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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twelve to twenty-five percent of human population suffer from sleep disorders and sleep-related breathing disorders have a frequency of 5-10%. The association between sleep-related breathing disorders and several diseases, mainly cardiovascular and dysmetabolic, is well known. The aim of this study was to assess the prevalence of this association in a group of 620 patients, aged between 18 and 78 years and referred to the Laboratory of Respiratory Pathophysiology of the Umberto I Hospital of Rome. All patients had a clinical history of a sleep-related breathing disorder and answered a specific questionnaire. One-hundred-and-thirty-seven patients (120 males and 17 females, mean age 64 years), whose questionnaire was suggestive of a sleep-related breathing disorder, underwent clinical assessment including blood tests, lung function tests, blood-gas analysis, ECG and nocturnal polysomnography, either as in- or as out-patients. The main associated pathologies were: arterial hypertension (54.7%), chronic obstructive pulmonary disease (17.9%), obesity (63.1%), dyslipidemia (41%), type 2 diabetes mellitus (6.3%), gastroesophageal reflux (27.3%) and cardiac arrhythmias (4.2%); 95 patients with obstructive sleep apnea syndrome were treated, on the basis of the polysomnography outcomes and according to the Italian Association of Sleep Medicine Guidelines, either with preventive strategies for risk factor reduction, or with medical (positive pressure ventilation, oxygen, assessment of the best drug medication) and/or ear, nose end throat surgical therapies. In most patients, the improvement in the sleep-related breathing disorder was associated with an improvement in their systemic pathology, in particular cardiovascular disease, suggesting the need of a deeper consideration and comprehension of nocturnal apneas.
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PMID:[Relationship between the obstructive sleep apnea syndrome and internal medicine]. 1517 2

Among a consecutive series of 9,279 sternotomies performed during a period of 2(1/2) years, 61 (0.66%) patients developed significant wound complications. Of these, 58 (95.1%) survived. Sternal infection occurred in 36 patients (0.39%). Predisposing factors included chronic obstructive pulmonary disease, diabetes mellitus, obesity, closed chest massage, prolonged assisted ventilation, and excessive bleeding after operation. Positive end expiratory pressure (PEEP) did not, in itself, predispose to sternal dehiscence. Intermittent positive pressure breathing (IPPB) treatments caused excessive coughing, which may have increased the likelihood of dehiscence. Disposable drapes and expeditious surgery probably contributed to the low incidence of wound infection. Early diagnosis, surgical debridement, rewiring and primary closure with substernal drainage, without continuous antibiotic irrigation, resulted in satisfactory resolution in most patients.
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PMID:Wound complications after median sternotomy: A study of 61 patients from a consecutive series of 9,279. 1521 89

After cardiac surgery, healing can be delayed by sternal wound infection, particularly if mediastinitis develops. Because of the technical simplicity of omentopexy, we recommend the use during open-heart surgery of an omental pedicle graft in selected cases to prevent postoperative complications. This article describes our experience over a 4-month period (from 30 March 1989 through 2 August 1989) with this technique in 50 consecutive patients at moderate-to-high risk for postoperative sternal and mediastinal problems. The patients included 39 men (78%) and 11 women (22%), whose ages ranged from 22 to 83 years (mean, 55 years). Preoperative risk factors included extreme obesity, 13 patients (26%); chronic obstructive pulmonary disease, 13 patients (26%); diabetes mellitus, 6 patients (12%); obesity and diabetes, 8 patients (16%); and obesity, diabetes, and chronic obstructive pulmonary disease, 3 patients (6%). Operative risk factors included cardiac reoperation involving prolonged surgery, 6 patients (12%); bilateral mammary grafting, 17 patients (34%); and the need for prolonged (greater than 72-hour) mechanical respiratory assistance, 2 patients (4%). Three of the 50 patients (6%) were considered to be at moderate risk due to an increase in nosocomial infections at the time of their surgical procedures. Although the omentopexy itself caused no complications, 5 patients had major complications related to the cardiac procedure. Two of these patients died, for an operative mortality of 4%; death was caused by progressive peritonitis in 1 case and by cardiac tamponade in the other case. At least 2 of the remaining 3 patients withstood localized mediastinal infection and had thereafter an extremely benign postoperative course. We conclude that an omental pedicle graft, placed prophylactically in patients at risk for sternal wound infection, can serve as a valuable adjunct to healing after cardiac surgery.
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PMID:Routine application of the omental pedicle graft in 50 consecutive patients at risk for sternal wound infection. 1522 3

