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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Factors associated with increased severity of sleep apnea; obesity, the supine sleep posture, and age, were tested for their association with the effectiveness of the Tongue Retaining Device (TRD) for the control of the apneic events in a group of 16 male patients. Sixty-nine percent of the patients (11 of 16) were successful with this treatment. The strongest predictor of this success was the presence of an increased severity associated with the supine sleep posture. Patients with substantial worsening of apnea index while in the supine sleep position were more responsive to the TRD than those who were equally affected in both sleep positions. A discriminant function analysis that entered age, obesity, and the ratio of apneas per hour in side v back sleep posture correctly classified the success of patients' response to this treatment.
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PMID:Predicting response to the tongue retaining device for sleep apnea syndrome. 400 36

The etiology of the obesity-hypoventilation syndrome (OHS) is unknown. Recent reports that treatment of obstructive sleep apnea with nasal continuous positive-airway pressure eliminates the manifestations of OHS suggests that obstructive sleep apnea may contribute to OHS. The purpose of this study was to determine whether hypoxemia during sleep was more severe in patients with OHS than in those without OHS. In our sleep laboratory, we studied 32 subjects with a ratio of the forced expiratory volume in one second over the forced vital capacity (FEV1/FVC) greater than 0.73 and no neuromuscular disease. Seven subjects had OHS characterized by obesity and daytime hypercapnia, and 25 subjects did not. The seven patients with OHS all had sleep apnea. Of the 25 without OHS, 23 had sleep apnea. Subjects with OHS had significantly greater oxyhemoglobin desaturation during sleep than subjects without OHS, even when subjects with and without OHS were matched for sex and weight. These findings are consistent with the hypothesis that severe sleep apnea is a contributing cause of OHS.
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PMID:Oxyhemoglobin saturation during sleep in subjects with and without the obesity-hypoventilation syndrome. 400 62

Sixty-one patients (pts) with sleep apnea (SA), 35 with narcolepsy (N) and 24 with idiopathic hypersomnolence (H) were studied in the Clinical Research Center. The height to body weight ratio was less than normal in SA pts (0.32 +/- 0.01 vs 0.45 +/- 0.01, p less than 0.01), but normal in N and H pts (0.45 +/- 0.02 and 0.45 +/- 0.01, respectively). Twenty-four hour urinary epinephrine (E) plus norepinephrine (NE) was greater than normal (p less than 0.01), but not different among SA, N and H pts. The incidence of mitral valve prolapse (MVP) was greater in N (49%) and H (58%) compared to SA (20%) (p less than 0.01). The ratio of the pre-ejection period to the left ventricular ejection time (PEP/LVET) was abnormal (greater than 0.42) in 36% of the pts with SA and only in one pt with N and H (p = 0.02). The % shortening of the echocardiographic internal diameter (% delta D) was abnormal (less than 28%) in 28% of pts with SA and normal in all pts with N and H (p = 0.02). The incidence of malignant ventricular dysrhythmias (24 hour Holter) was 26% in SA, 3% in N and 4% in H (p = 0.04). Thus, pts with impaired alertness have high adrenergic tone despite evidence for a role of catecholamines in wakefulness. Left ventricular dysfunction, malignant dysrhythmias and obesity are common findings in SA, while MVP is very common in N and H.
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PMID:Anthropometric characteristics, cardiac abnormalities and adrenergic activity in patients with primary disorders of sleep. 658 Mar 72

Twenty-seven cases of adult sleep apnea are reported. The patients were studied with all-night polysomnography. Seven (26%) had predominately obstructive sleep apnea, while another seven (26%) had predominantly central sleep apnea. Thirteen patients (48%) were found to have a mixed pattern. Obesity was not a reliable guideline for predicting differential etiology. We conclude that sleep studies with specific monitoring are essential in the evaluation of the adult with sleep apnea prior to therapeutic intervention.
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PMID:Evaluation of the adult with sleep apnea. 662 51

Fifteen morbidly obese patients with Sleep Apnea Syndrome (SAS) were studied during nocturnal sleep before and between 2 to 4 months after a weight reduction surgery. Six patients were also recorded between 4 to 8 months after surgery. Postoperative recordings revealed a dramatic reduction in the sleep apnea index and an improvement in sleep motility and daytime vigilance levels. A further decrease in apneas and sleep motility was seen in the late post-treatment recording. These results indicate that weight reduction surgery is an effective definitive treatment for obesity associated SAS.
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PMID:Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery. 669 24

