Sleep apnea means that
your breathing often is blocked or partly
blocked during sleep. The problem can be mild to severe, based on
how often your lungs don't get enough air. This may happen from 5 to
more than 50 times an hour.
This topic focuses on obstructive sleep apnea, which is the most common
type.
A less common type of apnea, called central sleep apnea,
can occur in people who have had a stroke, have heart failure, or have a brain
tumor or infection. Even though this topic isn't about central sleep apnea,
some of the treatments discussed here may also help treat it. Talk with your
doctor to find out more about central sleep apnea.
What causes obstructive sleep apnea?
Blocked or
narrowed airways in your nose, mouth, or throat can cause sleep apnea. Your
airway can become blocked when your throat muscles and tongue relax during
sleep.
Sleep apnea can also occur if you have large
tonsils or adenoids or a large
uvula. During the day, when you are awake and standing
up, these may not cause problems. But when you lie down at night, they can
press down on your airway, narrowing it and causing sleep apnea. Sleep apnea
can also occur if you have a problem with your jawbone.
The main symptoms of sleep apnea that you may
notice are:
Not feeling rested after a night’s
sleep.
Feeling sleepy during the day.
Waking up with a
headache.
Your bed partner may notice that while you sleep:
You stop breathing.
You often snore
loudly.
You gasp or choke.
You toss and turn.
Children who have sleep apnea:
Nearly always snore.
May
be hyperactive or have problems paying attention during the
day.
May be
restless during sleep and wake up often. They also may have problems
with bed-wetting.
But children may not seem very sleepy during the day (a key
symptom in adults). The only symptom of sleep apnea in some children may be
that they do not grow as quickly as most children their age.
Should you worry about sleep apnea?
If you have
sleep apnea, you may not be sleeping as well as you could. And you may be more
likely to end up with serious problems such as:
Your doctor will probably examine you and ask about your past health. He
or she may also ask you or your sleeping partner about your snoring and sleep
behavior and how tired you feel during the day.
Your doctor may
suggest a
sleep study. A sleep study usually takes place at a
sleep center, where you will spend the night. Sleep studies find out how often
you stop breathing or have too little air flowing into your lungs during sleep.
They also find out how much oxygen you have in your blood during sleep. You may
have blood tests and X-rays.
How is it treated?
You may be able to treat mild sleep apnea by
making changes in how you live and the way you sleep. For example:
Lose weight if you are
overweight.
Sleep on your side and not your back.
Avoid alcohol and medicines such as
sedatives before bed.
If lifestyle changes do not help sleep apnea, you
may be able to use an oral breathing device. These devices help keep your
airway open while you sleep.
If you have moderate to
severe sleep apnea, you may be able to use a machine that helps you breathe
while you sleep. This treatment is called
continuous positive airway pressure, or CPAP (say
“SEE-pap”). Sometimes medicine that helps you stay awake during the day may be
used along with CPAP. If your tonsils, adenoids, uvula, or
other tissues are blocking your airway, your doctor may suggest surgery to open
your airway.
A blockage or narrowing of the
airways in your nose, mouth, or throat generally causes obstructive
sleep apnea (OSA). This usually occurs when the throat
muscles and tongue relax during sleep and partially or completely block the
airway. When you stop breathing or have reduced flow of air into your lungs
during sleep, the amount of oxygen in your blood decreases briefly.
Obstructive sleep apnea can also occur if you have bone deformities or
enlarged tissues in your nose, mouth, or throat. For
example, you may have enlarged
tonsils. During the day when you are awake and
standing up, this may not cause problems. But when you lie down at night, the
tonsils can press down on your airway, narrowing it and causing sleep
apnea.
Other factors that may
contribute to sleep apnea include:
Drinking alcohol, which affects the part of the
brain that controls breathing. This may relax the breathing muscles and cause a
narrowing of the airway and sleep apnea.
Obesity. Fat in
the neck area can press down on the tissues around the airways. This narrows
the airways and can cause sleep apnea. About 70% of people who have sleep apnea
are obese.1
Some medicines that are taken for conditions such as
allergies,
depression,
insomnia, or
anxiety. These medicines, especially
sedatives, can also relax the muscles and tissues in
the throat, causing it to narrow.
