Generic placeholder image

Current Indian Science


ISSN (Print): 2210-299X
ISSN (Online): 2210-3007

Review Article

Neurobiological Staging with Special Reference to Sleep Apnoea Syndrome: An Update

Author(s): Anuj Kumar Sharma and Mayank Kulshreshtha*

Volume 1, 2023

Published on: 03 May, 2023

Article ID: e130223213642 Pages: 8

DOI: 10.2174/2210299X01666230213154619



Sleep apnea (SA) or Obstructive sleep apnoea (OSA) is a widely spread sleep disorder marked by repetitions of a complete or partial collapse of the upper airways during sleep. The pathogenesis of OSA is due to the recurrent obstruction of the pharyngeal airway during sleep. The risk factors contributing to upper airway obstruction are obesity, cardiovascular diseases, craniofacial changes, alcohol and smoking. The condition is associated with significant morbidity and mortality. The diagnosis is established with polysomnography (PSG). Lifestyle changes such as weight loss, keeping away from alcohol, tobacco, and sedatives and altering the usual sleeping body position help out in decreasing apnoea symptoms. Various treatments are available for the successful management of this disease, such as continuous positive airway pressure (CPAP) is mainly used in patients with severe SA and oral appliances are widely used in mild to moderate SA and for patients intolerant to CPAP therapy. There are many options available for surgical therapy, with the UPPP (Uvulopalato-pharyngoplasty) being the most widely employed. Also, a number of medications such as tricyclic antidepressants (TCA’s), decongestants, nasal steroids, antihypertensive agents, CNS stimulants and supplementary oxygen are used for treating patients with OSA.

Keywords: Sleep apnea syndrome, Sleep, Brain, Polysomnography, Positive airway pressure, Medication.

