Talk:Sleep apnea/Archive1

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Contents 1 the test can be perfectly normal ??? 2 our vibration sensors ??? 3 central sleep? 4 new figure 5 Text removed from article 6 "Training apnea"? 7 How many pepole affected by this condition? 8 Recent reversions 9 3RR warning

[edit] the test can be perfectly normal ???

I haven't modified your text but your latest edit has muddied the water. Remember that pulse oximetry is a crude way of measuring whether the oxygen saturation is normal. The 95 percent confidence limit for SpO2 as a measure of SaO2 is ±2 to 3 percent at best. The strength of pulse oximetry for the diagnosis of sleep apnea is its reliability as a trend monitor. Oximetry identifies drops in the oxygen saturation and it is the occurrence of the drop, not its magnitude, that is important. We see very symptomatic patients who have many tiny desaturations associated with arousal whose SpO2 never goes below 90 percent. Others may have a couple of clusters of drops to the 70s during REM sleep but have little disturbance of their sleep most of the night. So the important question is not whether the saturation is "within the normal range" but whether it is stable. Note also that "oxygen concentration" is a pretty meaningless term when you are talking about oximetry. Its nearest equivalent in pulmonary physiology is FO2. Here we are talking about SaO2 (or SpO2). Adawson13

I've taken the liberty of restoring my statement that overnight oximetry can be normal in moderately severe sleep apnea. I don't believe it belongs in the article but I can show you plenty of examples from my practice of sleep disorders medicine. This is not a trivial matter. I commonly see patients whose primary care physician had ordered an oximetry and then did not refer the patient to a sleep specialist when the test proved to be normal. A recent article from the Mayo Clinic has an interesting discussion of this problem ( Martinez MW, Rodysill KJ, Morgenthaler TI. Use of ambulatory overnight oximetry to investigate sleep apnea in a general internal medicine practice. Mayo Clin Proc. 2005 Apr;80(4):455-62.) adawson13.

Thanks for indicating a source. The article you quote doesn't mention "tests" but results : it refers to "normal" and "abnormal oximetry results" which makes sense. The tests have to be normal to be relevant. The results of abnormal tests are not relevant. The results of normal tests can be both normal or abnormal, ie indicating if the concentration of oxygen is or is not within normal range.Jclerman 21:18, 2 October 2005 (UTC)

Thanks for clarifying your point which had me puzzled at first. Physicians commonly refer to a test as being abnormal when it would be grammatically preferable to say that its results are abnormal. I hope you don't think your correctness on that point justifies deleting an important piece of clinical information. Adawson13

Rather than deleting questions, can you clarify what's the meaning of "the test can be perfectly normal"? If the test is abnormal, its results are not relevant! Jclerman 06:12, 28 September 2005 (UTC)

Say what you mean. Are you looking for it to read "the test RESULTS can be perfectly normal?" If so, why not edit it so? Sfahey 17:27, 30 September 2005 (UTC)

I mean that without a reference pointing to the source of the statement, I don't know what the statement intends to mean. The author of the statement deserves to be given the opportunity to explain what she/he intended to say. The statement is ambiguous since it can have two interpretations even with your suggested edit(s). Anyhow, for lack of a verifiable source (ie, reference) the statement is temporarily deleted until the reference to oximetry tests can be verified.Jclerman 18:10, 30 September 2005 (UTC)

[edit] our vibration sensors ???

Rather than deleting questions, can you clarify who is the "owner" of the vibration and/or the sensors? Jclerman 06:12, 28 September 2005 (UTC)

For lack of verifiable source(s) to ascertain whether "our" was either a vendor's self-reference or a typo for "your", "four", or "or", the statement has been temporarily deleted.Jclerman 18:10, 30 September 2005 (UTC)

[edit] central sleep?

are there any treatments for central sleep apnea? Kingturtle 03:32, 20 Sep 2004 (UTC)

the condition to begin with is very uncommon, and i believe has many possible causes, including stuff like heart failure, for which treatment must be individualized.Sfahey 16:30, 20 Sep 2004 (UTC)

See prevalence of different apneas in: http://ajrccm.atsjournals.org/cgi/content-nw/full/157/1/144/T1Jclerman 06:12, 28 September 2005 (UTC)

For men aged 65 to 100 the prevalence is very common, nearly the same as for obstructive apnea.Jclerman 06:12, 28 September 2005 (UTC)

For more reliable information search PubMed (MEDLINE, Entrez). Jclerman 06:12, 28 September 2005 (UTC)

Theophylline is the only medical (i.e. pharmaceutical) treatment I'm aware of. BiPAP is also sometimes tried. IdahoEv 05:56, 20 Oct 2004 (UTC)

What is the Prognosis of untreated sleep apnea?

