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Published ahead of print on November 10, 2005, doi:10.1164/rccm.200509-1478OE

Am. J. Respir. Crit. Care Med., Volume 173, Number 1, January 2006, 7-15

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Submitted on September 21, 2005
Accepted on November 9, 2005

Advances in Sleep-Disordered Breathing

Allan I Pack1*

1 Department of Medicine, Division of Sleep Medicine, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania School of Medicine, Philadelphia, PA, United States

* To whom correspondence should be addressed. E-mail: pack{at}mail.med.upenn.edu.

Since the original clarification of the obstructive nature of OSA in 1965, much has been learned about the disorder. It is a condition with a high prevalence with obesity as a major risk factor. It aggregates in families, a relationship that is not simply explained by obesity. Pre-menopausal women are relatively protected from the disorder with OSA being uncommon in this group. Its prevalence in women rises after menopause. While OSA is a risk factor for excessive sleepiness, there is developing evidence that it is also a risk factor for hypertension, acute cardiovascular events and insulin resistance. The first line of therapy is nasal continuous positive airway pressure (CPAP). Data as to the efficacy of CPAP in severe OSA have come from randomized, placebo-controlled clinical trials with the end-points being sleepiness, quality of life and 24-hour ambulatory blood pressure. Data are currently less convincing for treatment outcomes in mild-to-moderate OSA, and new clinical trials to assess outcomes in this group are underway. Thus, even though this field only began towards the end of the first century of the American Thoracic Society, substantial progress has been made, and OSA has increasingly emerged as a major public health concern.
Key words: Obstructive sleep apnea, Obesity, Hypertension, Metabolic Syndrome, Sleep




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