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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We compared self- and spouse reports of snoring and other symptoms of sleep apnea syndrome ascertained from married couples in a community-based survey. Agreement between the two types of report varied between 70-98%, but was modest (kappa = -0.01-0.52) when adjusted for chance. For men, spouse reports yielded higher prevalence rates for snoring and for four other symptoms. For women, estimates of symptom prevalence were consistently lower by spouse report than by self-report. In multivariate analyses, the effect on snoring of gender and obesity increased and of age decreased when spouse reports were compared to self-reports. Snoring, according to spouse reports, was a significant risk factor for ischemic heart disease, but snoring according to self-reports showed a smaller effect and was not statistically significant. Snoring was not associated with hypertension when defined by either self- or spouse report. These observations suggest that questionnaire data of snoring and other symptoms of sleep apnea syndrome may be misclassified in part, and that such misclassification can affect estimates of prevalence and effects.
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PMID:Comparison of self- and spouse reports of snoring and other symptoms associated with sleep apnea syndrome. 235 96

We have investigated the ability of a statistical model developed from clinical data and questionnaire responses to predict disturbance of breathing during sleep. Data from 100 consecutive patients referred for sleep study for suspected sleep apnea were used to develop the model using logistic regression analysis. For each subject, the model predicted the probability of having an apnea-hypopnea index (AHI) greater than 15; this probability was compared with the AHI measured from sleep study. A probability cutoff point (= 0.15) was decided on that minimized the number of subjects with false-negative predictions. Four terms--apneas observed by bed partner, hypertension, body mass index, and age--were found to contribute significantly to the model with observed apneas being by far the most predictive term of the four (adjusted odds ratio 19.7). When the model was tested to estimate the probability of an AHI greater than 15 for 105 patients from a second group of consecutive patients referred for sleep study, the model correctly classified 33 of 36 patients with a measured AHI greater than 15 (sensitivity = 92%) and 35 of 69 patients with a measured AHI less than or equal to 15(specificity = 51%). This study shows that analysis of clinical features of patients presenting with suspected sleep apnea may reduce the need for sleep studies by about one-third yet still lead to the identification of the great majority of patients with abnormal breathing during sleep.
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PMID:Estimation of the probability of disturbed breathing during sleep before a sleep study. 236 60

We compared 8 patients diagnosed with geriatric sleep apnea syndrome (GSAS) with 12 healthy older controls (GCON) matched on age, sex, weight, education, and socioeconomic standing. GSAS was diagnosed if patients had an apnea + hypopnea index (AHI) greater than or equal to 10 and an impairment involving at least two of the following: hypertension, cardiac arrhythmias, or daytime hypersomnolence. In addition to significant differences on selection variables (e.g., AHI, frequency of hypertension, Multiple Sleep Latency Test), GSAS patients had significantly more sleep disturbance, were sleepier on subjective measures, were more depressed, and had lower scores on tests of nonverbal problem solving and nonverbal memory. Thus, GSAS resembles SAS described in middle-aged populations. More research is needed to determine the most efficient diagnostic parameters for identifying pathological levels of SDB in older persons.
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PMID:Geriatric sleep apnea syndrome: a preliminary description. 239 13

Epidemiologic studies revealed that up to 10 percent of middle-aged men show more than 10 cessations of breathing of more than 10 seconds' duration. In these patients, increased morbidity and mortality rates have been proved. More than 50 percent of apnea patients exhibit arterial hypertension, and up to 50 percent of hypertensive patients experience sleep apnea. Patients with sleep apnea and essential hypertension need special attention paid to their antihypertensive therapy because the following side effects of drugs have to be avoided: increases of cardiac insufficiency, hyperviscosity of the blood, intensification of the hypersomnia by central sedation, intensification of a pre-existing tendency towards arrhythmias, and deprivation of deep and rapid eye movement sleep. In this study, the effects of angiotensin-converting enzyme inhibitors in patients with sleep apnea and hypertension are examined. An interim evaluation of six patients (aged 50 to 57) yielded the following results: Average Broca index, 124; average blood pressure before therapy, 159/102 mm Hg; average blood pressure after therapy, 132/78; a decrease of the apnea and hypopnea index from x = 31 (range, 12 to 77) to x = 20 (range, two to 54). Therapy did not influence sleep structure: before therapy, an average of 19 percent of sleep episodes were of the rapid eye movement type (range, 11 to 32 percent); after therapy, 23 percent were of this type on average (range, 21 to 25 percent). A final evaluation will be carried out after the second study phase for 12 patients who have been treated in a double-blind scheme with metropolol versus cilazapril.
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PMID:Effects of cilazapril on hypertension, sleep, and apnea. 253 65

Eight studies that examined the relation between snoring and vascular disease were identified. The prevalence of habitual snoring, measured by questionnaire or interview, varied from 3% to 29% of adults and was dependent on age, sex, obesity, and smoking habit. In men, habitual snoring was associated with hypertension and ischaemic heart disease, with adjusted relative risks in the range 1.3-2.0. For women, only one study provided adjusted estimates of relative risk, which were 2.8 for hypertension and 1.2 for angina. Adequately adjusted relative risks for cerebrovascular disease have not been reported, but unadjusted estimates varied from 1.6 to 10.3. These studies had several limitations, including the lack of a standard definition of snoring, the use of unvalidated questionnaires, and failure to account for confounding variables and the possibility of reporting bias. Only one study was prospective. Epidemiological criteria for a causal association between snoring and vascular disease have not been satisfied. The apparent excess risk is probably due to the consequences of sleep apnoea rather than snoring itself.
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PMID:Is snoring a cause of vascular disease? An epidemiological review. 256 56

