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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The distribution of symptoms, physiologic responses, and upper airway structure in members of one family with three generations of subjects with sleep apnea (SA) is reported. Questionnaire data were obtained from ten family members (ages 7 to 66 years), overnight sleep studies were performed in nine subjects, and ventilatory responses to hyperoxic hypercapnia and to eucapnic hypoxia and cephalometry were obtained in five subjects. All ten family members reported habitual snoring or nighttime snorting/gasping; five of ten family members also reported excessive daytime sleepiness. All studied subjects except for a pregnant woman had greater than ten apneas/hypopneas per hour. Ventilatory responses to hypoxia were markedly reduced in all five subjects studied (less than or equal to 0.51 L/min/SaO2); hypercapnic responses were reduced in three of five subjects (less than or equal to 0.61 L/min/mm Hg CO2). No subject was morbidly obese (body mass index less than 29 kg/m2) or demonstrated retrognathia. The posterior airway space was reduced in three subjects, and the mandibular to hyoid distance was increased in four subjects. The two subjects with the longest soft palates and the most inferiorly displaced hyoids had the most severe sleep disorder. Sleep apnea was present, albeit less profound, in the one subject with normal anatomy who had an abnormal hypoxic ventilatory response. The distribution of these physiologic and anatomic measurements in this family provides further support for a genetic basis for SA, and suggests that the disorder may occur as a result of interactions between ventilatory control abnormalities and anatomic risk factors.
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PMID:A family study of sleep apnea. Anatomic and physiologic interactions. 239 35

Twenty-four children suspected of having apnea induced by lymphoid pharyngeal obstruction were studied by nocturnal polygraphy. The data recorded were: instantaneous cardiac frequency, thoracic movements, naso-oral flux, transcutaneous PO2 and PCO2. Episodes of hypoxemia and of hypercapnia related to obstructive apneas were found in 19 children; the mean of the lowest values of PtcO2 during sleep was 58.4 mmHg versus 85 mmHg during wakefulness. The mean od the highest values of PtcCO2 was 50 mmHg during sleep versus 40 mmHg during wakefulness. Six children presented with marked hypoxemia (PtcO2 less than or equal to 50 mmHg). Transcutaneous blood gas monitoring is indicated in all children presenting with sleep disorders due to pharyngeal obstruction. The finding of a marked hypoxemia should suggest removal of the obstacle concerned.
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PMID:[Alveolar hypoventilation during sleep in pharyngeal obstruction caused by lymphoid hypertrophy in children]. 646 33

Respiratory disorders during sleep were studied in 42 patients with Duchenne muscular dystrophy (DMD) (mean age 18.4 years). Chest and abdominal movement, nasal airflow, snoring sounds, eye movement, and oxygen saturation were monitored during sleep. Three patterns of disorders were found: obstructive apnea, central apnea, and paradoxical respiration without upper airway obstruction (non-obstructive paradoxical respiration). Of these three patterns, obstructive apnea was the most common. Hypertrophy of the tongue and collapsibility of the upper airway seemed to be responsible for the obstructive apnea in these patients. The relationships between PaCO2 while breathing room air and the various indices of respiratory disorders were studied. The index of central apnea differed significantly between patients in whom PaCO2 was less than 50 Torr (early disease, n = 22) and those in whom PaCO2 was greater than or equal to 50 Torr (advanced disease, n = 20), but the indices of obstructive apnea and non-obstructive paradoxical respiration did not differ between those two groups. In conclusion, sleep disorders were common in patients with DMD, and the most common was obstructive apnea. In the patients with advanced DMD, blood gas analysis showed hypercapnia, and the index of central sleep apnea was high, probably because of respiratory muscle weakness or abnormalities in the respiratory center.
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PMID:[Respiratory disorders during sleep in Duchenne muscular dystrophy]. 747 61

