Obstructive sleep apnea: from the beginnings, to the risk factors and to occupational medicine assessment

Open access

Abstract

Over the last thirty years, the pathogenesis of obstructive sleep apnea syndrome (OSAS) has begun to be elucidated worldwide due to the presence of standardized diagnostic and treatment. In adults, the clinical diagnosis may be suggestive of OSAS when symptoms like fatigue, lack of concentration, poor work performance, absenteeism, daytime sleepiness, insomnia, snoring, nocturnal respiratory distress or apnea episodes witnessed by others are present. Some medical conditions found in employees’ personal history such as craniofacial abnormalities, some endocrine diseases, arterial hypertension, especially resistant arterial hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, obesity, diabetes mellitus, cognitive dysfunction or mental disorders may be the alarm signal for OSAS. The assessment of all risk factors, clinical presentation and diagnosis must become an important part of occupational medical examinations and performed in all workers due to its major public health potential and impact on survival. The early identification of OSAS among workers performed by the occupational physician can potentially reduce the risk of work injuries and fatalities. In conclusion, OSAS is a complex entity and an important public health problem. The delay in diagnosis and treatment contributes to the increase of healthcare services demand and implicitly to general mortality.

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  • 1.Uehli K Mehta AJ Miedinger D. Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Med Rev 2014;18:61-73.

  • 2.Teculescu D. Sleeping disorders and injury prevention of occupational or domestic accidents. Sante Publique 2007;19:147–52.

  • 3.Swanson LM Arnedt JT Rosekind MR. Sleep disorders and work performance: Findings from the 2008 National Sleep Foundation Sleep in America poll. J Sleep Res 2011;20:487–94.

  • 4.Ulfberg J Carter N Talback M. Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea. Chest 1996;110:659–63.

  • 5.Teran-Santos J Jimenez-Gomez A Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander.N Engl J Med 1999; 340:847–51.

  • 6.Ellen RL Marshall SC Palayew M. Systematic review of motor vehicle crash risk in persons with sleep apnea. J Clin Sleep Med 2006;2:193–200.

  • 7.Kryger MH. Fat sleep and Charles Dickens: literary and medical contributions to the understanding of sleep apnea. Clin Chest Med 1985;6(4):555-62.

  • 8.Morgan EJ Zwillich CW. The Obesity-Hypoventilation Syndrome. West J Med 1978;129:387-93.

  • 9.Burwell CS Robin ED Whaley RD. Extreme obesity associated with alveolar hypoventilation-a Pickwickian Syndrome. Obes. Res 1994;2(4):390–7.

  • 10.Olson AL Zwillich C. The obesity hypoventilation syndrome. Am J Med 2005;118:948-56.

  • 11.Gaustaut H Tassinari CA Duron B. Polygraphic study of diurnal and nocturnal (hyponic and respiratory) episodal manifestations of pickwick syndrome. Rev. Neurol 1965;112:568-79.

  • 14.Thorpy M. Historical perspective on sleep and man. In: Culebras A (ed.). Sleep disorders and neurological disease New York: Marcel Dekker; 2000 p. 1-36.

  • 15.Sullivan CE Issa FG Berthon-Jones M Eves L. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862-5.

  • 16.Young T Evans L Finn L. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705–6.

  • 17.Kapur V Strohl KP Redline S. Underdiagnosis of sleep apnea syndrome in US communities. Sleep Breath 2002;6:49–54.

  • 18.Sharma SK Katoch VM Mohan A. Consensus and evidence-based INOSA Guidelines 2014 (first edition). Indian J Med Res 2014;140:451.

  • 19.Young T Skatrud J Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA 2004;291:2013-6.

  • 20.Chervin RD. Sleepiness fatigue tiredness and lack of energy in obstructive sleep apnea. Chest. 2000;118:372–9.

  • 21.Shepertycky MR Banno K Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 2005;28:309–14.

  • 22.Young T Hutton R Finn L. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996;156:2445–51.

  • 23.Breugelmans JG Ford DE Smith PL. Differences in patient and bed partner-assessed quality of life in sleep-disordered breathing. Am J Respir Crit Care Med 2004;170:547–52.

  • 24.Tasali E Ip MSM. Obstructive sleep apnea and metabolic syndrome: alterations of glucose metabolism and inflammation. Proc Am Thorac Soc 2008;5:207-17.

  • 25.Eikermann M Jordan AS Chamberlin NL. The influence of aging on pharyngeal collapsibility during sleep. Chest 2007;131:1702-9.

  • 26.Ong KC Clerk AA. Comparison of the severity of sleep-disordered breathing in Asian and Caucasian patients seen at a sleep disorders center. Respir Med 1998;92:843–8.

  • 27.Li KK Kushida C Powell NB. Obstructive sleep apnea syndrome: a comparison between Far-East Asian and white men. Laryngoscope 2000;110:1689–93.

  • 28.Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proc Am Thorac Soc 2008;5:136–43.

  • 29.Bixler EO Vgontzas AN Lin HM. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med 2001;163:608–13.

