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. 2008:7:Doc03.
Epub 2010 Oct 7.

Early diagnosis of sleep related breathing disorders

Joachim T Maurer  1
Affiliations

Early diagnosis of sleep related breathing disorders

Joachim T Maurer. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2008.

Abstract

Obstructive sleep apnea (OSA) being the most frequent sleep related breathing disorder results in non-restorative sleep, an increased cardiovascular morbidity and mortality as well as an elevated number of accidents. In Germany at least two million people have to be expected. If obstructive sleep apnea is diagnosed early enough then sleep may regain its restorative function, daytime performance may be improved and accident risk as well as cardiovascular risk may be normalised. This review critically evaluates anamnestic parameters, questionnaires, clinical findings and unattended recordings during sleep regarding their diagnostic accurracy in recognising OSA. There are numerous tools with insufficient results or too few data disqualifying them for screening for OSA. Promising preliminary results are published concerning neural network analysis of a high number of clinical parameters and non-linear analysis of oximetry itself or in combination with heart rate. Nasal pressure recordings can be used for risk estimation even without expertise in sleep medicine. More data is needed. Unattended portable monitoring used by qualified physicians is the gold standard procedure when screening methods for OSA are compared. It has a very high sensitivity and specificity well documented by several meta-analyses.

Keywords: early diagnosis; obstructive sleep apnea, diagnostics; questionnaires; screening; sleep related breathing disorders; unattended portable monitoring.

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Figures

Table 1
Table 1. Classification of Sleep Related Breathing Disorders (according to ICSD 2 [4])
Table 2
Table 2. Symptoms of obstructive sleep apnoea (according to Guilleminault 1976 [15])
Table 3
Table 3. Studies concerning history, clinical findings and prediction models
Table 4
Table 4. Studies concerning the Berlin questionnaire
Table 5
Table 5. Studies concerning oximetry
Table 6
Table 6. Studies concerning airflow measurements
Table 7
Table 7. Studies concerning two channel systems
Figure 1
Figure 1. Two minutes of polygraphic recording showing an obstructive apnea. There is a rise of pulse rate during recuperation of breathing as autonomous sign of the central nervous system arousal. (Schnarch: snoring; Thor: thorax movement; Abd: abdominal movement; Pos: body position; Pulsfreq: pulse rate; SpO2: oxygen saturation)
Figure 2
Figure 2. Stepwise approach according to the German BUB-guidelines [18]
Figure 3
Figure 3. Diagnostic flow chart for the cardinal symptom “Non-restorative sleep” of the German Sleep Society (DGSM) [127]
Figure 4
Figure 4. Berlin questionnaire [23]
Figure 5
Figure 5. SleepStrip®, airflow is measured with a thermistor
Figure 6
Figure 6. Different 4- to 7-channel devices for the diagnosis of OSA
See this image and copyright information in PMC

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