The objective of this study was to assess the blood pressure pattern in patients with nasal polyposis. Twenty-seven patients with nasal polyposis (18 males and 9 females), ranging in age from 15 to 72 years (mean 37.1 years) were eligible for inclusion in the study. All patients were hospitalized overnight before surgery. After the basal blood pressure measurements were taken, non-invasive ambulatory blood pressure monitoring was carried out. Oxygen saturation was measured via a finger probe and venous blood sampling was taken for catecholamine level during the full night. All measurements were repeated 4 months after nasal surgery. Mean values for nocturnal decline in blood pressure and heart rate before surgery were less marked than those measured after surgery. Mean decline values (+/- SD) were; 4.6 +/- 2.4 mmHg for systolic blood pressure, 5.8 +/- 3.8 mmHg for diastolic blood pressure, and 7.9 +/- 3.9 beats/min for heart rate before surgery, 9.3 +/- 2.8 mmHg, 8.5 +/- 4.1 mmHg and 10.4 +/- 4.3 beats/min after surgery (p < 0.01), respectively. Whereas mean and minimum SaO2 (%) significantly increased (p < 0.01), catecholamine levels decreased (p < 0.05 for adrenaline, p < 0.01 for noradrenaline) after surgery. A correlation was found between BMI and blood pressure as well as between duration of obstruction and blood pressure. Patients who snored had higher blood pressure values than those who did not. Our data show that in cases of nasal polyposis, hypoxia, hypercapnia, snoring, and sleep disorders may develop and persons with nasal polyposis and snoring have an increased risk of hypertension and loss of nocturnal decline in blood pressure.
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PMID:Loss of nocturnal decline of blood pressure in patients with nasal polyposis. 1059 94

Obesity is a well-known cause of upper airway narrowing, respiratory failure and resulting hypoxemia and hypercapnia, and cardiac arrhythmias during sleep. Obese patients are prone to snore loudly and to develop obstructive sleep apnea syndrome and also obesity-hypoventilation syndrome. Repeated nocturnal upper airway obstruction may cause respiratory failure and cor pulmonale and frequent awakenings, and result in nocturnal choking, with daytime drowsiness, somnolence and irritability. The purpose of this article is to review the evidence for these accepted facts and to consider a variety of new information that relates to the pathogenesis, symptomatology and treatment of sleep disorders caused by obesity.
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PMID:Sleep-related Disorders in the Obese. 1076 3

Chronic obstructive lung diseases (COPD) are a complex disease state which not rarely can be associated with significant systemic manifestations. These alterations, though recognized since long time, are currently under extensive research, due to the increasing appreciation of their relevant negative role in the prognosis and health-related quality of life (Hr-QoL) of the COPD patients. The most clinically important are the decrease in body weight with loss of skeletal muscle mass (cachexia), osteoporosis, hypercapnia-induced peripheral edema, neuro-psychiatric disorders, such as oxygen-related cognitive impairment and depression, excessive polycytaemia and sleep disorders. Chronic systemic inflammation, oxidative stress and chronic hypoxia are believed as the main factors involved in the pathogenesis of systemic effects seen in COPD. Their adequate control with nutritional support, change of life-style and targeted pharmacological treatment is able to improve the prognosis and Hr-QoL among these COPD patients.
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PMID:[Chronic obstructive lung disease. Systemic manifestations]. 1272 1

The most common sleep disorder in children is obstructive sleep apnea syndrome (OSAS). The majority of children with OSAS improve following tonsillectomy and adenoidectomy (T&A). T&A as an outpatient procedure in children is very common. Young age in considered risk factors for postoperative respiratory complications. The purpose of this study is to analyze our experience with postoperative T&A complications in patients younger than 2 years of age. A total of 39 T&A were performed in children younger than 2 years of age. OSAS diagnosis was confirmed by overnight polysomnography (PSG). All the patients were hospitalized and monitored by overnight pulse oximetry monitoring. Post-operatively there was marked improvement in respiratory function in all the patients comparing pre- and post-operative nadir oxygen saturation (P<0.05). Complications were documented in seven patients (20%). Five of the complications occurred in children older than 1 year of age. Bleeding occurred in two patients (5.7%). Three patients (8.6%) had dehydration, one patient (2.9%) had hypercarbia and one patient had laryngospasm. In this study there was a low incidence of peri- and post- operative respiratory complications in children younger than 2 years of age who undergo T&A for OSAS. Identification of OSAS severity may be an important factor in determining the risk of T&A in a young child.
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PMID:Complications of adenotonsillectomy in children with OSAS younger than 2 years of age. 1288 Jun 63

