Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- insomnia, especially sleep-maintenance insomnia
- poor concentration and attention span
- observed periodic breathing or cessation of breathing or snoring during sleep (by partner)
- transient dyspnoea that awakens from sleep or prevents sleep onset
- headaches upon waking
- complaints of poorly restorative sleep and/or daytime sleepiness
- periodic breathing during wakefulness
Outros fatores diagnósticos
- abnormal heart rhythm or the presence of third or fourth heart sounds
- focal abnormality on neurological examination
- neuromuscular weakness
- history of endocrine disorders
Fatores de risco
- congestive heart failure
- stroke
- renal failure
- male sex
- atrial fibrillation
- age ≥60 years
- opioid use
- brainstem lesions
- neuromuscular weakness
- acromegaly
- hypothyroidism
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- overnight polysomnography
Investigações a serem consideradas
- serum thyroid stimulating hormone
- serum creatinine
- ECG
- serum insulin-like growth factor 1 (acromegaly testing)
- echocardiogram
Algoritmo de tratamento
without Cheyne-Stokes breathing: due to medical disorder
without Cheyne-Stokes breathing: primary (idiopathic)
with Cheyne-Stokes breathing
due to high-altitude periodic breathing
due to medication or substance misuse
treatment-emergent CSA
Colaboradores
Autores
Bernardo J. Selim, MD
Associate Professor of Medicine
Director of Respiratory Care Unit
Division of Pulmonary, Critical Care, and Sleep Medicine
Mayo Clinic
Rochester
MN
Declarações
BJS declares that he has no competing interests.
Lauren A. Tobias, MD
Assistant Professor of Medicine
Yale University School of Medicine
Department of Internal Medicine
Section of Pulmonary, Critical Care and Sleep Medicine
New Haven
CT
Declarações
LAT declares that she has no competing interests.
Agradecimentos
Dr Bernardo J. Selim and Dr Lauren A. Tobias would like to gratefully acknowledge Dr J. Shirine Allam, Dr Timothy I. Morgenthaler, and Dr Christine H. Won, previous contributors to this topic.
Declarações
JSA and TIM declare that they have no competing interests. CHW declares that she has been a speaker for Respironics CME.
Revisores
Teofilo Lee-Chiong, MD
National Jewish Medical and Research Center
Denver
CO
Declarações
TLC has been reimbursed by the American College of Chest Physicians (ACCP), American Academy of Sleep Medicine, American Thoracic Society, and Cephalon, the manufacturer of modafinil, for attending several conferences. He has been paid by the ACCP for running educational programs and by Elsevier for serving as consultant of the Sleep Medicine Clinics. He has also received research funding from the National Institutes of Health, Respironics, Restore, and Schwarz Pharma, and has been a member of the speakers' bureau for GlaxoSmithKline.
John A. Fleetham, MD, FRCP
Professor
University of British Columbia
Vancouver
Canada
Declarações
JAF declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
American Academy of Sleep Medicine. The AASM international classification of sleep disorders - third edition, text revision (ICSD-3-TR). Jun 2023 [internet publication].Texto completo
Randerath W, Verbraecken J, Andreas S, et al. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017 Jan;49(1):1600959.Texto completo Resumo
Mayer G, Arzt M, Braumann B, et al. German S3 guideline nonrestorative sleep/sleep disorders, chapter "sleep-related breathing disorders in adults," short version: German Sleep Society (Deutsche Gesellschaft für Schlafforschung und Schlafmedizin, DGSM). Somnologie (Berl). 2017;21(4):290-301.Texto completo Resumo
Aurora RN, Bista SR, Casey KR, et al. Updated adaptive servo-ventilation recommendations for the 2012 AASM guideline: "The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses". J Clin Sleep Med. 2016 May 15;12(5):757-61.Texto completo Resumo
Aurora RN, Chowdhuri S, Ramar K, et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep. 2012 Jan 1;35(1):17-40.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Obstructive sleep apnoea
- Sleep-related hypoventilation/hypoxaemic syndromes
- Depression
Mais Diagnósticos diferenciaisDiretrizes
- International classification of sleep disorders, 3rd edition, text revision (ICSD-3-TR)
- Sleep-disordered breathing and cardiac arrhythmias in adults: mechanistic insights and clinical implications: a scientific statement from the American Heart Association
Mais DiretrizesFolhetos informativos para os pacientes
Sleep apnoea in adults (obstructive)
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice
O uso deste conteúdo está sujeito ao nosso aviso legal