Talk:Sleep apnea/Archive 2

Amazing
Amazing. People delete screening information on the sleep apnea page and do not replace it. Hello? Not to worry, will do and post it shortly.

I think I may have merged them.```` Posted unsigned: 17:51, August 12, 2006 User:DrSculerati
 * Merged what? --Jclerman 01:43, 13 August 2006 (UTC)

It has been suggested that Obstructive sleep apnea following pharyngeal flap surgery be merged into this article or section. (Discuss) I did a lot of writing and editingand put in the issue of pharyngeal flap surgery into the main article. DrSculerati

Connections between sleep apnea and stroke
Relatively recently, there was a big media focus here in Sweden on the connection between sleep apnea (in the media first portrayed by/present as snoring) and such things as stroke and heart attacks/heart failure. A few quick googlings seem to support this claim, but I do not feel comfortable in my knowledge, or rather lack there of, to try to write this into the article, especially since I don't have any academic/scientific references.--kissekatt 03:07, 24 September 2005 (UTC)

I'll see what I can do. This is important info that might be relevant to may who look at this page. Thanks for the tip. MrSandman 13:30, 24 September 2005 (UTC)

Yale University study:

Obstructive sleep apnea as a risk factor for stroke and death.

"Conclusion: The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension."

hschultz 19 September 2006

Has anybody heard of pillar procedure ? Or has anybody undergone this procedure ? Please post the pluses and minuses of this procedure. Thanks.

The pillar procedure is where they take 3 inserts and insert them into the posterior soft palate, resulting in a stiffening effect, with the goal of lessening the vibration/possible collapse that occurs. The problem with the pillar procedure, as with all surgical interventions for OSA, is the results are variable and unpredictable. I would venture to say that the pillar procedure is only a viable option in either primary snoring, or very mild OSA (overall AHI < 5-10). Surgical intervention for treatment of OSA is limited to a few situations. These include: a) mild OSA (overal AHI < 5-10) and even then, the results are variable, but you can usually predict about a 50% reduction in events. So someone that had an overall AHI                                 of 5-10 would go to 2.5-5.    b) enlarged tonsils. If a person has large tonsils (3-4+) and significant OSA, then T&A is usually the first treatment choice. You still need to repeat the PSG after the surgery (after adequate time for healing has been had) to ensure resolution of the OSA. c) If a patient is intolerant of CPAP (i.e. they need 20+ cm pressure), then surgery (e.g. UPPP) may help clear some space. This will not cure the OSA, but rather clear            enough space so that they may be able to adequately control their OSA on a lower pressure requirement (i.e. 12cm vs 20+cm.)  thus making CPAP more tolerable P a            for the patient who can't handle the higher pressures.

Often times people go to surgery with the thought it will get rid of their OSA. In the select, rare, patient population this happens. But more often than not, the patient has the surgery (which has inherant risks, complications, and pain) and still ends up on the one thing they were trying to avoid in the first place: CPAP.--Sleep3r 14:58, 19 July 2006 (UTC)

Intro
The intro paragraph seems pretty bad to me, but I'm not an expert. It says "these episodes commonly last 10 seconds or more". Aren't the episodes defined to last ten seconds or more (i.e. an apnea is a cessation in breathing for more than 10 seconds)? Also, "in the morning people will not be aware of the disturbances in their sleep". Shouldn't this be "may not be aware", given that patients with sleep apnea frequently have problems with insomnia, and that they are often asked if they awaken short of breath? Finally, "Most people with sleep apnea will have a combination of both types" (OSA and CSA). Since CSA is rare, shouldn't it be some people? I've tried to fix this up. –Joke 02:41, 24 January 2006 (UTC)


 * From a previous comment, above: 
 * See prevalence of different apneas in: http://ajrccm.atsjournals.org/cgi/content-nw/full/157/1/144/T1Jclerman 06:12, 28 September 2005 (UTC)


 * For men aged 65 to 100 the prevalence is very common, nearly the same as for obstructive apnea.Jclerman 06:12, 28 September 2005 (UTC)


 * For more reliable information search PubMed (MEDLINE, Entrez). Jclerman 06:12, 28 September 2005 (UTC)

Ok, fair enough. But most people aren't 65-100. Overall in that study, OSA is eight times as prevalent as CSA. –Joke 04:25, 24 January 2006 (UTC)

Side effects ...
..(of oral appliances) "are common, but rarely is the patient aware of them." This sounds off. Any takers? Sfahey 04:20, 27 March 2006 (UTC)

Co-Morbidities with Sleep Apnea
Personal story: I was diagnosed with OSA in 1995, and have been using a CPAP or BiPAP ever since. The CPAP/BiPAP is only a treatment, not a cure. It's no substitute to an unobstructed night's sleep.

Although I was diagnosed with sleep apnea at age 28, I believe I had OSA in my early childhood. Its effects were minimized in high school - the only time in my life where I was near an ideal weight. Even at 19, and only 10-20 pounds overweight, I believe I had OSA even then, looking back at the symptoms I had back then (including very high blood pressure).

Over the years, I have also been diagnosed with narcolepsy-type problems, restless legs syndrome (gone since CPAP), high blood pressure (treatable with the CPAP if I sleep well enough), asthma, hypogonadism, enlarged prostate, fibromyalgia and, now, it's also suspected that I also have ADHD (inattentive type), which has yet to be tested and confirmed. It has also aggravated my weight. Since I have low energy, my body tends to eat to make up for lost energy. When I have sugar and caffeine, my ADHD symptoms are reduced, finally giving me a chance to focus, but this also causes weight gain. I had lost 130 pounds at one point, but the OSA never went away, and it never reduced. I honestly believe that, if I can conquer OSA once and for all, all of my other health problems will slowly go away.

This leads me to my point. The article, although good, doesn't list or link to other co-morbid conditions. I'd like to see a Co-Morbitities section added to the article. --Bmeloche 05:21, 28 March 2006 (UTC)

Would like to see discussion on use of supplemental oxygen, difficulties adjusting to sleep machines, further discussion of Central and Mixed Sleep Apnea, sleep architecture, and sleep stages. Thanks for doing this. Already this is one of the better sources of info on Sleep Apnea easily available on the net.

Inappropriate link to bruxism-related commercial product
As noted previously on this talk page, there's a periodically reappearing link to a Wikipedia page for BiteStrip, a commercial product for diagnosing bruxism. Bruxism is another sleep disorder and not apnea. Linking to Bitestrip seems doubly inappropriate -- it's not just unrelated but it's unrelated and commercial. I deleted the link then thought better of it, reverting my deletion and posting this comment. I did not want to be rude. Perhaps someone can explain why this link should be included -- otherwise I recommend deleting it.--A. B. 19:21, 24 May 2006 (UTC)
 * Thanks for pointing this out.. I never noticed it. I went ahead and deleted it.. this way you don't feel bad.

The link to the product, as well as the link to bruxism was not relevant to this article. MrSandman 20:50, 24 May 2006 (UTC)

Try using PubMed and search on Bruxism and sleep apnea. See:

Sleep Med. 2002 Nov;3(6):513-5.

"Two polysomnographic (PSG) recordings were carried out. The first showed 67 events of sounded tooth grinding, most of them appearing as an arousal response at the end of apnea/hypopnea events in both the supine and lateral postures. During the CPAP titration night most breathing abnormalities were eliminated and a complete eradication of the tooth grinding events was observed. The results of this study suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep."

and

Singapore Med J. 2002 Nov;43(11):554-6. Related Articles, Links

Habitual snoring and sleep bruxism in a paediatric outpatient population in Hong Kong.

Ng DK, Kwok KL, Poon G, Chau KW.

