deglutition apnea


apnea

 [ap´ne-ah] cessation of breathing, especially during sleep. The most common type is apnea" >adult sleep apnea. Central apnea in which there is failure of the central nervous system drive to respiration sometimes occurs in infants younger than 40 weeks after the date of conception.adult sleep apnea frequent and prolonged episodes in which breathing stops during sleep. Diagnosis is confirmed by monitoring the subject during sleep for periods of apnea and lowered blood oxygen levels. Sleep apnea is divided into three categories: (1) obstructive, resulting from obstruction of the upper airways; (2) central, caused by some pathology in the brain's respiratory control center; and (3) mixed, a combination of the two (see above).Treatment. Obstructive and mixed types are amenable to therapy. Since many sleep apnea patients are overweight, weight loss improves the symptoms. Central sleep apnea is the most difficult to control. Medications to stimulate breathing have not proven beneficial. Mechanical ventilation or administration of oxygen during the night may help some patients.
The most common treatment for obstructive sleep apnea is nasal continuous positive airway pressure, which the patient uses during sleep; the positive pressure exerted prevents the airway from obstructing. Another method that may be tried is a dental appliance to move the jaw forward during sleep. In the most refractory cases, such as when an anatomical airway obstruction can be demonstrated, surgery to remove it may be performed after consultation with a surgeon experienced in evaluating and treating such obstructions. Another treatment that is occasionally used is insertion of a special type of tube" >tracheostomy tube that can be plugged during the day for normal use of the upper airway and opened at night to bypass upper airway obstructioncentral apnea (central sleep apnea) see apnea" >adult sleep apnea.deglutition apnea a temporary arrest of the activity of the respiratory nerve center during an act of swallowing.initial apnea a condition in which a newborn fails to establish sustained respiration within two minutes of delivery.late apnea cessation of respiration in a newborn for more than 45 seconds after spontaneous breathing has been established and sustained.mixed apnea see apnea" >adult sleep apnea.obstructive apnea (obstructive sleep apnea) see apnea" >adult sleep apnea.primary apnea cessation of breathing resulting when a fetus or newborn infant is deprived of oxygen; exposure to oxygen and stimulation usually restore respiration.prolonged infantile apnea sudden infant death syndrome.secondary apnea a period of time following primary apnea during which continued asphyxia of the fetus or newborn, with a fall in blood pressure and heart rate, necessitates artificial ventilation for resuscitation and reestablishment of ventilation.sleep apnea transient periods when breathing stops during sleep; see apnea" >adult sleep apnea.

de·glu·ti·tion ap·ne·a

inhibition of breathing during swallowing.

apnea

(ap-ne'a, ap'ne-) [ ¹an- + -pnea] Temporary cessation of breathing and, therefore, of the body's intake of oxygen and release of carbon dioxide. It is a serious symptom, esp. in patients with other potentially life-threatening conditions. See: apnea monitoring; Cheyne-Stokes respiration; sleep apnea; sudden infant death syndrome

central apnea

Apnea during sleep that occurs when the respiratory center of the brainstem does not send normal periodic signals to the muscles of respiration. Observation of the patient reveals no respiratory effort (no movement of the chest, and no breath sounds).

deglutition apnea

Apnea while swallowing.

mixed apnea

Dysfunctional breathing during sleep that combines elements of obstructive and central sleep apneas.

obstructive apnea

Absent or dysfunctional breathing that occurs when the upper airway is intermittently blocked during sleep. Observation of the patient reveals vigorous but ineffective respiratory efforts, often with loud snoring or snorting.

obstructive sleep apnea

Abbreviation: OSA
Sleep apnea.

positional sleep apnea

Obstructive sleep apnea that occurs primarily when the patient is lying on his back (supine).

apnea of prematurity

Abbreviation: AOP
A condition of the premature newborn, marked by repeated episodes of apnea lasting longer than 20 sec. The diagnosis of AOP is one of exclusion, made when no treatable cause can be found. Increased frequency of apneic episodes directly relates to the degree of prematurity. AOP is not an independent risk factor for sudden infant death syndrome. Apneic episodes may result in bradycardia, hypoxia, and respiratory acidosis.

Treatment

There is no specific treatment. Initial efforts should begin with the least-invasive method. Tactile stimulation is often successful with early recognition. When gentle stimulation does not produce a response, bag and mask ventilation is initiated. Methylxanthines such as caffeine, theophylline, and aminophylline are helpful.

Patient care

Care includes maintenance of a neutral thermal environment, avoidance of prolonged oral feedings, use of tactile stimulation early in the apneic episode, and ventilatory support as needed. The infant who has experienced and survived an episode of apnea is maintained on cardiac and respiratory monitoring devices. Before discharge, parents are taught cardiopulmonary resuscitation, use of monitoring equipment, and how to recognize signs of medication toxicity if medications are used.

sleep apnea

The temporary absence of breathing during sleep. This common disorder affects about 10% of all middle-aged men and about 5% of middle-aged women in the U.S. and is classified according to the mechanism involved and by whether or not it is associated with daytime sleepiness. Synonym: obstructive sleep apnea

In obstructive sleep apnea, vigorous respiratory efforts are present during sleep but the flow of air in and out of the airways is blocked by upper airway obstruction. Patients with obstructive apnea are usually middle-aged, obese men who make loud snorting, snoring, and gasping sounds during sleep. By contrast, central sleep apnea is marked by absence of respiratory muscle activity. Patients with central apnea may exhibit excessive daytime sleepiness, but snorting and gasping during sleep are absent. Occasionally life-threatening central apneas occur as a result of strokes.

Mixed apnea begins with absence of respiratory effort, followed by upper airway obstruction. Whenever apneas are prolonged, oxygenation drops and carbon dioxide blood levels rise. Patients often awaken many times during the night or have fragmented sleep architecture. In the morning, many patients complain of headache, fatigue, drowsiness, or an unsatisfying night's rest. In addition, these individuals often have hypertension, arrhythmias, type 2 diabetes mellitus, or signs and symptoms of right-sided heart failure. Although these findings may suggest the diagnosis, formal sleep studies in a laboratory are needed to document the disorder and to measure the effects of apneas on oxygenation and other physical parameters.

Symptoms

Partners of patients with sleep apnea are often the first to notice the patient's disordered breathing during sleep. Occasionally patients see their health care providers because of hypersomnolence: they may report falling asleep during the daytime in unusual circumstances, e.g., at traffic lights or whenever seated in a quiet room.

Treatment

Optimal therapy of obstructive sleep apnea is to assist breathing with continuous positive airway pressure (CPAP) if the patient cannot correct the condition by losing weight. CPAP provides a pneumatic splint that maintains airway patency during sleep. Palatal obstruction, a finding in a small number of patients, can be surgically corrected. Medroxyprogesterone may be of some benefit but is clearly less effective than CPAP.