Breathing disorders
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Breathing Disorders: An Overview
Prevalence of Sleep-Disordered Breathing
General Population
Sleep-disordered breathing (SDB) is a prevalent condition with significant health implications. The HypnoLaus study, conducted in Lausanne, Switzerland, found that 23.4% of women and 49.7% of men had moderate-to-severe SDB, defined as an apnea-hypopnea index (AHI) of 15 or more events per hour. This high prevalence is attributed to improved recording techniques and new criteria for defining respiratory events.
United States Trends
In the United States, the Wisconsin Sleep Cohort Study reported a substantial increase in SDB prevalence over two decades. For men aged 30-49, the prevalence was 10%, and for those aged 50-70, it was 17%. Among women, the prevalence was 3% for ages 30-49 and 9% for ages 50-70. These increases are likely linked to the rising obesity rates, a major risk factor for SDB.
Middle-Aged Adults
Among middle-aged adults, the Wisconsin Sleep Cohort Study also found that 24% of men and 9% of women had an AHI of 5 or higher, indicating undiagnosed SDB. The study highlighted that male sex and obesity were strongly associated with the condition.
Elderly Population
In a survey of elderly individuals in San Diego, California, 24% had an apnea index (AI) of 5 or more, and 62% had a respiratory disturbance index (RDI) of 10 or more. Factors such as high body mass index (BMI), snoring, and daytime sleepiness were significant predictors of SDB in this age group.
Types of Breathing Disorders
Central Sleep Apnea (CSA)
Central sleep apnea (CSA) involves the cessation of respiratory effort during sleep and is often associated with cardiovascular and neurological disorders. CSA can also occur under positive airway pressure treatment, opioid use, or at high altitudes. The European Respiratory Society has highlighted the need for better diagnostic and therapeutic standards for CSA, especially in heart failure patients.
Dysfunctional Breathing
Dysfunctional breathing encompasses various patterns that result in dyspnea and other symptoms without significant physiological respiratory or cardiac disease. Common patterns include hyperventilation syndrome, periodic deep sighing, thoracic dominant breathing, forced abdominal expiration, and thoraco-abdominal asynchrony. These patterns require specific diagnostic and therapeutic approaches.
Sleep-Related Breathing Disorders in Children
Obstructive sleep-disordered breathing (SDB) in children aged 1-23 months is often linked to upper airway obstruction. Conditions such as pulmonary hypertension, growth delay, and behavioral problems may coexist. Polysomnography is the preferred diagnostic tool, and treatments include adenotonsillectomy and continuous positive airway pressure (CPAP).
Impact on Health
Pulmonary Hypertension
Sleep-related breathing disorders, including obstructive and central apneas, can increase pulmonary arterial pressure (PAP) both during sleep and wakefulness. Conditions like obesity hypoventilation syndrome (OHS) and overlap syndrome (COPD with OSA) can lead to severe pulmonary hypertension, necessitating treatment to improve pulmonary hemodynamics.
Neuromuscular Diseases
In neuromuscular diseases, SDB results from reduced lung volumes during sleep and compromised respiratory muscle function. These patients are prone to both obstructive and central sleep-disordered breathing, which can be exacerbated by noninvasive ventilation. Polysomnography is crucial for diagnosing and optimizing treatment in these cases.
Conclusion
Breathing disorders, particularly sleep-disordered breathing, are highly prevalent and have significant health implications across various populations. Improved diagnostic techniques and targeted treatments are essential for managing these conditions effectively. Understanding the different types of breathing disorders and their impact on health can guide better clinical practices and improve patient outcomes.
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