Department of Paediatrics, Kwong Wah Hospital, Waterloo Road, Hong Kong, SAR China. dkkng@ha.org.hk

OBJECTIVE: To determine the prevalence of habitual snoring and sleep bruxism in children attending the out-patient clinics of a paediatric department. METHODOLOGY: A cross-sectional survey of parents was conducted with questionnaire administered by paediatric nurses. Parents were recruited when they brought their children to the out-patient clinics. Sex and age were recorded. Presence and absence of habitual snoring and sleep bruxism were noted. Types of diseases that brought the children to the out-patient clinics were also noted. RESULTS: Twenty-nine of the 200 recruited children were noted to have habitual snoring (14.5%, 95% C.I. 10%-20%). The mean age of these habitual snorers was 6.2 +/- 3.1 years. For habitual snorers, male to female ratio was 1.4 to 1. Sixteen of these 28 children accepted a sleep polysomnographic examination. Eleven children were found to have snoring during the night of study. Two were found to have obstructive sleep apnoea syndrome. Sleep bruxism was found in 17 children (8.5%, 95% C.I.5%-13%). Sleep bruxism was closely related to habitual snoring as 16 out of the 17 children with sleep bruxism were also habitual snorers (p < 0.0001). CONCLUSION: Habitual snoring and sleep bruxism were commonly found in children attending paediatric clinics. Paediatricians should be aware of these problems and be prepared to deal with them. Habitual snoring and sleep bruxism were closely related. Further studies into this relationship is needed.

hschultz 19 September 2006

Deaths
Why was the reference to Jerry Garcia removed? It was noted on his page that he died of a heart attack as a result of sleep apnea. Wouldn't it be useful to note other famous people that have died as a result of a complication caused by sleep apnea? --Ddspell 03:38, 7 June 2006 (UTC)

Thousands of people die of heart attacks and other illnesses related to sleep apnea each year. I don't see how listing famous people is helpful, and frankly, this page is too long already. A list with one persons name is not a list.. and does not warrant a new category. If you want to provide statistics referring to mortality secondary or primary to OSA.. then that would be great. MrSandman 13:47, 7 June 2006 (UTC)

Merge w/ post-op obstructive apnea?
Support. This is a no-brainer. Sfahey 19:30, 4 August 2006 (UTC)

Tagged "central apnea" section for cleanup
I hope that didn't seem rude to tag this section. This article contains lots of excellent information, but this section in particular seems to need the wording tweaked. I've seen bad articles tagged with Cleanup, and this section (and article) are certainly not that, but I think could be much better with wordsmithing. Quintote 01:38, 3 September 2006 (UTC)

== Complex Sleep Apnea section modifications

I have modified this section for two reasons. The text was far to explicit for a relatively poorly documented manifestation of sleep disordered breathing; especially one lacking any long-term studies on consequences. The second deletion was to the extensive "adaptive servo ventilation references". This is a new therapy which has not been tested in these patients in a longitudinal trial; accordingly, the therapy has not been demonstrated as substantially different to existing therapies in terms of meaningful outcomes. It also seemed to be somewhat commercial. Sleepydadpro 08:14, 17 October 2006 (UTC)

Shocked that this article lacks a section on driving
I recently went to my doctor for hypersomnia and was told I might have sleep apnea. I wanted to schedule a test but first had to sign a paper claiming that I had read the risks of driving w/ sleep apnea. It is basically a print out of this: http://www.nhtsa.dot.gov/people/injury/olddrive/Sleep%20Apnea/index.htm

I asked my doctor if they can revoke my license for having sleep apnea and he said most likely not, but that I can get sued for being in a crash. It's unlikely I will get sued if I am being treated, but I decided to just not get tested and will resort to self-medicating my fatigue with amphetamine. ANYWAY! My point is that this is a big issue with sleep apnea and some states are thinking about revoking licenses from people who have sleep disorders.

I would appreciate if somebody can look more into this and put up section in the main article. I have added a stub to get the ball rolling. —Preceding unsigned comment added by 71.249.64.128 (talk) 21:08, 3 December 2007 (UTC)

Order of central and obstructive sections
To me having the section for the less common form of apnea appearing first seems counterintuitive. If this was recommended as an article by a sleep lab for patients to read it would be preferable for the most common cause to occur first, with less common following. Please correct me however if the current order was used for a particular purpose.-- —The preceding unsigned comment was added by 202.124.78.211 (talk) 13:11, 25 December 2006 (UTC).


 * This reader also agrees with this recommendation. OSA is always listed first in general information articles about sleep apnea.


 * Unfortunately, it appears that when this was rearranged, the "treatment" section got misplaced. I moved it back to its proper place, since all the treatment information is about OSA, not CSA. &mdash; Lawrence King ( talk ) 05:00, 3 March 2007 (UTC)

"Public Examples"
Do we really know that every single one of these people has sleep apnea?

From the standpoint of being an encyclopedia, it's important that we meet these key policies here: More important than that, however, is that we're pronouncing stuff to the world about people's personal medical health. Anything we write here has to meet Biographies of living persons.
 * No original research
 * Verifiability

I suggest either deleting the whole section or else deleting any name that's not footnote with a reliable source. --A. B. (talk) 12:50, 12 January 2007 (UTC)

I second the call to remove the section simply because it adds nothing to the article 207.157.65.2 20:18, 16 March 2007 (UTC)


 * Word up. Removed.  130.126.196.123 04:23, 3 April 2007 (UTC)

Polysomnograph
It appears that managing OSAS without polysomnography is actually pretty well possible. JFW | T@lk  07:10, 6 February 2007 (UTC)

Build to a higher than "jewish" level (hypercapnia).
I am a layman reading this article, but was quite disturbed when I read the following: "the concentration of carbon dioxide will build to a higher than jewish level (hypercapnia)", someone with the expertise please clear up such nonsense.

80.165.240.102 09:34, 16 February 2007 (UTC)

Martin Hansen, Denmark


 * A vandal inserted "jewish" on 14 February; I spotted and reverted this about 45 minutes later. Are you still seeing that somehow 2 days later? If so there's some sort of software bug that needs reporting.


 * In any event, thanks for the report. --A. B. (talk) 16:48, 16 February 2007 (UTC)

Central Sleep Apnea
There is no "Treatment" section. Can this please be added? —Preceding unsigned comment added by Sjschultz (talk • contribs) 06:55, 20 February 2007


 * I added a very tiny bit, but hopefully someone can add more. &mdash; Lawrence King ( talk ) 05:07, 3 March 2007 (UTC)

"New Method: Throat, Jaw and Tongue Exercises"
This section appears to be advertising. Any qualms with a major rewrite? --Wootonius 23:17, 17 April 2007 (UTC)


 * This was totally spam inserted here and into Snoring article. I have removed it and warned the user. --killing sparrows 23:59, 17 April 2007 (UTC)

Page separation
This page has grown into a huge size. I think it should be separated. Perhaps OSA and CSA can have their own page.--Countincr ( T@lk ) 20:31, 11 June 2007 (UTC)


 * I think that three pages are currently wanted:


 * sleep apnea to introduce the general concept and explain that there are three major types: obstructive, central, and complex
 * obstructive sleep apnea, and
 * central sleep apnea.

Does anyone object to this approach? WhatamIdoing (talk) 02:49, 14 January 2008 (UTC)


 * Since there were no objections, I've started this process. The new OSA page should be ready for you within the hour.  WhatamIdoing (talk) 18:39, 23 January 2008 (UTC)

Pickwickian syndrome
In modern usage in the US, pickwickian syndrome is not the same as OSA. Pickwickian syndrome connotes usually very severe OSA associated with morbid obesity, along with restrictive lung disease due to the weight of the patient's chest wall upon the lungs. The result is severe hypoxemia and hypercapnea which often leads to cor pulmonale. Treating the OSA with CPAP often improves the condition greatly, as it gives the patient's diaphragm some rest which allows them to make a better breathing effort during the daytime. Tracheostomy is still used in extreme cases. If the patient can lose wieght that would obviously be the best. This is different than OSA as most cases of OSA that are seen do not involve daytime hypoxemia and hypercapnea, as the patients are not usually so obese as to have their chest walls literally squashing the life out of them. I'm not sure if this distinction holds true in the medical terminology outside of the US, but if so, the section on history should be changed to note that OSA is a component of pickwickian syndrome, but they are not equivalent. 139.127.225.36 12:17, 16 July 2007 (UTC)
 * I wish medicine would follow the taxonomy standards of the sciences. Plant and animal species are characterized by descriptions PLUS voucher specimens which are preserved, e.g. in herbaria for plants. Then, that specimen and its description defines that species. If variations are found, e.g., in other continents, they are defined on basis of a new voucher specimen and labeled subspecies, variations, cultivars, or new species as per the taxonomy rules. I wish clinical medicine would follow the same rules. Then we wouldn't be discussing what really is this or that syndrome. Jclerman 13:56, 16 July 2007 (UTC)

Sleep apnea and obesity?
It's common lore that there is a high correlation between obesity and sleep apnea. i didn't notice anything about this in the article (though i did skim quickly).

