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OSAS: The Magnitude of the Problem

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Abstract

Obstructive sleep apnea syndrome (OSAS) is more frequently diagnosed than in the past. Epidemiological studies have confirmed a high prevalence of the disease in middle-aged adults but also in the elderly. The characteristics of this potentially life-threatening disorder are snoring loudly, excessive daytime sleepiness, disturbed memory and concentration as well as cardiovascular and metabolic morbidity. Moreover, a large percentage of individuals suffer from OSAS without overt daytime symptoms. Obesity, gender, age and race are all important risk factors for OSAS. Moreover, smoking and alcohol consumption appear to increase the occurrence of the disorder. OSAS is a heterogeneous problem that may not conform to the typical history and physical findings in the presence of other disorders.

OSAS also represents a serious economic burden for the patient, their employers and the social healthcare system. Finally, it represents a serious hazard for drivers, their passengers and innocent bystanders. This data may emphasise the importance of the early detection of OSAS and the need for adequate treatment.

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References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.

    CAS  PubMed  Google Scholar 

  2. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. A population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.

    PubMed  Google Scholar 

  3. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance – United States, 1971–2000. MMWR. 2002;51:1–16.

    Google Scholar 

  4. Lindberg A, Jonsson AC, Rönmark E, et al. Prevalence of chronic obstructive pulmonary disease according to BTS, ERS, GOLD and ATS criteria in relation to doctor’s diagnosis, symptoms, age, gender, and smoking habits. Respiration. 2005;72:471–9.

    PubMed  Google Scholar 

  5. Von Mutius E, Martinez FD, Fritzsch C, Nicolai T, Roell G, Thiemann H. Prevalence of asthma and atopy in two areas of West and East Germany. Am J Respir Crit Care Med. 1994;149:358–64.

    Google Scholar 

  6. Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med. 1999;159:502–7.

    CAS  PubMed  Google Scholar 

  7. Marin JM, Crrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–53.

    PubMed  Google Scholar 

  8. Valipour A, Lothaller H, Rauscher H, Zwick H, Burghuber OC, Lavie P. Gender-related differences in symptoms of patients with suspected breathing disorders in sleep: a clinical population study using the sleep disorders questionnaire. Sleep. 2007;30(3):312–9.

    PubMed  Google Scholar 

  9. Bixler EO, Vgontzas AN, Ten Havre T, et al. Effects of age on sleep apnea in men: prevalence and severity. Am J Respir Crit Care Med. 1998;157:144–8.

    CAS  PubMed  Google Scholar 

  10. Durán J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163:685–9.

    PubMed  Google Scholar 

  11. McNicholas WT, Bonsignore MR. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur Respir J. 2007;29:156–78.

    CAS  PubMed  Google Scholar 

  12. Report of a Task Force of the American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89.

    Google Scholar 

  13. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  14. Verbraecken J, De Backer W. Upper airway mechanics. Respiration. 2009;78:121–33.

    PubMed Central  PubMed  Google Scholar 

  15. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep. Update of the 2007 AASM Manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012;8(5):597–619.

    PubMed Central  PubMed  Google Scholar 

  16. Epstein LJ, Kristo D, Strollo Jr PJ, et al. Clinical guidelines for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.

    PubMed  Google Scholar 

  17. Ayappa I, Norman RG, Krieger AC, Rosen A, O’malley RL, Rapoport DM. Non-Invasive detection of respiratory effort-related arousals (REras) by a nasal cannula/pressure transducer system. Sleep. 2000;23(6):763–71.

    CAS  PubMed  Google Scholar 

  18. Iber C, Ancoli-Israel S, Chesson AL, et al. The AASM Manual for the scoring of sleep and associated events: rules, terminology and technical specifications. AASM Manual for scoring sleep. AASM, Westchester, IL, USA. 2007.

    Google Scholar 

  19. Gold AR, et al. The symptoms and signs of upper airway resistance syndrome. A link to the functional somatic syndromes. Chest. 2003;123:87–95.

    PubMed  Google Scholar 

  20. Bao G, Guilleminault C. Upper airway resistance syndrome – one decade later. Curr Opin Pulm Med. 2004;10:461–7.

    PubMed  Google Scholar 

  21. Piper AJ. Nocturnal hypoventilation – identifying and treating syndromes. Indian J Med Res. 2010;131:350–65.

    PubMed  Google Scholar 

  22. Mokhlesi B. Obesity hypoventilation syndrome: a state-of-the-art review. Respir Care. 2010;55:1347–65.

    PubMed  Google Scholar 

  23. Berger KI, Goldring RM, Rapoport DM. Obesity hypoventilation syndrome. Semin Respir Crit Care Med. 2009;30:253–61.

    PubMed  Google Scholar 

  24. Berger KI, Ayappa I, Chatr-Amontri B, et al. Obesity hypoventilation syndrome as a spectrum of respiratory disturbances during sleep. Chest. 2001;120:1231–8.