  • 30.Shahar E Redline S Young T. Hormone replacement therapy and sleep-disordered breathing. Am J Respir Crit Care Med 2003;167:1186-92.

  • 31.Romero-Corral A Caples SM Lopez-Jimenez F. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest 2010;137:711-9.

  • 32.Mihăicuţă S. Curs practic de somnografie. Timişoara: Ed. Victor Babes; 2010 p. 115-24.

  • 33.Frey WC Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003;13:676-83.

  • 34.Schwartz AR Patil SP Laffan AM. Obesity and obstructive sleep apnea – pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc 2008;5:185-92.

  • 35.Miyazaki M Kim YC Gray-Keller MP. The biosynthesis of hepatic cholesterol esters and triglycerides is impaired in mice with a disruption of the gene for stearoyl-CoA desaturase 1. J Biol Chem 2000;275:30132–8.

  • 36.Ntambi JM Miyazaki M Stoehr JP. Loss of stearoyl-CoA desaturase-1 function protects mice against adiposity. Proc Natl Acad Sci U S A 2002;99:11482–6.

  • 37.Foster GD Sanders MH Millman R. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care 2009;32:1017–9.

  • 38.Schwab RJ Goldberg AN Pack AI. Sleep Apnea Syndromes. In: Fishman AP (ed). Fishman’s Pulmonary Diseases and Disorders. New York: McGraw Hill Book Company; 1998 p.1617-37.

  • 39. Zhou XS Shahabuddin S Zahn BR. Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep. J Appl Physiol 2000;89(1):192-9.

  • 40.Dancey DR Hanly PJ Soong C. Gender differences in sleep apnea: the role of neck circumference. Chest 2003;123:1544–50.

  • 41.Kohler M Bloch KE Stradling JR. The role of the nose in the pathogenesis of obstructive sleep apnoea and snoring. Eur Respir J 2007;30:1208-15.

  • 42.Nuckton TJ Glidden DV Browner WS. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep 2006;29:903-8.

  • 43.Gaudette E Kimoff RJ. Pathophysiology of OSA. Eur Respir Monogr 2010;50:31-50.

  • 44.Redline S Tishler PV. The genetics of sleep apnea. Sleep Med Rev 2000;4:583-602.

  • 45.Kaparianos A Sampsonas F Karkoulias K. Obstructive sleep apnoea syndrome and genes. Neth J Med 2006;64:280-9.

  • 46.Lin YN Li QY Zhang XJ. Interaction between smoking and obstructive sleep apnea: not just participants. Chin Med J (Engl) 2012;125:3150-6.

  • 47.Lam JC Sharma SK Lam B. Obstructive sleep apnoea: definitions epidemiology & natural history. Indian Journal of Medical Research 2010;131:165.

  • 48.Mitler MM Dawson A Henriksen SJ. Bedtime ethanol increases resistance of upper airways and produces sleep apneas in asymptomatic snorers. Alcohol Clin Exp Res 1998;12:801-5.

  • 49.Maasilta P Bachour A Teramo K. Sleep-related disordered breathing during pregnancy in obese women. Chest 2001;120:1448–54.

  • 50.Izci B Vennelle M Liston WA. Sleep-disordered breathing and upper airway size in pregnancy and post-partum. Eur Respir J 2006;27:321–7.

  • 51.Sahin FK Koken G Cosar E. Obstructive sleep apnea in pregnancy and fetal outcome. Int J Gynaecol Obstet 2008;100:141-6.

  • 52.Farah L Lazenby AJ Boots LR. Prevalence of polycystic ovary syndrome in women seeking treatment from community electrologists: Alabama Professional Electrology Association Study Group. J Reprod Med 1999;44:870–4.

  • 53.Azziz R Woods KS Reyna R. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745–9.

  • 54.Vgontzas AN Legro RS Bixler EO. Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab 2001;86:517–20.

  • 55.Fogel RB Malhotra A Pillar G. Increased prevalence of obstructive sleep apnea syndrome in obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 2001;86:1175–80.

  • 56.Gopal M Duntley S Uhles M Attarian H. The role of obesity in the increased prevalence of obstructive sleep apnea syndrome in patients with polycystic ovarian syndrome. Sleep Med 2002;3:401–4.

  • 57.Pelttari L Rauhala E Polo O. Upper airway obstruction in hypothyroidism. J Intern Med 1994;236:177–81.

  • 58.Grunstein RR Sullivan CE. Sleep apnea and hypothyroidism: mechanisms and management. Am J Med 1988;85:775–9.

  • 59.Guilleminault C Kirisoglu C Poyares D. Upper airway resistance syndrome: A long-term outcome study. J Psychiatr Res 2006;40:273–9.

  • 60.Berry RB Gamaldo CE Harding SM. The AASM manual for the scoring of sleep and associated events: rules terminology and technical specifications: version 2.0.3. American Academy of Sleep Medicine. 2014.

  • 61.Sateia MJ. International classification of sleep disorders. Chest

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