If it's in there somewhere it might be good to make easier to find. if it's not there it would be worth adding.

Questions to address:

-- Is there a documented correlation between obesity and sleep apnea?

-- Is there a documented causal relationship?

-- If so, does losing weight tend to [reduce or eliminate] the sleep apnea? —Preceding unsigned comment added by 68.80.214.27 (talk) 14:01, 13 November 2007 (UTC)

My understanding is that there is a statistical correlation, but that it's not a causative link. I'll see if I can find some good data and insert it somewhere appropriate --Minerva9 (talk) 23:50, 31 January 2008 (UTC)

this is NOT a symptom
"The most serious consequence of obstructive sleep apnea is to the heart. In severe and prolonged cases, there are increases in pulmonary pressures that are transmitted to the right side of the heart. This can result in a severe form of congestive heart failure (cor pulmonale)." is in the symptom section. it is a RESULT. Please fix it. -Winter123 (talk) 09:04, 16 December 2007 (UTC)
 * Is there any reason you couldn't fix it yourself?--NapoliRoma (talk) 18:38, 16 December 2007 (UTC)

CPAP
NIV? ==

The treatment described in the article as "CPAP" sounds very like the treatment prescribed for me, except that in my case it was called "NIV" (which is an initialism for "Non-Invasive (positive-pressure) Ventilation", "non-invasive" meaning delivered via a face mask rather than via a tracheostomy. Are these in fact two slightly different treatments, or is this (as I suspect) simply another difference between AmericanEnglish and British English?

Perhaps this information could be checked further, and if verified, added to the article? 86.145.251.4 (talk) 09:38, 23 January 2008 (UTC)

Non invasive positive pressure is the correct name for CPAP. CPAP is continuous positive airway pressure. NPPV is non invasive positive pressure ventilation also known as BIPAP. BIPAP is a trademarked name for NPPV. —Preceding unsigned comment added by 63.150.69.253 (talk) 03:21, 17 April 2010 (UTC)

CPAP section edited
I edited the paragraph about CPAP to include a reference that cites CPAP as the most common form of treatment for sleep apnea --Minerva9 (talk) 23:44, 31 January 2008 (UTC)

As a sleep apnea sufferer, I was initially presscribed to use CPAP therapy. Insurance was not a problem. The doctor did not take into account blockages in the nasal cavity (deviated septum and a mass of cartilage) that was more than 60% blocked. I later discovered that CPAP users only have a 60% success rate (continue using the machine after 3 months) as opposed to OAT users, who enjoyed a 90% success rate. This was information I gleaned here and there. Has anyone come across any studies that discuss success rates among users? maclilus (talk) 17:41, 19 December 2008 (UTC)

Section references
Should the Section references for Clinical details be merged into the References section? Temporaluser (talk) 22:11, 1 March 2008 (UTC)


 * That'd be nice, but I'm not sure what parts of that long section these references are supposed to support. WhatamIdoing (talk) 00:35, 2 March 2008 (UTC)

Merck manual online: reference
Please stop reverting this link. Read the reasons posted with the edits. If you believe that it is selling something, tell us what are the free online Merck manuals selling. And what is the Mayo clinic not selling? IMHO feel free to insert a condition in your living will: "do not diagnose and/or treat me following the Merck manuals" but let others use the information. BTW, such manuals saved my life twice from iatrogenic ADRs. And, please, when expressing personal points of view, precede them with the customary IMHO. Jclerman (talk) 04:22, 4 July 2008 (UTC)
 * I have read your reasons, and found them unrelated to the requirements for adding a new external link. The Mayo clinic link is an article discussing a new medical finding. Your deep respect for the Merck manual aside, the Merck site is not cited in the entry, contains no new information on the topic, and heavily promotes the sale of said manual on each page. I do not believe the information within it is sufficient to overrule the guidelines excluding commercial links as indicated in wp:el. I'll give your other, more personal advice all due consideration. - JeffJonez (talk) 15:48, 4 July 2008 (UTC)
 * Since we don't agree and nobdy else has joined this discussion I suggest (a) that we request an opinion by one of the Wikipedia procedures used to resolve differences, i.e. either a third party opinion or an arbitration procedure, and (b) that the outcome be made into a Wikipedia policy and be applied to all the Wikipedia articles that cite one or more of the Merck Manuals. A clustered list of about 70 articles can be easily retrieved by the search engine Clusty. Jclerman (talk) 22:48, 4 July 2008 (UTC)

Jclerman, can you identify any piece of information at the Merck link that is not in this (or other highly related) article? WhatamIdoing (talk) 21:38, 6 July 2008 (UTC)
 * The Merck Manual is an expert peer reviewed constantly updated professional reference to this and other articles written by Wikipedians. An extensive list of such articles is given in the next section. Anyhow, see both, that one and a clustered one here: . Jclerman (talk) 00:07, 7 July 2008 (UTC)
 * I don't think you understood my question. I am very familiar with the Merck Manual.  You want to link to the Merck Manual's article on sleep apnea, right?  What information is present in the MM article on sleep apnea that is not present in the Wikipedia articles on sleep apnea (= sleep apnea and obstructive sleep apnea)?  WhatamIdoing (talk) 06:14, 7 July 2008 (UTC)

To the third party or arbitrating body
For reference to the Merck Manuals in Wikipedia, and for adoption of future policies (see preceding section) about linking to Wikipedia articles, Google search for this:
 * merck manual site:wikipedia.org

Jclerman (talk) 05:16, 5 July 2008 (UTC)

A news article with some material
http://money.cnn.com/2008/08/19/smallbusiness/biz_owner_nightmare.fsb/index.htm?postversion=2008082510

This talks about how sleep apnea affects businesses WhisperToMe (talk) 20:42, 26 August 2008 (UTC)