Chronic alveolar hypoventilation is a classic feature of the "pickwickian syndrome" (i.e. obesity-hypoventilation syndrome) but in fact hypercapnia is observed in a minority of obstructive sleep apnoea syndrome (OSAS) patients. Most recent studies having included large numbers of unselected, consecutive OSAS patients agree on a prevalence of 10-20% of alveolar hypoventilation. The mechanisms of hypercapnia in OSAS are not fully understood but the determining factors of daytime respiratory insufficiency are probably the presence of a marked obesity, leading to the obesity hypoventilation syndrome and, principally, the association of OSAS with chronic obstructive pulmonary disease. This association (the so-called "overlap syndrome") is observed in >10% of OSAS patients. Bronchial obstruction is generally mild to moderate and may be asymptomatic. The severity of the nocturnal events (apnoeas, hypopnoeas) and a (possible) diminished chemosensitivity to hypercapnic and hypoxic stimuli do not appear to be determining factors of hypercapnia. The most important consequence of chronic alveolar hypoventilation is pulmonary hypertension which is only observed in patients with daytime arterial blood gases disturbances, and which can lead to right heart failure. When nasal continuous positive airway pressure fails to correct sleep-related hypoxaemia, supplementary O, must be given or another way of assisted ventilation (BIPAP) must be considered. In the most severe patients (diurnal PaO(2) <55 mmHg) conventional O(2) therapy (>or=16h/24h) is required in addition to nocturnal ventilation.
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PMID:Daytime hypoventilation in obstructive sleep apnoea syndrome. 1531 Apr 91

Sleep has effects on breathing, including changes in respiratory control, airways resistance and muscular contractility. These sleep-related modifications in the respiratory system do not induce adverse effects in healthy subjects, but may cause problems in patients with chronic obstructive pulmonary disease (COPD). Hypo-ventilation causes the most important gas-exchange alteration during sleep in COPD patients, leading to hypercapnia and hypoxemia, especially during rapid-eye-movement (REM) sleep. Blood gases alterations lead to increased arousals, sleep disruption, pulmonary hypertension and higher mortality. The presence of other sleep-related breathing disorders, like sleep apnea syndrome, may induce a more pronounced impairment of gas exchange, both during sleep and wakefulness, and development of symptoms like excessive daytime somnolence. Nocturnal oximetry is recommended to evaluate gas exchange during sleep in COPD patients. Sleep studies are usually indicated when there is a possibility of sleep apnea or obesity-hypoventilation syndrome. The role of non-invasive mechanical ventilation in managing COPD patients with nocturnal hypoventilation is discussed.
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PMID:Sleep disordered breathing in patients with chronic obstructive pulmonary disease. 1533 44

Previous studies have revealed the relationship between asthma with obesity and low body mass index (BMI) with chronic obstructive pulmonary disease (COPD). Tumor necrosis factor-alpha (TNF-alpha) is thought to be related with low BMI. The aim of this study was to determine sputum and serum TNF-alpha levels in patients with COPD and asthma and to evaluate whether these parameters had correlation with BMI. Thirty patients with moderate persistent asthma and 26 patients with moderate -severe COPD were included. After BMI values were calculated, sputum was induced by inhalation of hypertonic saline solution and blood was drawn for analysis of serum TNF-alpha levels. There were significant differences in age, serum and sputum TNF-alpha levels between asthma and COPD subjects (Sputum TNF-alpha: asthma; 513 +/- 151 pg/mL-COPD: 333 +/- 126 pg/mL, p< 0.001; Serum TNF-alpha: asthma; 332 +/- 114 pg/mL-COPD: 197 +/- 81 pg/mL, p< 0.001), however there was no difference in BMI (asthma; 28 +/- 5.7-COPD; 26.6 +/- 12.9, p= 0.1). Patients were divided into four categories according to their BMI values as underweight, normal, overweight and obese. In asthmatics; there were 12 (40%) obese and 11 (36%) overweight patients while 9 (34%) of COPD patients were underweight. No significant difference was observed among these four groups according to serum-sputum TNF-alpha and smoking history both in asthmatics and in COPD subjects. While there was no correlation between BMI and serum-sputum TNF-alpha levels, BMI was significantly correlated with both smoking history and duration of disease in COPD patients. As a result, most of the asthmatic patients were described as overweight and obese while no such variation was noted in the COPD patients. The induced sputum TNF-alpha levels has no additional benefit on serum TNF-alpha levels which has already known to be associated with BMI.
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PMID:[Body mass index and serum and sputum TNF-alpha levels relation in asthma and COPD]. 1535 39

