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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstructive sleep apnea syndrome (OSAS) was diagnosed in157 subjects based on clinical symptoms, physical evaluation, cephalometric x-ray films, and polysomnography. These index cases identified 844 living first-degree relatives. Mailings were sent to 792 (94%). The mailing consisted of two identical questionnaires, one for the family member of the index case and one to be given to a friend (not a relative) of approximately the same age. In response, we received 531 (63%) questionnaires from relatives and 198 (25%) questionnaires from age-matched nonrelated friends, which were used as a control group. A more extensive investigation was performed on first-degree relatives of the index group living in the San Francisco Bay Area or vicinity. Two hundred seventy-nine relatives (100%) were identified. One hundred sixty-six subjects (59%) as well as 69 age-matched friends (ie, 41% of the 166 relatives and 25% of the potential total group) agreed to participate in further studies. These subjects had interviews, clinical investigations, and nonattended ambulatory monitoring. Cephalometric x-ray films could be obtained on only 22 of 166 participating relatives and 6 of 69 friends. Body mass index was not a differentiating measure between relatives and friends. Odds ratios (ORs) were calculated from the questionnaiare data. The report of tiredness, fatigue, and sleepiness did not distinguish family members from friends. The OR, however, progressively increases when there is a positive history of near nightly loud snoring (OR = 1.78; 95% confidence interval [CI] 1.25-2.54) or a positive history of daytime sleepiness in conjunction with near nightly loud snoring (OR = 3.11; 95% CI = 1.94-4.99). The investigation in the Bay Area indicated that, when first-degree relatives were compared with friends, the complaint of daytime tiredness, sleepiness, or both with the presence of a high and narrow(ogival) hard palate sharply differentiated between friends and relatives (OR = 10.9, 95, CI = 5.31-22.5). An Epworth Sleepiness Scale score of 9 or greater with the presence of another symptom associated with OSAS, and a respiratory disturbance index greater than 5 (number of apneas and hypopneas per hour of sleep > 5) gave an OR of 45.6 (95% CI = 18.8-11.0). Disproportionate craniofacial anatomy was common in familial groups with OSAS. Craniofacial familial features can be a strong indicator of risk for the development of OSAS.
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PMID:Familial aggregates in obstructive sleep apnea syndrome. 778 44

The purpose of this study is to investigate the effects of surgical treatment of psychophysiological and psychological measurement of obstructive sleep apnea syndromes (OSAS) patients, and to clarify the interrelationships regarding an evaluation of its improvement. The subjects, 17 inpatients (mean age: 41.9 +/- 13.8 [17-61] 15 males, 2 females), were given the diagnosis of OSAS at the International Classification of Sleep Disorders. 4-5 days before (Pre-Treatment: PT), 5-22 days after (13.0 +/- 4.8 days, Post-Operation: PO) and 3-6 months after (4.2 +/- 1.0 months, Follow Up: FU) the surgery, the examinations were performed. Polysomnography (PSG) were recorded from 21:00 to 6:00. Following PSG, for the changes in daytime sleepiness, Multiple Sleep Latency Test (MSLT), Stanford Sleepiness Scale (SSS) and Spaceaeromedicine fatigue check list (SAM) were applied with the interval of 2 hours from 8:00 to 20:00. The psychological battery were performed at PT and FU, that consisted of Uchida-Kraepelin Test (U-K), Wechsler Adult Intelligence Scale-Revised (WAIS-R), Benton Visual Retention Test (BVRT) and Minnesota Multiphasic Personality Inventory (MMPI). Surgical procedures were determined by means of radiological and endoscopic examinations. The results were as follows. A. Psychophysiological measurement (1) Apnea Index (AI) decreased at PO compared with PT. Further at FU. AI improved significantly compared with PT and PO [AI: 43.9 +/- 19.2-->20.5 +/- 16.5-->11.2 +/- 11.4]. And apnea duration shortened significantly at PO and FU. In addition, % time O2 saturation below 90% (SaO2 < or = 90%) decreased significantly at FU compared with PT. (2) With the improvement of respiratory disturbance, the sleep architecture of FU improved more than those of PO, such as increase of sleep efficiency, %stage 2 and %stage 3 + 4, decrease of No. of stage shift, %Wake and %stage 1. (3) Daily average of MSLT Scores at PO did not change compared with PT. But at FU, they improved significantly to normal range [6.7 +/- 3.0-->8.0 +/- 3.5-->11.4 +/- 3.9 (min.)], whereas daily average of SSS and SAM improved significantly at both PO and FU compared with PT. B. Psychological measurement (1) Dysfunction of task performance improved at FU. Mean value in U-K (1st and 2nd half) and mean IQ (performance and total) in WAIS-R increased significantly at FU compared with PT. (2) Immediate visual memories in BVRT did not change within normal range. (3) MMPI profiles at PT didn't show any personality or mood characteristics.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Psychophysiological and psychological consequences after surgical treatment of obstructive sleep apnea syndromes]. 787 Aug 43