Keele, C.A.; Neil, E.; Joels, N. Samson Wright’s Applied Physiology, 13th ed; Oxford University Press, 2000.
Solso, R.L. Cognitive Psychology, 6th ed; Pearson Education Pvt Ltd, 2006.
Marieb, E.N. Human Anatomy & Physiology, 6th ed; Dorling Kindersley Pvt Ltd, 2006.
Tortora, G.J.; Derrickson, B. Principles of Anatomy and Physiology, 10th ed; John Wiley and Sons: USA, 2003.
Waugh, A.; Grant, A. Ross and Wilson Anatomy and Physiology in Health and Illness, 12th ed; Churchill Livingstone: Spain, 2014.
Colledge, N.R.; Walker, B.R.; Ralston, S.H. Davidson’s Principles and Practice of Medicine, 21st ed; Churchill Livingstone: UK, 1974.
Steriade, M. Acetylcholine systems and rhythmic activities during the waking–sleep cycle. Prog. Brain Res., 2004, 145, 179-196.
[] [PMID: 14650916]
Datta, S. Cellular and chemical neuroscience of mammalian sleep. Sleep Med., 2010, 11(5), 431-440.
[] [PMID: 20359944]
Datta, S. Cellular basis of pontine ponto-geniculo-occipital wave generation and modulation. Cell. Mol. Neurobiol., 1997, 17(3), 341-365.
[] [PMID: 9187490]
Lemke, T.L.; Williams, D.A.; Roche, V.F.; Zito, S.W. Foy’s Principles of Medicinal Chemistry, 7th ed; Wolters Kluwer (India) Pvt Ltd: New Delhi, 2017.
Martin, S.; Engleman, H.M.; Kingshott, R.N.; Douglas, N.J. Microarousals in patients with sleep apnoea/hypopnoea syndrome. J. Sleep Res., 1997, 6(4), 276-280.
[] [PMID: 9493529]
Otzenberger, H.; Gronfier, C.; Simon, C.; Charloux, A.; Ehrhart, J.; Piquard, F.; Brandenberger, G. Dynamic heart rate variability: a tool for exploring sympathovagal balance continuously during sleep in men. Am. J. Physiol - Heart C., 1998, 275, 946-50.
Moruzzi, G.; Magoun, H.W. Brain stem reticular formation and activation of the EEG. Electroencephalogr. Clin. Neurophysiol., 1949, 1(1-4), 455-473.
[] [PMID: 18421835]
Magoun, H.W. Caudal and cephalic influences of the brain stem reticular formation. Physiol. Rev., 1950, 30(4), 459-474.
[] [PMID: 14786044]
Lu, J.; Greco, M.A. Sleep circuitry and the hypnotic mechanism of GABAA drugs. J. Clin. Sleep Med., 2006, 2(2), S19-S26.
[] [PMID: 17557503]
Panula, P.; Pirvola, U.; Auvinen, S.; Airaksinen, M.S. Histamine-immunoreactive nerve fibers in the rat brain. Neuroscience, 1989, 28(3), 585-610.
[] [PMID: 2710333]
Takahashi, K.; Lin, J.S.; Sakai, K. Neuronal activity of histaminergic tuberomammillary neurons during wake-sleep states in the mouse. J. Neurosci., 2006, 26(40), 10292-10298.
[] [PMID: 17021184]
Reiner, P.B.; McGeer, E.G. Electrophysiological properties of cortically projecting histamine neurons of the rat hypothalamus. Neurosci. Lett., 1987, 73(1), 43-47.
[] [PMID: 3561856]
Lin, J.S.; Sakai, K.; Jouvet, M. Evidence for histaminergic arousal mechanisms in the hypothalamus of cat. Neuropharmacology, 1988, 27(2), 111-122.
[] [PMID: 2965315]
Mochizuki, T.; Yamatodani, A.; Okakura, K.; Horii, A.; Inagaki, N.; Wada, H. Circadian rhythm of histamine release from the hypothalamus of freely moving rats. Physiol. Behav., 1992, 51(2), 391-394.
[] [PMID: 1313592]
Lin, J.S.; Sakai, K.; Vanni-Mercier, G.; Jouvet, M. A critical role of the posterior hypothalamus in the mechanisms of wakefulness determined by microinjection of muscimol in freely moving cats. Brain Res., 1989, 479(2), 225-240.
[] [PMID: 2924157]
Nauta, W.J.H. Hypothalamic regulation of sleep in rats; an experimental study. J. Neurophysiol., 1946, 9(4), 285-316.
