Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

200 of 300 patients who were operated on because of strident snoring or of a sleep apnoea syndrom were examined in a follow-up study. In 93.5% turbinectomy was performed simultaneously, in 50% septum plasty, and in 9.5% endonasal revision of the sinus. On Improvement of snoring was noted in 81.5% of the patients, cessation or improvement of the apnoea in 83%. Daily tiredness was reduced in 65% of the operated patients, and partner problems were solved in 78%. Recommendation for operation was given in 75.5% of the cases. Due postoperative complaints and the lack of results, however, 21.5% could not, and 3% restricted their recommendation to others to undergo surgery. The satisfactory results and the high acceptance of the operation confirmed uvulopalatopharyngoplasty as a solid and efficient operation to help patients suffering from an obstructive sleep apnoea syndrome. If the operation is performed carefully and cautiously, there is no fear of negative consequences such as rhinophonia and difficulties in swallowing.
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PMID:[Results of follow-up after uvulopalatopharyngoplasty]. 205 22

Thirty-four patients (32 male, 2 female; mean age 53 +/- 7 years) with confirmed sleep apnea syndrome (SAS) were studied before and after uvulopalatopharyngoplasty (UPPP). Clinical symptoms were tiredness, excessive daytime sleepiness and snoring. All patients were overweight. Patients underwent a thorough physical and oropharyngeal examination and polysomnography before and 3 months after surgery. On the basis of post-operative results, patients are divided into 3 groups: --group 1: 16 cured patients: apnea index (A.I./h) 38 +/- 17 before and 4.4 +/- 4 apneas/h sleep after surgery. Improved nocturnal hypoxemia: mean minimum oxyhemoglobin saturation (SAO2) before and after UPPP in NREM sleep 83 +/- 4% v. 90 +/- 4% in REM sleep 76 +/- 11% v. 85 +/- 7%. Uninterrupted sleep is restored; --group 2: 8 improved patients: A.I./h of 64 +/- 11 before and 20 +/- 6 after UPPP: improved nocturnal hypoxemia: mean minimum SAO2 in NREM sleep 74 +/- 10% before and 86 +/- 6% after UPPP: in REM sleep 59 +/- 9% before and 79 +/- 6% after UPPP, lower amount and percentage of fragmented sleep; --group 3: 10 non-improved patients: A.I./h unchanged 55 +/- 22% before and 50 +/- 20% after UPPP. Persistent nocturnal hypoxemia: mean minimum SAO2 in NREM sleep 76 +/- 13 before and 81 +/- 12% after UPPP: in REM sleep 63 +/- 16% before and 65 +/- 24% after UPPP. Sleep remains fragmented. In this last group patients are more overweight and all suffer from severe SAS with greater nocturnal oxyhemoglobin desaturation. Surgical treatment by UPPP is shown to be effective for 70% of our patients. Better results are obtained when SAS is less severe and overweight less important.
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PMID:[Efficacy of uvulopalatopharyngoplasty (UPPP) and modifications in sleep structure in the sleep apnea syndrome (SAS)]. 261 54

Fatigue is commonly reported by patients with rheumatoid arthritis (RA), and it is frequently used to evaluate disease activity and response to therapy. We theorized that the feeling of fatigue in patients with RA may be a manifestation of disturbance of sleep. Sixteen patients with chronic, active RA, who were selected for early onset of fatigue (less than 6 hours after morning awakening), were extensively evaluated by formal all-night polysomnographic recording and multiple sleep latency testing (MSLT). Although no sleep deprivation was found, all patients had some type of marked disturbances of sleep, including unanticipated sleep apnea (2 patients), frequent movement of extremities (all 16 patients), and frequent arousal (all 16 patients). The alpha-delta sleep pattern was present in 13 patients, and 7 were found by MSLT to be hypersomnolent. None of the patients accurately recognized the degree of their sleep disruption. Our findings from the MSLT indicate that fatigue in patients with RA may be a manifestation of sleep fragmentation, rather than a nonspecific constitutional symptom.
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PMID:Sleep fragmentation in rheumatoid arthritis. 276 10

Napoleon would sleep very little. He frequently woke up during night and worked. Brief sleeping time in day repaired his fatigue. He had also a short and thick neck. In the last fourth of his life he progressively suffered from obesity, daily involuntary sleepiness and his intellectual capabilities undoubtedly decreased. Our experience of 48 cases of sleep apnea syndrome diagnosed by mean of polysomnography allow no to think that Napoleon suffered from this disease. Historical consequences of this pathology is discussed.
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PMID:[Did Napoleon suffer from sleep apnea syndrome?]. 304 29

To describe the affective changes associated with sleep restoration we assessed psychologic symptoms using the Profile of Mood States questionnaire before and two months after treatment with nasal continuous positive airway pressure (NCPAP) in seven men with obstructive sleep apnea (OSA). The results were compared with those of a control group of patients with OSA who did not receive NCPAP. Two of six mood factors, depression and fatigue, improved significantly following treatment with NCPAP. Total Mood Disturbance (TMD) score was used to assess global mood differences. The mean TMD score for the patients before treatment was 1.7 and during treatment decreased to -7.6 (p less than 0.05). This mean decrease of 9.3 in the TMD score implies generalized improvement in mood. These findings support the opinion that sleep fragmentation and abnormalities of respiration during sleep are at least partially responsible for affective changes seen in sleep apnea. These psychologic disturbances improve after treatment with NCPAP.
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PMID:Neuropsychologic symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure. 305 55