    CAS  PubMed  Google Scholar 

  25. Stradling JR, Davies RJ. Sleep. 1: Obstructive sleep apnoea/hypopnoea syndrome: definitions, epidemiology, and natural history. Thorax. 2004;59:73–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  26. Stradling JR, Barbour C, Glennon J, Langford BA, Crosby JH. Prevalence of sleepiness and its relation to autonomic evidence of arousals and increased inspiratory effort in a community based population of men and women. J Sleep Res. 2000;9:381–8.

    CAS  PubMed  Google Scholar 

  27. McNicholas WT, Bonsignore MR. Obstructive sleep apnoea. Introduction. Eur Respir Mon. 2010;50:vii–ix.

    Google Scholar 

  28. Janson C, Gislason T, De Backer W, et al. Daytime sleepiness, snoring and gastro-oesophageal reflux amongst young adults in three European countries. J Intern Med. 1995;237:277–85.

    CAS  PubMed  Google Scholar 

  29. Schmidt-Nowara WW, Coultas DB, Wiggins C, et al. Snoring in a Hispanic-American population. Risk factors and association with hypertension and other morbidity. Arch Intern Med. 1990;150:597–601.

    CAS  PubMed  Google Scholar 

  30. Lindberg E, Taube A, Janson C, et al. A 10-year follow-up of snoring in men. Chest. 1998;114:1048–55.

    CAS  PubMed  Google Scholar 

  31. Svensson M, Lindberg E, Naessen T, et al. Risk factors associated with snoring in women with special emphasis on body mass index: a population-based study. Chest. 2006;129:933–41.

    PubMed  Google Scholar 

  32. Cirignotta F, D’Alessandro R, Partinen M, et al. Prevalence of every night snoring and obstructive sleep apnoeas among 30-69-year-old men in Bologna, Italy. Acta Psychiatr Scand. 1989;79:366–72.

    CAS  Google Scholar 

  33. Franklin KA, Gislason T, Omenaas E, et al. The influence of active and passive smoking on habitual snoring. Am J Respir Crit Care Med. 2004;170:799–803.

    PubMed  Google Scholar 

  34. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.

    CAS  PubMed  Google Scholar 

  35. Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152:1673–89.

    CAS  PubMed  Google Scholar 

  36. Lindberg E. Epidemiology of OSA. Eur Respir Mon. 2010;50:51–68.

    Google Scholar 

  37. Lecube A, Sampol G, Lloberes P, et al. Asymptomatic sleep-disordered breathing in premenopausal women awaiting bariatric surgery. Obes Surg. 2010;20:454–61.

    PubMed  Google Scholar 

  38. Young T, Shahar E, Nieto FJ, et al. Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: the sleep Heart Health Study. Arch Intern Med 2002;162(8):893–900.

    Google Scholar 

  39. Young T. Sleep-disordered breathing in older adults: is it a condition distinct from that in middle-aged adults? Sleep. 1996;19(7):529–30.

    CAS  PubMed  Google Scholar 

  40. Lévy P, Pépin JL, Malauzat D, et al. Is sleep apnea syndrome in the elderly a specific entity? Sleep. 1996;19:S29–38.

    PubMed  Google Scholar 

  41. Lavie P, Lavie L, Herer P. All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age. Eur Respir J. 2005;25:514–20.

    CAS  PubMed  Google Scholar 

  42. Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156(21):2445–51.

    CAS  PubMed  Google Scholar 

  43. Ye L, Pien GW, Weaver TE. Gender differences in the clinical manifestation of obstructive sleep apnea. Sleep Med. 2009;10:1075–84.

    PubMed  Google Scholar 

  44. Hader C, Schroeder A, Hinz M, et al. Sleep disordered breathing in the elderly: comparison of women and men. J Physiol Pharmacol. 2005;56 Suppl 4:85–91.

    PubMed  Google Scholar 

  45. Wetter DW, Young TB, Bidwell TR, et al. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med. 1994;154:2219–24.

    CAS  PubMed  Google Scholar 

  46. Newman AB, Nieto FJ, Guidry U, et al. Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol. 2001;154:50–9.

    CAS  PubMed  Google Scholar 

  47. Peppard PE, Austin D, Brown RL. Association of alcohol consumption and sleep disordered breathing in men and women. J Clin Sleep Med. 2007;3:265–70.

    PubMed Central  PubMed  Google Scholar 

  48. Villaneuva AT, Buchanan PR, Yee BJ, Grunstein RR. Ethnicity and obstructive sleep apnoea. Sleep Med Rev. 2005;9:419–36.

    PubMed  Google Scholar 

  49. Lee RW, Vasudavan S, Hui DS, Prvan T, Petocz P, Darendeliler MA, Cistulli PA. Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea. Sleep. 2010;33:1075–80.

    PubMed Central  PubMed  Google Scholar 

  50. Banno K, Kryger MH. Sleep apnea: clinical investigations in humans. Sleep Med. 2007;8:400–26.

    PubMed  Google Scholar 

  51. Tkacova R, Dorkova Z. Clinical presentations of OSA in adults. Eur Respir Mon. 2010;50:86–103.

    Google Scholar 

  52. Peter JH, Koehler U, Grote L, Podszus T. Manifestations and consequences of obstructive sleep apnoea. Eur Respir J. 1995;8:1572–83.

