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

It is likely sleep apnea is highly prevalent in patients with congestive heart failure (CHF). However, as awareness is low and consensus guidelines do not exist, sleep apnea is not routinely screened for or diagnosed in CHF practice. Untreated sleep apnea may promote fatigue as well as left ventricular dysfunction, disease progression, and increased mortality. Available screening tools lack sensitivity or specificity, and there are insufficient numbers of sleep laboratories to accommodate the potentially large number of patient referrals with CHF for definitive diagnosis. In CHF patients with obstructive sleep apnea and sleepiness, treatment includes continuous positive airway pressure which may improve left ventricular function; optimal treatment for the non-sleepy patient is not established. There is no consensus regarding treatment for central sleep apnea. Studies which evaluate cardiovascular endpoints will be necessary to define management strategies for patients with CHF and either obstructive or central sleep apnea.
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PMID:Sleep apnea: implications for heart failure. 1752 97

Sleep related breathing disorders are common and their potential to disrupt sleep leading to daytime fatigue and hypersomnolence is widely acknowledged. In the future, obstructive sleep apnoea (OSA) may become even more important because obesity as a main risk factor is increasingly prevalent. Apart from disturbing sleep, OSA has also been recognised as a risk factor for hypertension, acute cardiovascular events and metabolic disturbance such as insulin resistance. Several randomised controlled trials demonstrated a positive effect of nasal continuous positive airway pressure (CPAP) treatment on arterial blood pressure, leading the "Joint National Council on High Blood Pressure" to list obstructive sleep apnoea as the first identifiable cause of arterial hypertension. Recently, a growing body of evidence demonstrated also a risk reduction of fatal and non-fatal cardiovascular events by treatment of obstructive sleep apnoea. A beneficial effect of treatment of OSA was also shown for patients with heart failure, or heart rhythm disturbance. Obstructive sleep apnoea may no longer be seen as a cause for daytime sleepiness and impaired quality of life only, but also as an independent risk factor, at least for the occurrence of hypertension but probably for any cardiovascular and cerebrovascular disease. While prospective controlled trials to document a reduction of cardiovascular morbidity and mortality are awaited, therapeutic nihilism seems no longer appropriate. With effective treatment available, subgroups that may profit best remain to be identified.
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PMID:Obstructive sleep apnea and cardiovascular disease - time to act! 1752 76

Fibromyalgia syndrome (FMS) is characterized by chronic widespread musculoskeletal pain, stiffness and tenderness at multiple points. Sleep disturbances are common in FMS and patients usually complain about nonrestorative sleep. Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive pharyngeal collapse during sleep. Recurrent arousals from sleep occurs to restore pharyngeal patency in OSAS and this results in increased sympathetic activity and fragmentation of sleep. Sleep disturbances may lead to musculoskeletal pain and some studies suggest a relation between OSAS and FMS. Since OSAS is strongly associated with increased risk of myocardial infarction, cerebrovascular accidents and congestive heart failure, its diagnosis and treatment are of particular importance. Herein we present a female patient with diagnosis of FMS for 10 years who had complaints of morning fatigue, restless sleep, sleepiness during day and snoring besides musculoskeletal symptoms. Severe OSAS was diagnosed after polysomnographic analysis and FMS symptoms were totally improved with nasal continuous positive airway pressure treatment.
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PMID:Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report. 1758 51

