Page 210 - Cardiac Nursing

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186 PA R T I I / Physiologic and Pathologic Responses
DISPLAY 8-2 International Classification of Sleep Disorders (continued)
Propriospinal myoclonus at sleep onset Sleep-related gastroesophageal reflux disease
Excessive fragmentary myoclonus Sleep-related coronary artery ischemia
Sleep-related abnormal swallowing, choking,
Other Sleep Disorders and laryngospasm
Other physiological (organic) sleep disorder
Other sleep disorder not due to substance or known Appendix B: Other Psychiatric and Behavioral
physiological condition Disorders Frequently Encountered in the
Environmental sleep disorder Differential Diagnosis of Sleep Disorders
Mood disorders
Appendix A: Sleep Disorders Associated With Anxiety disorders
Conditions Classifiable Elsewhere
Somatoform disorders
Fatal familial insomnia Schizophrenia and other psychotic disorders
Fibromyalgia Disorders usually first diagnosed in infancy, childhood,
Sleep-related epilepsy or adolescence
Sleep-related headaches Personality disorders
From AASM. (2005). The international classification of sleep disorders. Westchester, IL: American Academy of Sleep Medicine.
severe; however, it can be debilitating, causing a broad range of neu- lar impact of sleep in obstructive sleep apnea (OSA), central sleep ap-
ropsychological deficits affecting daytime functioning and quality nea (CSA), and snoring/upper airway resistance syndrome (UARS).
of life. EDS can even be life threatening because of associated alter-
ations in alertness and reactivity. 124–130 Increased napping has also Obstructive Sleep Apnea
been associated with increased mortality in the elderly. 137,138 Patients with sleep apnea repeatedly stop breathing during sleep
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for periods of 10 seconds or longer (Fig. 8-7). Apnea can be ob-
SLEEP-RELATED DISORDERED structive (a collapsed upper airway blocks airflow despite effort to
BREATHING breathe), central (no respiratory effort), or mixed (central, then
obstructive component). A predominance of obstructive apnea is
Sleep-related changes in breathing and oxygenation have important the most common pattern and can lead to repetitive episodes of
cardiovascular consequences. This section focuses on the cardiovascu- hypoxemia that are terminated by brief arousals. Typical patients
■ Figure 8-7 Recording of multiple
physiologic signals in a formal polysomno-
graphic sleep evaluation. In this example,
the patient has an obstructive apnea with
cessation of oral and nasal airflow despite
effort to breathe. The interrupted breath-
ing is accompanied by a decrease in oxygen
saturation and slowing of the heart rate
and is followed by an arousal. ECG, elec-
trocardiogram; EEG, electroencephalo-
gram; EMG, electromyogram; EOG,
electro-oculogram. (From White, D. [1992].
Obstructive sleep apnea. Hospital Practice,
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27[5A], 68.)
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