    CAS  PubMed  Google Scholar 

  53. Guilleminault C, Stoohs R, Clerk A, et al. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104:781–7.

    CAS  PubMed  Google Scholar 

  54. Vgontzas AN, Zoumakis E, Lin HM, et al. Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab. 2004;89:4409–13.

    CAS  PubMed  Google Scholar 

  55. Ohayon MM. Epidemiology of excessive daytime sleepiness. Sleep Med Clin. 2006;1:9–16.

    Google Scholar 

  56. Hirshkowitz M, Gast H. Sleep-related breathing disorders and sleepiness. Sleep Med Clin. 2006;1:491–8.

    Google Scholar 

  57. Silber MH. The investigation of sleepiness. Sleep Med Clin. 2006;1:1–7.

    Google Scholar 

  58. Martin SE, Engleman HM, Kingshott RN, Douglas NJ. Microarousals in patients with sleep apnoea/hypopnoea syndrome. J Sleep Res. 1997;6(4):276–80.

    CAS  PubMed  Google Scholar 

  59. Hosselet J, Ayappa I, Norman RG, Krieger AC, Rapoport DM. Classification of sleep-disordered breathing. Am J Respir Crit Care Med. 2001;163:398–405.

    CAS  PubMed  Google Scholar 

  60. Arand D, Bonnet M, Hurwitz T, Milter M, Rosa R, Sangal RB. The clinical use of the MSLT and MWT. Sleep. 2005;28:123–44.

    PubMed  Google Scholar 

  61. Krieger J, McNicholas WT, Levy P, et al. Public health and medicolegal implications of sleep apnoea. Eur Respir J. 2002;20:1594–609.

    CAS  PubMed  Google Scholar 

  62. Boudewyns A, Willemen M, De Cock W, et al. Does socially disturbing snoring and/or excessive daytime sleepiness warrant polysomnography? Clin Otolaryngol. 1997;22:403–7.

    CAS  PubMed  Google Scholar 

  63. Koutsourelakis I, Perraki E, Economou NT, et al. Predictors of residual sleepiness in adequately treated obstructive sleep apnoea patients. Eur Respir J. 2009;34:687–93.

    CAS  PubMed  Google Scholar 

  64. Stradling JR, Smith D, Croby J. Post-CPAP sleepiness – a specific syndrome? J Sleep Res. 2007;16:436–8.

    PubMed  Google Scholar 

  65. Pépin JL, Viot-Blanc V, Escourrou P, et al. Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study. Eur Respir J. 2009;33:1062–7.

    PubMed  Google Scholar 

  66. Walters AS. Clinical identification of the simple sleep-related movement disorders. Chest. 2007;131:1260–6.

    PubMed  Google Scholar 

  67. Bonsignore MR, McNicholas WT. Sleep-disordered breathing in the elderly. Eur Respir Mon. 2009;43:179–204.

    Google Scholar 

  68. Gami AS, Howard DE, Olson EJ, et al. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;353(12):1206–14.

    Google Scholar 

  69. Artz M, Young T, Finn L, et al. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172:1447–51.

    Google Scholar 

  70. Duran-Cantolla J, Aizpuru F, Martinez-Null C, Barbé-Illa F. Obstructive sleep apnea/hypopnea and systemic hypertension. Sleep Med Rev. 2009;13:323–31.

    PubMed  Google Scholar 

  71. Veale D, Pepin JL, Levy PA. Autonomic stress tests in obstructive sleep apnea syndrome and snoring. Sleep. 1992;15:505–13.

    CAS  PubMed  Google Scholar 

  72. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med. 2002;166(2):159–65.

    PubMed  Google Scholar 

  73. Silverberg DS, Oksenberg A. Are sleep-related breathing disorders important contributing factors to the production of essential hypertension? Curr Hypertens Rep. 2001;3(3):209–15.

    CAS  PubMed  Google Scholar 

  74. Hedner J, Bengtsson-Bostrom K, Peker Y, Grote L, Rastam L, Lindblad U. Hypertension prevalence in obstructive sleep apnoea and sex: a population-based case-control study. Eur Respir J. 2006;27(3):564–70.

    CAS  PubMed  Google Scholar 

  75. Suzuki M, Guilleminault C, Otsuka K, Shiomi T. Blood pressure “dipping” and “non-dipping” in obstructive sleep apnea syndrome patients. Sleep. 1996;19(5):382–7.

    CAS  PubMed  Google Scholar 

  76. Davies CW, Crosby JH, Mullins RL, Barbour C, Davies RJ, Stradling JR. Case-control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax. 2000;55(9):736–40.

    CAS  PubMed Central  PubMed  Google Scholar 

  77. Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, Skatrud J. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157(15):1746–52.

    CAS  PubMed  Google Scholar 

  78. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep heart health study. JAMA. 2000;283(14):1829–36.

    CAS  PubMed  Google Scholar 

  79. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.

    CAS  PubMed  Google Scholar 

  80. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.

