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

Snoring usually is trivial and unimportant, but it can turn into a social or medical problem. Obesity, hypertension and heart disease are more frequent among snorers than among nonsnorers, and especially snorers with hypersomnia during the day are at risk. Hypersomnia in association with snoring usually signifies obstructive sleep apnea. Increased resistance in the upper airways, together with negative inspiratory pharyngeal pressure and muscular hypotonia during deep non-REM and REM sleep, lead to collapse of the pharynx, hypoxia and hypercapnia. Only after arousal from sleep does muscle tone return, pharyngeal obstruction reopen and airflow resume. Since this process can occur 300 or 400 times a night, repetitive alveolar hypoventilation leads to pulmonary-arterial hypertension and cor pulmonale, and the repetitive sympathetic activations can cause systemic hypertension or serious cardiac arrhythmias. The countless arousals deprive the sufferer of deep non-REM and REM sleep and their consequence is sleep fragmentation. The symptoms are excessive daytime sleepiness, intellectual deterioration and personality and behavioral changes. Oronasomaxillofacial, endocrine and neuromuscular anomalies and diseases predispose to sleep apnea, and alcohol or CNS-depressant drugs can favour its occurrence. Diagnosis is made by nighttime oxymetry, and if this is abnormal, by polysomnography. After polysomnography it is possible to distinguish between obstructive and nonobstructive sleep apnea, and the decisions for an adequate treatment can be made.
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PMID:[Dangerous snoring. Sleep-apnea syndrome]. 331 92

Sleep apnoea syndromes are a frequent disease, with an incidence of more than 1% in the adult population, a strong male predominance, and a maximal frequency between 40 and 60 years. Their clinical manifestations are dominated by snoring and daytime sleepiness, at times associated with morning headaches, intellectual deficiency, sexual impotence. Obesity, hypertension and polycythemia are not uncommon. These patients are at risk for accidents due to sleepiness, sudden death due to sleep apnoea-related cardiac arrhythmias, ischemic attacks related to hypertension and polycythemia and right heart failure secondary to pulmonary hypertension and alveolar hypoventilation. The most frequent form of sleep apnoea syndromes include obstructive and mixed apnoeas. Their mechanism involves both anatomic factors (upper airway narrowing) and functional factors (defective activation of upper airways dilatory muscles) which lead to upper airway occlusion upon inspiration during sleep. Two therapeutic strategies are possible: a surgical one, uvulopalatopharyngoplasty, the efficacy of which is inconstant and unpredictable and nasal continuous positive airway pressure, which is constantly efficacious but constraining. Central sleep apnoea syndromes are rare, less clearly defined and more difficult to treat.
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PMID:[Sleep apnea syndromes in adults]. 332 Dec 51

We report the association between hostility and the incidence of ischemic heart disease (IHD) in 3,750 Finnish men aged 40-59. Hostility was assessed from self-ratings on irritability, ease of anger-arousal, and argumentativeness, and four groups were formed from the summed hostility ratings. At baseline, the age-adjusted relative risk (RR) of the prevalence of angina pectoris between the highest and lowest hostility groups was 2.88 (95% confidence limits (CL), range 1.71-4.77). A three-year follow-up yielded 65 deaths and 109 IHD-incident cases. Hostility did not predict IHD among healthy men, but among men with previous IHD and hypertension (N = 104), the age-adjusted RR of IHD between the highest and lowest hostility groups was 12.9 (95% CL, 3.92-42.6). After standardization for smoking, obesity, heavy alcohol use, and snoring, the RR was 14.6 (95% CL, 1.94-110). When the degree of dyspnea at baseline was also standardized, the RR was 21.1 (95% CL, 1.59-282). Our data suggest that extreme hostility is not a consequence of symptom severity; rather, hostility is a strong determinant of coronary attack among hypertensive men with IHD.
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PMID:Hostility as a risk factor for mortality and ischemic heart disease in men. 341 67

The prevalence of snoring, overweight and systemic hypertension was estimated in a random sample of 4,064 Swedish men, aged 30-69 years. Of the responders, 15.5% complained of habitual snoring and 29.6% of occasional snoring. Although there was an age-related increase in the prevalence of snoring up to 60 years, habitual snoring was found to be mainly related to body mass index (BMI) (p less than 0.0001) but not to age. Altogether 299 men (9.3%) reported hypertension, 21.5% of whom were habitual snorers, compared with 14.9% of the non-hypertensives (p less than 0.01). The hypertensives were also more often overweight. Logistic multiple regression analyses showed that among subjects 40-49 years old there was an average increase in the predicted prevalence of hypertension from 6.5% among non-snorers to 10.5% of habitual snorers in the same weight group. For the whole study population, however, the increase was mainly dependent on age and BMI. Thus, the importance of habitual snoring for the prevalence of hypertension differs in various age groups.
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PMID:Snoring and systemic hypertension--an epidemiological study. 342 94

Sleep-related breathing disorders may contribute to the nocturnal peak in human mortality. Nocturnal hypoxia has been associated with serious ventricular tachyarrhythmias as well as life-threatening bradyarrhythmias. Obesity and snoring, both of which increase with age, have been identified as risk factors for sleep-related breathing disorders, as have hypertension and heart disease.
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PMID:Cardiopulmonary disorders during sleep: diagnosis and management. 354 25