Humans spend one-third of their lives sleeping, yet the role of this phase of the circadian rhythm is not clear. Theories postulating the purpose of sleep include the restorative theory and the humeral theory. Both theories have identified weaknesses. What is known is that chronic disruption of sleep and/or sleep deprivation causes significant physiological and psychological symptoms. These include fatigue, lethargy and daytime somnolence accompanied by irritability, memory loss, decrease in judgment and paranoia. Obstructive sleep apnea (OSA) imposes another, more life-threatening dimension for the client.
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PMID:Obstructive sleep apnea. 798 95

Patients with noninsulin-dependent diabetes mellitus (NIDDM) are often obese and frequently complain of tiredness. These features are also characteristically seen in patients with obstructive sleep apnea (OSA). Therefore, it was the aim of this study to assess the prevalence of OSA among a group of obese NIDDM patients who have some clinical features of OSA. The effect of reversal of OSA by nasal continuous positive airway pressure (CPAP) treatment on insulin responsiveness was also investigated. From a population of 179 NIDDM patients with a body mass index (BMI) greater than 35 kg/m2, we performed ambulatory sleep monitoring on 31 (15 males and 16 females) who admitted to either heavy snoring or excessive sleepiness. Results were reviewed by a sleep physician blinded to the clinical status of the patients, and 22 (70%) were found to have moderate or severe OSA, with mean oxygen desaturation indexes of 10.3 +/- 5.3 and 30.7 +/- 13.2 episodes/h, respectively. A subgroup of 10 patients (seven males and three females) with a mean BMI of 42.7 +/- 4.3 kg/m2 was treated with nightly CPAP for 4 months. These subjects all had significant OSA, with frequent obstructive apneas (mean, 47 +/- 31.6 episodes/h) and oxygen desaturation (mean minimum O2 saturation, 74 +/- 9.5%), as determined by polysomnography. One patient was excluded from analysis because of infrequent use of CPAP. Insulin responsiveness in terms of glucose disposal measured by hyperinsulinemic euglycemic clamps improved from 11.4 +/- 6.2 to 15.1 +/- 4.6 mumol/kg.min (P < 0.05) during CPAP treatment. These results indicate that OSA occurs commonly in obese NIDDM patients with excessive sleepiness or heavy snoring. Treatment of their OSA may improve insulin responsiveness.
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PMID:Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. 798 75

Recent studies of obstructive sleep apnea and its comorbidity with other systemic diseases have stimulated interest in the relationship of apnea to renal disease and hypertension. Polysomnographic sleep studies in patients on dialysis who complain of day-time fatigue or sleepiness reveal significant apnea in up to 73% of those studied. Abnormalities in respiratory controller mechanisms from chronic hypocarbia, metabolic acidosis, and uremic toxins have been blamed for the occurrence of apnea in this setting. Proteinuria and sometimes nephrotic syndrome have been recognized in morbidly obese patients with sleep apnea syndrome. Renal biopsies of such patients have shown glomerulomegaly and focal segmental sclerosis. It is postulated that these lesions may result from increased glomerular filtration and blood flow. Elevated urine output, sodium and chloride excretion, and atrial natriuretic peptide have been well demonstrated in obstructive apnea patients and correct to control levels with treatment of the apnea. Both acute (with each apnea) and chronic daytime blood pressure elevation are frequently observed in sleep apnea patients, and occult sleep apnea is postulated as one possible cause of "primary" hypertension in middle-aged men. In younger patients, such hypertension seems to be more reversible with the elimination of apnea. In older patients, however, the cure of systemic hypertension cannot be guaranteed with the elimination of the apnea, and asymptomatic apnea patients tend not to tolerate the bother and discomfort of apnea treatment with nasal continuous positive airway pressure. Therefore, aside from a careful history regarding sleep symptomatology, polysomnographic studies of clinic populations with primary hypertension to search for apnea as a cause cannot be recommended.
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PMID:Obstructive sleep apnea and the kidney. 830 38

Relatively little data exist concerning the manifestations of repeated obstructive sleep apnea in normal infants. A questionnaire concerning daytime and sleep habits was completed by the parents of 4,100 healthy infants before they underwent a 9-hour night monitoring study. One hundred infants with an obstructive apnea index above 1.2 were randomly selected. They formed the "apnea" group. From the initial population, 300 infants with no apnea were also selected to form the "no-apnea" group. Both groups were matched for sex, gestational age, post conceptional age, birth weight, mother's age, parity and a family history of sudden infant death. Five variables from the questionnaires significantly differentiated the two groups of infants. When awake, the infants with apnea were characterized by a greater frequency of breathholding spells (22% of apnea infants) and episodes of fatigue during feeding (28%) than the non-apnea infants. During sleep, they exhibited a greater frequency of profuse sweating (15%), snoring (26%) or noisy breathing (44%). Multiple symptoms were present in some infants. A stepwise logistic regression resulted in two significant independent variables: profuse sweating during sleep (p = 0.008) and noisy breathing (p = 0.002). The predictive value of these two symptoms was tested on a new group of 650 healthy infants. The two independent variables led to the correct classification of 60 of the 67 infants with apnea (89.67%) and 382 of the 583 non-apnea infants (65.5%). A positive history alone had a positive predictive value of 0.21.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical symptoms associated with brief obstructive sleep apnea in normal infants. 837 81