[] [PMID: 20991815]
Moore, R.Y. Retinohypothalamic projection in mammals: a comparative study. Brain Res., 1973, 49(2), 403-409.
[] [PMID: 4124397]
Kalsbeek, A.; Cutrera, R.A.; van Heerikhuize, J.J.; van der Vliet, J.; Buijs, R.M. GABA release from suprachiasmatic nucleus terminals is necessary for the light-induced inhibition of nocturnal melatonin release in the rat. Neuroscience, 1999, 91(2), 453-461.
[] [PMID: 10366002]
Roseboom, P.H.; Coon, S.L.; Baler, R.; McCune, S.K.; Weller, J.L.; Klein, D.C. Melatonin synthesis: analysis of the more than 150-fold nocturnal increase in serotonin N-acetyltransferase messenger ribonucleic acid in the rat pineal gland. Endocrinology, 1996, 137(7), 3033-3045.
[] [PMID: 8770929]
Schomerus, C.; Korf, H.W. Mechanisms regulating melatonin synthesis in the mammalian pineal organ. Ann. N. Y. Acad. Sci., 2005, 1057(1), 372-383.
[] [PMID: 16399907]
Liu, J.; Clough, S.J.; Hutchinson, A.J.; Adamah-Biassi, E.B.; Popovska-Gorevski, M.; Dubocovich, M.L. MT 1 and MT 2 melatonin receptors: A therapeutic perspective. Annu. Rev. Pharmacol. Toxicol., 2016, 56(1), 361-383.
Guilleminault, C.; Quo, S.D. Sleep-disordered breathing. A view at the beginning of the new millennium. Dent. Clin. North Am., 2001, 45(4), 643-656.
[] [PMID: 11699234]
Guilleminault, C.; Tilkian, A.; Dement, W.C. The sleep apnea syndromes. Annu. Rev. Med., 1976, 27(1), 465-484.
[] [PMID: 180875]
Brouilette, R.; Hanson, D.; David, R.; Klemka, L.; Anna, S.; Fernbach, S.; Hunt, C. A diagnostic approach to suspected obstructive sleep apnea in children. J. Pediatr., 1984, 105(1), 10-14.
[] [PMID: 6737123]
Chung, F.; Crago, R.R. Sleep apnoea syndrome and anaesthesia. Can. Anaesth. Soc. J., 1982, 29(5), 439-445.
[] [PMID: 6751498]
Rundell, O.H.; Jones, R.K. Polysomnography methods and interpretations. Otolaryngol. Clin. North Am., 1990, 23(4), 583-592.
[] [PMID: 2199895]
Rivlin, J.; Hoffstein, V.; Kalbfleisch, J.; McNicholas, W.; Zamel, N.; Bryan, A.C. Upper airway morphology in patients with idiopathic obstructive sleep apnea. Am. Rev. Respir. Dis., 1984, 129(3), 355-360.
[PMID: 6703493]
Schellenberg, J.B.; Maislin, G.; Schwab, R.J. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am. J. Respir. Crit. Care Med., 2000, 162(2), 740-748.
[] [PMID: 10934114]
Dempsey, J.A.; Veasey, S.C.; Morgan, B.J.; O'Donnell, C.P. Pathophysiology of sleep apnea. Physiol Rev., 2010, 90(1), 47-112.
Chervin, R.D. Sleepiness, fatigue, tiredness, and lack of energy in obstructive sleep apnea. Chest, 2000, 118(2), 372-379.
[] [PMID: 10936127]
Kalucy, M.J.; Grunstein, R.; Lambert, T.; Glozier, N. Obstructive sleep apnoea and schizophrenia – A research agenda. Sleep Med. Rev., 2013, 17(5), 357-365.
[] [PMID: 23528272]
Vale, J.; Manuel, P.; Oliveira, E.; Oliveira, A.R.; Silva, E.; Melo, V.; Sousa, M.; Alexandre, J.C.; Gil, I.; Sanchez, A.; Nascimento, E.; Torres, A.S. Obstructive sleep apnea and diabetes mellitus. Rev Port Pneumol, 2015, 21(2), 55-60.
[] [PMID: 25926367]
Pillar, G.; Shehadeh, N. Abdominal fat and sleep apnea: the chicken or the egg? Diabetes Care, 2008, 31(7)(Suppl. 2), S303-S309.
[] [PMID: 18227501]
Young, T.; Shahar, E.; Nieto, F.J.; Redline, S.; Newman, A.B.; Gottlieb, D.J.; Walsleben, J.A.; Finn, L.; Enright, P.; Samet, J.M. Predictors of sleep-disordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch. Intern. Med., 2002, 162(8), 893-900.
[] [PMID: 11966340]
