Outcomes Data for Continuous Positive Airway Pressure Treatment: What Do We Really Know?

Obstructive sleep apnea is one of the most common chronic respiratory illnesses, causing daytime sleepiness and cognitive and cardiovascular morbidity. The most successful treatment has been with positive airway pressure (continuous positive airway pressure or bilevel positive airway pressure). It has been surprisingly difficult to demonstrate improvement in these outcomes with continuous positive airway pressure treatment.

Obstructive Sleep Apnea: Treatment with Positive Airway Pressure.

As in other adults, continuous positive airway pressure treatment for obstructive sleep apnea should be the mainstay of treatment. Benefits include improvements in sleepiness and quality of life, as well as improvements in hypertension control, arrhythmias, cardiovascular risk, and mortality. This article discusses issues in prescribing this treatment, including those related specifically to elderly individuals.

Normal and Abnormal Sleep in the Elderly.

Sleep-related complaints are so common in older adults that it may be difficult to distinguish whether the complaint is a consequence of normal aging or a disease process. The elderly are more likely to have common medical problems that affect sleep, and the most common sleep problems, including sleep apnea and insomnia, are more prevalent in this demographic. This article briefly describes normal sleep in general, the clinical assessment of sleep complaints, and expected changes with aging, with an overview of the epidemiology of insomnia and sleep apnea in this age group.

Sleep in the Elderly: Unanswered Questions.

Sleep normally changes with aging, with implications for healthy elderly individuals as well as for those with disease states. Less slow wave sleep (deep sleep) is expected, along with more awakenings, and a tendency toward earlier sleep times. Rapid eye movement sleep behavior disorder is seen primarily in elderly individuals, and it often represents the earliest sign of a chronic and progressive neurologic disease.

Sleep in the intensive care unit.

Sleep is commonly disrupted in intensive care unit patients. The causes of this sleep disruption include the underlying medical illness itself, intensive care unit (ICU) environment, psychological stress, and effects of many medications and other treatments used to help those who are critically ill. The purpose of this review is to discuss the relevant literature in this regard, in order to improve the knowledge and recognition of this problem by health care providers.

Smoking and sleep disorders.

Cigarette smoking is the most important cause of preventable disease, disability, and premature death in the United States. In addition to adverse effects on respiratory, cardiovascular, cerebrovascular, and other systems, accumulating evidence indicates that cigarette smoking may also increase morbidity by adversely affecting sleep. This article focuses on the effects of cigarette smoking, nicotine, and pharmacologic agents used for smoking cessation on neuronal systems regulating sleep and clinically apparent sleep disorders.

Sleep in the elderly. What is normal?

Sleep is a basic biologic function that changes with normal aging and in many pathologic states. Some of the changes with aging are so profound that it is difficult to separate normal aging from disease. The problem is made worse by the difficulty of recognizing many common sleep disorders.