Thirty male patients evaluated sequentially for sleep apnea syndrome by all-night clinical polysomnography were compared for apnea plus hypopnea index (A + HI) during the time in the side versus time in the back sleep posture. For 24 subjects of this sample, who occupied both major body positions during the evaluation night, the apnea index was found to be twice as high during the time spent sleeping on their backs as it was when they slept in the side position. This difference is reliable and inversely related to obesity. Five patients meeting diagnostic criteria for sleep apnea on an all-night basis fell within normal limits while in the side sleep position. This suggests sleep position adjustment may be a viable treatment for some nonobese sleep apnea patients.
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PMID:Effect of sleep position on sleep apnea severity. 674 55

Three patients with the obesity hypoventilation syndrome and one patient with the sleep apnea syndrome underwent gastroplasty for weight reduction. A tracheostomy was also performed in the patient with sleep apnea. The PaO2 rose from an average of 51 +/- 9 to 71 +/- 5 torr and the PaCO2 fell from an average of 51 +/- 21 to 41 +/- 6 torr within two to ten months following bariatric surgery. The improved arterial blood gases were associated with an increased forced vital capacity in each patient. The change in maximum voluntary ventilation was variable. Sleep capneography demonstrated cure of the patient with sleep apnea permitting removal of the tracheostomy. All four patients have returned to productive lives in society. Given proper pre- and postoperative care, patients with respiratory insufficiency tolerate the operation well. Respiratory insufficiency associated with morbid obesity should be considered an indication for the gastroplasty procedure, rather than a contraindication as previously suggested.
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PMID:Gastroplasty for respiratory insufficiency of obesity. 678 2

To define the roles of mechanical loading, respiratory neuromuscular control, and sleep apnea in the pathogenesis of obesity hypoventilation, respiratory muscle drive and output, assessed by diaphragmatic electromyogram (EMGdi) and mouth occlusion pressure (P 0.15), respectively, were determined during CO2 chemostimulation in nonobese volunteers who were subjected to abdominal mass loading, and in three groups of markedly obese patients: eucapnic obese without sleep apnea (O), eucapnic obese with sleep apnea (OSA), and hypercapnic obese with sleep apnea (OH). The P0.15 responses were decreased in OSA and OH, but the EMGdi responses were not significantly different from those in control subjects. In O patients EMGdi responses were significantly greater than those in control subjects as well as those in OSA and OH patients. EMGdi and P0.15 responses increased in all nonobese subjects when they were subjected to mass loading. We conclude that both OSA and OH patients were equally unable to develop the expected increase in respiratory muscle drive and output. The presence of sleep apnea, possibly by causing nocturnal hypoxemia and/or sleep fragmentation, may result in impaired mass load compensation and predispose obese patients to develop hypercapnia.
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PMID:Mass loading, sleep apnea, and the pathogenesis of obesity hypoventilation. 681 71

Disorders of breathing related to sleep are relatively newly recognized and less than fully understood. This review presents the terminology used to describe them, and describes the physiology of sleep and the control of ventilation, the pathophysiology of breathing disorders during sleep, their various clinical manifestations, current diagnostic techniques, and the treatment modalities available at present. Among the diagnostic approaches discussed are airway fluoroscopy during sleep, pneumography, and polysomnography. Approaches to medical and surgical management of these disorders are reviewed. Speculation regarding the underestimation of the prevalence of these disorders, the male predominance, and their relationship to snoring, coronary artery disease, and hypertension, which also show male predominance, are presented. Also suggested is a relationship of sleep apnea, obesity, and mental retardation in childhood-onset or congenital disorders such as Down's syndrome and Prader-Willi syndrome, and in other endocrine dysfunction diseases.
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PMID:Sleep-related breathing disorders. 702 76

Four morbidly obese men who had been found to have significant sleep-disordered breathing and oxygen desaturation were restudied after an average weight loss of 108 kg (range 53-155 kg). In all subjects, weight loss was accompanied by a significant reduction in the number of episodes per hour of sleep-disordered breathing events. In three of the four subjects, there was improvment in the severity of desaturation accompanying abnormal breathing. The two subjects with daytime somnolence and hypercapnia prior to weight loss showed the most dramatic improvement in desaturation. This suggests that obesity is a cause, rather than an effect, of the sleep apnea syndrome.
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PMID:The effect of weight loss on sleep-disordered breathing and oxygen desaturation in morbidly obese men. 710 55


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