Comment on "complex" sleep-disordered breathing
This section could warrant its own article, or some further clarification within this article. In 2005, Gilmartin et. al. at Harvard's teaching affiliate Beth Israel Deaconess Medical Center published an article in which they proposed that there may be a subset of apnea patients with defective respiratory control, especially problems with CO2 homeostasis, who are resistant to CPAP therapy. While this has long been known in heart failure, the article indicated that the problem was not exclusive to heart failure and was seen in a wide variety of disease conditions. Some of the same researchers had previously published a small clinical trial in which six non-heart failure patients had been successfully treated with low-dose carbon-dioxide and CPAP. The Harvard researchers called this condition Complex Sleep-Disordered Breathing and focused especially on an underlying etiology of disordered CO2 sensitivity leading to unstable respiratory control. After this work was published The Mayo Clinic press office announced that Mayo researchers had discovered a new form of sleep apnea, Complex Sleep Apnea, although their paper in Sleep argued that complex sleep apnea was probably not distinct from obstructive apnea. The Mayo researchers focused on the problem of induction of central apneas when trying to treat certain OSA patients with CPAP. No pressure could be found at which all obstruction could be abolished without causing central apneas. In 2006, The U.S. Centers for Medicare and Medicaid Services (CMS) anounced a reimbursement ruling regarding Complex Sleep Apnea, or "CompSA", presumably in response to the newly FDA-cleared adaptive servo-ventilation system being offered by one of the CPAP vendors. The CMS reimbursement criteria were consistent with the Mayo work, in that CPAP failure became the defining characteristic of CompSA, permitting eligibility for the higher reimbursement rates paid for ASV therapy. As the current Wikipedia article points out, other researchers have asserted that the conversion to central apnea is a short-lived phenomenon and that after about six months of CPAP therapy, patients generally respond to typical CPAP therapy. The Harvard researchers in the meantime have attempted to examine the respiratory control aspects of Complex Apnea, and have published a series of technical articles using a technique they dub Cardio-Pulmonary Coupling, or CPC, an analytical modality that uses the electrocardiogram tracing to reconstruct a synthetic respiratory channel using a technique called EDR. They perform spectral analysis to identify repetitive respiratory events, further classifying patterns of breathing by frequency of events and consistency of timing between events. They applied this technique to several thousand recordings in the Sleep Heart Health Study and found that patients with frequent, regularly spaced events like those found in periodic breathing syndromes were highly likely to fail CPAP therapy, whereas patients with less frequent and irregularly-spaced events more common in obstructive apnea seemed to do well with conventional CPAP. Work in the early 1980's by Khoo, et. al. attempted to explain periodic breathing, including Cheyne-Stokes respiration and other central apnea syndromes in terms of control theory, placing much emphasis on excessive peripheral ventilatory response to carbon dioxide. The timings that Khoo described are consistent with those found in the subset of patients failing CPAP in the Harvard CPC work, possibly lending some support to the hypothesis that these patients are suffering from defective respiratory control due to altered CO2 sensitivity. If so, Complex Sleep-Disordered Breathing may result from excessive respiratory loop gain, and may in fact be an expression of periodic breathing due to respiratory instability. Hopefully, further elucidation of this will be forthcoming. In the meantime, there are serious technical problems affecting much research in this area, having to do with the scoring criteria for respiratory events used in research studies, as well as instrumentation. A number of studies in this area continue to use desaturation-linked arousal scoring, as well as other arbitrary criteria for scoring events such as central hypopneas. This is a potential problem in that patients with very high event frequencies (>60/hr) may not experience sufficient desaturations or arousal durations to meet scoring criteria, paradoxically causing them to be defined out of their disease. In general, apnea scoring rules are not specifically optimized to identify fast-cycling respiratory dyscontrol, raising the possibility that studies showing that complex patients improve after six months of CPAP are overlooking substantial residual disease that simply does not fit current scoring schemes. In addition, the use of thermistors for flow measurement instead of the more sensitive nasal canula makes it difficult to identify especially central hypopneas, which are common in complex and mixed disease, and some work in this area has suffered from this. So far, no paper has appeared which attempts to prove or explain how chronic CPAP use would correct excessive CO2 sensitivity, and thus address defective respiratory control, although hypotheses have been put forward. This discussion is important in light of Javaheri's analysis of a large population of heart failure patients, which showed a roughly 50% reduction in life expectancy for those with mixed and central apnea syndromes. Since complex apnea appears not only in the setting of heart failure, but also in renal failure, stroke, advanced diabetes, and as idiopathic disease, it is worth asking whether similar bad outcomes exist in these diseases when complex apnea is present. Another question has to do with the possibility that CPAP is being prescribed widely to patients for whom it is a poor therapeutic choice. The Harvard CPC work indicated that as many as one in five apnea patients fit the breathing pattern that seems to be associated with CPAP failure, and even the Mayo study gave figures in the low to mid-teens. If even the lower-end estimates are correct it raises the possibility that several hundred thousand U.S. patients annually are receiving prescriptions for CPAP that may be of questionable therapeutic benefit, or even worse, may exacerbate their disease. This would be a public health problem of the first order, given the accumulated data on the increased risk of MI and stroke with untreated sleep apnea. In view of the potential risk to the public, much more should be done than the few published studies that seek to dismiss the problem based on analytic techniques not optimized for identifying respiratory dyscontrol. I realize that this post is not referenced, although I would be happy to provide the appropriate citations. zzzzzchecker —Preceding undated comment was added at 13:53, 16 October 2008 (UTC).

downgrade to start
This article needs a lot of work, such as PMID and adequate citations (see academic journal or Template:cite journal for how it is done. Pustelnik (talk) 20:47, 20 December 2008 (UTC)
 * The article has structure and some refs; that's (at least) C-class, not Start. Please use clean up templates, not article assessment, to indicate that the specific kind of grunt work that needs to be done.  Note, also, that the use of citation templates is never required.  WhatamIdoing (talk) 02:34, 21 December 2008 (UTC)

Article Severly Lacking Information On Aspects of Surgery And Sleep Deprivation Symptoms
In 2007 I added the following two edits (with lots of references cited).

* 02:09, 23 November 2007 (hist) (diff) m Sleep apnea ‎ (→Surgical intervention) * 07:42, 22 November 2007 (hist) (diff) Sleep apnea ‎ (Painful surgical treatments usually have a low success rate not reflected in the article.)

I have no idea when this was removed. The long term success rate of surgery in the treatment of Sleep Apnea is low. Most of the surgery available is hideously painful and anyone considering it should know this. For example UPPP surgery has a rate of around 50%. http://www.umm.edu/patiented/articles/what_surgical_procedures_sleep_apnea_000065_10.htm

Also there needs to be more information on the symptoms. I had very bad sleep apnea for a long time before I was diagnosed. I had no idea I had it and only worked out what was happening when I video taped myself sleeping. It usually comes as a shock that there's anything wrong. You just feel exhausted all the time, and eventually start feeling sleepy and "dopey" all the time. You also get some nasty symptoms that are the same or similar to sleep deprivation. I got to the point where I was having halucinations and sleep paralysis, falling asleep at my desk in meetings and at work. "Excessive daytime sleepiness" doesn't even begin to describe how bad it can get.

It looks like a lot more has been removed. The current article is a lot less useful than it was a year or so ago. —Preceding unsigned comment added by Syousef1975 (talk • contribs) 03:37, 23 January 2009 (UTC)

;) A Talk of the Symptoms of mild sleep apnea
I have been suffering from apnea, and I don't feel pain even though I dont breathe for at least 1 minute. Is this rare? -Sneaky Oviraptor18talk edits tribute 19:58, 11 May 2009 (UTC)
 * Edit:

4-month old vandalism
FYI. Just removed four month old vandalism. Perhaps some bot should watch for the word crap? - Hordaland (talk) 11:58, 31 October 2009 (UTC)

Hi I am not sure if this is the right place to post this, but... I just read the article and I think there is some more vandalism on it. I am not one of the writers, so I don't think I am qualified to make this change myself. But there seems to be a joke on the article. Under Epidemiology heading, it says: "Also tickling of the abdomen, buttock and sole of the foot have been found to be affective alternative treatments for sleep apnea." Obviously a joke. — Preceding unsigned comment added by AmyRosenberg1 (talk • contribs) 14:46, 19 October 2011 (UTC)

Citation Verification
(Part of the WikiProject Medicine effort)

I hope that these sources will be of assistance in the efforts to improve this wiki.

Introduction Section
ICD9|327.2
 * broken link: the link doesn’t work, although the second link (780.57) does

“Sleep apnea (or sleep apnoea in British English) is a sleep disorder characterized by pauses in breathing during sleep. Each episode, called an apnea (Greek: ἄπνοια (ápnoia), from α- (a-), privative, πνέειν (pnéein), to breathe), lasts long enough so that one or more breaths are missed, and such episodes occur repeatedly throughout sleep.”
 * Specify: The citation listed here appears to be a personal website, almost like a medical blog.  I suggest a more reliable source, such as the World Health Organization’s article on respiratory disorders, page 32:  http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf

“The standard definition of any apneic event includes a minimum 10-second interval between breaths, with either a neurological arousal (a 3-second or greater shift in EEG frequency, measured at C3, C4, O1, or O2) or a blood oxygen desaturation of 3–4% or greater, or both arousal and desaturation.”
 * Citation needed. I could find no source that verified these exact numbers.
 * I believe this comes from the AASM guidelines; I'll try to confirm if I can find a copy around.--MarmotteiNoZ 08:37, 11 December 2010 (UTC)

“Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or a "sleep study".”
 * Citation needed: I suggest Obstructive Sleep Apnea:  Diagnosis and Treatment, page 43, http://books.google.com/books?id=xnxB5OJKVVYC&pg=PA59&dq=diagnose+sleep+apnea&cd=4#v=onepage&q&f=false

“Clinically significant levels of sleep apnea are defined as five or more episodes per hour of any type of apnea”
 * Citation needed: I suggest Primary Care Medicine: Office Evaluation and Management of the Adult Patient, page 372:  http://books.google.com/books?id=bIZvJPcSEXMC&pg=PA372&dq=five+or+more+episodes+per+hour+sleep+apnea&cd=1#v=onepage&q=five%20or%20more%20episodes%20per%20hour%20sleep%20apnea&f=false

“(from the polysomnogram)”
 * I suggest rewording to “(as measured by a polysomnogram)” or removing this parenthetical statement

“Breathing is interrupted by the lack of respiratory effort in central sleep apnea; in obstructive sleep apnea, breathing is interrupted by a physical block to airflow despite respiratory effort. In complex (or "mixed") sleep apnea, there is a transition from central to obstructive features during the events themselves.”
 * Citation needed: I suggest Otolaryngology--head & neck surgery, Volume 1, page 1547, http://books.google.com/books?id=yMRsAAAAMAAJ&q=lack+of+respiratory+effort&dq=lack+of+respiratory+effort&cd=2

“Regardless of type, the individual”
 * Suggest “an individual” rather than “the individual”

“the individual with sleep apnea is rarely aware of having difficulty breathing, even upon awakening”
 * Citation needed: I suggest the World Health Organization’s article on respiratory disorders, page 32:  http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf

What is this "apnoea in BRITSH English"? What you call 'British English' is English. Otherwise it is Jamaican English, Australian English, American English or some other off-shoot. —Preceding unsigned comment added by 182.53.148.86 (talk) 12:14, 10 January 2011 (UTC)

Obstructive sleep apnea section
Note: this section was checked for accuracy, but the main article on obstructive sleep apnea was not. Many of these suggestions may apply to the main article as well.

“Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing”
 * Suggest previously cited article: http://www.journalsleep.org/ViewAbstract.aspx?pid=26630

“The muscle tone of the body ordinarily relaxes during sleep”
 * Suggest “The residual muscle tension of the body (muscle tone) ordinarily relaxes during sleep” to avoid confusion with the more colloquial use of the term “muscle tone”

“may not be important”
 * Suggest “may not have long-term deleterious effects”,  because “important” is vague

“but chronic severe obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), sleep deprivation, and other complications. The most serious complication is a severe form of congestive heart failure called cor pulmonale.”
 * Citation needed: suggest Snoring and obstructive sleep apnea, page 10-12, http://books.google.com/books?id=jUEFn5RfqqoC&pg=PA208&dq=cor+pulmonale+apnea&cd=6#v=onepage&q&f=false

“Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more likely to have OSA than young people. Men are more likely to suffer sleep apnea than women and children are, though it is not uncommon in the latter two population groups.”
 * Citation needed: suggest the WHO article, page 32, http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf, although it doesn’t discuss the obesity risk factor.  This reference also applies to the two paragraph following this paragraph.

“Many people benefit from sleeping at a 30-degree elevation of the upper body”. This citation for this statement is a primary source. I suggest this review article instead: https://ckm.osu.edu/sitetool/sites/intmedpulmpublic/documents/Standards%20of%20practice%20review.pdf.

The 3 citations following “…are also recommended as a treatment for sleep apnea,” are also all primary sources. Again, recommend the above review article instead, which has good summarizes of all the possible treatments for OSA, including discussions of CPAP and surgery.

The paragraph on snoring is only supported by one primary source. This textbook may be a better general source for the entire discussion of snoring and sleep apnea: Snoring and obstructive sleep apnea;  http://books.google.com/books?id=jUEFn5RfqqoC&printsec=frontcover#v=onepage&q&f=false

The following two sources: are primary sources that could be removed because the immediately follow references are both review article that nicely summarize the effects of sleep-disordered breathing:
 * Yan-fang S, Yu-ping W (August 2009). "Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients"
 * Bixler EO, Vgontzas AN, Lin HM, et al. (November 2008). "Blood pressure associated with sleep-disordered breathing in a population sample of children"
 * Leung RS (2009). "Sleep-disordered breathing: autonomic mechanisms and arrhythmias"
 * Silverberg DS, Iaina A, Oksenberg A (January 2002). "Treating obstructive sleep apnea improves essential hypertension and life"

Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V (November 2005). "Obstructive sleep apnea as a risk factor for stroke and death".
 * Primary source claim: This article is a primary source.  I suggest the following, freely-available review article:  “The effect of obstructive sleep apnea on chronic medical disorders”; http://www.ncbi.nlm.nih.gov/pubmed/17373350.

“Sleep apnea sufferers also have a 30% higher risk of heart attack or premature death than those unaffected”.
 * Dead link: The original link for this statement doesn’t work, but it is supported by the review article listed in my preceding paragraph:  http://www.ncbi.nlm.nih.gov/pubmed/17373350

Kumar R, Birrer BV, Macey PM, et al. (June 2008). "Reduced mammillary body volume in patients with obstructive sleep apnea".
 * Primary source claim: Both this citation and the one immediately following it, which is the lay summary of the same article, are primary source references.  However, I wasn’t able to find any reviews that cite this finding.

Central sleep apnea section
This entire section is unreferenced. I suggest the following general sources:
 * http://www.ncbi.nlm.nih.gov/pubmed/18758947 - a free review article. Not the most comprehensive review on PubMed, but it’s very good and it’s free
 * http://www.ncbi.nlm.nih.gov/pubmed/19110133 - another excellent review article, but not free
 * http://books.google.com/books?id=aSvyYIsL5EoC&printsec=frontcover#v=onepage&q&f=false – this book has a good section on central sleep apnea that is partially available to free preview, page 388

“Even in severe cases of central sleep apnea, the effects almost always result in pauses that make breathing irregular, rather than cause the total cessation of breathing.”
 * Citation needed: This whole section is in need of citations, but this particular paragraph, which discusses the effects of hypoxia, may want to reference this review article:  http://www.ncbi.nlm.nih.gov/pubmed/19506312, which summarizes many of the effects on hypoxia on rodent models.

“In people with epilepsy, the hypoxia caused by apnea may trigger seizures that had previously been well controlled by medications”.
 * Verification needed: the following case study (primary source) suggests that the causative link between seizures/epilepsy and apnea is not a particularly strong one:  http://www.ncbi.nlm.nih.gov/pubmed/17420849

Mixed apnea and complex sleep apnea section
“The presence of central sleep apnea without an obstructive component is a common result of chronic opiate use (or abuse) owing to the characteristic respiratory depression caused by large doses of narcotics” *Incorrect positioning in the article – this sentence would fit better in the “central sleep apnea” section. This statement also requires a citation. One source that suggest a link between depressive drug use and sleep apnea is the Merck Manual of Health and Aging, page 438, though it is far from conclusive and actually suggests that drug use contributes to obstructive sleep apnea more than it does to central sleep apnea: http://books.google.com/books?id=dqU68DdZ8poC&printsec=frontcover#v=onepage&q&f=false

“Complex sleep apnea has recently been described by researchers as a novel presentation of sleep apnea.”
 * Dubious: these two recent reviews suggest that the definition of complex sleep apnea and its description as a “novel presentation of sleep apnea” is controversial:  http://www.ncbi.nlm.nih.gov/pubmed/18853694; http://www.ncbi.nlm.nih.gov/pubmed/18853695

“As of July 2007, there has been no alternate convincing evidence produced that these central sleep apnea events associated with CPAP therapy for obstructive sleep apnea are of any significant pathophysiologic importance.”
 * Dated info: see the above two reviews for a more recent discussion of complex sleep apnea, its causes, and its status as a real disease.  The subsequent paragraph, “Research is ongoing, however, at the Harvard Medical School, including adding dead space to positive airway pressure for treatment of complex sleep-disordered breathing” is also dated, and references only a single, limited case study.

Treatment section
“The CPAP machine assists only inhaling, whereas a BiPAP machine assists with both inhaling and exhaling and is used in more severe cases.”
 * Citation needed: I suggest this review, http://www.ncbi.nlm.nih.gov/pubmed/16570030

‘Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF (December 2007). "Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option?”
 * Primary source claim: This is a primary source article.  I suggest either this excellent review - http://www.ncbi.nlm.nih.gov/pubmed/17136406, or the Chan et al. reference immediately following this one, which is listed below and now has a PMID nmber.

“Chan A, Lee R, Cistulli PA. Oral Appliances for Obstructive Sleep Apnea [Review]. Chest (In Press). 2007 Aug; 132(2):693-9”
 * Dead link: this paper now has a PMID that can be included:  http://www.ncbi.nlm.nih.gov/sites/entrez.

“CPAP and OAT are generally effective only for obstructive and mixed sleep apnea which have a mechanical rather than a neurological cause.”
 * Citation needed: this statement is supported by the reference listed above, http://www.ncbi.nlm.nih.gov/sites/entrez

“In mild cases of obstructive sleep apnea, use of a specially shaped pillow or shirt may reduce sleep apnea episodes, usually by causing users to sleep on the side instead of on the back or in a reclining position instead of flat.”
 * Citation needed: I suggest the following excellent review for a discussion of many different positional treatment options:  https://ckm.osu.edu/sitetool/sites/intmedpulmpublic/documents/Standards%20of%20practice%20review.pdf

“For patients who do not tolerate or fail nonsurgical measures, surgical treatment to anatomically alter the airway is available”
 * I think the paragraphs following this sentence could all be moved to the “Surgery” subsection. Additionally, there is a lot of detail here that might be better summarized the way it is on the US Department of Health and Human Services website:  http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html

“For patients who fail these operations, the facial skeletal may be advanced by means of a technique called maxillomandibular advancement, or two-jaw surgery (upper and lower jaws)”
 * Citation needed: for a discussion of the multiple surgery options for sleep apnea, try this book, page 167:  http://books.google.com/books?id=e9rL_f3tNbUC&printsec=frontcover#v=onepage&q&f=false.  For a discussion of maxillomandibular advancement, try this link:  http://www.sleepapneasurgery.com/maxillomandibular_advancement.html

“Technically, this is accomplished by a surgery similar to orthognathic surgeries addressing an abnormal bite. The surgery involves a Lefort type one osteotomy and bilateral sagittal split mandibular osteotomies.”
 * I think these two sentences might be more detailed than a general audience requires or wants.