Rare upper airway lesions may be mistaken for asthma. A 16-year-old Hispanic male athlete presented to our allergy clinic with a 4-month history of wheezing and snoring with hoarseness and progressive fatigue on exertion or during sleep. His mother taped periods of harsh stridor and sleep apnea. There was no family history of vocal cord abnormalities. A year before the onset of symptoms, he suffered injury to his oral cavity with a loss of consciousness during a wrestling match. He denied dysphagia or dysphonia. He failed to respond to bronchodilators, cromolyn, or prednisone therapy during 4 weeks. On referral to our clinic, his physical examination and tape recording were characterized by harsh inspiratory stridor. His pulmonary function tests were significant for peak flow depressed out of proportion to FEV1 with reduced FVC, no response to bronchodilator, and flattened inspiratory loop unresponsive to cough or panting. Fluoroscopy and endoscopy of the upper airway was consistent with "marked bilateral limitation of vocal cord abduction." Sleep study demonstrated desaturation with CO2s in the 60s during sleep. He was started on continuous positive airway pressure, 10 cm at night, with no desaturation or sleep disturbance on follow-up.
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PMID:Bilateral abductor paresis masquerading as asthma. 337 24

This report discusses mechanisms causing the airways to open during obstructive sleep apnea (OSAS). In 4 male patients with OSAS, 92 nonrapid eye movement (NERM) sleep apnea episodes and 37 rapid eye movement (REM) sleep apnea episodes were analyzed breath by breath during a one-night study. We calculated the pressure time index of the diaphragm (the product of inspiratory time/cycle duration (Tl/Ttot) and mean transdiaphragmatic pressure swing), evaluated the sleep stages via EEG, and performed frequency spectrum analysis of the EMG of the diaphragm. It was found that with each occluded inspiratory effort the tension time index of the diaphragm (TTdi) increased progressively to reach or slightly exceed the fatigue threshold, 0.15 to 0.18 (during NREM sleep the TTdi of the last occluded breath was 0.195 +/- 0.045 and during REM sleep the TTdi of the last occluded breath was 0.153 +/- 0.037); that a close time relationship was observed as well between the onset of arousal and the opening of the airways. Our data suggest that the airways may be triggered to open by a protective reflex originating in the larynx or the inspiratory muscles upon reaching a certain degree of contraction.
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PMID:Inspiratory muscle activity as a trigger causing the airways to open in obstructive sleep apnea. 381 99

The factors which produce closure of the upper airway (UAW) in patients with the sleep apnea syndrome are still poorly understood. A distinction should be made between the factors which induce closure and those which reopen the UAW. Neurologic factors include arousal phenomena, the magnitude and timing of various motor outputs, and postsynaptic inhibition. Mechanical factors include the anatomy of the UAW, especially that above the tongue, the position of the neck and jaw, and mucosal adherence once occlusion has occurred. Muscle factors include the type of myosin isozyme, the forces generated by the large number of UAW muscles and the diaphragm, and the possibility of high-frequency fatigue occurring during occlusion. Hypoxia and acidosis probably play a critical role in making the UAW less stable. Currently, the best method to prevent UAW closure is by nasal CPAP. Patients with life-threatening arrhythmias due to sleep apnea should have a tracheostomy. The role of drugs is controversial. Respiratory or muscle stimulants should probably be avoided; oxygen, medroxyprogesterone, and protriptyline may be useful adjuncts.
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PMID:Clinical conference in pulmonary disease. Factors influencing upper airway closure. 673 71

Symptoms suggesting autonomic instability and increased adrenergic effect were identified in 53 patients with primary disorders of impaired wakefulness. Urine and plasma catecholamine concentrations were significantly increased in patients with sleep apnea. Excessive increases in heart rate during isoproterenol infusions suggested adrenergic hyperresponsiveness as an alternative explanation for symptoms of catecholamine excess in some individuals. Twenty-two patients demonstrated mitral valve prolapse (MVP), implicating primary neurologic disturbances as potential factors in the fatigue and lassitude often associated with MVP. The catecholamine abnormalities may explain some of the difficulties frequently encountered in using stimulants to treat sleep disorders.
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PMID:Adrenergic hyperactivity and cardiac abnormality in primary disorders of sleep. 718 91

Obstructive sleep apnea is becoming more widely recognized. Otolaryngologists will be called upon to evaluate affected patients and offer consultation as to the appropriateness of surgical intervention. The extent to which this syndrome is attributable to edema of the larynx and hypopharynx is unknown. It may, on occasion, explain chronic fatigue, weight loss, and daytime somnolence seen in some patients following irradiation of the head and neck. Sleep apnea associated with upper airway obstruction can be confirmed by polysomnography during sleep. Monitoring the EEG, electro-oculogram, electromyogram, ECG, airflow, and respiratory effort allows differentiation of obstructive sleep apnea from central or mixed apnea. Once the diagnosis of obstructive sleep apnea is established, treatment consists of correcting the airway obstruction.
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PMID:Sleep apnea syndrome and supraglottic edema. 739 96


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