Waking with an unrefreshed feeling after sleep, having
problems with memory and concentration, feeling tired, and experiencing
personality changes.
Morning or night headaches. About half of all
people with sleep apnea report headaches.2
Heartburn or a sour taste in the mouth at
night.
Swelling of the legs.
Getting up during the night to urinate (nocturia).
Sweating and chest pain while you are sleeping.
Symptoms of sleep apnea that others may notice
include:
Episodes of not breathing (apnea), which may
occur as few as 5 times an hour (mild apnea) to more than 50 times an hour
(severe apnea). How many episodes you have determines how
severe your sleep apnea is.
Loud
snoring. Almost all people who have sleep apnea snore,
but not all people who snore have sleep apnea.
Restless tossing and
turning during sleep.
Nighttime choking or gasping spells.
Symptoms in children
In children, symptoms of
sleep apnea depend on how old the child is:
In children younger than 5, symptoms include
snoring, mouth breathing, sweating, restlessness, and waking up a
lot.
In children 5 years and older, symptoms include snoring, bed
wetting, doing poorly in school, and not growing as quickly as they should for
their age. These children may also have behavior problems and a short attention
span.
Children who have sleep apnea nearly always snore. But
they may not appear to be excessively sleepy during the day (a key symptom in
adults). The only symptom of sleep apnea in some children may be that they do
not grow as quickly as they should for their age.
Although rare,
in children sleep apnea can cause
developmental delays and can cause failure
of the right side of the heart (cor pulmonale).
Obstructive
sleep apnea (OSA) causes your airway to
narrow or close off, reducing or stopping breathing for short
periods during sleep. If your breathing stops,
you may make grunting, gasping, or snorting sounds and restless body movements.
As breathing resumes, loud
snoring starts. This may happen many times during a
night.
How often
your breathing is interrupted while you sleep
determines the
severity of sleep apnea.
When you stop breathing, the oxygen levels in your blood go
down and
carbon dioxide levels go up. This makes your heart and
blood vessels work harder and can affect your heart rate and
nervous system. This in turn may lead to
other problems including
high blood pressure (hypertension) and
coronary artery disease (CAD). Sleep apnea can also
make these diseases worse and more difficult to treat. Sleep apnea also raises
your risk of having a stroke.3
Because
sleep apnea disturbs your sleep, it can make you very tired during the day. If
you have sleep apnea, you may:
Be more likely to have a car
accident.
Perform poorly at school or work and have difficulty
concentrating. You also may have memory problems.
Have personality
changes, anxiety, and depression.
Certain factors make it more
or less likely that you will have obstructive
sleep apnea (OSA). Some of these you cannot change,
while others you can.
Factors you cannot change
Factors that you cannot
change and that may make it more likely you will have sleep apnea
include:
Aging. Sleep apnea is most common in people age
30 and older.
Male gender. Sleep apnea is more common in men.
Some studies have indicated that about 2 to 3 times more men than women have
sleep apnea, and sleep laboratories report that 5 or 6 times more men than
women have the disease.1
Family history. If other members of your family
have sleep apnea, you are more likely to get the disease than someone who does
not have a family history of the disease.
Ethnicity. Blacks, Hispanics, and Pacific
Islanders have a greater risk of sleep apnea than white people. Blacks get
sleep apnea at a younger age than whites.1
Deformities of the spine. Deformities of the
spine, such as
scoliosis, may interfere with breathing and contribute
to sleep apnea.
Conditions that may cause head and face (craniofacial) abnormalities. Conditions such as
Marfan's syndrome and
Down syndrome may result in craniofacial abnormalities
and increase the risk for sleep apnea.
Menopause. Recent studies indicate that sleep
apnea occurs more often in women who have been through
menopause than in women who have not.1 After menopause, women get sleep apnea at a rate similar to
men.2 Experts do not know why or how menopause
increases the risk of sleep apnea.
Factors you may be able to change
Factors that
you may be able to change that will reduce your chances of having sleep apnea
include:
Obesity. About 70% of people who have sleep apnea
are
obese.1 Obesity is the factor
most likely to lead to sleep apnea.
