62,65-68 Children with sleep-disordered breathing have a threefold increase in behavioral and neurocognitive abnormalities. It has been estimated that 5% to 39% of attention-deficit/hypcractivity disorder (ADHD) could be attributed to sleep-disordered breathing.65-69 In OSAS, the PSG demonstrates more than five obstructive apneas per hour of sleep and one or more of the following: best frequent arousals associated with the apneas; bradytachycardia; and arterial oxygen desaturation in association with the apneas. Sleep architecture in OSAS and UARS patients is abnormal with fragmented sleep (mainly during non-rapid eye movement [NREM] stages 1 and 11) and frequent arousals and awakenings.
Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical The amount of SWS (NREM stages III and IV) and REM sleep is decreased.4,7 MSLT performed the day after the PSG may or may not demonstrate sleepiness (ie, mean sleep kinase inhibitor Temsirolimus latency <10 min). Treatment for OSAS consists of nonsurgical as well as surgical treatments. Nonsurgical treatment encompasses general/behavioral measures, such as weight loss, body position during sleep (avoid supine position), and mechanical measures, which include continuous positive airway pressure (CPAP) or bilcvel positive airway pressure (BIPAP) and oral
appliances. Inhibitors,research,lifescience,medical A consensus statement by Loube and colleagues recommended CPAP treatment for all OSAS patients with RDI>30 regardless of symptoms and Inhibitors,research,lifescience,medical for patients with RDI=5 or 30 events per hour if accompanied by symptoms of excessive daytime somnolence, impaired cognition, mood disorders, insomnia, or documented cardiovascular
diseases (ischemic heart disease, hypertension), or stroke.70 Improvement or elimination of apneas improves sleep architecture and reduces daytime sleepiness.71,72 Beneficial effects Inhibitors,research,lifescience,medical of CPAP or surgery reported in patients with frequent sleep apneas (>20) and patients with sleep-disordered breathing (RD1<20) without subjective pathological sleepiness include improvement in well-being, mood, functional status, breathing, oxygen saturation, Dacomitinib and cardiac rhythm.71-76 CPAP has also been successfully utilized to treat OSAS in infants and children younger than 2 years of age.77,78 However, compliance with CPAP is problematic, with published rates ranging from 65% to 95% when assessed subjectively.79,87 Strollo and colleagues have recommended management strategies for common side effects of nasal CPAP.80 Autotitrating continuous positive airway pressure (APAP) can be used to treat many patients with OSAS or to identify an effective optimal fixed level of CPAP for treatment, but is not recommended for patients with congestive heart failure, chronic obstructive pulmonary disease, daytime hypoxemia and respiratory failure from any cause, or prominent nocturnal desaturation other than from OSAS.
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