- • Sleepiness in the day or wakefulness at night
(insomnia) can be caused by medical disorders other than sleep apnea.
- • Conditions such as heart failure, chronic obstructive
lung disease, asthma, gastroesophageal reflux, fibromyalgia, Parkinson’s
disease, and seizures are associated with sleepiness and manifestations
- • Treatment directed at the underlying medical condition
often decreases sleepiness and improves patient function.
Many respiratory diseases have manifestations during sleep. Medical,
neurological, and psychiatric conditions may present as primary
sleep problems or generate sleep complaints, in particular, sleepiness
during the daytime. Insomnia, especially awakening from sleep (sleep
maintenance insomnia), is common in patients with sleep apnea and
narcolepsy but also in patients with chronic obstructive pulmonary
disease (COPD), asthma, gastroesophageal reflux, and fibromyalgia.
It may be difficult when patients first present to separate symptoms
due to pulmonary diseases from those caused by sleep-disordered
breathing. This can be especially challenging for the physician,
because sleep apnea, heart failure, and COPD are all common in middle-aged
and older adults and may all be present in the same patient. It
is important to identify patients with impaired sleep resulting
from medical conditions other than sleep apnea as treatment differs.
This chapter highlights common medical diagnoses associated with
daytime sleepiness or sleep symptoms that may masquerade as sleep
apnea. For details on a general approach to sleepiness and the sleep
disorders that come to the attention of an internist, specifically
sleep apnea, narcolepsy, restless leg syndrome, and periodic limb
movements, see Chapters 28: Sleep Apnea & the Upper Airway
Resistance Syndrome and 29: Evaluation of Sleepiness & Sleep
Disorders Other Than Sleep Apnea: Narcolepsy, Restless Leg Syndrome,
& Periodic Limb Movements.
Common medical conditions with sleep manifestations are listed
in Table 30–1. The conditions highlighted in this
chapter include cardiac, pulmonary, musculoskeletal, and neurological
disorders. Both sleepiness and difficulty staying asleep with frequent
nocturnal awakenings are particularly problematic for some patients
with congestive heart failure, COPD, asthma, gastroesophageal reflux
disease, Parkinson’s disease, and fibromyalgia. Seizures
may present with daytime sleepiness even without documented nocturnal
Conditions That Impair Sleep and Lead to Daytime Sleepiness. |Favorite Table|Download (.pdf)
Conditions That Impair Sleep and Lead to Daytime Sleepiness.
|Congestive heart failure|
|Chronic obstructive pulmonary disease|
|Nonketotic hyperosmolar coma|
|Central nervous system infection|
|Chronic fatigue syndrome|
|Mood disorders, especially depression|
- • Obstructive sleep apnea and central sleep apnea
(Cheyne–Stokes respirations) are common in heart failure
and disrupt sleep.
- • Treatment of central sleep apnea in patients with
heart failure improves survival.
Congestive heart failure (CHF) is ...