Sleep Medicine in Critical Care Medicine: Diagnosis and Practical Approach

Contents
Preface
Chapter 1
Prevalence of Sleep-Disordered  Breathing (SDB) in Patients with  Mechanical Ventilation
	Abstract
	1. Introduction
	2. Sleep Disordered Breathing
	3. Prevalence of OSA in ICU
	4. Postoperative Prolonged Mechanical Ventilation in ICU in Obstructive Sleep
	Apnea Patients
	Conclusion
	References
Chapter 2
Interaction of Sleep- Disordered Breathing  and Mechanical Ventilation
	Abstract
	Key Points
	References
Chapter 3
Respiratory Muscles  (Inspiratory, Expiratory) and  Sleep Disordered-Breathing
	Abstract
Introduction
	Diaphragm
	Respiration
	Muscles of Respiration
		Impact of Increased Load on the Respiratory Muscle Pump
		Obesity Hypoventilation Syndrome
		Contributory Factors during Sleep
		Obstructive Sleep Apnoea
	Conclusion
	References
Chapter 4
The Importance of Upper  Airways Features in Sleep  Breathing Disorders
	Abstract
	Key Points
	Introduction
	Adult OSA Patients
		Clinical Investigation
		Correlation between UA Clinical Examination and UA Anatomical Collapsibility
	Pediatric OSA Patients
		Clinical Investigation
	Final Considerations
	References
Chapter 5
Devices for Diagnosis  of Sleep Breathing Disorders
	Abstract
	Introduction
		Type IV Studies
		Two-Channel Type IV Sleep Studies
		Other Type IV Studies
		Single-Channel Type IV Sleep Studies
		Type III Studies
		Type II and I Studies
		PAT
		Monitoring of Carbon Dioxide
	Conclusion
	References
Chapter 6
How to Diagnose Sleep-Related Breathing Disorders outside the Sleep Laboratory
	Abstract
	Introduction
	Technologies to Diagnose  Sleep-Disordered Breathing
		Polysomnography
			Disadvantages of Polysomnography
		Classification of Diagnostic Devices for Sleep Disordered Breathing
		Polysomnography Outside the Sleep Laboratory
			Unattended PSG
		Portable Respiratory Polygraphy (Type 3 Devices)
		Nocturnal Pulse-Oximetry and Type 4 Devices
			Agreement of Pulse Oximetry Parameters with PSG-Derived AHI
			The Oximetry Trace
			The Heart Rate Trace
			Pulse Oximetry in Patients with Underlying Lung Disease
		Nocturnal Transcutaneous Capnography
		Peripheral Arterial Tonometry to Diagnose Sleep-Related  Breathing Disorders
	Conclusion
	References
Chapter 7
Hypoxic and Hypercapnic  Respiratory Failure:  Implications for Sleep Medicine,  Diagnosis and Practical Approach
	Abstract
	Introduction
	Obesity Hypoventilation Syndrome
	Chronic Obstructive Pulmonary Disease (COPD)
	Neuromuscular Disorders
	Conclusion
	Key Points
	References
Chapter 8
Intermittent Hypoxia, Sympathetic Activity and Oxidative Stress in OSA and CPAP Effects
	Abstract
	Introduction
	Intermittent Hypoxia in OSA
		Intermittent Hypoxia and Sympathetic Activity and Hypertension
		CPAP Effects on Sympathetic Activity and Blood Pressure in OSA
		The Effects of Intermittent Hypoxia and CPAP on the Cardio-  and Cerebrovascular System
		Intermittent Hypoxia and Oxidative Stress
		CPAP Effects on Oxidative Stress in OSA
	Role of Intermittent Hypoxia in  the Critically-Ill Patient
	References
Chapter 9
Effect of CPAP on Cognition  and Brain Function
	Abstract
	Introduction
	CPAP Therapy
	References
Chapter 10
Effect of CPAP on Co-Morbidities  (Cardiac, Renal and Liver)
	Abstract
	Cardiac Co-Morbidities
		Arterial Hypertension
		Heart Failure
		Atrial Fibrillation
		Myocardial Infarction
	Renal Co-Morbidities
	Liver Co-Morbidities