Activation of the genioglossus (GG) muscles is necessary to maintain the patency of the upper airway. In the condition of obstructive sleep apnea (OSA) this mechanism fails and the possible role of fatigue in its pathogenesis is still not fully understood. In this paper, a new electrode design for recording the genioglossus surface electromyogram (sEMG) is presented. The new design differs from a widely used GG surface electrode in both electrode configuration (unilateral rather than bilateral) and electrode material (Ag-AgCl rather than stainless steel (SS)). The separate effects of these factors were evaluated during force-varying and fatiguing contractions on normal human subjects and using GG sEMG model simulations. Unilateral sEMG was found to have lower amplitude, lower frequency content and a different rate of change of median frequency during fatiguing contractions. It was shown to overcome several disadvantages posed by the bilateral configuration and be more selective. Ag-AgCl has more favorable impedance characteristics and resulted in greater signal amplitudes. It was concluded that the new design is more suitable for detecting GG sEMG and allows more reliable interpretation of changes in sEMG due to physiological mechanisms, thus providing a new methodology for studying GG function and the role of fatigue in OSA.
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PMID:Improved surface EMG electrode for measuring genioglossus muscle activity. 1770 98

One of the hallmarks of obstructive sleep apnea (OSA) is loud snoring. Army conscripts sleep in barracks, and loud snorers are easily detected. We made polygraphic recordings from these snorers during one night spent in the hospital, to find the ones suffering from OSA. Forty-nine conscripts (all male; mean age, 21 +/- 2 years; body mass index, 25 +/- 3 kg/m2) were studied; 32 (65%) complained about daytime sleepiness, and one had caused a shipwreck during an episode of fatigue. Oxygen levels decreased 4 to 9% >20 times per hour (4-9% oxygen desaturation index [ODI4] of >20 hours) for three subjects (6%). Eleven additional subjects (22%) had ODI4 values of >10 hours. Four (8%) of them did not complain about daytime sleepiness. The mean apnea index (AI) was 11 +/- 13 hours; 20 patients (41%) had AI values exceeding 10 hours. ODI4 and AI were significantly correlated (r = 0.67; p < 0.001). Body mass index did not correlate significantly with ODI4 or apnea index. Approximately one-fifth of loudly snoring conscripts suffer from OSA. Loud snorers should be examined before being selected for duties requiring maintenance of high alertness.
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PMID:Obstructive sleep apnea in loudly snoring army conscripts. 1780 83

Although humans spend as much as a third of their life sleeping, many schools of medicine around the world do not provide sufficient knowledge about the physiology and pathology of sleep to their students, as if diseases fall asleep at night. People suffering from impaired sleep are often unaware of the problem. Along with poor knowledge of sleep pathologies on the part of medical staff, this leads to underdiagnosis and misdiagnosis of sleep disorders. One of the symptoms indicating sleep abnormality is complaint of fatigue, which can represent: physical weakness, mental fatigue, or sleepiness. The latter type is associated with several sleep disorders, among which are: obstructive sleep apnea, periodic limb movement in sleep, narcolepsy, idiopathic hypersomnia and circadian rhythm sleep disorders. To provide accurate diagnosis and appropriate treatment, medical education programs should offer the students a deeper knowledge of sleep medicine.
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PMID:[Diseases don't sleep at night]. 1780 68

Residual excessive sleepiness (ES) and impaired cognition can occur despite effective and regular nasal continuous positive airway pressure (nCPAP) therapy in some patients with obstructive sleep apnea (OSA). A pooled analysis of two 12-week, randomized, double-blind studies in nCPAP-adherent patients with ES associated with OSA evaluated the effect of armodafinil on wakefulness and cognition. Three hundred and ninety-one patients received armodafinil (150 or 250 mg) and 260 patients received placebo once daily for 12 weeks. Efficacy assessments included the Maintenance of Wakefulness Test (MWT), Cognitive Drug Research cognitive performance battery, Epworth Sleepiness Scale, and Brief Fatigue Inventory. Adverse events were monitored. Armodafinil increased mean MWT sleep latency from baseline to final visit by 2.0 min vs a decrease of 1.5 min with placebo (P < 0.0001). Compared with placebo, armodafinil significantly improved quality of episodic secondary memory (P < 0.05) and patients' ability to engage in activities of daily living (P < 0.0001) and reduced fatigue (P < 0.01). The most common adverse events were headache, nausea, and insomnia. Armodafinil did not adversely affect desired nighttime sleep, and nCPAP use remained high (approximately 7 h/night). Adjunct treatment with armodafinil significantly improved wakefulness, long-term memory, and patients' ability to engage in activities of daily living in nCPAP-adherent individuals with ES associated with OSA. Armodafinil also reduced patient-reported fatigue and was well tolerated.
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PMID:Armodafinil improves wakefulness and long-term episodic memory in nCPAP-adherent patients with excessive sleepiness associated with obstructive sleep apnea. 1787 55