Gami, A.S.; Pressman, G.; Caples, S.M.; Kanagala, R.; Gard, J.J.; Davison, D.E.; Malouf, J.F.; Ammash, N.M.; Friedman, P.A.; Somers, V.K. Association of atrial fibrillation and obstructive sleep apnea. Circulation, 2004, 110(4), 364-367.
[] [PMID: 15249509]
Javaheri, S. Sleep disorders in systolic heart failure: A prospective study of 100 male patients. The final report. Int. J. Cardiol., 2006, 106(1), 21-28.
[] [PMID: 16321661]
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.
[] [PMID: 16641120]
Bhushan, A.; Kulshreshtha, M. A scientific update on myocardial infarction: A life-threatening issue. Cardiology Plus, 2019, 4(3), 71-80.
Bhushan, A.; Kulshreshtha, M. Cardioprotective Activity of Agaricus bisporus Against Isoproterenol- Induced Myocardial Infarction in Laboratory Animals. Curr. Nutr. Food Sci., 2018, 14, 1-7.
Hui, D.S.C.; Ko, F.W.S.; Chu, A.S.Y.; Fok, J.P.C.; Chan, M.C.H.; Li, T.S.T.; Choy, D.K.L.; Lai, C.K.W.; Ahuja, A.; Ching, A.S.C. Cephalometric assessment of craniofacial morphology in Chinese patients with obstructive sleep apnoea. Respir. Med., 2003, 97(6), 640-646.
[] [PMID: 12814148]
Chang, E.T.; Shiao, G.M. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med., 2008, 9(4), 403-410.
[] [PMID: 17658296]
Phillips, B.A.; Danner, F.J. Cigarette smoking and sleep disturbance. Arch. Intern. Med., 1995, 155(7), 734-737.
[] [PMID: 7695462]
Young, T.; Peppard, P.; Palta, M.; Hla, K.M.; 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), 1746-1752.
[] [PMID: 9250236]
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), 1230-1235.
[] [PMID: 8464434]
Roehrs, T.; Zorick, F.; Sicklesteel, J.; Roth, T.; Wittig, R. Age-related sleep-wake disorders at a sleep disorder center. J. Am. Geriatr. Soc., 1983, 31(6), 364-370.
[] [PMID: 6853947]
Roth, T.; Roehrs, T.; Conway, W. Behavioral morbidity of apnea. Semin. Respir. Crit. Care Med., 1988, 9(6), 554-559.
Findley, L.J.; Unverzagt, M.E.; Suratt, P.M. Automobile accidents involving patients with obstructive sleep apnea. Am. Rev. Respir. Dis., 1988, 138(2), 337-340.
[] [PMID: 3195832]
Bixler, E.O.; Vgontzas, A.N.; Lin, H.M.; Ten Have, T.; Rein, J.; Vela-Bueno, A.; Kales, A. Prevalence of sleep-disordered breathing in women: effects of gender. Am. J. Respir. Crit. Care Med., 2001, 163(3), 608-613.
[] [PMID: 11254512]
Portier, F.; Portmann, A.; Czernichow, P.; Vascaut, L.; Devin, E.; Benhamou, D.; Cuvelier, A.; Muir, J.F. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am. J. Respir. Crit. Care Med., 2000, 162(3), 814-818.
[] [PMID: 10988088]
Mattei, A.; Tabbia, G.; Baldi, S. Diagnosis of sleep apnea. Minerva Med., 2004, 95(3), 213-231.
[PMID: 15289750]
Li, Z.; Celestin, J.; Lockey, R.F. 2016 in review. J. Allergy Clin. Immunol. Pract., 2016, 4, 852-861.
[] [PMID: 27372597]
Anandam, A.; Akinnusi, M.; Kufel, T.; Porhomayon, J.; El-Solh, A.A. Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis. Sleep Breath., 2013, 17(1), 227-234.
[] [PMID: 22374151]
Epstein, L.J.; Kristo, D.; Strollo, P.J., Jr; Friedman, N.; Malhotra, A.; Patil, S.P.; Ramar, K.; Rogers, R.; Schwab, R.J.; Weaver, E.M.; Weinstein, M.D. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J. Clin. Sleep Med., 2009, 5(3), 263-276.
[] [PMID: 19960649]
Menon, A.; Kumar, M. Influence of body position on severity of obstructive sleep apnea: a systematic review. ISRN Otolaryngol., 2013, 2013, 1-7.
[] [PMID: 24223313]