    CAS  PubMed  Google Scholar 

  81. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.

    PubMed Central  PubMed  Google Scholar 

  82. Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2010;182:269–77.

    PubMed Central  PubMed  Google Scholar 

  83. Kiely J, McNicholas W. Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. Eur Respir J. 2000;16:128–33.

    CAS  PubMed  Google Scholar 

  84. Good D, Henkle J, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke. 1996;27(2):252–9.

    CAS  PubMed  Google Scholar 

  85. Bassetti C, Milanova M, Grugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006;37(4):967–72.

    PubMed  Google Scholar 

  86. Bassetti C, Aldrich MS, Chervin RD, Quint D. Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients. Neurology. 1996;47(5):1167–73.

    CAS  PubMed  Google Scholar 

  87. Wessendorf TE, Teschler H, Wang YM, Konietzko N, Thilmann AF. Sleep-disordered breathing among patients with first-ever stroke. J Neurol. 2000;247(1):41–7.

    CAS  PubMed  Google Scholar 

  88. Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. In Collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation. 2008;118:1080–111.

    PubMed  Google Scholar 

  89. Baguet JP, Hammer L, Levy P, Pierre H, Launois S, Mallion JM, Pepin JL. The severity of oxygen desaturation is predictive of carotid wall thickening and plaque occurrence. Chest. 2005;128(5):3407–12.

    PubMed  Google Scholar 

  90. Suzuki T, Nakano H, Maekawa J, Okamoto Y, Ohnishi Y, Yamauchi M, Kimura H. Obstructive sleep apnea and carotid-artery intima-media thickness. Sleep. 2004;27(1):129–33.

    PubMed  Google Scholar 

  91. Parra O, Arboix A, Montserrat JM, Quinto L, Bechich S, Garcia-Eroles L. Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J. 2004;24(2):267–72.

    CAS  PubMed  Google Scholar 

  92. Liston R, Deegan P, McCreery C, McNicholas W. Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias. Postgrad Med J. 1994;70(822):275–80.

    CAS  PubMed Central  PubMed  Google Scholar 

  93. Koehler U, Schafer H. Is obstructive sleep apnea (OSA) a risk factor for myocardial infarction and cardiac arrhythmias in patients with coronary heart disease (CHD)? Sleep. 1996;19(4):283–6.

    CAS  PubMed  Google Scholar 

  94. Shepard Jr JW. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med. 1992;13(3):437–58.

    PubMed  Google Scholar 

  95. Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S. Association of nocturnal arrhythmias with sleep-disordered breathing: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2006;173(8):910–6.

    PubMed Central  PubMed  Google Scholar 

  96. Ryan CM, Usui K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax. 2005;60(9):781–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  97. Peker Y, Kraiczi H, Hedner J, Loth S, Johansson A, Bende M. An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J. 1999;14(1):179–84.

    CAS  PubMed  Google Scholar 

  98. Sorajja D, Gami AS, Somers VK, Behrenbeck TR, Garcia-Touchard A, Lopez-Jimenez F. Independent association between obstructive sleep apnea and subclinical coronary artery disease. Chest. 2008;133(4):927–33.

    PubMed Central  PubMed  Google Scholar 

  99. Hayashi M, Fujimoto K, Urushibata K, Uchikawa S, Imamura H, Kubo K. Nocturnal oxygen desaturation correlates with the severity of coronary atherosclerosis in coronary artery disease. Chest. 2003;124(3):936–41.

    PubMed  Google Scholar 

  100. Franklin KA, Nilsson JB, Sahlin C, Naslund U. Sleep apnoea and nocturnal angina. Lancet. 1995;345(8957):1085–7.

    CAS  PubMed  Google Scholar 

  101. Peled N, Abinader EG, Pillar G, Sharif D, Lavie P. Nocturnal ischemic events in patients with obstructive sleep apnea syndrome and ischemic heart disease: effects of continuous positive air pressure treatment. J Am Coll Cardiol. 1999;34(6):1744–9.

    CAS  PubMed  Google Scholar 

  102. Gami AS, Svatikova A, Wolk R, Olson EJ, Duenwald CJ, Jaffe AS, Somers VK. Cardiac troponin T in obstructive sleep apnea. Chest. 2004;125(6):2097–100.

    CAS  PubMed  Google Scholar 

  103. Narkiewicz K, Montano N, Cogliati C, van de Borne PJ, Dyken ME, Somers VK. Altered cardiovascular variability in obstructive sleep apnea. Circulation. 1998;98(11):1071–7.

    CAS  PubMed  Google Scholar 

  104. Kuniyoshi FH, Garcia-Touchard A, Gami AS, et al. Day-night variation of acute myocardial infarction in obstructive sleep apnea. J Am Coll Cardiol. 2008;52(5):343–6.

    PubMed  Google Scholar 

  105. Drager LF, Bortolotto LA, Lorenzi MC, et al. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(5):613–8.

    PubMed  Google Scholar 

  106. Baguet JP, Hammer L, Levy P, et al. Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients. J Hypertens. 2005;23(3):521–7.