Cytokines are proteins produced by leukocytes and other cells that function as intercellular mediators acting on several target tissues, resulting in multiple biologic actions. Over the last decade, medical research has explored the interaction between cytokines and sleep disorders. The aim of this review is to illustrate recent advances in knowledge about the relationship between cytokines and disorders of excessive sleepiness. Cytokines may have an important role in mediating excessive daytime sleepiness in sleep loss or insomnia. Alterations of the immune system have also been associated with narcolepsy. The relationship between cytokines and hormonal regulatory mechanisms may explain symptoms like fatigue and sleepiness in chronic inflammatory diseases. Cytokines may play an important role in the pathogenesis of obstructive sleep apnea and cardiovascular consequences of this condition. New biologic treatments targeting cytokines have been investigated in conditions characterized by sleep disturbance.
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PMID:Cytokines and pathological sleep. 1802 71

The "typical" presentation of obstructive sleep apnea (OSA) is chronic loud snoring and excessive daytime sleepiness in middle-aged obese men. OSA can result in increased risk for cardiovascular morbidity and mortality. The diagnostic features of OSA in older adults are similar to those in younger adults; however, the older adult may be less likely to seek medical attention or have the sleep disorder recognized because symptoms of snoring, sleepiness, fatigue, nocturia, unintentional napping, and cognitive dysfunction may be ascribed to the aging process itself or to other disorders. This article reviews the basic terminology and pathophysiology of sleep-disordered breathing, discusses why OSA may be even more prevalent in older adults than in the middle-aged group, and reviews similarities and differences between the two groups in the manifestations, consequences, and treatments of OSA.
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PMID:Obstructive sleep apnea in older adults. 1803 38

Obstructive sleep apnoea is characterised by intermittent hypoxia due to recurrent obstructions of the pharyngeal airway during sleep. We have shown that chronic intermittent hypoxia impairs respiratory muscle function and CNS control of upper airway patency. In this study, we tested the hypothesis that disruption of an endogenous antioxidant defence system exacerbates the effects of intermittent hypoxia on upper airway muscle contractile function. Thirty-two male Wistar rats were placed in restrainers with their heads in hoods in which the ambient oxygen concentration could be modified by controlling the gas supply to the hoods. Sixteen rats were exposed to alternating equal periods of hypoxia and normoxia, twice per minute, 8 hours per day for 1 week. The remaining 16 animals were exposed to normoxia continuously under identical experimental conditions. In both groups, half the animals received daily injections of buthionine sulfoxamine (BSO), an inhibitor of the rate-limiting enzyme in glutathione synthesis. The other half received daily vehicle injections. At the end of the 1-week treatment period, the sternohyoid muscles were removed and fatigue characteristics were determined in vitro. Intermittent hypoxia was associated with a decrease in sternohyoid muscle endurance, an effect that was exacerbated by treatment with BSO. In separate experiments, daily treatment with the antioxidant N-acetyl cysteine blocked the deleterious effects of intermittent hypoxia on respiratory muscle function. We suggest that oxidative stress contributes to impaired upper airway muscle endurance in our animal model and that endogenous glutathione may be especially important in limiting free radical-induced muscle dysfunction. Our results may have particular relevance to respiratory disorders associated with recurrent hypoxia, such as the sleep apnoea/hypopnoea syndrome.
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PMID:Oxidative stress impairs upper airway muscle endurance in an animal model of sleep-disordered breathing. 1808 17


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