Neck circumference. People who are overweight may
have extra tissue around their neck, adding to their risk for sleep apnea. The
risk increases for a man whose neck measures more than 17 inches around and for
a woman whose neck measures more than 16 inches around.
Enlarged tissues of the nose, mouth, or throat.Enlarged tissues in the nose, mouth, or throat can
cause narrowing or blockage of the airway while you sleep, making sleep apnea
more likely. Surgery can sometimes correct the blockage and improve sleep
apnea.
Bone deformities. Bone deformities of the nose,
mouth, or throat can interfere with breathing, causing sleep apnea. Some people
who have sleep apnea have a small, receding jaw. Surgery can sometimes correct
these deformities and improve sleep apnea.
Use of alcohol or medicine. Drinking alcohol or
taking certain medicines before going to sleep can increase the risk for sleep
apnea. These include sleeping pills and
sedatives.
Sleeping on your back and using pillows. Sleeping
on your back and using one or more pillows may make sleep apnea symptoms
worse.
Smoking. Smoking can increase your risk for sleep
apnea, because the nicotine that is in tobacco relaxes the muscles that keep the
airways open.
Poor sleep habits. Going to bed in different places or waking up at different times may increase your risk for sleep apnea.
Disorders of the hormone (endocrine) system. Disorders of the endocrine system (such as
hypothyroidism and
acromegaly) may increase your risk for sleep
apnea.
You or your bed partner snores loudly and
heavily and feels sleepy during the day.
You notice that your bed
partner stops breathing, gasps, or chokes during sleep.
You
sometimes fall asleep at inappropriate times, such as while you are talking or
eating.
Your child snores, has difficulty breathing while sleeping,
sleeps restlessly, wakes up often, and is very sleepy during the day.
Watchful Waiting
Watchful waiting is a wait-and-see approach. If
you get better on your own, you will not need treatment. If you get worse, you
and your doctor will decide what to do next. Watchful waiting may be right for
you if you snore but are not
excessively sleepy during the day.
Watchful waiting may not be right if you notice that your sleeping
partner snores loudly and heavily, is restless during sleep, and is sleepy
during the day. If you think your sleeping partner may have periods when
breathing stops, suggest that he or she talk with a doctor.
Who To See
Health professionals who can check people who have
symptoms of obstructive
sleep apnea (OSA) include:
If your doctor thinks that you may have sleep apnea, he
or she may have you see a specialist who treats sleep disorders. The specialist
can help arrange and interpret a
sleep study and prescribe treatment for the disease,
such as
continuous positive airway pressure (CPAP).
Other health professionals may be able to help
you if you have other problems that are caused by sleep apnea. If you:
Your doctor will
examine you and ask you and possibly your sleeping
partner questions about your lifestyle, snoring, sleep behavior, and how tired
you feel during the day (this is called a
medical history). Your doctor may ask you to complete
a questionnaire, such as the Epworth Sleepiness Scale. The answers to questions
in this questionnaire can help the doctor find out if you have sleep apnea. If
your doctor thinks that you may have obstructive
sleep apnea (OSA), he or she may suggest sleep studies
or other tests.
Sleep studies
are a series of tests that record what happens to your body during sleep. The
most important test for sleep apnea is polysomnography. This test records
electrical activity of your brain, eye movement, muscle activity, heart rate,
breathing, airflow through your nose and mouth, and blood oxygen levels (saturation). Polysomnography is the only sure way to
find out whether you have sleep apnea. For more information, see:
If your sleep apnea has not improved after initial
treatment, and if
enlarged tissues in your mouth and throat are causing
it, your doctor may do one or more tests before suggesting surgery to remove
the excess tissue. These tests may include:
A
CT scan of the head to look for an overly large tongue
and excessive soft tissue in the neck, as well as to locate the narrowest part
of your airway.
X-rays. A cephalometric X-ray is a type
of head X-ray that allows your doctor to see bone deformities of the skull.
This type of X-ray test may not be available in every hospital.
To diagnose sleep apnea in children, doctors follow similar
steps. According to the American Academy of Pediatrics:4
During a routine checkup, your doctor will ask you and your child
about snoring. If your child snores, be sure to tell your doctor.