The aim of this review was to analyse the effects of intermittent hypoxia (IH) on pulmonary haemodynamics, comparing results of animal experiments with results of clinical studies. In animal investigations even short hypoxic exposure, continuously or in short repeated episodes mimicking obstructive sleep apnoea (OSA), leads to pulmonary artery remodelling and to pulmonary hypertension (PH). Results of investigations on effects of nocturnal IH on pulmonary haemodynamics in patients with chronic obstructive pulmonary disease (COPD) are discordant. Earlier studies reported the development of mild PH in subjects desaturating during sleep, while more recent investigations did not confirm those findings. Alveolar IH developing during apnoeic episodes during sleep in OSA patients is a disease-induced model to study its effects on pulmonary haemodynamics. In the majority of studies in OSA patients pulmonary arterial pressure remained within normal values. PH was found in patients with OSA accompanied by COPD and/or extreme obesity. People commuting between lowland and high altitude due to their employment, are also repeatedly exposed to IH. Results of clinical investigations suggest that it did not lead to the development of permanent PH. The mechanisms of discrepancies between effects of intermittent hypoxia in animal models and in humans remain to be studied.
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PMID:Effects of intermittent hypoxia on pulmonary haemodynamics: animal models versus studies in humans. 1564 Mar 39

Sleep apnoea syndrome is a well recognized entity. Sleep studies of diagnosed patients with sleep apnoea were analyzed to understand the clinical profiles of Nepalese patients with this disorder. Eighty nine patients were diagnosed to have sleep apnoea syndrome during the period of 15 months starting from November 2003. All these patients were subjected to a detailed clinical evaluation including symptoms, presence or absence of other risk factors and co-morbidities, general physical and systemic examination and relevant investigations before performing polysomnography. Clinical profiles of patients who were confirmed to have sleep apnoea syndrome with apnoea hypopnoea index (AHI) more than five were included in the study. Forty one patients (46.1%) were found to have mild disease (AHI 6-20), 22 patients (24.7%) had moderate disease (AHI 21-40) and 26 patients (29.2%) were found to have severe disease. The common symptoms were snoring, excessive daytime sleepiness, frequent awakenings, nocturia, and choking spells during sleep. Obesity was found to be the most important risk factor associated with sleep apnoea. Males having collar size more than 16 inches and females with collar size more than 14.5 inches were found to have an increased risk to develop this problem. Hypertension (66.3%), chronic obstructive pulmonary disease (43.2%) and cardiac diseases (19.1%) were the common co-morbidities associated with this disorder. Sleep apnoea syndrome is not an uncommon problem in Nepalese population. It could be the cause of various cardiovascular problems and may complicate patients with chronic obstructive pulmonary disease.
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PMID:Sleep apnoea syndrome in Nepal. 1629 18

Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.
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PMID:Evidence for prescribing exercise as therapy in chronic disease. 1664 91

Sedentary lifestyles and increased pollution brought about by industrialization pose major challenges to the prevention of both obesity and chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, obstructive sleep apnea and obesity hypoventilation syndrome. Obesity has emerged as an important risk factor for these respiratory diseases, and in many instances weight loss is associated with important symptomatic improvement. Moreover, obesity may influence the development and presentation of these diseases. In this article, we review the current understanding of the influence of obesity on chronic respiratory diseases and the clinical management of obesity concurrent with asthma, COPD, obstructive sleep apnea or obesity hypoventilation syndrome.
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PMID:The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. 1742 May 4


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