    CAS  PubMed  Google Scholar 

  107. Tsioufis C, Thomopoulos K, Dimitriadis K, et al. The incremental effect of obstructive sleep apnoea syndrome on arterial stiffness in newly diagnosed essential hypertensive subjects. J Hypertens. 2007;25(1):141–6.

    CAS  PubMed  Google Scholar 

  108. Drager LF, et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest. 2007;131:1379–86.

    PubMed  Google Scholar 

  109. Alchanatis M, Tourkohoriti G, Kosmas EN, et al. Evidence for left ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J. 2002;20(5):1239–45.

    CAS  PubMed  Google Scholar 

  110. Shivalkar B, Van de Heyning C, Kerremans M, et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol. 2006;47:1433–9.

    PubMed  Google Scholar 

  111. Minoguchi K, Yokoe T, Tazaki T, et al. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(5):625–30.

    PubMed  Google Scholar 

  112. Lavie L. Obstructive sleep apnoea syndrome – an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35–51.

    PubMed  Google Scholar 

  113. Aurigemma GP, Gaasch WH. Diastolic heart failure. N Engl J Med. 2004;351(11):1097–105.

    CAS  PubMed  Google Scholar 

  114. Chan J, Sanderson J, Chan W, Lai C, Choy D, Ho A, Leung R. Prevalence of sleep-disordered breathing in diastolic heart failure. Chest. 1997;111(6):1488–93.

    CAS  PubMed  Google Scholar 

  115. Fung JW, Li TS, Choy DK, et al. Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest. 2002;121(2):422–9.

    PubMed  Google Scholar 

  116. Arias MA, Garcia-Rio F, Alonso-Fernandez A, Mediano O, Martinez I, Villamor J. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation. 2005;112(3):375–83.

    PubMed  Google Scholar 

  117. Shahar E, Whitney CRS. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.

    CAS  PubMed  Google Scholar 

  118. He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Chest. 1988;94:9–14.

    CAS  PubMed  Google Scholar 

  119. Sahlin C, Sandberg O, Gustafson Y, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med. 2008;168:297–301.

    PubMed  Google Scholar 

  120. Peker Y, Hedner J, Kraiczi H, et al. Respiratory disturbance index: an independent predictor of mortality in coronary artery disease. Am J Respir Crit Care Med. 2000;162:81–6.

    CAS  PubMed  Google Scholar 

  121. Lavie P, Herer P, Peled R, et al. Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep. 1995;18:149–57.

    CAS  PubMed  Google Scholar 

  122. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31:1071–8.

    PubMed Central  PubMed  Google Scholar 

  123. Punjabi N, Caffo BS, Goodwin JL, et al. Sleep disordered breathing and mortality: a prospective cohort study. PLoS Med. 2009;6:1–9.

    Google Scholar 

  124. Lavie P, Lavie L. Unexpected survival advantage in elderly people with moderate sleep apnoea. J Sleep Res. 2009;18:397–403.

    PubMed  Google Scholar 

  125. Goff EA, O’Driscoll DM, Simmonds AK, et al. The cardiovascular response to arousal from sleep decreases with age in healthy adults. Sleep. 2008;31:1009–17.

    PubMed Central  PubMed  Google Scholar 

  126. Strohl KP, Novak RD, Singer W, et al. Insulin levels, blood pressure and sleep apnea. Sleep. 1994;17(7):614–8.

    CAS  PubMed  Google Scholar 

  127. Ip MS, Lam B, Ng MM, et al. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670–6.

    PubMed  Google Scholar 

  128. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85(3):1151–8.

    CAS  PubMed  Google Scholar 

  129. Punjabi NM, Sorkin JD, Katzel LI, et al. Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med. 2002;165(5):677–82.

    PubMed  Google Scholar 

  130. Stoohs RA, Facchini F, Guilleminault C. Insulin resistance and sleep-disordered breathing in healthy humans. Am J Respir Crit Care Med. 1996;154(1):170–4.

    CAS  PubMed  Google Scholar 

  131. Punjabi NM, Shahar E, Redline S, et al. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–30.

    PubMed  Google Scholar 

  132. Reichmuth KJ, Austin D, Skatrud JB, et al. Association of sleep apnoea and type II diabetes: a population based study. Am J Respir Crit Care Med. 2005;172(12):1590–5.

    PubMed Central  PubMed  Google Scholar 

  133. Stamatakis K, Sanders MH, Caffo B, et al. Fasting glycemia in sleep disordered breathing: lowering the threshold on oxyhemoglobin desaturation. Sleep. 2008;31:1018–24.

    PubMed Central  PubMed  Google Scholar 

  134. Botros N, Concato J, Mohsenin V, et al. Obstructive sleep apnoea as a risk factor for type 2 diabetes. Am J Med. 2009;122:1122–7.

    PubMed Central  PubMed  Google Scholar 

  135. Grassi G, Seravalle G, Quarti-Trevano F, et al. Reinforcement of the adrenergic overdrive in the metabolic syndrome complicated by obstructive sleep apnoea. J Hypertens. 2010;28:1313–20.

