continuous positive airway pressure to treat vascular disease related to obstructive sleep apnea? Pharmacol Ther S0163-7258(17):30297–30298. https://doi.org/10.1016/j.pharmthera.2017.12.006

    Article  CAS  Google Scholar 

  • Heinzer R, Marques-Vidal P, Marti-Soler H et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir 3:310–318

    CAS  Google Scholar 

  • Hirshkowitz M (2016) Polysomnography challenges. Sleep Med Clin 11:403–411

    PubMed  Google Scholar 

  • Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    CAS  PubMed  Google Scholar 

  • Lavie L (2003) Obstructive sleep apnoea syndrome – an oxidative stress disorder. Sleep Med Rev 7:35–51

    PubMed  Google Scholar 

  • Liu HM, Chian IJ, Kuo KN, Liou CM, Chen C (2017) The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis. Ther Adv Respir Dis 11:20–29. https://doi.org/10.1177/1753465816677006

    Article  PubMed  Google Scholar 

  • Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053

    PubMed  Google Scholar 

  • Marshall J, Hildebrandt S, Sydow H, Nolting HD, Burgart E, Woköck T (2017) Gesundheitsreport 2017. Medhochzwei, DAK-Gesundheit/Heidelberg

    Google Scholar 

  • Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M, Tafti M, Tufik SB, Bittencourt L, Tufik S, Haba-Rubio J, Heinzer R (2016) The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med 4:742–748

    PubMed  Google Scholar 

  • Mayer G, Arzt M, Braumann B, Ficker JH, Fietze I, Galetke W, Maurer JT, Orth M, Penzel T, Pistner HP, Randerath W, Rösslein M, Sitter H, Stuck BA (2017) S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen - Kapitel “Schlafbezogene Atmungsstörungen”. Somnologie 20 (Suppl s2):S97–S180

    Google Scholar 

  • McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, Mediano O, Chen R, Drager LF, Liu Z, Chen G, Du B, McArdle N, Mukherjee S, Tripathi M, Billot L, Li Q, Lorenzi-Filho G, Barbe F, Redline S, Wang J, Arima H, Neal B, White DP, Grunstein RR, Zhong N, Anderson CS, SAVE Investigators and Coordinators (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375:919–931

    PubMed  Google Scholar 

  • Morgenthaler TI, Aurora RN, Brown T et al (2008) Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. Sleep 31:141–147

    PubMed  PubMed Central  Google Scholar 

  • Morin CM, Belleville G, Bélanger L, Ivers H (2011) The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34:601–608

    PubMed  PubMed Central  Google Scholar 

  • Netzer NC, Stoohs RA, Netzer CM (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131:485–491

    CAS  PubMed  Google Scholar 

  • Ohayon MM (2011) Epidemiological overview of sleep disorders in the general population. Sleep Med Rev 2:1–9

    Google Scholar 

  • Ohayon MM, Zulley J (2001) Correlates of global sleep dissatisfaction in the German population. Sleep 24:780–787

    CAS  PubMed  Google Scholar 

  • Ong TH, Raudha S, Fook-Chong S et al (2010) Simplifying STOP-BANG: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 14:371–376

    PubMed  Google Scholar 

  • Penzel T, Peter H, Peter JH, Becker HF, Fitze I, Fischer J, Mayer G, Podszus T, Raschke F, Riemann D, Schäfer T, Sitter H (2005) Gesundheitsberichterstattung des Bundes. Heft 27: Schlafstörungen. Robert-Koch Institut

    Google Scholar 

  • Penzel T, Schöbel C, Fietze I (2015) Revise respiratory event criteria or revise severity thresholds for sleep apnea definition. J Clin Sleep Med 11:1357–1359

    PubMed  PubMed Central  Google Scholar 

  • Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014

    PubMed  PubMed Central  Google Scholar 

  • Pereira EJ, Driver HS, Stewart SC et al (2013) Comparing a combination of validated questionnaires and level III portable monitor with polysomnography to diagnose and exclude sleep apnea. J Clin Sleep Med 9:1259–1266