“Possibly owing to changes in pulmonary oxygen stores, sleeping on one's side (as opposed to on one's back) has been found to be helpful for central sleep apnea with Cheyne-Stokes respiration (CSA-CSR).” Primary source claim: Just like in the introduction, this source is primary, and this review might be better - https://ckm.osu.edu/sitetool/sites/intmedpulmpublic/documents/Standards%20of%20practice%20review.pdf.

‘"Sleep Apnea". Diagnosis Dictionary. Psychology Today. http://www.psychologytoday.com/conditions/sleep-apnea.”
 * Failed verification – this source doesn’t talk about Acetazolamide

“Low doses of oxygen are also used as a treatment for hypoxia but are discouraged due to side effects”
 * Failed verification – the Psychology today source doesn’t mention hypoxia and the other two references are in Spanish and German.
 * Dubious - Additionally, hypoxia is the absence of oxygen, so treating with low doses of oxygen is probably not used as a treatment for it.

Surgery section
The long term efficacy of surgery (except Tracheostomy) is known to be awful and the available surgerys are known to be some of the most painful peformed. Worse surgery can make CPAP less effective afterwards if it fails or apneas recur. http://www.health.com/health/condition-article/0,,20188724,00.html http://www.umm.edu/patiented/articles/what_surgical_procedures_sleep_apnea_000065_10.htm I've added such information and better sources than above throughout the years and they are always removed. It is often very biased sites offering the surgery that are positive about outcomes. The current state of this articlei s abysmal. Syousef1975 (talk) 04:48, 14 January 2011 (UTC)

“In contrast, although not well known, surgery is more expensive and can treat directly the causes of sleep apnea”
 * Citation needed: almost all of the sources listed in this paragraph from this sentence on are primary sources, and the paragraph itself discusses the results of the studies in too much detail.  I suggest removing most of the details and summarizing the following excellent review - http://www.ncbi.nlm.nih.gov/pubmed/19950024

“Individuals with sleep apnea generally require more intensive monitoring after surgery for these reasons.”
 * Citation needed: This review, while not freely available, offers an excellent discussion of the needs of apnea patients after surgery and can be used as a citation for this entire paragraph:  http://www.ncbi.nlm.nih.gov/pubmed/19944343

Alternative treatments section
“Ojay, Alise. "About Singing for Snorers"”
 * Verify credibility: it’s not clear that the paragraphs about “singing for snorers” contains any reliable information, as all the references are self-published or are articles written by the subject of the paragraph.  However, the paragraphs are clear that the claims are unproven, so I don’t consider them particularly damaging.

Epidemiology section
“It is estimated that 20 million Americans are affected by sleep apnea”
 * Citation needed: the WHO literature on sleep apnea suggests that 1-6% of the total adult population is afflicted with sleep apnea.  http://www.who.int/gard/publications/chronic_respiratory_diseases.pdf.  I suggest changing this statistic to a percentage, to avoid outdated numbers as the population changes.

“The Wisconsin Sleep Cohort Study found that, among the middle-aged, nine percent of women and 24 percent of men had sleep apnea.”
 * Citation needed: this text is both a primary source and is probably outdated.  I suggest citing the other references in this section, which are both more current and are reviews.

History section
“The first reports in the medical literature of what is now called obstructive sleep apnea date only from 1965, when it was independently described by French and German investigators”
 * Citation needed: this book is from 1965 and seems to be an excellent source for a ll the information that was available at that time, particularly page 143.  http://books.google.com/books?id=7wz3-a7Bg9IC&printsec=frontcover#v=onepage&q&f=false

Tracheostomy was the recommended treatment and, though it could be life-saving, postoperative complications in the stoma were frequent in these very obese and short-necked individual.
 * Citation needed: this book has a good description of tracheostomy and its history starting on page 501:  http://books.google.com/books?id=KNPjukeqNbUC&printsec=frontcover#v=onepage&q&f=false

“The management of obstructive sleep apnea was revolutionized with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates”
 * Citation needed: this is the original paper - http://www.ncbi.nlm.nih.gov/pubmed/6112294

AMFEditor (talk) 23:53, 3 May 2010 (UTC)

Nasopharyngeal stent
The following was moved here from the article page for discussion. (I corrected the link in ref #1 and the date in ref #2.) Similar material has been removed from the article several times before, but it seems that the editor who has been restoring it has been making an effort to improve it. Unfortunately it may have fundamental problems that are not correctable. In any case, the editor should get consensus before restoring similar material again.


 * A new conservative therapy, especially for those patients being incompliant with CPAP therapy, is the nasopharyngeal stent, . This concept of mechanically splinting the throat and thereby preventing collapse of the airway passage has already been successfully clinically tested in the 1980ies in the U.S. before advent of CPAP by inserting latex tubes through the nose into the throat. Therapeutic efficacy was very good, yet long-term use led to mucosal irritation and patient incompliance. The new nasopharyngeal stent is a mesh made from thin nitinol wires, therefore very open-porous avoiding the disadvantages of the nasopharyngeal tube. Therapeutic efficacy and good patient compliance compared to CPAP have been proven in a clinical trial.


 * 1.
 * 2.
 * 3.
 * (Babelfish translation of ref #3.)

Comments:

1) Reference #1 is a manufacturer's website that is promoting the product and is not a reliable source, in my opinion.

2) Reference #3 is an abstract for a talk given at a conference and does not have a corresponding full text journal article. It briefly describes a study and doesn't go into much detail. For example, it does not mention the number of patients, which may be a very small number. The study appears to be only preliminary since a translation of the abstract says, "Conclusion: In further investigations it must be examined whether the positive results of this study are confirmed. If this applies, the nasopharyngeale Stent in selected cases represents an alternative to the CPAP therapy."

Note that this contradicts the manufacturer's website of reference #1 which claims that the "results from the clinical study demonstrate therapeutic efficacy" of their device, which apparently isn't true according to the above conclusion from the abstract which says that confirmation is required before the stent can be used as an alternative to CPAP. If it were demonstrated already, confirmation wouldn't be needed. The edit appears to be promoting the product in a manner similar to the manufacturer. Presumably this was unintentional. The edit makes a claim at the end that "Therapeutic efficacy and good patient compliance compared to CPAP have been proven in a clinical trial.[3]" Reference #3 didn't give any results for patient compliance in the study. --Bob K31416 (talk) 03:34, 20 September 2010 (UTC)

My two bits: one small scale clinical trial isn't sufficiently notable for mention in this article. Rklawton (talk) 03:39, 20 September 2010 (UTC)

Surgery Costs and Prevalence
While the article mentions success rates there is no indication of the costs of the surgery options for Maxillomandibular advancement (MMA), ie whether it is expensive or an affordable option for the average person and how often this option is used (ie how many such procedures are done annually). I'm not sure if this is true (perhaps someone who knows more about it can clarify at least a ballpark in this article). --EvenGreenerFish (talk) 23:57, 9 January 2011 (UTC)

Apnea vera
When I type in apnea vera, I get redirected to sleep apnea. My teacher in physiology has the following question for homework: "After a brief period of hyperventilation, 'apnea vera' occurs. Define apnea vera, and describe the feedback loop causing apnea vera."