    CAS  PubMed  Google Scholar 

  136. Stamatakis KA, Punjabi NM. Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest. 2010;137:95–101.

    CAS  PubMed Central  PubMed  Google Scholar 

  137. Naegele B, Thouvard V, Pepin JL, et al. Deficits of cognitive functions in patients with sleep apnea syndrome. Sleep. 1995;18(1):43–52.

    CAS  PubMed  Google Scholar 

  138. Twigg GL, Papaioannou I, Jackson M, et al. Obstructive sleep apnea syndrome is associated with deficits in verbal but not visual memory. Am J Respir Crit Care Med. 2010;182:98–103.

    PubMed Central  PubMed  Google Scholar 

  139. Naegele B, Launois SH, Mazza S, et al. Which memory processes are affected in patients with obstructive sleep apnea? An evaluation of 3 types of memory. Sleep. 2006;29:533–44.

    PubMed  Google Scholar 

  140. Quan SF, Wright R, Baldwin CM, et al. Obstructive sleep apnea-hypopnea and neurocognitive functioning in the Sleep Heart Health Study. Sleep Med. 2006;7:498–507.

    PubMed  Google Scholar 

  141. Arnsten AF, Li BM. Neurobiology of executive functions: catecholamine influences on prefrontal cortical functions. Biol Psychiatry. 2005;57(11):1377–84.

    CAS  PubMed  Google Scholar 

  142. Verstraeten E, Cluydts R. Executive control of attention in sleep apnea patients: theoretical concepts and methodological considerations. Sleep Med Rev. 2004;8(4):257–67.

    PubMed  Google Scholar 

  143. Kales A, Caldwell AB, Cadieux RJ, Vela-Bueno A, Ruch LG, Mayes SD. Severe obstructive sleep apnea-II: associated psychopathology and psychosocial consequences. J Chron Dis. 1985;38(5):427–34.

    CAS  PubMed  Google Scholar 

  144. Alchanatis M, Deligiorgis N, Zias N, Amfilochiou A, Gotsis E, Arakatsani A, et al. Frontal brain lobe impairment in obstructive sleep apnoea: a proton MR spectroscopy study. Eur Respir J. 2004;24(6):980–6.

    CAS  PubMed  Google Scholar 

  145. Ayalon L, Ancoli-Israel S, Klemfuss Z, et al. Increased brain activation during verbal learning in obstructive sleep apnea. Neuroimage. 2006;31:1817–25.

    PubMed  Google Scholar 

  146. Glasser M, Bailey N, McMillan A, Goff E, Morrell MJ. Sleep apnoea in older people. Breathe. 2011;7(3):249–56.

    Google Scholar 

  147. Mazza S, Pepin JL, Naegele B, et al. Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J. 2006;28:1020–8.

    CAS  PubMed  Google Scholar 

  148. Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99(4):1592–9.

    PubMed  Google Scholar 

  149. Lévy P, Bonsignore MR, Eckel J. Sleep, sleep-disordered breathing and metabolic consequences. Eur Respir J. 2009;34:243–60.

    PubMed  Google Scholar 

  150. Chobanian AV, Bakris GL, Black HR, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.

    CAS  PubMed  Google Scholar 

  151. Angelico F, del Ben M, Augelletti T, et al. Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting. Eur J Int Med. 2010;21:191–5.

    Google Scholar 

  152. Sin DD, Fitzgerald F, Parker JD, et al. Risk Factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999;160:1101–6.

    CAS  PubMed  Google Scholar 

  153. Vanderveken OM, Boudewijns A, Ni Q, et al. Cardiovascular implications in the treatment of obstructive sleep apnea. J Cardiovasc Transl Res. 2011;4(1):53–60.

    PubMed  Google Scholar 

  154. Gami AS, Pressman G, Caples SM, et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation. 2004;110:364–7.

    PubMed  Google Scholar 

  155. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28(3):596–602.

    CAS  PubMed  Google Scholar 

  156. Grunstein R. Endocrine disorders. In: Kryger MH, Roth T, Dement W, editors. Principles and practice of sleep medicine, vol. 105. Philadelphia, PA: Elsevier Saunders; 2005. p. 1237–45.

    Google Scholar 

  157. Fritschi C, Quinn L. Fatigue in patients with diabetes: a review. J Psychosom Res. 2010;69(1):33–41.

    PubMed Central  PubMed  Google Scholar 

  158. Chotinaiwattarakul W, O’Brien LM, Fan L, Chervin RD. Fatigue, tiredness, and lack of energy improve with treatment for OSA. J Clin Sleep Med. 2009;5(3):222–7.

    PubMed Central  PubMed  Google Scholar 

  159. Lewis G, Wessely S. The epidemiology of fatigue: more questions than answers. J Epidemiol Commun Health. 1998;46:2–97.

    Google Scholar 

  160. Trombetta IC, Somers VK, Maki-Nunes C, et al. Consequences of comorbid sleep apnea in the metabolic syndrome – implications for cardiovascular risk. Sleep. 2010;33(9):1193–9.