A complete sleep study generally is needed to tell if your child
has sleep apnea and is not just snoring.
In general,
your doctor will have you try lifestyle changes and CPAP first. Surgery might
be a first choice only if the sleep apnea is caused by a blockage that is
easily fixed.
You may need to be treated for other health problems
before you are treated for sleep apnea. For example, people who also have
inflammation of the nasal passages (rhinitis) may
need to use nose spray to reduce the inflammation. People who have an
underactive thyroid gland (hypothyroidism) need to take thyroid
medicine.
Children have the same treatment options as adults. But
surgery (tonsillectomy and adenoidectomy) typically is the
first choice because enlarged tonsils or adenoids cause most cases of sleep
apnea in children. If surgery is not possible
or does not work, children are treated using CPAP.
Initial treatment
The first treatment for
obstructive
sleep apnea (OSA) consists of making lifestyle
changes. Your sleep apnea may be helped if you:
Lose weight (if needed). Small studies have
shown that losing weight decreases the number of times an hour that you stop
breathing (apnea) or that a reduced amount of air enters your lungs
(hypopnea).5 Experts agree that weight loss should be
part of managing sleep apnea.5
Wake up at the same time every
morning.
Sleep
on your side. Try this: Sew a pocket in the middle of the back of your pajama
top, put a tennis ball into the pocket, and stitch it shut. This will help keep
you from sleeping on your back. Sleeping on your side may eliminate mild sleep
apnea.6
Avoid the use of alcohol and some
medicines, especially sleeping pills and
sedatives, before bed.
Quit smoking. The
nicotine in tobacco relaxes the muscles that keep the airways open. If you
don't smoke, those muscles are less likely to collapse at night and narrow the
airways.
Raise the head of your bed
4 in (10 cm) to
6 in (15 cm) by putting bricks
under the legs of the bed. You can also use a special pillow (called a cervical
pillow) when you sleep. A cervical pillow can help your head stay in a position
that reduces sleep apnea. Using regular pillows to raise your head and upper
body will not work.
Promptly treat breathing problems, such as a
stuffy nose caused by a cold or allergies.
All people who have sleep apnea should make these
lifestyle changes. They may be all that is needed to relieve
mild sleep apnea.
Some people use nasal
strips, which widen the nostrils and improve airflow. Although these strips may
decrease snoring, they cannot treat sleep apnea.
It may
take time for you to be at ease when you use CPAP. You may find that you want
to take the mask off, or you may find it difficult to sleep while using it. If
you can't get used to it, talk to your doctor. You might be able to try another
type of mask or make other adjustments.
CPAP does not
always get rid of daytime sleepiness. If you still feel sleepy during the day
while using CPAP at night, tell your doctor.
Some
CPAP devices automatically adjust air pressure or use different air pressures
when you breathe in or out. They are easier and more comfortable for some
people to use.
Other medical treatment includes
oral breathing devices. These devices reposition your tongue and jaw during
sleep, which opens up your airways.
Surgery might be the
first treatment only when a blockage can be fixed easily,
such as when you have overly large tonsils.
Ongoing treatment
Ongoing treatment for
obstructive
sleep apnea (OSA) includes using
continuous positive airway pressure (CPAP) or an
oral breathing device and making changes in your lifestyle. Lifestyle changes
include losing weight (if needed), improving sleep habits (such as sleeping on
your side and waking up at the same time every morning),
avoiding the use of alcohol and certain medicines (especially sleeping pills
and
sedatives) before bed, and stopping smoking. Sometimes
medicine to help you stay awake during the day is used along with CPAP.
If CPAP is not working, you may need
another
sleep study to find out whether your CPAP machine
needs to be adjusted. You may also need to think about surgery. Surgical
choices include:
Uvulopalatopharyngoplasty, which removes excess tissue
in the throat to make the airway wider. It is the most common surgery to treat
sleep apnea in adults.
Tonsillectomy and/or adenoidectomy, which removes the tonsils and/or the adenoids. It may be
used if you have enlarged
tonsils and adenoids that are blocking your airway
during sleep. This is often the first treatment option for children because
enlarged tonsils and adenoids are usually the cause of their sleep
apnea.