That really doesn't sound like sleep apnea to me. I suggest a new page should be created for apnea vera; short of that, it should be mentioned in this article and/or the automatic reroute should be removed. Being rerouted to sleep apnea makes my brain muddle up in trying to figure out if it's the same thing, or another version of sleep apnea somehow, or what. Jojojlj (talk) 03:29, 3 March 2011 (UTC)

Hypoxic Pulmonary Vasoconstriction
I know obstructive sleep apnoea can induce hypoxic pulmonary vasoconstriction. I do not feel qualified or have the knowledge to make the necessary amendments, if someone is an expert, your modifications would be appreciated. Also overall, i think the page looks a little messy in comparison to some of the others (ie its in essay format, adding pictures/diagrams/bullet points might help improve the page). Not complaining, appreciate where it is at, just suggesting some possibly refinements to take it from good to excellent :) — Preceding unsigned comment added by 49.2.10.223 (talk) User:Tmoney 21:36, 8 October 2011 (UTC)

Cannabis as alternative treatment
"Cannabis shows potential in sleep apnea treatment". The reference cited in support of this statement was a study of 11 rats treated with delta 9-tetrahydrocannabinol. A PubMed search on "sleep apnea" AND "cannabis" yields only 1 hit, an article on respiratory function in patients on methadone maintenance, many of them current or past users of marijuana. I think this statement is misleading and should be deleted. Adawson13 (talk) 16:46, 11 September 2012 (UTC)

*Bangs head against table* Yes. Please Delete. Thanks. — Preceding unsigned comment added by 216.54.214.194 (talk) 07:09, 2 April 2013 (UTC)

Q. Categorisation of chronic rhinitis?
Is insufficient nocturnal ventilation due to chronic rhinitis or other nasal blockages deemed to be sleep apnea? If not, is it a form of sleep disordered breathing? If not, is there a term for the sleep-related aspect? 92.29.18.107 (talk) 23:56, 16 August 2013 (UTC)

ACP guideline
The American College of Physicians has issued a clinical practice guideline: 10.7326/0003-4819-159-7-201310010-00704 JFW &#124; T@lk  07:42, 24 September 2013 (UTC)

Dronabinol, study in humans
See section "Human study, January 2013", on use of Dronabinol for sleep apnea at

Talk page for Tetrahydrocannabinol.

--Hordaland (talk) 23:31, 16 January 2014 (UTC)

As stated in the article, there needs to be more sources and facts-based research to back up the central sleep apnea section of the article. The sentences at the beginning are a bit wordy and could have the points and focus of the sentences narrowed down. Amykchristensen (talk) 08:40, 5 March 2014 (UTC)

Untitled
Some text in this article was originally taken from http://www.ninds.nih.gov/disorders/sleep_apnea/sleep_apnea.htm (public domain)
 * And thanks for a great article. -- Charles Edwin Shipp (talk) 21:22, 6 June 2014 (UTC)

Commendable structure of the TALK page
Possibly, other WP page/articles should use this structure; not seen often enough. -- Charles Edwin Shipp (talk) 11:56, 7 June 2014 (UTC)

Sleep Apnea
The second sentence of the third paragraph of this section. There is good content in the sentence but the structuring could be better to improve understanding as it is read. Perhaps break up the sentence into two. The first part taking about witnessing an episode and the second sentence talking about noticing effects on the body (sequelae.) The fourth paragraph contains unnecessary usage of the word 'that.' It could be eliminated from most of the sentences without changing other grammar or the thought of the sentence. This fourth paragraph does contain great content and defines sleep apnea with more detail. These four intro paragraphs effectively narrow the definition and ideas of sleep apnea starting broader at the beginning and becoming more specific at the end.

Comment: The rather alarming statement that sleep apnea may lead to death due to lack of oxygen is not well supported by reference [8]. What [8] says is "Increase the risk of serious health problems, including diabetes and even death." To me this implies that the death is indirect; sleep apnea may aggravate other conditions, or cause you to crash your car, etc.; it doesn't say you may asphyxiate in your bed. Regardless, this source is neither sufficiently formally scientific nor detailed and clear enough to support the sentence in the article. 67.255.0.138 (talk) 07:31, 9 April 2015 (UTC)

Oximetry
The second sentence has some awkward wording which makes the though less clear.

Obstructive sleep apnea
The second sentence of the first paragraph could be rephrased for clarity. Perhaps something like this,"The muscle tone of the body ordinarily relaxes during sleep. The throat, or the human airway, is composed of collapsible walls of soft tissue which may obstruct breathing during sleep." In the third sentence I am not sure the usage of the word 'important.' Perhaps a better suited phrase would be 'a concern.' Sleep apnea symptoms during an upper respiratory infection still could be important, but I do understand from the thoughts in the paragraph it is not as much of a "red-flag" as OSA. The statistic in the fourth paragraph about diabetes patients having three times the risk of OSA needs a citation. Check the section for unnecessary usage of the word 'that.'

Central sleep apnea
Check section and correct any unnecessary usage of the 'that.' this is the worst kind of sleep apnea since there seems to be no cure. I've heard some people who have had tracheotomy and months later they were cured of all sleep apnea, but I didn't have an immediate cure even 6 weeks after the operation though I think I regained some of my concentration and clarity.

there are drug treatments including klonopin and diamox — Preceding unsigned comment added by 71.125.23.96 (talk) 04:07, 7 May 2014 (UTC)

is central apnea due possibly to a degeneration of neurons in the brainstem and can be treated somehow? could years of not sleeping or exhaustion lead to this or a narrowed airway/jaw structure? — Preceding unsigned comment added by 71.125.23.96 (talk) 04:12, 7 May 2014 (UTC)

Mixed apnea and complex sleep apnea
Knowledgable information, and what I would guess is indeed fact-based, in the section but needs support and citation. there is a theory that OSA can damage the brain and cause white tangles which leads to central apnea, it seems that this happens, that your apnea becomes worse and your oxygen levels begin to plummet in sleep and during the day for mysterious reasons

Medications
The first sentence is a run-on sentence. This makes it hard to track the thought and understand all of the information without having to re-read the long sentence. Breaking the sentence will benefit reader understanding.

Surgery
Citations are needed. a great question is if tracheotomy is a cure? some people say they have been cured of sleep apnea a few months after tracheotomy, but it can have bad complications

Alternative treatments
Eliminate unnecessary usage of 'that.' Good content with citations present. Kmarsha3 (talk) 04:45, 31 March 2014 (UTC)

article needs a rewrite
much unsourced content. too many primary sources and concomitant lack of recent reviews. will try to work on this over the next week, and will address relevant things mentioned above. Jytdog (talk) 12:54, 9 April 2015 (UTC)

Effects of Sleep Apnea need their own section
The paragraphs on the effects of sleep apnea in the introduction are good, but too long for the introduction. They need to be moved to their own section, expanded and a replacement summary of the effects written for the introduction. Cptbigglesworth266 (talk) 08:50, 16 April 2015 (UTC)

Restructure obstructive sleep apnea risks under Risks headline
The structure of the sentences beyond the second paragraph make the actual topic seem ambiguous to a casual reader until they get to the part where all of those risks are for obstructive sleep apnea. The statement should be made as the first part of the second sentence that those risks are for obstructive sleep apnea.

As it is, it looks as such:

"Risk factors include being male, overweight, obese, or over the age of 40; or having a large neck size (greater than 16–17 inches), enlarged tonsils, enlarged tongue, small jaw bone, gastroesophageal reflux, allergies, sinus problems, family history of sleep apnea, or deviated septum causing nasal obstruction.[15] Alcohol, sedatives and tranquilizers also promote sleep apnea by relaxing the throat. People who smoke have sleep apnea at three times the rate of people who have never smoked.[16] All the factors above may contribute to obstructive sleep apnea. Central sleep apnea is more influenced by being male, being older than 65 years, having heart disorders such as atrial fibrillation, and stroke or brain tumor. Brain tumors may hinder the brain's ability to regulate normal breathing.[16] High blood pressure is also very common in people with sleep apnea.[17]"

Which would be better understood as:

"Risk factors for obstructive sleep apnea include being male, overweight, obese, being over the age of 40, having a large neck size (greater than 16–17 inches), enlarged tonsils, enlarged tongue, small jaw bone, gastroesophageal reflux, allergies, sinus problems, family history of sleep apnea, or deviated septum causing nasal obstruction.[15] Alcohol, sedatives and tranquilizers also promote sleep apnea by relaxing the throat. People who smoke have sleep apnea at three times the rate of people who have never smoked.[16]

Risk factors for central sleep apnea include being male, being older than 65 years, having heart disorders such as atrial fibrillation, and stroke or brain tumor. Brain tumors may hinder the brain's ability to regulate normal breathing.[16] High blood pressure is also very common in people with sleep apnea.[17]" — Preceding unsigned comment added by Rikorage (talk • contribs) 06:38, 14 March 2016 (UTC)