Men who snore heavily have an increased incidence of hypertension, angina, stroke, and neuropsychologic dysfunction, which may be due to nocturnal oxygen desaturation. Nocturnal oxygen therapy might be beneficial to such individuals by improving oxygenation and relieving tissue hypoxia. Twenty-eight asymptomatic heavy snoring men were recruited for polysomnographic monitoring during sleep. During the first half-night, air was breathed through a nasal cannula, and during the latter half-night, 2 L/min oxygen was administered. Breathing air, 20 subjects demonstrated sleep apneas, hypopneas and nocturnal oxygen desaturation. Eighteen subjects had more than ten apneas plus hypopneas per hour. Thirteen subjects reached low oxygen saturation below 80 percent and eight below 70 percent. Only 13 of the 20 subjects showed improvement with oxygen therapy. Apneas alone were not decreased in frequency and were lengthened with oxygen therapy. Episodes of oxygen desaturation were improved by oxygen therapy and consequently, rates of hypopnea were decreased. Severe sleep apnea, hypopnea and oxygen desaturation are common in asymptomatic male snorers, and oxygen therapy is not always beneficial.
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PMID:Snoring, nocturnal hypoxemia, and the effect of oxygen inhalation. 362 20

Complaints about sleep are extremely common in the elderly, leading to an impression that aging-related sleep problems are virtually normal and benign. However, studies have shown that such complaints as habitual snoring, frequent awakening, nocturnal sweating, and awakening with anxiety, may be signs of genuine sleep disorders. The most prevalent and most serious aging-related sleep disorder is sleep apnea. There is recent evidence of an association between sleep apnea and circulatory disorders, including hypertension, stroke, and angina pectoris, and with reduced life expectancy. The older sleep apnea victim may not complain of daytime sleepiness, the usual symptom in younger patients. Sleep apnea, and several other sleep disorders of the elderly are treatable, once an accurate diagnosis is made. Physicians are urged to make questions about sleep as routine as the taking of blood pressure.
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PMID:Sleep disorders in the elderly: rationale for clinical awareness. 367 42

In a study conducted in four family practice units in Toronto, Canada, 2001 subjects reported on snoring and medical conditions in members of their households. For spouses the prevalence of snoring increased with age up to the seventh decade, with a higher prevalence of nearly 85% in husbands. For 11 medical problems an association existed between snoring, its frequency, and the presence of the condition. This association continued when the data were corrected for sex, age, and marital state. For hypertension both men and women who snored between the fifth and 10th decades had a twofold increase over non-snorers. The prevalence of heart disease and other conditions, except for diabetes and asthma, also increased in snorers in this age group. When corrected for smoking and obesity the association between snoring, hypertension, and heart disease persisted. These findings extend those of Lugaresi et al, and if they could be confirmed snoring as a risk factor for conditions other than sleep apnoea and sleep disorders might be considered. Methods of alleviating the acoustic annoyance of snoring may also provide direct medical benefits.
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PMID:Snoring as a risk factor for disease: an epidemiological survey. 392 56

The clinical course and characteristics of severe obstructive sleep apnea are described for 50 adults whose condition warranted recommendation for tracheostomy. All patients had a history of snoring, excessive daytime sleepiness and sleep attacks, nocturnal snorting and gasping sounds and observer-noted nocturnal breath cessations. Generally, these symptoms became manifest before age 40, their appearance tended to cluster together within only a few years and, invariably, they were chronic. Aside from snoring, excessive daytime sleepiness was on average often the first symptom and began at a mean age of 36 years. However, in half of the patients either hypertension or overweight preceded excessive daytime sleepiness by at least 1 year. Physicians in the office setting should suspect severe obstructive sleep apnea in patients who have loud snoring and either excessive daytime sleepiness, hypertension, or obesity. Further evidence of apnea can be obtained by determining the presence of the additional signs of loud nocturnal snorting and gasping sounds and nocturnal breath cessations.
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PMID:Severe obstructive sleep apnea--I: Onset, clinical course, and characteristics. 399 56

The development of important respiratory disorders and significant hypertension in association with increasing body weight is not widely recognized. Altered respiratory function results from a combination of mechanical impedance to breathing exerted by thoracic and abdominal fat and a ventilation-perfusion mismatch. Sleep-disordered breathing with periods of hypoventilation, with or without apnoeic episodes, may commonly occur in patients with extreme obesity. Nocturnal hypercapnia and hypoxia in such patients may lead to a decrease in ventilatory drive, abnormal central respiratory control and possibly, in time, the development of the obese-hypoventilation syndrome. Respiratory abnormalities should be suspected in obese patients with a history of restlessness at night, loud snoring and daytime somnolence. Treatment is substantial weight reduction, but short-term measures include the use of compressed air via nasal cannulae for obstructive apnoea, and drugs which alter sleep pattern or stimulate respiration. The alterations in endocrine function, which accompany weight gain, may contribute to an increase in blood pressure and there appears to be a relationship between plasma insulin and catecholamine concentrations, fat cell size and the development of hypertension. The confirmation of a raised blood pressure requires that readings be taken with an adequately sized arm-cuff. In many instances endocrine function becomes normal with weight loss, and there is a corresponding decrease in blood pressure. The ideal management for an obese hypertensive patient is the combination of a suitable calorie-restricted diet with a programme of physical exercise.
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PMID:Clinical complications of obesity. 639 58


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