Attention-deficit/hyperactivity disorder. Attention—deficit/hyperactivity disorder in chil— dren may include symptoms of inattention, academic impairment, hyperactivity, and in- ternalizing behaviors, all of which may also be symptoms of childhood obstructive sleep apnea hypopnea. The presence of other symptoms and signs of childhood obstructive sleep apnea hypopnea (e.g., labored breathing or snoring during sleep and adenotonsillar hypertrophy) would suggest the presence of obstructive sleep apnea hypopnea. Obstruc- co-occur, and there may be causal links between them; therefore, risk factors such as en- larged tonsils, obesity, or a family history of sleep apnea may help alert the clinician to their co-occurrence.
Substance/medication-induced insomnia or hypersomnia. Substance use and substance withdrawal (including medications) can produce insomnia or hypersomnia. A careful his- tory is usually sufficient to identify the relevant substance/medication, and follow-up shows improvement of the sleep disturbance after discontinuation of the substance/med- ication. In other cases, the use of a substance/ medication (e.g., alcohol, barbiturates, ben- zodiazepines, tobacco) has been shown to exacerbate obstructive sleep apnea hypopnea.
An individual with symptoms and signs consistent with obstructive sleep apnea hypop- nea should receive that diagnosis, even in the presence of concurrent substance use that is exacerbating the condition.
Systemic hypertension, coronary artery disease, heart failure, stroke, diabetes, and increased mortality are consistently associated with obstructive sleep apnea hypopnea. Risk esti- mates vary from 30% to as much as 300% for moderate to severe obstructive sleep apnea hypopnea. Evidence of pulmonary hypertension and right heart failure (e.g., cor pulmo- nale, ankle edema, hepatic congestion) are rare in obstructive sleep apnea hypopnea and pulmonary comorbidities. Obstructive sleep apnea hypopnea also may occur with in- creased frequency in association with a number of medical or neurological conditions (e.g., cerebrovascular disease, Parkinson’s disease). Physical findings reﬂect the co-occurrence of these conditions.
As many as one-third of individuals referred for evaluation of obstructive sleep apnea hypopnea report symptoms of depression, with as many of 10% having depression scores consistent with moderate to severe depression. Severity of obstructive sleep apnea hypop- nea, as measured by the apnea hypopnea index, has been found to be correlated with se- verity of symptoms of depression. This association may be stronger in males than in females.
Reiationship to International Classification of
The International Classification of Sleep Disorders, 2nd Edition (ICSD-Z), differentiates 11 sub- types of ”sleep-related breathing disorders,” including primary central sleep apnea, ob- structive sleep apnea, and sleep-related hypoventilation.
A. Evidence by polysomnography of five or more central apneas per hour of sleep.
B. The disorder is not better explained by another current sleep disorder.
Specify whether: 327.21 (647.31) Idiopathic central sleep apnea: Characterized by repeated epi- sodes of apneas and hypopneas during sleep caused by variability in respiratory effort but without evidence of airway obstruction.
786.04 (R063) Cheyne-Stokes breathing: A pattern of periodic crescendo- a frequency of at least five events per hour, accompanied by frequent arousal.
780.57 (647.37) Central sleep apnea comorbid with opioid use: The pathogenesis of this subtype is attributed to the effects of opioids on the respiratory rhythm genera- tors in the medulla as well as the differential effects on hypoxic versus hypercapnic re- spiratory drive.