Pharyngeal muscles are the effector organ by which the brainstem regulates pharyngeal airway size and patency during breathing. These muscles have fast contractile rates, and may be susceptible to develop fatigue when driven at the high levels required to overcome structural pharyngeal narrowing, especially under hypoxic conditions. Diseases with an increased prevalence of sleep apnea are associated with changes in pharyngeal muscle properties, and conversely diseases which primarily alter neuromuscular function have a significant prevalence of sleep apnea. However, further studies are needed to define the precise role of pharyngeal muscle fatigue, and of changes in pharyngeal muscle properties with disease, in the pathophysiology of obstructive sleep apnea.
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PMID:Muscles of the pharynx: structural and contractile properties. 844 23

Nasal continuous positive airway pressure (CPAP) has become the nonsurgical treatment of choice for obstructive sleep apnea syndrome (OSAS). Recent evidence suggests that intermittent use of CPAP by patients is more common than nightly compliance. To determine the consequences of intermittent CPAP use, in terms of a return of sleep-disordered breathing and daytime hypersomnolence, 15 OSAS subjects were evaluated at three times: (1) before CPAP treatment (pretreatment), (2) after 30 to 237 days posttreatment during a night of CPAP use (on CPAP), and (3) during a night without CPAP (off CPAP). Evaluations of sleep-disordered breathing and three domains of hypersomnolence, physiologic sleep tendency, subjective sleepiness, and performance, were accomplished with the respiratory disturbance index (RDI), multiple sleep latency test (MSLT), Stanford sleepiness scale (SSS), and psychomotor vigilance task (PVT), respectively. CPAP use was encouraged and monitored from pretreatment to post-treatment by daily diaries for most subjects and an electronic device for a subset of subjects. As expected, CPAP eliminated apneas and hypopneas, and following the on CPAP night, there were statistically significant improvements in objective measures of sleepiness (MSLT and PVT). Subjective measures of sleepiness and fatigue also showed improvement. Sleeping without CPAP for one night reversed virtually all of the sleep and daytime alertness gains derived from sleeping with CPAP. This occurred despite a statistically significant reduction in the RDI on the night off CPAP (M = 36.8, SD = 28.0 events/h) relative to the pretreatment night (M = 56.6, SD = 24.8 events/h), which may be due to a lessening of the edema of the upper airway following CPAP use.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. 848 26

56 patients with habitual snoring (n = 43) or with complicated snoring accompanied by sleep apnea syndrome (n = 13) under went uvulopalatopharyngoplasty. The patients were observed for a period of 2 to 84 months (average: 20,8 months). Postoperatively, 80 % showed a disappearance or great reduction of snoring intensity. Other symptoms of obstructive sleep apnea syndrome such as apneas, tiredness during the day and deterioration of sleep quality also improved markedly. In ten out of 13 patients with a demonstrated sleep apnea syndrome, the apneas disappeared or became noticeably reduced (in seven patients shown by means of a polysomnographic check-up). Two patients developed velopharyngeal stenosis, which was subsequently corrected. Other operative side effects were temporary (from days to weeks) and only minor (transient speaking problems, nasal regurgitation, rhinopharyngitis sicca, taste disturbances).
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PMID:[Uvulo-palatopharyngioplasty: indication, technique and results in relation to ronchopathy and sleep apnea syndrome]. 868 62

OSAS, a common cause of disrupted sleep and EDS, result from repetitive closure of the upper airway during sleep. It probably represents the most severe syndrome related to obstruction of the upper airway; less severe forms include UARS, a syndrome characterized by the need for increased effort to breath but no prominent apneas or hypopneas, and primary snoring. Initial clues to the presence of OSAS and related disorders are derived from the history and include loud snoring, EDS or insomnia, and witnessed apneas. Some patients, especially women, may complain mostly of tiredness or fatigue, and children may present with behavioral abnormalities. Obesity, a large neck circumference, and a crowded oropharynx are common on physical examination. Nonobese patients, in particular, often have retrognathia, a high-arched narrow palate, macroglossia, enlarged tonsils, temporomandibular joint abnormalities, or chronic nasal obstruction. The clinical suspicion of obstructed nocturnal breathing is confirmed by overnight polysomnography, and an MSLT may be used to assess sleepiness. Esophageal manometry during polysomnography facilitates diagnosis of UARS. Treatment most commonly consists of nasal CPAP or BPAP, although problems with compliance make surgical treatment preferable in some cases. Although UPPP eliminates sleep apnea only in a minority of patients, combining UPPP with maxillofacial procedures appears to improve outcomes. Other treatments such as the use of dental appliances or medications, weight loss, and positional therapy may be useful as adjunctive therapy for moderate to severe OSAS or as primary treatments for UARS or mild OSAS.
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PMID:Obstructive sleep apnea and related disorders. 887 78


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