Sleep Disorders: Sleep-Related Breathing Disorders.

Sleep-related breathing disorders or sleep-disordered breathing are characterized by abnormal respiration during sleep. They are grouped into obstructive sleep apnea (OSA), central sleep apnea, sleep-related hypoventilation, and sleep-related hypoxemia disorder. OSA is a common disorder encountered in the family medicine setting that is increasingly being recognized because of the obesity epidemic and greater public and physician awareness. OSA is characterized by recurrent episodes of partial or complete closure of the upper airway resulting in disturbed breathing during sleep. It is associated with decreased quality of life and significant medical comorbidities. Untreated OSA can lead to a host of cardiovascular diseases including coronary artery disease, stroke, and atrial fibrillation. Patients who report symptoms of snoring, witnessed apneas, or daytime sleepiness should be screened for sleep apnea. In-laboratory attended diagnostic polysomnography or portable home sleep testing can be used to diagnose sleep apnea. Continuous positive airway pressure (CPAP) therapy is the first-line treatment for OSA in adults. Other modalities include mandibular advancement devices, surgery, or upper airway stimulation therapy. Adjunctive therapy should include weight loss in overweight patients, avoidance of sedatives and alcohol before sleep, and possibly positional therapy.