Other surgical procedures, which are used to repair
bone and tissue problems in the mouth and throat.
In some cases, you
may need surgery. Surgical options include:
Uvulopalatopharyngoplasty, which
removes excess tissue in the throat to make the airway wider. It is the most
common surgery to treat sleep apnea in adults.
Tonsillectomy and/or adenoidectomy, which removes the
tonsils and/or the adenoids. It may be used if you have enlarged
tonsils and adenoids that are blocking your airway
during sleep. This is often the first treatment option for children, because
enlarged tonsils and adenoids are usually the cause of their sleep
apnea.
Other surgical procedures, which are used to repair
bone and tissue problems in the mouth and throat.
Tracheostomy, which creates a hole in the windpipe
(trachea). A tube is then put in the hole to bring air in. Doctors rarely use
this surgery, because it may cause other health problems. But when other
techniques have failed, almost all people who are treated with tracheostomy
will be cured of their sleep apnea.
Bariatric surgery if you are extremely overweight (severely obese) and the excess
weight is making your sleep apnea worse. This surgery is done only for people
who cannot lose weight with diet and exercise. Bariatric surgery can promote
weight loss that improves sleep apnea.7
Research shows that continuous
positive airway pressure (CPAP) decreases daytime sleepiness, especially in
people who have moderate to severe sleep apnea.8, 5 But CPAP may not work as well
for people who have mild sleep apnea.5
CPAP can lower daytime and nighttime blood pressure.9
If you use CPAP to treat sleep apnea, you need
to use it every night. If you do not use it, your symptoms will return right
away.
Treatment of obstructive sleep apnea in people with coronary
artery disease lowers the risk of some heart problems.10
You can help prevent obstructive
sleep apnea (OSA) and snoring if you:
Avoid the use of alcohol and medicines, such as
sleeping pills and
sedatives, before bed. These can relax your throat
muscles and slow your breathing.
Eat sensibly, exercise, and stay at a weight that is as close
as possible to a healthy body weight.
Sleep on your side. Sleeping
on your back can increase snoring. Try this: Sew a pocket in the middle of the
back of your pajama top, put a tennis ball into the pocket, and stitch it shut.
This will help keep you from sleeping on your back. Sleeping on your side may
eliminate
mild sleep apnea.6
Quit smoking. The nicotine in tobacco relaxes the
muscles that keep the airways open. If you don't smoke, those muscles are less
likely to collapse at night and narrow the airways.
Raise the head
of your bed 4 in (10 cm) to
6 in (15 cm) by putting bricks
under the legs of the bed. You can also use a special pillow (called a cervical
pillow) when you sleep. A cervical pillow can help your head stay in a position
that reduces sleep apnea. Using regular pillows to raise your head and upper
body will not work.
Promptly treat breathing problems, such as a
stuffy nose caused by a cold or allergies. Breathing problems can increase the
risk of snoring. Avoid taking
antihistamines, because they can make you drowsy and
make apnea episodes worse. Instead, use decongestants, which decrease
drainage.
You can treat obstructive
sleep apnea (OSA) at home if you have
mild sleep apnea (5 or fewer apnea episodes an hour).
Home treatment for sleep apnea includes:
Losing weight. Many people who have sleep apnea are
overweight. Small studies have shown that losing weight reduces the number
of times an hour that you stop breathing (apnea) or that the airflow to your
lungs is reduced (hypopnea).5 Experts agree that
weight loss should be part of managing sleep apnea.5
Limiting the use of alcohol and medicine. Drinking
excessive amounts of alcohol or taking certain medicines, especially sleeping
pills or
sedatives, before sleep may make symptoms worse.
Getting plenty of sleep. Apnea episodes may be more
frequent when you have not had enough sleep.
Sleeping on your side. Try this: Sew a pocket in
the middle of the back of your pajama top, put a tennis ball into the pocket,
and stitch it closed. This will help keep you from sleeping on your back.
Sleeping on your side may eliminate mild sleep apnea.6
You can try using a special pillow (called a cervical pillow) when you sleep. A
cervical pillow can help your head stay in a position that reduces sleep
apnea.