Obstructive sleep apnea page
This page could use more harmonization with the Obstructive sleep apnea page. I don't have time to do a full job of this now, but am noting it here in case others might want to pick up parts of the job. Thanks. -Dan Eisenberg (talk) 03:29, 15 August 2016 (UTC)

Subsections
This is an extremely long article, and I basically had to read through the entire article to find the section I wanted, central sleep apnea. Having a header "classification" that has no subsection when there are three main types is not helpful. It's much better to be able to see central sleep apnea directly in the contents, and it also makes it possible to link to this section when relevant, rather than the entire classification section alone. Readers have the option of collapsing contents boxes if they don't like them, or seperating the article into separate ones. In this case, with a three-header limit, the relevant material is simply hidden and hard to find, when it is one of the major subjects. Another option is simply removing "classification" entirely, since the header itself is content free--it has no text of its own, just subsections. Hence I am restoring the 4-level headers at this point. μηδείς (talk) 21:36, 23 February 2017 (UTC)
 * I have moved the classification section up a header level to address the issue you mention. Let me know if that works. Doc James  (talk · contribs · email) 10:35, 24 February 2017 (UTC)
 * Works fine for me. μηδείς (talk) 20:35, 24 February 2017 (UTC)

Text
The Lancet review from 2009 says "In randomised trials, treating OSA with continuous positive airway pressure lowered blood pressure, attenuated signs of early atherosclerosis, and, in patients with heart failure, improved cardiac function. Current data therefore suggest that OSA increases the risk of developing cardiovascular diseases, and that its treatment has the potential to diminish such risk."

The 2015 review says "CPAP is highly effective in controlling symptoms, improving quality of life and reducing the clinical consequences of sleep apnoea and we must consider it as a first-line option."

IMO this supports "With proper use, CPAP improves outcomes and appears to decreases the risk of death due to heart disease." Doc James (talk · contribs · email) 22:45, 15 April 2017 (UTC)

Oropharyngeal Exercises
I don't have the time to add right now, but looks like Oropharyngeal Exercises
 * might merit a section. -Pengortm (talk) 05:38, 16 June 2017 (UTC)

Exercise for lessening OSA
Also might merit inclusion, but don't have the time to properly integrate right now: http://dx.doi.org/10.5665/sleep.1422 - Pengortm (talk) 14:21, 17 June 2017 (UTC)


 * Systematic reviews citing the above: 10.5665/sleep.3056; 10.1016/j.sleep.2014.05.012; 10.1016/j.ijporl.2016.06.017; 10.1007/s11325-013-0806-7 PriceDL (talk) 17:32, 18 June 2017 (UTC)

CPAP Picture
Can we replace the picture of CPAP wear with something a little more like this? https://www.thecpapshop.com/respironics-dreamwear-nasal-cpap-mask-1 That horrible, ancient mask on the picture is bound to scare people off CPAP therapy before even trying it.
 * You'd need a free image of that. peterl (talk) 00:07, 30 May 2019 (UTC)

Work plan for Wikiedu Medicine project
Hello I am a med student part of the wikiedu medicine project for the summer and I chose to work on this page for the next few weeks.

I would like to start by cleaning up the introduction and eliminating a lot of the extra information in the introduction/summary.

Risk Factors section requires more verified citations. Mechanism section needs more information and citations

Diagnosis and Classifcations- Diagnosis section heading is regular font while the subsections under diagnosis are in bold text. Under classifications there is a lot of information that is without any verifiable citation.

Management- Again the main the heading is in regular text while some of the sub sections are in bold text. Other subsections are in different text sizes as well. I feel that maybe the flow of the management section could also be better. The section could start with more common and less invasive treatment options to more drastic and more invasive options.

Once I have cleaned these sections up I will address the rest of the article with the epidemiology and history of the disease further down the course.

Any suggestions are welcome. Pbnj1518 (talk) 16:15, 17 July 2019 (UTC)Pbnj1518

Reveiw
@ Pbnj1518 I think you did a great job addressing the issues you said that you would in your initial plan on this talk page. Sources have been added, the intro has great information, text fonts and sizes match up to help the flow of the article. The only issue I can see that may need some maintenance are the bullet points. I'm not sure if you added them or not but I've caught some lash for using them, although I think they add clarity and overall readability. Other than that I think you have done an excellent job.

Hello I am a psychology student and using this article for my capstone. Overall the article is very informative. However, It seem to misplaced information in the definition section. I made a change in that section to make the definition more clear. I took off the information of how sleep apnea my cause hyperactivity or problems in school.Roopeterson (talk) 00:11, 23 September 2019 (UTC)

I'm a psychology student taking my capstone class I found information on exercise and how it helps with sleep apnea, I input it into the treatment section.Roopeterson (talk) 02:18, 25 September 2019 (UTC)

Should oral appliance be moved to main Management section rather than under Other?
Currently, the section on surgery says that oral appliances should be considered before surgery, with references suggesting this. However, surgery is under the main section of Management, while oral appliances is under Other. Perhaps Oral appliances should be moved just above surgery. Nereocystis (talk) 18:59, 21 August 2020 (UTC)

Reference for 1 in 10 figure
It seems to me that the reference for the 1 in 10 figure should be doi:10.1016/S2213-2600(19)30198-5, rather than doi:10.3233/JAD-200571, right?

Wesleyac (talk) 12:21, 27 April 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 28 August 2019 and 6 December 2019. Further details are available on the course page. Student editor(s): Roopeterson. Peer reviewers: Cjackson1215.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 09:29, 17 January 2022 (UTC)

Extremely repetitive
What the title says. 91.129.100.157 (talk) 06:27, 6 December 2022 (UTC)

Important role of ANP (cardiac hormone)
Neurologist Guy Leshziner describes in "The Nocturnal Brain" Page 83 (hardback) that ANP is produced in spikes many times a night in relation to sleep apnea / apnoea. This is an important but incredibly poorly understood symptom of sleep apnea/apnoea, and a major issue: sleep is disturbed by apnea/apnoea which causes ANP spikes which disturb sleep which causes worse symptoms: I am medically trained and had no idea the heart secreted hormones to control blood volume thinking it was done through kidneys: Drs should be aware patients presenting with "I snore and have to get up in the night to pee so much it disturbs my sleep" likely have *severe* sleep apnea/apnoea and are at high risk. Can someone please add this ? Thanks 92.1.65.238 (talk) 08:09, 7 April 2023 (UTC)
 * That is Guy Leschziner—see an extract from The Nocturnal Brain at this unreliable source. ANP is discussed at Atrial natriuretic peptide. Johnuniq (talk) 08:38, 7 April 2023 (UTC)

Evaluation
I found this article on Wikipedia to be very informative, there is a lot of information on the topic which allows readers to really grasp the issue and relay how it is to live with it. - CCasscake (talk) 16:44, 7 February 2024 (UTC)

Wiki Education assignment: 2023-24 WikiMed Directed Studies

 * Workplan-> edit lead section for sleep apnea, update missing references, move information that is not reflected in the body of the article out of the lead section, add information regarding diagnosis of CSA and OSA, add citations for risk factors section.

Hdnguy35 (talk) 19:19, 13 March 2024 (UTC)

— Assignment last updated by RiotingDaffodil (talk) 18:08, 11 March 2024 (UTC)

2023-24 WikiMed Directed Studies - Peer Review
Lead

The lead section does include an introductory sentence that concisely and clearly describes the article’s topic. The lead section mentions the link between Alzheimer’s disease and OSA, however, this is not discussed in the content of article. The lead section is a bit overly detailed.

Content

Additional content added into the "signs and symptoms" and "risk factors" sections provide more easy-to-understand information with added citations. Overall, the article content provides comprehensive information on the topic.

Tone and balance

The article content is neutral. There are no claims that appear heavily biased toward or attempt to persuade the reader in favor of  any particular position.

Source and references

The added content is backed by a reliable secondary source and the content accurately reflects what the cited sources say. The sources are current and reflect the available literature on the topic. The links work.

Organization

The content added is well written and easy to read. It is free of grammatical and spelling errors.

Overall impressions

The content added makes the lead section easier to read and understand.

Knn0059 (talk) 18:17, 14 March 2024 (UTC)