    PubMed Central  PubMed  Google Scholar 

  161. Parati G, Lombardi C, Hedner J, et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J. 2013;41:523–38.

    CAS  PubMed  Google Scholar 

  162. Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499–519.

    PubMed  Google Scholar 

  163. Artz M, Young T, Finn L, et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med. 2006;166:1716–22.

    Google Scholar 

  164. Kanagala R, Murali NS, Friedman PA, Ammash NM, et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107:2589–94.

    PubMed  Google Scholar 

  165. Bansal A, Lee-Chiong T. Sleep and medical disorders. In: Butkov N, Lee-Chiong T, editors. Fundamentals of sleep technology, vol. 22. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. p. 186–97.

    Google Scholar 

  166. Khawaja IT, Sayyed RT, Jaouni H. Obstructive sleep apnea: an unrecognized but prevalent condition. Compr Ther. 2000;26:294–7.

    CAS  PubMed  Google Scholar 

  167. Bottini P, Tantucci C. Sleep apnea syndrome in endocrine diseases. Respiration. 2003;70:320–7.

    PubMed  Google Scholar 

  168. Weiss V, Sonka K, Pretl M, et al. Prevalence of sleep apnea syndrome in acromegaly population. J Endocrinol Invest. 2000;23:515–9.

    CAS  PubMed  Google Scholar 

  169. Isono S, Sacki N, Tanaka A, et al. Collapsibility of passive pharynx in patients with acromegaly. Am J Respir Crit Care Med. 1999;160:64–8.

    CAS  PubMed  Google Scholar 

  170. Bengtsson B, Brummer R, Eden S, et al. Body composition in acromegaly. Clin Endocrinol. 1989;30:121–30.

    CAS  Google Scholar 

  171. Shipley JE, Schteingart DE, Tandon R, et al. Sleep architecture and sleep apnea in patients with Cushing’s syndrome. Sleep. 1992;15:514–8.

    CAS  PubMed  Google Scholar 

  172. Yanovsky JA, Cutler JB. Glucocorticoid action and the clinical features of Cushing’s syndrome. Endocrinol Metab Clin N Am. 1994;23:487–509.

    Google Scholar 

  173. Rosenow F, McCarthy V, Caruso AC. Sleep apnoea in endocrine disease. J Sleep Res. 1998;7:3–11.

    CAS  PubMed  Google Scholar 

  174. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care. 1998;21(4):518–24.

    CAS  PubMed  Google Scholar 

  175. West SD, Nicoll DJ, Stradling JR. Prevalence of obstructive sleep apnea in men with type 2 diabetes. Thorax. 2006;61:945–50.

    CAS  PubMed Central  PubMed  Google Scholar 

  176. Babu AR, Herdegen J, Fogelfeld L, Shott S, Mazzone T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med. 2005;165(4):447–52.

    PubMed  Google Scholar 

  177. Pallayova M, Donic V, Tomori Z. Beneficial effects of severe sleep apnea therapy on nocturnal glucose control in persons with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2008;81:e8–11.

    CAS  PubMed  Google Scholar 

  178. Ficker JH, Dertinger SH, Siegfried W, et al. Obstructive sleep apnoea and diabetes mellitus: the role of cardiovascular autonomic neuropathy. Eur Respir J. 1998;11(1):14–9.

    CAS  PubMed  Google Scholar 

  179. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB. The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med. 2003;163:427–36.

    PubMed Central  PubMed  Google Scholar 

  180. Reaven G. Role of insulin resistance in human disease. Banting lecture. Diabetes. 1997;37(12):1595–607.

    Google Scholar 

  181. DeFronzo R, Ferrannini E. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14:173–94.

    CAS  PubMed  Google Scholar 

  182. Kahn R, Buse J, Ferrannini E, et al. The metabolic syndrome: time for a critical appraisal. Diabetes Care. 2005;28:2289–304.

    PubMed  Google Scholar 

  183. Dorkova Z, Petrasova D, Molcanyiova A, et al. Effects of CPAP on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest. 2008;134:686–92.

    CAS  PubMed  Google Scholar 

  184. Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S. Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev. 2011;20(121):183–94.

    CAS  PubMed  Google Scholar 

  185. Klink ME, Dodge R, Quan SF. The relation of sleep complaints to respiratory symptoms in a general population. Chest. 1994;105(1):151–4.

    CAS  PubMed  Google Scholar 

  186. Lee R, McNicholas WT. Obstructive sleep apnea in chronic obstructive pulmonary disease patients. Curr Opin Pulm Dis. 2011;17:79–83.

    Google Scholar 

  187. McNicholas WT, Verbraecken J, Marin JM. Sleep disorders in chronic obstructive pulmonary disease: the forgotten dimension. Eur Respir Rev. 2013;22(129):365–75.

    PubMed  Google Scholar 

  188. Rodrigues CJO, Marson O, Tufic S, et al. Relationship among end-stage renal disease, hypertension, and sleep apnea in nondiabetic dialysis patients. Am J Hypertens. 2005;18:152–7.

    Google Scholar 

  189. Beecroft JM, Pierratos A, Hanly PJ. Clinical presentation of obstructive sleep apnea in patients with end-stage renal disease. J Clin Sleep Med. 2009;5:115–21.