Sleep apnea (SA) is associated with increased morbidity of the cardiovascular system, the interaction between the disordering of respiratory coordination and cardiovascular regulation being largely unknown. In 64 patients (age: mean = 54.1; range: 35-67 years) with an increased apnea index (AI greater than 10), a cardiac catheterisation investigation was performed to exclude coronary heart disease (CHD) or cardiomyopathy. CHD was excluded in 39 patients, 6 patients had coronary single-vessel disease, 9 patients coronary two-vessel, and 10 three vessel disease. In 10 patients, cardiomyopathy was detected, while high-grade impairment of the left ventricular ejection fraction (greater than 30%) was observed in five patients. With the exception of a single patient, CHD was observed only in patients in the over-fifty age group. Arterial hypertension was seen in 84% of the patients with, and in 69% of the patients without, CHD. The patient groups with and without coronary heart disease did not differ with respect to apnea index, ten minute index, or the average duration of the 30 longest apneic episodes. Anginal complaints, observed in a total of 72% of the patients, were one of the major indications for coronary angiography. These results do not support the assumption that SA is primarily a consequence of underlying cardiac disease, but do indicate that SA must be considered a cardiac risk factor, especially in view of the fact that pronounced nocturnal changes in blood gases and haemodynamics, together with malignant arrhythmias, are found in conjunction with this disturbance of breathing.
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PMID:[Results of left heart catheterization study in 64 patients with nocturnal disorders of respiratory control (sleep apnea)]. 260 54

During the last years, medical interest has focused on sleep related diseases, especially the sleep apnea syndrome (SAS) and the nocturnal breathing abnormalities associated with broncho-pulmonary diseases. It now appears that SAS is far more prevalent than previously believed. In this review article we present the clinical features, the investigations and the current therapeutic methods. We also discuss the recent developments in our understanding of the SAS pathophysiology and their implications in the disease's management. Clinical importance of sleep related disorders of breathing is appreciated when one looks at some of the secondary effects including hypertension, angina pectoris, cardiac insufficiency and worsening of a broncho-pulmonary disease (hypoxemia, hypercapnia); these are associated with a high degree of morbidity. The recent advent of ambulatory screening systems allows an easier evaluation of patients at risk, such as obese or hypertensive snorers and patients with hypersomnolence; then the diagnostic polysomnographic studies can be reserved for subjects in whom home recording is abnormal. A precise and early diagnosis is important to allow the initiation of treatment such as Continuous Positive Airway Pressure (CPAP) or naso-pharyngeal surgery.
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PMID:[The sleep apnea syndrome. A general review]. 265 45

Sleep apnea and obstructive snoring are sleep related breathing disorders (SRBD). Nevertheless, there is only a quantitative difference between snoring and the obstructive form of sleep apnea. Snoring occurs in at least 20% of the population; 50% of the 50 year old male snore. Although in most of the cases only harmless snoring is concerned. It becomes serious if it leads as the independent SRBD "obstructive snoring" to a continuous oxygen desaturation and a sleep disturbance or, if in cases of sleep apnea a postapnoic snoring is concerned. The snoring pattern "loud and irregular" is always a sign for a serious SRBD. Still, no exact statement can be given concerning the frequency of obstructive snoring. However, the prevalence of sleep apnea in men of the mean age group has been determined to 10%. By the so-called sleep apnea syndrome are summarized clinical pictures with symptoms and findings caused by sleep apnea, respectively with those which can be reduced by sufficiently early introduced therapy. Most frequent symptoms and findings are: hypertension, loud and irregular snoring, daytime sleepiness and nocturnal cardiac arrhythmias. Especially hypersomnia has always to be taken seriously. In relation with other symptoms and findings associated with apnea it is always an indication for the examination for sleep apnea and obstructive snoring.
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PMID:[Snoring and sleep apnea syndrome]. 266 55

People with snoring, excessive daytime somnolence, and nocturnal breath cessation are very likely to have sleep apnea, particularly if they are obese or hypertensive. We collected epidemiologic data to determine the frequency of these findings in an unselected adult population. Respondents in a random digit dialing telephone survey included 685 people (356 women and 329 men, with a mean age of 50 years). Snoring was reported by 37%, gasping by 8%, excessive daytime somnolence by 36%, and hypertension by 28%; all symptoms were more prevalent in respondents older than 50 years. Snoring and gasping were more common in men than in women. Six persons (1%) had all four risk factors, plus a body mass index of one standard deviation above the mean. Eleven respondents (2%) had all four risk factors, but lower weight. We conclude that all risk factors for sleep apnea are more prevalent in persons over the age of 50 years, and that the incidence of sleep apnea in the general population may be 1%.
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PMID:Sleep apnea: prevalence of risk factors in a general population. 267 53

This paper reviews the epidemiological literature on the linkage between sleep apnea and essential hypertension. Despite the large number of case reports, general overviews and the wide acceptance of this linkage, surprisingly, only four epidemiological articles were identified. The prevalence of sleep apnea among hypertensives ranged between 26% and 47.8% (mean = 33.6%) across the studies as compared to the estimated prevalence of 0.4% to 1.4% in the general population. There seem to be no consistently replicated risk factors for apnea amongst hypertensives, although older age, relative obesity, and severity of hypertension have been suggested as possible markers for this co-morbidity. The findings require further replication with special efforts at studying: (1) unmedicated hypertensive patients; (2) patients without significant cardiac or renal complications; and (3) patients across a broad range of age, obesity, and severity of hypertension.
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PMID:Sleep apnea and essential hypertension: a critical review of the epidemiological evidence for co-morbidity. 268 Jan 71


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