The problems children have in sleeping are manifold; the gamut of disorders that have been described ranges from simple, occasional snoring with no accompanying complications, through the syndrome of increased blockage of the upper airways to the obstructive sleep apnea-hypopnea syndrome (OSAHS) where respiratory difficulties accompanied by hypoxemia, hypercapnia and structural sleep difficulties. Mouth breathing and chronic snoring occur frequently in children, with the incidence of snoring, identical for both sexes, varying between 3.2 and 27%. Difficulties in sleeping begin between the ages of the 3 and 9, peaking between 3 and 6. These results demonstrate, in a general way, the disparity between growth of the adenoids and tonsils, and upper airway growth. A differential diagnosis between the various pathological possibilities is based on the observed clinical signs and symptoms, analysis of cephalometric radiographs, polysomnography, a nocturnal cardio-respiratory polygraph and a video film taken during sleep. Snoring is the most characteristic sign of OSAHS in children. We do not yet have available any synthetic study that would sum up results of studies of sleep disorders in children. Nevertheless, we can define obstructive sleep apnea in children as the partial or total cessation of nose and mouth breathing for a period double that of the normal respiratory cycle. Classical treatment of children who suffer from severe respiratory difficulties during sleep, after identification of the etiology of the problem, consists of surgical removal of the adenoids or tonsils and, in certain, continuous positive pressure to assist breathing. The authors of this article have worked with 137 patients between the ages of 6 and 9, 77 of whom were chronic snorers with an average age of 7 years 6 months. The average age of the control group of 60 children was 7 years 2 months. We collected clinical data, medical histories, and distributed a questionnaire to determine individual sleep and vigilance behavior of each child in the sample. To complete our evaluation, we made a cephalometric analysis of facial type, antero-postero skeletal pattern, upper airways, and hyoid bone position. The symptom that we encountered most frequently in young chronic snorers was agitated and uneasy sleep, sometimes accompanied by bed-wetting and cervical hyperextension. We often found daytime symptoms of hyperactivity and personality or behavioral problems. Hypertrophy of the adenoids, the adenoidal fascia, and the tonsils were also frequent clinical signs. The cephalometric analyses often showed the patients to be of the dolichocephalic facial type, often with the mandible rotated posteriorly. The children were as likely to be classified as Class II owing to retrognathic mandibles as to be Class III owing to maxillary deficiencies or mandibular excess. At the level of the upper airways, it appears that the development of snoring can be explained by a reduction in the dimensions of the upper pharynges accompanied by an increase in the dimensions of the middle and lower pharynges.
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PMID:[Chronic snoring and obstructive sleep apnea-hypopnea syndrome in children]. 1530 72

Obtructive sleep apnoea syndrome (OSAS) is a common disorder in the general population with an estimated prevalence in an adult population of 2% in women and 4% in men. Although several studies have suggested that headaches, particularly morning headaches, are more common in patients with OSAS than in normal subjects, others have yielded contradictory findings. When the sleep-related breathing disorder was treated with success, the headache generally disappeared, supporting a causal role of the sleep disorder for headache. Several hypotheses have been proposed to explain the relationship between OSAS and the occurrence of headache, particularly on awakening. Night-time fluctuations of oxygen saturation during the night with hypercapnia, vasodilatation, increased intracranial pressure and impaired sleep quality are all considered contributing factors. However the exact mechanisms of headache pathogenesis and the relationship between OSAS, headache and morning headaches in particular remain controversial.
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PMID:Sleep-related breathing disorders and headache. 1668 20

Patients with obesity hypoventilation syndrome (OHS) have a lower quality of life, more healthcare expenses, a greater risk of pulmonary hypertension, and a higher mortality compared to eucapnic patients with obstructive sleep apnea (OSA). Despite significant morbidity and mortality associated with OHS, it is often unrecognized and treatment is frequently delayed. The objective of this observational study was to determine the prevalence of OHS in patients with OSA seen at the sleep disorders clinic of a large public urban hospital serving predominantly minority population and to identify clinical--not mechanistic--predictors that should prompt clinicians to measure arterial blood gases. In the first stage, we randomly selected 180 patients referred to our sleep disorders clinic between 2000 and 2004 for suspicion of OSA. From this retrospective random sample we calculated the prevalence of OHS in patients with OSA and identified independent clinical predictors using logistic regression. In the second stage, we prospectively validated these predictors in a sample of 410 consecutive patients referred to the sleep disorders clinic for suspicion of OSA between 2005 and 2006. The prevalence of OHS in patients with OSA was 30% in the retrospective random sample and 20% in the prospective sample. Three variables independently predicted OHS in both samples: serum bicarbonate level (p < 0.001), apnea-hypopnea index (p = 0.006), and lowest oxygen saturation during sleep (p < 0.001). Due to the serious morbidity associated with OHS, we selected a highly sensitive threshold of serum bicarbonate level. A threshold of 27 mEq/l had a sensitivity of 92% and a specificity of 50%. Only 3% of patients with a serum bicarbonate level <27 mEq/l had hypercapnia compared to 50% with a serum bicarbonate > or =27 mEq/l. In conclusion, OHS is common in severe OSA. A normal serum bicarbonate level excludes hypercapnia and an elevated serum bicarbonate level should prompt clinicians to measure arterial blood gases.
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PMID:Obesity hypoventilation syndrome: prevalence and predictors in patients with obstructive sleep apnea. 1765 82


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