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A contemporary review of obstructive sleep apnea

Ralls, Franka,b; Cutchen, Lisaa,b

Current Opinion in Pulmonary Medicine: November 2019 - Volume 25 - Issue 6 - p 578–593
doi: 10.1097/MCP.0000000000000623
SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Brian D. Kent
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Purpose of review This review provides a contemporary review of sleep apnea with emphasis on definitions, epidemiology, and consequences.

Recent findings Amyloid β-42 is one of the main peptides forming amyloid plaques in the brains of Alzheimer patients. Poorer sleep quality and shorter sleep duration have been associated with a higher amyloid burden. Decreased sleep time in the elderly is a precipitating factor in amyloid retention. Studies have shown that the dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of gamma-aminobutyric acid (GABA) and glutamate play a role in sleep disordered breathing (SDB).

Summary Untreated sleep disordered breathing (obstructive sleep apnea and/or central sleep apnea) are an important cause of medical mortality and morbidity. OSA is characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep followed by hypoxia and sympathetic activation. Apneic events are terminated by arousal, followed by increases in pulse and blood pressure, and re-oxygenation and the release of inflammatory factors. Individuals with OSA have an increased risk of developing atrial fibrillation. Hypoxemia and poor sleep quality because of OSA increase the risk of cognitive decline in the elderly.

aUNM Sleep Disorders Center

bDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA

Correspondence to Frank Ralls, MD, Associate Professor of Internal Medicine, University of New Mexico, Program Director: UNM Sleep Medicine Fellowship, Medical Director, University Hospital Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building 2, Albuquerque, NM 87102, USA. Tel: +1 505 272 6110; fax: +1 505 272 6112; e-mail: FRalls@salud.unm.edu

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