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Essentials of Diagnosis

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  • • 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 during sleep.
  • • Treatment directed at the underlying medical condition often decreases sleepiness and improves patient function.

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General Considerations

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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.

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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 awakenings.

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Table Graphic Jump Location
Table 30–1. Conditions That Impair Sleep and Lead to Daytime Sleepiness.
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Essentials of Diagnosis

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  • • 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.

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General Considerations

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Congestive heart failure (CHF) is ...

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