    PubMed Central  PubMed  Google Scholar 

  190. Jean G, Piperno D, Francois B, et al. Sleep apnea incidence in maintenance hemodialysis patients: influence of dialysate buffer. Nephron. 1995;71:138–42.

    CAS  PubMed  Google Scholar 

  191. Choi JB, Loredo JS, Norman D, et al. Does obstructive sleep apnea increase hematocrit? Sleep Breath. 2006;10:155–60.

    PubMed  Google Scholar 

  192. Moore-Gillon JC, Treacher DF, Gaminara EJ, Pearson TC, Cameron IR. Intermittent hypoxia in patients with unexplained polycythaemia. Br Med J. 1986;293:588–90.

    CAS  Google Scholar 

  193. Carlson JT, Hedner J, Fagerberg B, Ejnell H, Magnusson B, Fyhrquist F. Secondary polycythaemia associated with nocturnal apnoea – a relationship not mediated by erythropoietin? J Int Med. 1992;231:381–7.

    CAS  Google Scholar 

  194. Krieger J, Sforza E, Delanoe C, Petiau C. Decrease in hematocrit with continuous positive airway pressure treatment in obstructive sleep apnoea patients. Eur Respir J. 1992;5:228–33.

    CAS  PubMed  Google Scholar 

  195. Young T, Blustein J, Finn L, Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997;20:608–13.

    CAS  PubMed  Google Scholar 

  196. Tarasiuk A, Greenberg-Dotan S, Brin YS, Simon T, Tal A, Reuveni H. Determinants affecting health-care utilization in obstructive sleep apnea syndrome patients. Chest. 2005;128:1310–4.

    PubMed  Google Scholar 

  197. Sassani A, Findley LJ, Kryger M, Goldlust E, George C, Davidson TM. Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. Sleep. 2004;27:453–8.

    PubMed  Google Scholar 

  198. Peker Y, Hedner J, Johansson A, Bende M. Reduced hospitalization with cardiovascular and pulmonary disease in obstructive sleep apnea patients on nasal CPAP treatment. Sleep. 1997;20:645–53.

    CAS  PubMed  Google Scholar 

  199. Krieger J, Meslier N, Lebrun T, et al. Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure: a prospective study. The Working Group ANTADIR, Paris and CRESGE, Lille, France. Association Nationale de Traitement a Domicile des Insuffisants Respiratoires. Chest. 1997;112:1561–6.

    CAS  PubMed  Google Scholar 

  200. Ayas NT, FitzGerald JM, Fleetham JA, et al. Cost-effectiveness of continuous positive airway pressure therapy for moderate to severe obstructive sleep apnea/hypopnea. Arch Intern Med. 2006;166:977–84.

    PubMed  Google Scholar 

  201. Tousignant P, Cosio MG, Levy RD, et al. Quality adjusted life years added by treatment of obstructive sleep apnea. Sleep. 1994;17:52–60.

    CAS  PubMed  Google Scholar 

  202. Alghanim N, Comondore VR, Fleetham J, Marra CA, Ayas NT. The economic impact of obstructive sleep apnea. Lung. 2008;186:7–12.

    PubMed  Google Scholar 

  203. Prosser LA, Stinnett AA, Goldman PA, et al. Cost-effectiveness of cholesterol-lowering therapies according to selected patent characteristics. Ann Intern Med. 2000;132:769–79.

    CAS  PubMed  Google Scholar 

  204. Albarrak M, Banno K, Sabbagh AA, et al. Utilization of healthcare resources in obstructive sleep apnea syndrome: a 5-year follow-up study in men using CPAP. Sleep. 2005;28:1306–11.

    PubMed  Google Scholar 

  205. Ulfberg J, Carter N, Talback M, Edling C. Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea. Chest. 1996;110:659–63.

    CAS  PubMed  Google Scholar 

  206. Ayas NT, Marra C. Continuous positive airway pressure therapy for obstructive sleep apnea syndrome: do the dollars make sense? Sleep. 2005;28:1211–3.

    PubMed  Google Scholar 

  207. Kapur VK, Alfonso-Cristancho R. Just a good deal or truly a steal? Medical cost savings and the impact on the cost-effectiveness of treating sleep apnea. Sleep. 2009;32:135–6.

    PubMed Central  PubMed  Google Scholar 

  208. Bahammam A, Delaive K, Ronad J, et al. Health care utilization in males with obstructive sleep apnea syndrome two years after diagnosis and treatment. Sleep. 1999;22:740–7.

    CAS  PubMed  Google Scholar 

  209. Banno K, Manfreda J, Walld R, Delaive K, Kryger MH. Healthcare utilization in women with obstructive sleep apnea syndrome 2 years after diagnosis and treatment. Sleep. 2006;29:1307–11.

    PubMed  Google Scholar 

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Verbraecken, J.A. (2015). OSAS: The Magnitude of the Problem. In: de Vries, N., Ravesloot, M., van Maanen, J. (eds) Positional Therapy in Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-319-09626-1_2

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