    PubMed  PubMed Central  Google Scholar 

  • Qaseem A, Dallas P, Owens DK, Starkey M, Holty JE, Shekelle P (2014) Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American college of physicians. Ann Intern Med 161:210–220

    PubMed  Google Scholar 

  • Resnick HE, Redline S, Shahar E, Gilpin A, Newman A, Walter R, Ewy GA, Howard BV, Punjabi NM, Sleep Heart Health Study (2003) Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 26:702–709

    PubMed  Google Scholar 

  • Rosen IM, Kirsch DB, Chervin RD, Carden KA, Ramar K, Aurora RN, Kristo DA, Malhotra RK, Martin JL, Olson EJ, Rosen CL, Rowley JA, American Academy of Sleep Medicine Board of Directors (2017) Clinical use of a home sleep apnea test: an American Academy of sleep medicine position statement. J Clin Sleep Med 13:1205–1207

    PubMed  PubMed Central  Google Scholar 

  • Sanders MH, Montserrat JM, Farre R et al (2008) Positive pressure therapy: a perspective on evidence-based outcomes and methods of application. Proc Am Thorac Soc 5:161–172

    PubMed  PubMed Central  Google Scholar 

  • Schlack R, Hapke U, Maske U, Busch MA, Cohrs S (2013) Häufigkeit und Verteilung von Schlafproblemen und Insomnie in der deutschen Erwachsenenbevölkerung. Bundesgesundheitsblatt 6:740–748

    Google Scholar 

  • Schwartz AR, Bennett ML, Smith PL, De Backer W, Hedner J, Boudewyns A, Van de Heyning P, Ejnell H, Hochban W, Knaack L, Podszus T, Penzel T, Peter JH, Goding GS, Erickson DJ, Testerman R, Ottenhoff F, Eisele DW (2001) Therapeutic electrical stimulation of the hypoglossal nerve in obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 127:1216–1223

    CAS  PubMed  Google Scholar 

  • Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R (2017) Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath. https://doi.org/10.1007/s11325-017-1590-6

  • Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25

    CAS  PubMed  Google Scholar 

  • Silva GE, Vana KD, Goodwin JL et al (2011) Identification of patients with sleep disordered breathing: comparing the four-variable screening tool, STOP, STOP-Bang, and Epworth Sleepiness Scales. J Clin Sleep Med 7:467–472

    PubMed  PubMed Central  Google Scholar 

  • Strollo PJ Jr, Soose RJ, Maurer JT, de Vries N, Cornelius J, Froymovich O, Hanson RD, Padhya TA, Steward DL, Gillespie MB, Woodson BT, Van de Heyning PH, Goetting MG, Vanderveken OM, Feldman N, Knaack L, Strohl KP, STAR Trial Group (2014) Upper-airway stimulation for obstructive sleep apnea. N Engl J Med 370:139–149

    CAS  PubMed  Google Scholar 

  • Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865

    CAS  PubMed  Google Scholar 

  • Walters AS, LeBrocq C, Dhar A et al (2003) Validation of the international restless legs syndrome study group rating scale for restless legs syndrome. Sleep Med 4:121–132

    PubMed  Google Scholar 

  • Wirth KJ, Steinmeyer K, Ruetten H (2013) Sensitization of upper airway mechanoreceptors as a new pharmacologic principle to treat obstructive sleep apnea: investigations with AVE0118 in anesthetized pigs. Sleep 36:699–708

    PubMed  PubMed Central  Google Scholar 

  • Yalamanchali S, Farajian V, Hamilton C, Pott TR, Samuelson CG, Friedman M (2013) Diagnosis of obstructive sleep apnea by peripheral arterial tonometry: meta-analysis. JAMA Otolaryngol Head Neck Surg 139:1343–1350

    PubMed  Google Scholar 

  • Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    CAS  PubMed  Google Scholar 

  • Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157:1746–1752

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Penzel .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Penzel, T., Fietze, I. (2020). Clinical Aspects in Sleep Disorders and Apnea. In: Hock, F., Gralinski, M. (eds) Drug Discovery and Evaluation: Methods in Clinical Pharmacology. Springer, Cham. https://doi.org/10.1007/978-3-319-68864-0_41

Download citation

Publish with us

Policies and ethics