Diagnosing And Treating Co-Morbid Sleep Apnea In Neurological Disorders.

Obstructive sleep apnea (OSA) is an extremely common public health problem manifested by sleep-disordered breathing, daytime hypersomnia and poor sleep quality, adverse neurocognitive sequelae, and hypoxia. OSA occurs in about two to four percent of the general population, or an estimated 18 million Americans. Co-morbid OSA is even more frequent in neurological patients, affecting at least onethird of those with epilepsy and about two-thirds of stroke survivors. Just as effective treatment of OSA may improve hypertensive control and reduce risk of cardiovascular complications, there is now growing evidence that treating co-morbid OSA also improves neurological outcomes such as cognitive functioning and seizure control. Since neurologists frequently serve as principal care providers for those with epilepsy, stroke, multiple sclerosis, and migraine, it is crucial for neurology physicians to be familiar with the identification of sleep apnea early in its presentation to provide optimal care for their patients. This article reviews the typical common clinical manifestations of obstructive sleep apnea and its adverse impact on neurocognitive functioning, focuses on the influence of co-morbid OSA on selected neurological disorders, and provides some concluding practical pointers on the diagnosis and treatment of OSA for practicing neurologists. OSA and The Spectrum of Sleep Disordered Breathing Obstruction of the upper airway during sleep causes a continuum of breathing disturbances, varying from mild snoring, to partial airway obstruction causing a heightened respiratory effort necessary to preserve airflow and oxygenation, thereby leading to arousal (a respiratory effort related arousal, or RERA), to airflow limitation (hypopnea), and to cessation of airflow (apnea). Some patients have a typical predisposing anatomy of a narrowed oropharynx. Anatomical factors at the level of the nose, nasopharynx, oropharynx, or hypopharynx may all predispose, and most adult patients have multi-level obstructive factors. Common anatomical factors increasing vulnerability towards OSA include nasal septal deviation, polyps, a low-lying palate or redundant soft palatal tissue, a thickened tongue base, or a narrow hypopharynx. The mildest form of upper airway obstructive sleep disordered breathing is snoring. Snoring results from narrowing in the nasal passages or oropharynx significant enough to produce turbulent airflow, leading to vibration of the soft palatal tissue. Primary snoring is diagnosed when no other disturbance in sleep or respiration is found during polysomnography. While snoring has been correlated with risk of hypertension, primary snoring is basically otherwise benign except Diagnosing And Treating Co-Morbid Sleep Apnea In Neurological Disorders