If you are using a
continuous positive airway pressure (CPAP) machine to
help you breathe, use it every night. If you don't use it all night, every
night, your symptoms will return right away.
Doctors typically do not suggest medicines
for the treatment of obstructive
sleep apnea (OSA). But medicine can help reduce
daytime sleepiness when
continuous positive airway pressure (CPAP) is reducing
apneas—the number of times you stop breathing at night—but daytime sleepiness
continues.11, 12
Medication Choices
The U.S. Food and Drug Administration (FDA) has approved
wakefulness-promoting medicines for people who are using CPAP but still have
excessive daytime sleepiness:
Surgery for obstructive
sleep apnea (OSA) is usually not done unless other
treatments have failed or you are unable or choose not to use other
treatments.
Surgery Choices
Uvulopalatopharyngoplasty removes
excess tissue in the throat to make the airway wider. It is the most common
surgery to treat sleep apnea in adults.
Tonsillectomy and/or adenoidectomy removes the tonsils
and/or the adenoids. It is an option if you have enlarged
tonsils and adenoids that are blocking your airway
during sleep. This is often the first treatment option for children because
enlarged tonsils and adenoids are usually the cause of their sleep
apnea.
Tracheostomy creates a hole in the windpipe (trachea).
A tube is then put in the hole to bring air in. Doctors rarely use this surgery
because it may cause other health problems. But when other techniques have
failed, almost all people who are treated with tracheostomy will be cured of
their sleep apnea.
Bariatric surgery is done for weight
loss. If you are extremely overweight (severely obese) and the excess weight is
making your sleep apnea worse, you may consider surgery to help you lose
weight. Bariatric surgery can promote weight loss that improves sleep
apnea.7
Tonsillectomy and/or adenoidectomy usually is the
first choice for children, because enlarged tonsils or adenoids cause most
cases of sleep apnea in children. Other types of surgery may be needed to
correct birth defects that can cause sleep apnea symptoms.
What To Think About
If you are thinking about
having surgery to treat sleep apnea, talk with your doctor about having a
sleep study done first. Experts typically suggest
that you try
continuous positive airway pressure (CPAP) before
considering surgery. CPAP is a machine that increases air pressure in the
throat and prevents tissues in the airway from collapsing when you breathe
in.
In adults, uvulopalatopharyngoplasty (UPPP) is the most common
surgery used to treat sleep apnea.
There is no clear research on how well UPPP
works for sleep apnea.13
UPPP may stop
snoring, but apnea episodes may continue.1
Limited research shows that about 40% to 60%
of people who have UPPP see an improvement in their symptoms.2
You may still need other forms of treatment,
including continuous positive airway pressure (CPAP), after
surgery.
You will need sleep studies after surgery to make sure
periods of apnea do not continue or return.
UPPP usually is not
used to treat sleep apnea in children.
Tracheostomy is used only when all other treatments for
severe sleep apnea have failed or when you cannot
tolerate other treatments.
A rarely used option is repositioning
facial bones (maxillofacial reconstruction) if CPAP or UPPP do not work. This
surgery is designed to increase the size of the bones around the tongue and to
create pull (traction) on the base of the tongue, which enlarges the airway.
You will usually need more than one surgery.
Laser-assisted uvulopalatoplasty uses a laser to
perform surgery. It is sometimes used to treat mild to moderate sleep apnea,
although not all people benefit. This surgery is not approved by the American
Academy of Sleep Medicine to treat sleep apnea.14
Other treatment choices for
obstructive
sleep apnea (OSA) include:
Continuous positive airway pressure (CPAP). You use a breathing device that prevents your airway from
closing during sleep. It is the preferred treatment for sleep apnea.
Some
CPAP devices automatically adjust air pressure or use different
air pressures when you breathe in or out. They are easier and more comfortable
for some people to use.
Oral breathing devices. These reposition your tongue
and jaw during sleep, which opens up your airways. They may not work as well as
CPAP.
What to think about
Research shows that continuous
positive airway pressure (CPAP) decreases daytime sleepiness, especially in
people who have moderate to severe sleep apnea.8, 5 But CPAP may not work as well
for people who have mild sleep apnea.5
If you use CPAP to treat sleep apnea, you need to use it every night. If you do
not use it, your symptoms will return right away.
