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Understanding Sleep Apnea: A Comprehensive Guide and History

Explore the history, neuroanatomy, and physiology of sleep apnea in this informative guide from C. Tyler, the Medical Director of Kaiser Sleep Lab in San Francisco. Learn about risk factors, prevalence, diagnosis, treatment, and more. Dive into the importance of consolidated sleep and staying awake, with intriguing facts about sleep disorders and the impact of sleep deprivation on health.

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Understanding Sleep Apnea: A Comprehensive Guide and History

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  1. Sleep Apnea: • C Tyler

  2. Sleep Apnea Kaiser SF Sleep Lab a.k.a. ‘apnea clinic’ Part 1 C Tyler, Sep 2016 Medical Director Kaiser, San Francisco

  3. OSA

  4. What are we going to cover? • Brief History of Sleep • Neuroanatomy • Neuro transmitters • Importance of Consolidated Sleep – conversely the importance of staying awake… • The History of Sleep Apnea • Physiology of Sleep Apnea • Modern Definitions (criteria) of Sleep Apnea • Risk Factors • Prevalence • Diagnosis • Treatment • …a quiz

  5. We sleep so we can be awake:Excess Daytime Sleepiness (EDS) • Exxon Valdez • Three Mile Island and Chernobyl • Union Carbide at Bhopal • 100,000 MVAs annually due to driver drowsiness or fatigue • $3,000,000,000 / year • Libby Zion 1965-1984 • Phenylzine (Nardil) MAO-I + Meperidine + Haldol -> Seratonin Syndrome • International Classification of Sleep Disorders (ICSD)  • 88 sleep-related disorders

  6. Sleep in other Species • Humans: 8 h • Duck 10.8 h • Horse: 2.9 h • Dolphins: Put half a brain to sleep at a time • Fruit Flies: • Herbivors need time to forage • Predators eat huge meals • Birds don’t go limp during REM sleep • Flamingos sleep on one foot, bats hang upside-down

  7. History of Sleep Medicine • 1875 Electrical activity in brains of animals – Caton • 1880 Narcolepsy described – Gelineau • 1929 ‘Electroencephalogram of man’ – Berger • 1937 NREM described - Loomis • 1951 REM Sleep described – Kleitman • 1960 Sleep-onset REM in narcoleptics – Vogel • 1964 First Narcolepsy Clinic (Stanford) • 1972 Destruction of SCN eliminates circadian rhythms • 2007 RLS in 6% of population but 34% in iron deficient patients • 1989 Sleep deprivation results in death of rats - Rechtschaffen et al. • 1989 First Fellowship Training Programs • 1991 American Board of Sleep Medicine

  8. Deep Brain Structures and Sleep • 1920s: • Diabetes Insipidus caused by Hypothalamic lesions • (sleepiness coincided)

  9. The Isolated Forebrain:Frederick Bremer 1892-1982cerveau isolé • complete midbrain transection • EEG slow waves and spindles • structures below midbrain facilitate wake-state • Hypothesis: ‘wake’ d/t spinal sensory stimuli • mid-pontine transection (lower) ‘cerveauencephali’ • activated / wakelike forebrain EEG • structures between midpons and upper midbrain generating a wake state

  10. What is Sleep? • complex reversible state characterized by: • behavioral quiescence • diminished responsiveness to external stimuli • maintained by • CNS networks • Specific neurotransmitters

  11. Diurnal Cycles: the tides and sleep

  12. Staying in synch with our environment

  13. The Earth’s spin rate is slowing down • The earth spins once every 24 hr w.r.t. the Sun • …every 23h, 56min, 4 sec w.r.t. the Stars • Today is 1.7 milliseconds longer • than this day one century ago • Requires a‘Leap Second’ every 2 years or so

  14. Biological Clocks: • What for? • Why not just stay awake permanently?

  15. Theories of sleep • Restorative and somatic growth theory • Facilitation of anabolic processes • Metabolic theory • energy conservation • Survival theory • protective and adaptive behavior • Neural growth and processing • neuronal synaptic plasticity • brain development • restoration, learning, and memory consolidation • Evolutionary Specialization to unique environmental circumstances

  16. Why do we Sleep? • Brain recuperation: • Adaptation to special circumstances: • Activity of pray and predators • Non-competitive adaptation • Energy Conservation: • Hibernation • Adaptation to habitat: • Light/Dark • Hot/Cold

  17. Hormones:The night life of …

  18. Neural Control of Sleep Wake, NREM sleep, and REM sleep • generated/maintained by different neurons, networks, neurotransmitters • Primary Sleep and Wake Neurotransmitters • Glutamate: Primary excitatory neurotrans • ACh: main REM neurotrans • GABA: main NREM neurotransmitter • Wake Neurotransmitters • Glutamate PRINCIPAL (ARAS, RHT) • acetylcholine basal forebrain, PPT/LDT • dopamine subst nigra, BrStm, vntrl tgmnt • histamine tuberomammillary nucleus • hypocretin (orexin) lat hypothal prefornical • norepinephrine locus ceruleus • serotonin Raphe nuc, thalamus • Sleep Neurotransmitters • GABA, gamma-amino-butyric acid prinicple NREM VLPO, Thal, Hypothal, basal forebrain, cortex • acetylcholine principle REM sleep transmitter • adenosine (homeostatic generator) basal forebrain • Glycine: spinal cord (inhib motor)

  19. The seductive call of sleep: • More powerful than hunger • More powerful than sex • More powerful than money

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