The prognosis depends on many things... but it isn't hard to imagine that not breathing for around 15 seconds at a time... 15 or more times hour (usually around 30 times an hour)..all night... every night... is bad for you.

It is important to note, that while the prevalence is 'common' [meaning, you may see an occasional event on a study], the prevalence of clinically significant CSA is not common. That being said, the most important 'treatment' for CSA is to discover the underlying cause. The most common etilogy of secondary central sleep apnea is congestive heart failure (CHF). CHF results in an increased loop gain (similar to atrial fibrillation) which has effects on circulation time and chemo-receptors. Many patients undergoing sleep studies have the occasional central event, which do not require further evaluation. It is in the patient where central apneas dominate the sleep disordered breathing profile that further evaluation should be untdertaken.

Treatment of CSA, after a thorough cardiac workup (echocardiogram, EKG, physical exam), could include oxygen, positive pressure ventilaton, medryoxyprogeseterone, and acetazolamide.

[edit] new figure

I added a figure representing a 2 minute epoch (two minutes of data) of a patient that was diagnosed with moderate OSA. The apneas are underlined in red. The areas where the channel NAF goes relatively flat...and the snoring stops... represents the periods where this patent is not breathing. Each apnea is around 20 second long.

[edit] Text removed from article

I removed the following text from the article because it reads like an advert -- The Anome 14:34, 8 December 2005 (UTC)

The latest device for screening sleep apnea patients is called the SleepStrip. Israel's Technion University Sleep Lab in conjunction with SLP, Ltd., an Israeli sleep lab sensor manufacturer developed the SleepStrip as an inexpensive screening tool. The SleepStrip is a disposable, at-home sensor, which detects when the user stops breathing and displays a score in the morning after the test is completed. The SleepStrip does not replace a lab test. It is designed to screen the millions of people who otherwise might never make it to a lab in the first place -- denial of the condition is common. The SleepStrip is the first of several products developed by SLP for at-home screening of sleep-related disorders.

[edit] "Training apnea"?

While the "obstructive" and "central" types are both established terms, I can't find good references for "Training apnea". Is this a widely recognized category? If not, perhaps it should be deleted from the article. --Arcadian 15:48, 8 December 2005 (UTC)

I have removed the following section for now, until or unless it can be validated. "(Training Apnea; informal suggestion for identification) Noted amongst a minority of active free-divers, this is the case of subjects performing apnea while sleeping, generally coincident with a related dream. Some cases have been determined to last until the point at which diaphramatic contractions occur, and are estimated to be greater than one minute in length." --Arcadian 14:08, 9 December 2005 (UTC)

[edit] How many pepole affected by this condition?

Sleep is a hard to detect condition, where only the sleeping partner may indicate it. Are their estimates as to how many people in various geographies are affected by this?

Figures of 4 percent of men and 2 percent of women are the norm. Much higher for older people. The figure for women may be understated a bit but this seems to be guess work at the moment.

[edit] Recent reversions

Dear 12.73.194-201.x: As a bit of friendly advice, you may want to take a look at Wikipedia:Why create an account?. --Arcadian 17:09, 14 December 2005 (UTC)

[edit] 3RR warning

Please do not keep undoing other people's edits without discussing them first. This is considered impolite and unproductive. If you continue, you may be blocked from editing Wikipedia under the three-revert rule, which states that nobody may revert an article to a previous version more than three times in 24 hours. (Note: this also means editing the page to reinsert an old edit. If the effect of your actions is to revert back, it qualifies as a revert.) Thank you. ≈ jossi fresco ≈ t • @ 03:45, 15 December 2005 (UTC)