Dental Management of Sleep Disorders. Ronald Attanasio. Читать онлайн. Newlib. NEWLIB.NET

Автор: Ronald Attanasio
Издательство: John Wiley & Sons Limited
Серия:
Жанр произведения: Медицина
Год издания: 0
isbn: 9781119014621
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      Conceptual Overview

      Insomnia also needs to be considered and may be associated with painful conditions, psychological issues such as anxiety or depression, and may be residual to adequately managed SRBD. This association was first reported in 1973 [4]. It has been reported that about 50% of patients presented with both the SRBD and insomnia, and it was termed sleep breathing disorder plus [5] also referred to as complex insomnia [6].

      A brief discussion and review of respiration needs to be addressed. Under normal circumstances respiration is mostly considered to be involuntary. It is primarily under the control of the diaphragm that is innervated by the phrenic nerve, composed primarily of muscle fibers that cause contraction. The phrenic nerve is derived from the cervical nerves at the C‐3 to C‐5 level. During passive breathing the diaphragm contracts and moves downward causing an increase in the negative pressure within the lungs and the alveoli. This negative pressure causes air to enter the lungs to fill them. In addition, this action may be impacted by the action of the intercostal muscles as well as the scalenes. Expiration during quiet breathing is passive and there is no active muscle activity. The process is related to the elastic recoil of the lungs and the rib cage.

Schematic illustration of evolution of SRBD based on the acquisition of speech and the loss of the epiglottic-soft palatal lockup.

      Anatomy and Function of the Airway

      The understanding and focus is related to the pathophysiology of SRBD that begins with an understanding of the anatomy of the airway most often implicated in the onset and perpetuation of these conditions. The anatomy of the airway here focuses mainly on the upper airway, primarily the musculature that directly controls airway function, which has been broken down by anatomic location [7]. These same muscles are also involved in the function of speech and eating, hence breathing while awake is likely impacted by these functions but not during sleep and this then increases the likelihood for the SRBD.

      Soft Palate

Schematic illustration of the three regions of the upper airway: N, nasopharynx; O, oropharynx; and H, hypopharynx; E, is the epiglottis.