ABSTRACT
Obstructive sleep apnea is second only to asthma among prevalent respiratory diseases. As a result, primary care physicians must be comfortable working up and managing these patients. Respiration varies across the three sleep-wake states (wake, rapid eye movement, and nonrapid eye movement sleep). Obstructive sleep apnea is state dependent, occurring only during sleep. Although diurnal, obstructive lung diseases, congestive heart failure, and neuromuscular diseases are profoundly affected by the sleep state. Sleep-disordered breathing encompasses the full spectrum of respiratory ailments occurring during sleep. This chapter provides a practical approach to the sleep apnea syndromes (obstructive and central), disorders of nocturnal hypoventilation (obesity-hypoventilation and neuromuscular diseases), and cardiorespiratory illnesses exacerbated by sleep (congestive heart failure and chronic obstructive pulmonary diseases). Management strategies will be discussed in a subsequent chapter.
