Learning Objectives
Upon completion of this Continuing Education Course, you will be able to:

• Identify and discuss the key elements of what is referred to as Sleep Disordered Breathing
• Describe the prevalence, pathophysiology, and diagnostic techniques associated with each of the key elements of SDB
• Discuss the various treatments and their outcomes associated with each element

Introduction

Humans spend almost 30% of their lives sleeping. Over the past 30 years, physicians have begun to recognize many of the detrimental consequences of sleep disturbances produced by abnormal breathing patterns termed sleep-disordered breathing (SDB). Sleep apnea and other sleep-related breathing disorders constitute the greatest number of sleep disorders seen by pulmonologists as well as general practitioners in the outpatient setting. Besides being a common disorder, SDB also has been associated with considerable morbidity. Therefore, a basic understanding of this prevalent disease state is essential for the practicing physician.

SDB refers to a wide spectrum of sleep-related breathing abnormalities; those related to increased upper airway resistance include snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea-hypopnea syndrome (OSAHS). Many authors regard SDB as a continuum of a spectrum of diseases. This concept suggests that an individual who snores may be exhibiting the first manifestation of SDB and that snoring should not be viewed as normal. A patient can move gradually through the continuum, for example, with weight gain and eventual development of Pickwickian syndrome. He or she also can move rapidly through the spectrum through alcohol or sedative use, which can cause an individual who snores to turn into a snorer with obstructive sleep apnea (OSA). Additionally, although continuous positive airway pressure may be effective in the treatment of apnea, the individual may be left with continued residual UARS or snoring. Therefore, the clinician must recognize the continuum state of this disease entity because patients may continue to suffer from symptoms due to one aspect of SDB while being treated for another aspect of SDB.