Bidarian-Moniri, A.; Nilsson, M.; Rasmusson, L.; Attia, J.; Ejnell, H. The effect of the prone sleeping position on obstructive sleep apnoea. Acta Otolaryngol., 2015, 135(1), 79-84.
[] [PMID: 25384381]
Mansfield, D.R.; Gollogly, N.C.; Kaye, D.M.; Richardson, M.; Bergin, P.; Naughton, M.T. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am. J. Respir. Crit. Care Med., 2004, 169(3), 361-366.
[] [PMID: 14597482]
Guilleminault, C.; Abad, V.C. Obstructive sleep apnea. Curr. Treat. Options Neurol., 2004, 6(4), 309-317.
[] [PMID: 15157408]
Roebuck, A.; Monasterio, V.; Gederi, E.; Osipov, M.; Behar, J.; Malhotra, A.; Penzel, T.; Clifford, G.D. A review of signals used in sleep analysis. Physiol. Meas., 2014, 35(1), R1-R57.
[] [PMID: 24346125]
Friedman, M.; Ibrahim, H.; Lee, G.; Joseph, N.J. Combined uvulopalatopharyngoplasty and radiofrequency tongue base reduction for treatment of obstructive sleep apnea/hypopnea syndrome. Otolaryngol. Head Neck Surg., 2003, 129(6), 611-621.
[] [PMID: 14663425]
Fairburn, S.C.; Waite, P.D.; Vilos, G.; Harding, S.M.; Bernreuter, W.; Cure, J.; Cherala, S. Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxillomandibular advancement. J. Oral Maxillofac. Surg., 2007, 65(1), 6-12.
[] [PMID: 17174756]
Goldstein, N.A.; Post, J.C.; Rosenfeld, R.M.; Campbell, T.F. Impact of tonsillectomy and adenoidectomy on child behavior. Arch. Otolaryngol. Head Neck Surg., 2000, 126(4), 494-498.
[] [PMID: 10772303]
Krespi, Y.P.; Ling, E.H. Laser-assisted serial tonsillectomy. J. Otolaryngol., 1994, 23(5), 325-327.
[PMID: 7807635]
Polites, N.; Joniau, S.; Wabnitz, D.; Fassina, R.; Smythe, C.; Varley, P.; Carney, A.S. Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J. Surg., 2006, 76(4), 226-229.
[] [PMID: 16681537]
Ferguson, K.A.; Cartwright, R.; Rogers, R.; Schmidt-Nowara, W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep, 2006, 29(2), 244-262.
[] [PMID: 16494093]
Cartwright, R.; Stefoski, D.; Caldarelli, D.; Kravitz, H.; Knight, S.; Lloyd, S.; Samelson, C. Toward a treatment logic for sleep apnea: The place of the tongue retaining device. Behav. Res. Ther., 1988, 26(2), 121-126.
[] [PMID: 3365202]
Oliven, A.; O’Hearn, D.J.; Boudewyns, A.; Odeh, M.; De Backer, W.; van de Heyning, P.; Smith, P.L.; Eisele, D.W.; Allan, L.; Schneider, H.; Testerman, R.; Schwartz, A.R. Upper airway response to electrical stimulation of the genioglossus in obstructive sleep apnea. J. Appl. Physiol., 2003, 95(5), 2023-2029.
[] [PMID: 14555669]
Oliven, A.; Schnall, R.P.; Pillar, G.; Gavriely, N.; Odeh, M. Sublingual electrical stimulation of the tongue during wakefulness and sleep. Respir. Physiol., 2001, 127(2-3), 217-226.
[] [PMID: 11504591]
Schwartz, A.R.; Eisele, D.W.; Hari, A.; Testerman, R.; Erickson, D.; Smith, P.L. Electrical stimulation of the lingual musculature in obstructive sleep apnea. J. Appl. Physiol., 1996, 81(2), 643-652.
[] [PMID: 8872629]
Smith, I.E.; Quinnell, T.G. Pharmacotherapies for obstructive sleep apnoea: where are we now? Drugs, 2004, 64(13), 1385-1399.
[] [PMID: 15212557]
Hanzel, D.A.; Proia, N.G.; Hudgel, D.W. Response of obstructive sleep apnea to fluoxetine and protriptyline. Chest, 1991, 100(2), 416-421.
[] [PMID: 1864117]
Clarenbach, C.F.; Kohler, M.; Senn, O.; Thurnheer, R.; Bloch, K. Does nasal decongestion improve obstructive sleep apnea? J. Sleep Res., 2008, 17(4), 444-449.
[] [PMID: 18710420]