It may take time
for you to be at ease when you use CPAP. You may find that you want to take off
the mask, or you may find it difficult to sleep while using it. If you cannot
get used to it, talk to your doctor. You might be able to try another type of
mask or make other adjustments.
Nasal strips to decrease snoring
are available in most pharmacies. Nasal strips widen the nostrils and improve
airflow. Although these strips may decrease snoring, they cannot treat sleep
apnea.
If you are overweight and have sleep apnea, think about
getting nutritional counseling to help you lose weight.
National Institute of Neurological Disorders and
Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424 (301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
National Heart, Lung, and Blood Institute
(NHLBI)
P.O. Box 30105
Bethesda, MD 20824-0105
Phone:
(301) 592-8573
Fax:
(240) 629-3246
TDD:
(240) 629-3255
E-mail:
nhlbiinfo@nhlbi.nih.gov
Web Address:
www.nhlbi.nih.gov
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
Malhotra A, White DP (2002). Obstructive sleep apnea.
Lancet, 360(9328): 237–245.
Guilleminault C, Abad VC (2004). Obstructive sleep
apnea syndromes. Medical Clinics of North America,
88(3): 611–630.
Arzt M, et al. (2005). Association of sleep-disordered
breathing and the occurrence of stroke. American Journal of Respiratory and Clinical Care Medicine, 172(11): 1447–1451.
American Academy of Pediatrics (2002). Clinical
practice guideline: Diagnosis and management of childhood obstructive sleep
apnea. Pediatrics, 109(4): 704–712.
Hensley M, Ray C (2006). Sleep apnea. Clinical Evidence (15): 1–18.
Silverberg DS, et al. (2002). Treating obstructive
sleep apnea improves essential hypertension and quality of life.
American Family Physician, 65(2): 229–236.
Buchwald H, et al. (2004). Bariatric surgery: A
systematic review and meta-analysis. JAMA, 292(14):
1724–1737.
Giles TL, et al. (2006). Continuous positive
airways pressure for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews
(3).
Norman D, et al. (2006). Effects of continuous
positive airway pressure versus supplemental oxygen on 24-hour ambulatory blood
pressure. Hypertension, 47(5): 840–845.
Milleron O, et al. (2004). Benefits of obstructive
sleep apnoea treatment in coronary artery disease: A long-term follow-up study.
European Heart Journal, 25(9): 728–734.
Schwartz JRL, et al. (2003). Modafinil as adjunct
therapy for daytime sleepiness in obstructive sleep apnea: A 12-week,
open-label study. Chest, 124(6): 2192–2199.
Hirshkowitz M, et al. (2007). Adjunct armodafinil
improves wakefulness and memory in obstructive sleep apnea/hypopnea syndrome.
Respiratory Medicine, 101(3): 616–627.
Sundaram S, et al. (2005).
Surgery for obstructive sleep apnoea in adults.
Cochrane Database of Systematic Reviews (4).
Littner M, et al. (2001). Practice parameters for the
use of laser-assisted uvulopalatoplasty: An update for 2000. Sleep, 24(5): 603–619.
Other Works Consulted
Caples SM, et al. (2005). Obstructive sleep
apnea. Annals of Internal Medicine, 142(3):
187–197.
Collop NA, et al. (2007). Clinical
guidelines for the use of unattended portable monitors in the diagnosis of
obstructive sleep apnea in adult patients. Journal of Clinical Sleep Medicine, 3(7): 737–747.
Kushida CA, et al. (2006). Practice parameters for the
indications for polysomnography and related procedures: An update for 2005.
Sleep, 28(4): 499–521.
Kushida CA, et al. (2006). Practice parameters for the
treatment of snoring and obstructive sleep apnea with oral appliances: An
update for 2005. Sleep, 29(2): 240–243.
Kushida CA, et al. (2006). Practice parameters for the
use of continuous and bilevel positive airway pressure devices to treat adult
patients with sleep-related breathing disorders. Sleep,
29(3): 375–380.
Morgenthaler TI, et al. (2006). Practice parameters
for the medical therapy of obstructive sleep apnea. Sleep, 29(8): 1031–1035.
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