Institute for Continuing Education

Sleep Disordered Breathing

Course Objectives

Upon successful completion of this module, you will be able to:

• Analyze and apply the contemporary classification systems and updated diagnostic criteria established in the American Academy of Sleep Medicine 2024 standards for Obstructive Sleep Apnea, Central Sleep Apnea, and Sleep Hypoventilation Syndromes, demonstrating proficiency in distinguishing between these diagnostic categories during polysomnographic evaluation.
• Differentiate and identify the four key pathophysiological phenotypes that drive Obstructive Sleep Apnea pathogenesis, including anatomical collapsibility measured by critical closing pressure, arousal threshold variability, high loop gain representing ventilatory control instability, and diminished ventilatory response to carbon dioxide, recognizing how each phenotype manifests during diagnostic studies and influences therapeutic selection.
• Evaluate the appropriate clinical application, inherent limitations, and diagnostic accuracy of Home Sleep Apnea Testing compared to in-laboratory polysomnography, understanding when each modality should be employed based on patient characteristics, comorbidities, and pretest probability of sleep disordered breathing, while also recognizing the diagnostic implications of the Multiple Sleep Latency Test in the differential diagnosis of residual excessive daytime sleepiness.
• Critically assess contemporary therapeutic strategies for Obstructive Sleep Apnea through comprehensive comparison of Positive Airway Pressure modalities including Continuous Positive Airway Pressure, Bilevel Positive Airway Pressure, and Auto-adjusting Positive Airway Pressure, while evaluating the efficacy profile and appropriate patient selection for Oral Appliance Therapy and advanced surgical interventions such as Hypoglossal Nerve Stimulation, demonstrating competency in matching therapeutic approaches to individual patient phenotypes.
• Distinguish between the diverse etiologies of Central Sleep Apnea, particularly differentiating Cheyne-Stokes Breathing patterns associated with congestive heart failure from opioid-induced central sleep apnea and treatment-emergent central sleep apnea, while critically evaluating the appropriate application and significant contraindications of Adaptive Servo-Ventilation therapy based on current clinical trial evidence and cardiovascular risk stratification.
• Discuss the diagnostic criteria, pathophysiological mechanisms, and comprehensive management strategies for sleep-related hypoventilation disorders, including Obesity Hypoventilation Syndrome, neuromuscular disease-related hypoventilation, and restrictive chest wall disorders, demonstrating proficiency in selecting appropriate non-invasive ventilation modalities and understanding the critical role of pressure support in managing chronic hypercapnia.

Course Information

Humans spend almost 30% of their lives sleeping. Over the past 30 years, physicians have begun to recognize many of the detrimental consequences of sleep disturbances produced by abnormal breathing patterns termed sleep-disordered breathing (SDB).1 Sleep apnea and other sleep-related breathing disorders constitute the greatest number of sleep disorders seen by pulmonologists as well as general practitioners in the outpatient setting. Besides being a common disorder, SDB also has been associated with considerable morbidity. Therefore, a basic understanding of this prevalent disease state is essential for the practicing physician.