Lavigne, F.; Petrof, B.J.; Johnson, J.R.; Lavigne, P.; Binothman, N.; Kassissia, G.O.; Al Samri, M.; Giordano, C.; Dubé, N.; Hercz, D.; Benedetti, A.; Hamid, Q. Effect of topical corticosteroids on allergic airway inflammation and disease severity in obstructive sleep apnoea. Clin. Exp. Allergy, 2013, 43(10), 1124-1133.
[PMID: 24074330]
Di Murro, A.; Petramala, L.; Cotesta, D.; Zinnamosca, L.; Crescenzi, E.; Marinelli, C.; Saponara, M.; Letizia, C. Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism. J. Renin Angiotensin Aldosterone Syst., 2010, 11(3), 165-172.
[] [PMID: 20488824]
Ziegler, M.G.; Milic, M.; Elayan, H. Cardiovascular regulation in obstructive sleep apnea. Drug Discov. Today Dis. Models, 2011, 8(4), 155-160.
[] [PMID: 22125570]
Bucca, C.B.; Brussino, L.; Battisti, A.; Mutani, R.; Rolla, G.; Mangiardi, L.; Cicolin, A. Diuretics in obstructive sleep apnea with diastolic heart failure. Chest, 2007, 132(2), 440-446.
[] [PMID: 17699130]
Gaddam, K.; Pimenta, E.; Thomas, S.J.; Cofield, S.S.; Oparil, S.; Harding, S.M.; Calhoun, D.A. Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report. J. Hum. Hypertens., 2010, 24(8), 532-537.
[] [PMID: 20016520]
Edwards, B.A.; Connolly, J.G.; Campana, L.M.; Sands, S.A.; Trinder, J.A.; White, D.P.; Wellman, A.; Malhotra, A. Acetazolamide attenuates the ventilatory response to arousal in patients with obstructive sleep apnea. Sleep, 2013, 36(2), 281-285.
[] [PMID: 23372276]
Farney, R.J.; Walker, J.M.; Elmer, J.C.; Viscomi, V.A.; Ord, R.J. Transtracheal oxygen, nasal CPAP and nasal oxygen in five patients with obstructive sleep apnea. Chest, 1992, 101(5), 1228-1235.
[] [PMID: 1582276]
Chauncey, J.B.; Aldrich, M.S. Preliminary findings in the treatment of obstructive sleep apnea with transtracheal oxygen. Sleep, 1990, 13(2), 167-174.
[PMID: 2184489]
Hu, K.; Li, Q.; Yang, J.; Hu, S.; Chen, X. The effect of theophylline on sleep-disordered breathing in patients with stable chronic congestive heart failure. Chin. Med. J. (Engl.), 2003, 116(11), 1711-1716.
[PMID: 14642143]
Mitler, M.M.; Aldrich, M.S.; Koob, G.F.; Zarcone, V.P. Narcolepsy and its treatment with stimulants. ASDA standards of practice. Sleep, 1994, 17(4), 352-371.
[PMID: 7973321]
Kanbayashi, T.; Honda, K.; Kodama, T.; Mignot, E.; Nishino, S. Implication of dopaminergic mechanisms in the wake-promoting effects of amphetamine: a study of d- and l-derivatives in canine narcolepsy. Neuroscience, 2000, 99(4), 651-659.
[] [PMID: 10974428]
Guilleminault, C. Amphetamines and narcolepsy: use of the Stanford database. Sleep, 1993, 16(3), 199-201.
[] [PMID: 8506450]
Mayer, G.; Arzt, M.; Braumann, B. Correction: S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. Somnologie (Berl.), 2017, 21(4), 289.
Collop, N.A.; Tracy, S.L.; Kapur, V.; Mehra, R.; Kuhlmann, D.; Fleishman, S.A.; Ojile, J.M. Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation. J. Clin. Sleep Med., 2011, 7(5), 531-548.
[] [PMID: 22003351]
Qaseem, A.; Dallas, P.; Owens, D.K.; Starkey, M.; Holty, J.E.C.; Shekelle, P. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from theAmerican College of Physicians. Ann. Intern. Med., 2014, 161(3), 210-220.
[] [PMID: 25089864]
Penzel, T.; Schöbel, C.; Fietze, I. New technology to assess sleep apnea: wearables, smartphones, and accessories. F1000 Res., 2018, 7, 413.
[] [PMID: 29707207]

© 2024 Bentham Science Publishers | Privacy Policy