	References
Chapter 11
Nasal High Flow Therapy
	Abstract
	Introduction
	Physiological Benefits of High Flow Therapy
		Effects Related to High Flow Air Delivery
		Effects Related to Warmth and Humidified Air Delivery
		Effects of High Flow Therapy on ventilation
	Current Use of High Flow Therapy
		In the Hospital Setting
		In the Home Setting
	The Use of High Flow Therapy during Sleep
		High Flow Therapy in Patients with Sleep Apnea
		High Flow Therapy in Patients with Nocturnal Hypoxemia
	Conclusion
	References
Chapter 12
Options of Mechanical Ventilation in Sleep Related Breathing Disorders: Non-Invasive Mechanical Ventilation
	Abstract
	Introduction
		Delivery of Non-Invasive Ventilation
			Interface
			Image of the Human Head by Patrick J. Lynch Reproduced from Wikimedia Commons under CC BY 2.5 Licence
			Circuit
			Ventilator Modes and Settings
			Trigger
			Humidification
			Supplementary Oxygen
			Location of NIV Setup
			Monitoring during NIV Delivery
			Troubleshooting
				Patient Selection
			Unintentional Leak
				Patient-ventilator Asynchrony
				Skin Breakdown
				Use of Analgesia or Sedation
		NIV in the Management of Sleep-Related Breathing Disorders
			Obstructive Sleep Apnoea
			Obesity Hypoventilation Syndrome
			Central Sleep Apnoea
			Neuromuscular Disease
				Amyotrophic Lateral Sclerosis
				Other Neuromuscular Diseases and Chest Wall Disease
				COPD
	Conclusion
	References
Chapter 13
Patterns of Response to Non-Invasive Positive Pressure Ventilation (NIPPV) in Sleep-Related Breathing Disorders
	Abstract
	Abbreviations
	Introduction
	Positive Airway Pressure
		CPAP
		Automatic Adjustment of the Level of Continuous Positive Airway Pressure
		Bilevel
		Average Volume-Assured Pressure Support Ventilation (AVAPS)
		Volume-Targeted Ventilation (VTV)
		Pressure-Targeted Ventilation (PTV)
		Adaptive Servo-Ventilation (ASV)
	Clinical Implications
		Management of Non-Invasive Ventilation
			Patient-Ventilator Desynchrony
		Influence of Type of Exhalation Device and Connecting Circuits
		Effect of Dead Space
		The Choice of the Mask
		Influence of Unintentional Leaks
		Influence of the Upper Airway
	Conclusion
	References
Chapter 14
Non-Invasive Ventilation in Obesity Hypoventilation Syndrome
	Abstract
	Introduction
		Definition and Diagnosis of OHS
		Epidemiology
	Pathophysiology of Obesity and OHS
	Clinical Presentation and Comorbidities  in Patients with OHS
	Acute Hypercapnic Respiratory Failure in OHS
		Prognosis of OHS Patients Treated for AHRF
	Treatment of Stable OHS
		Positive Airway Pressure (PAP) Treatment
		Oxygen Therapy
		Weight Reduction Strategies
	Key Points
	References
Chapter 15
Sleep-Related Breathing Disorders  in Chronic Neuromuscular Diseases
	Abstract
	Abbreviations
	Introduction
	Pathophysiology
		Hypoventilation
		Diaphragmatic or Pseudo-Central Events
		Central Events
		Obstructive Events
	Diagnosis
	Treatment
	Key Points
	References
Chapter 16
Sleep-Related Breathing Disorders:  Invasive Mechanical Ventilation  (Non-Perioperative)
	Abstract
	1. Introduction
	2. Sleep Related Breathing Disorders  and Ventilator Modes
		2.1. Invasive Mechanical ventilation
		2.2.Ventilator Modes and Sleep
			2.2.1. Pressure Support Ventilation, Assist Control Ventilation:
			2.2.2. Proportional Assist Ventilation
			2.2.3. Neurally Adjusted Ventilatory Assist
	Conclusion
	References
Chapter 17
Airway Management in Sleep-Related Breathing Disorders:
Key Practical Approach
	Abstract
	Introduction
	Preoperative Assessment
	Intraoperative Assessment
	Upper Airway Edema and Fluid Management
	Key Points
	References
Chapter 18
Analgesia/Sedation Mechanical Ventilation: Key Practical Approach
	Abstract
	Pre-Operative Assessment
	Checklists
	Principles of Sedation
	Principles of Analgesia
	References
	Appendix
Chapter 19
Post-Operative Management  and Clinical Results
	Abstract
	Introduction
	Respiratory Conditions
	Cardiovascular Conditions
	Postanesthesia Care
	Postoperative Follow – Up
	Other Conditions
	Key Points
	References
Chapter 20
Extubation and Reintubation Failure:  Impact of Sleep Disordered Breathing
	Abstract
	Abbreviations
	Introduction
	Summary and Recommendation
	References
Chapter 21
Difficult Weaning and Ventilator  Dependent Patients:  Key Practical Recommendations
	Abstract
	Introduction
	Weaning Classification
	The Weaning Process
	Complex Weaning
		Physiological
			Respiratory Muscle Load
			Respiratory Capacity
			Respiratory Drive
			Cardiac
		Clinical
			Ventilation Associated Pneumonia (VAP)
			Physical Rehabilitation
			Nutrition
		Psychological
	Logistical Factors in the Management  of Prolonged Weaning
	References
Chapter 22
Prolonged Mechanical Ventilation:  How to Diagnose and Treat Sleep-Related Breathing Disorders
	Abstract
	Introduction
	Prolonged Mechanical Ventilation
	Sleep-Disordered Breathing
	Diagnosis of Sleep-Disordered Breathing  in Prolonged Mechanical Ventilation
	Other Diagnostic Options
	Potential Factors Associated with  the Presence of Sleep-Disordered Breathing  in Prolonged Mechanical Ventilation
	Treatment of Sleep-Disordered Breathing  in Prolonged Mechanical Ventilation
	Conclusion
	Key Points
	References
Chapter 23
The Role of Tracheostomy in  Short- and Long-Term Mechanical Ventilation: Implications and Effects
	Abstract
	Introduction
	Tracheostomy in Critically Ill Patients
	Tracheostomy in Patients with  Chronic Respiratory Failure
	Key Points
	References
Chapter 24
Sleep Disordered Breathing Disorders: Implications for Patient, Family, Physicians  and Other Caregivers
	Abstract
	Introduction
	Implication of Sleep Disordered Breathing  Disorders on the Patient
		Health Implications of Obstructive Sleep Apnoea for the Patient
		Obstructive Sleep Apnoea and Hypertension
		Obstructive Sleep Apnoea and Atrial Fibrillation
		Obstructive Sleep Apnoea and Heart Failure
		Obstructive Sleep Apnoea and Ischaemic Heart Disease
		Obstructive Sleep Apnoea and Pulmonary Hypertension
		Obstructive Sleep Apnoea and Stroke
		Obstructive Sleep Apnoea and Diabetes
		Obstructive Sleep Apnoea and the Liver
		Obstructive Sleep Apnoea and the Metabolic Syndrome
		Obstructive Sleep Apnoea and the Kidney
	OSA and Mortality
	Obstructive Sleep Apnoea and Sexual Function
	Obstructive Sleep Apnoea and Mood Disorder/ Neuropsychiatric Disorders
	Obstructive Sleep Apnoea and Perioperative Risk
		Social Implications of Obstructive Sleep Apnoea on the Patient
	Sleep Disordered Breathing and the Work Place
	OSA and Driving
	OSA and Travelling
	Implications of Sleep Disordered Breathing  Disorders on Partners and Family
		Effect of Untreated OSA on partners
		Effect of OSA Therapies on Partners’ Sleep and Daytime Functioning
		Impact of OSA on family
		OSA; Implication on Physicians and Care givers
	Conclusion
	References
About the Editors
Index
Blank Page