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{{Sleep apnea}}
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{{CMG}}; {{AE}} {{JH}}
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D.


==Overview==
==Overview==
The American Academy of Sleep Medicine published a diagnostic manual guidelines.<ref name="pmid23066376">{{cite journal| author=Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK et al.| title=Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. | journal=J Clin Sleep Med | year= 2012 | volume= 8 | issue= 5 | pages= 597-619 | pmid=23066376 | doi=10.5664/jcsm.2172 | pmc=PMC3459210 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23066376  }} </ref><ref name="pmid19960649">{{cite journal| author=Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP et al.| title=Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. | journal=J Clin Sleep Med | year= 2009 | volume= 5 | issue= 3 | pages= 263-76 | pmid=19960649 | doi= | pmc=PMC2699173 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19960649}}</ref>
The diagnosis of sleep apnea is is listed in the DSM-V guidelines using one of two indices, Apnea Hyponea Index (AHI) or Respiratory Disturbance Index (RDI).


==Diagnosis Criteria==
==Sleep Apnea Diagnosis Criteria==
The common indices used to assess breathing are Apnea Hyponea Index (AHI) and Respiratory Disturbance Index (RDI)
*AHI is the number of apneas or hypopneas recorded during the study per hour of sleep
*RDI is the average number of respiratory disturbances (obstructive apneas, hypopneas, and respiratory event-related arousals [RERAs]) per hour.


===DSM-V Diagnostic Criteria for Central Sleep Apnea===  
 
:*None/Minimal: < 5 per hour
:*Mild: ≥ 5, but < 15 per hour
:*Moderate: ≥ 15, but < 30 per hour
:*Severe: ≥ 30 per hour
 
===DSM-V Diagnostic Criteria for Central Sleep Apnea<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===  


Either criterion 1 or 2 must be met:
Either criterion 1 or 2 must be met:


1. Evidence by polysomnography of at least five obstructive apneas or hypopneas per hour of sleep and either of the following sleep symptoms:
1. Evidence by polysomnography of AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour of sleep and either of the following sleep symptoms:
 
*Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
*Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
*Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.
*Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.


2. Evidence by polysomnography of 15 or more obstructive apneas and/or hypopneas per hour of sleep regardless of accompanying symptoms.
2. Evidence by polysomnography of AHI or RDI greater than or equal to 15 events per hour of sleep regardless of accompanying symptoms
*Apnea Hypopnea Index (AHI) - the number of apneas or hypopneas recorded during the study per hour of sleep
*Based on the AHI, the severity of OSA is classified as follows:
:*None/Minimal: AHI < 5 per hour
:*Mild: AHI ≥ 5, but < 15 per hour
:*Moderate: AHI ≥ 15, but < 30 per hour
:*Severe: AHI ≥ 30 per hour
 
*The RDI is  the average number of respiratory disturbances (obstructive apneas, hypopneas, and respiratory event–related arousals [RERAs]) per hour.
 
 


===DSM-V Diagnostic Criteria for Central Sleep Apnea<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===
===DSM-V Diagnostic Criteria for Central Sleep Apnea<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===
{{cquote|
A. Evidence by polysomnography of five or more central apneas per hour of sleep.
'''''AND'''''
B. The disorder is not better explained by another current sleep disorder.
Specify whether:
* Idiopathic central sleep apnea: Characterized by repeated episodes of [[apnea]]s and [[hypopnea]]s during sleep caused by variability in respiratory effort but without evidence of airway obstruction.
* Cheyne-Stokes breathing: A pattern of periodic crescendo-decrescendo variation in tidal volume that results in central apneas and hypopneas at a frequency of at least five events per hour, accompanied by frequent arousal.


* Central sleep apnea comorbid with opioid use: The pathogenesis of this subtype is attributed to the effects of [[opioids]] on the respiratory rhythm generators in the [[medulla]] as well as the differential effects on [[hypoxic]] versus hypercapnic respiratory drive.
Criterion 1 and 2 must be met:
1.Evidence by polysomnography of AHI or RDI greater than or equal to 5 events per hour of sleep


Specify current severity:
2. The disorder is not better explained by another current sleep disorder
: Severity of central sleep apnea is graded according to the frequency of the breathing disturbances as well as the extent of associated oxygen desaturation and sleep fragmentation that occur as a consequence of repetitive respiratory disturbances.
}}


==References==
==References==

Revision as of 17:46, 7 July 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Saarah T. Alkhairy, M.D.

Overview

The diagnosis of sleep apnea is is listed in the DSM-V guidelines using one of two indices, Apnea Hyponea Index (AHI) or Respiratory Disturbance Index (RDI).

Sleep Apnea Diagnosis Criteria

The common indices used to assess breathing are Apnea Hyponea Index (AHI) and Respiratory Disturbance Index (RDI)

  • AHI is the number of apneas or hypopneas recorded during the study per hour of sleep
  • RDI is the average number of respiratory disturbances (obstructive apneas, hypopneas, and respiratory event-related arousals [RERAs]) per hour.


  • None/Minimal: < 5 per hour
  • Mild: ≥ 5, but < 15 per hour
  • Moderate: ≥ 15, but < 30 per hour
  • Severe: ≥ 30 per hour

DSM-V Diagnostic Criteria for Central Sleep Apnea[1]

Either criterion 1 or 2 must be met:

1. Evidence by polysomnography of AHI or RDI greater than or equal to 5 and less than or equal to 14 events per hour of sleep and either of the following sleep symptoms:

  • Nocturnal breathing disturbances: snoring, snorting/gasping, or breathing pauses during sleep.
  • Daytime sleepiness, fatigue, or unrefreshing sleep despite sufficient opportunities to sleep that is not better explained by another mental disorder (including a sleep disorder) and is not attributable to another medical condition.

2. Evidence by polysomnography of AHI or RDI greater than or equal to 15 events per hour of sleep regardless of accompanying symptoms

DSM-V Diagnostic Criteria for Central Sleep Apnea[1]

Criterion 1 and 2 must be met: 1.Evidence by polysomnography of AHI or RDI greater than or equal to 5 events per hour of sleep

2. The disorder is not better explained by another current sleep disorder

References

  1. 1.0 1.1 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.

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