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

Previous research on the medical consequences of shift work has mainly been concerned with sleep disorders and gastrointestinal disturbances. Cardiovascular disease has not been clearly implicated. The objective of the present study was to investigate a possible association between shift work and Coronary Heart Disease (CHD), which is the most common cause of death in industrialized countries. Previous research is reviewed and criticized for using simple approaches with little ability to quantify exposure and to control for selection. Two longitudinal and two cross-sectional studies have been carried out. One study has measured incidence of CHD in 504 male day and shiftworkers from 1968 to 1982/83. The results indicate that shift work is associated with CHD. Our result has demonstrated a dose-response relationship between years of shift work and CHD. Our findings on increased risk of CHD in shift workers are consistent with recent epidemiological studies from Sweden which have used register data. The cross-sectional studies in which two different cohorts of male blue-collar workers were investigated did show a higher percentage of smokers among shift workers. In addition, the shift workers had higher serum concentrations of serum triglycerides. The difference in serum triglyceride levels between day and shift workers could not be explained by obesity, smoking or alcohol intake in the statistical analyses. These results suggest that the prevalence of risk factors for CHD is higher among shift workers. A prospective study of 25 male shift and day workers, who were followed for six months, indicated that the diet of shift workers might be responsible for changes in the ratio between apoB and apoA-1, a ratio which is related to risk of coronary disease. The analyses of spontaneous changes in the diet showed that the shift workers tended to decrease the intake of dietary fibre and increase the intake of sacharose. The change in the ratio between apoB and apoA-1 correlated inversely with the change in intake of dietary fibre. It is concluded that spontaneous changes in the diet of shift workers might be responsible for changes in serum lipoproteins. Three major disease pathways from shift work to CHD are proposed: (i) disturbed physiological rhythm and/or a collision between the circadian rhythm and myocardial performance, (ii) changes in behaviour, and (iii) disturbed sociotemporal rhythmicity, which might lead to distress reactions.
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PMID:Shift work and coronary heart disease. 268 43

Of 22 patients investigated for sleep disorders, habitual snoring and/or daytime hypersomnolence, 12(10 men) had obstructive sleep apnea syndrome (OSAS). 3 OSAS were mild, 5 moderate and 4 severe. The leading symptoms were daytime hypersomnolence and habitual snoring. As risk factors we found retro-micrognathia in 2 patients, macroglossia secondary to acromegaly in 1, alcohol abuse in 7 and obesity in 6. Conservative measures improved the disorder subjectively in 6 patients. One patient had a relapse 6 months after uvulopalatopharyngoplasty. 4 patients were successfully treated by nasal CPAP. Other diagnoses were idiopathic alveolar hypoventilation (2), Cheyne-Stokes breathing secondary to low cardiac output (1), monosymptomatic narcolepsy (2), sleep disturbances secondary to depression (2), chronic benzodiazepine abuse (1) and chronic bronchitis without nocturnal hypoxemia (1). History, clinical observation and oxymetry make diagnosis possible in most cases of OSAS severe enough to require treatment. Polysomnography is time-consuming and should be reserved for selected cases.
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PMID:[Sleep-apnea syndrome. Elucidation, therapy and course]. 305 35

Obstructive sleep apnea syndrome (OSAS) is a common problem in middle-aged men. It is a syndrome often associated with upper airway anatomical abnormalities, but where the sleep disorder, part of the syndrome, impairs local upper airway reflexes involved in appropriate air exchange during sleep. We now have many possible treatments. It is better to associate them in a step-by-step approach. This implies development of appropriate services able to follow OSAS patients regularly. The immediate goal is to assure normal ventilation during sleep and maintenance of normal blood gases. This is obtained by use of nasal CPAP or nasal IPPV, less mutilating than tracheostomy. Weight loss and behavioral modification programs will improve some of the associated features of obesity, alcoholic intake, and smoking often associated with and worsening the sleep-related breathing disorders. Finally, an appropriate evaluation of the upper airway abnormalities will allow surgical approaches that, as a second step, will lead to an appropriate reconstruction of the upper airway and will allow discontinuation of mechanical devices, with a subsequent return to normal life for the patient. To offer only one of these services or to limit oneself to a single therapeutic approach is a long-term disservice to OSAS patients.
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PMID:Treatment of obstructive sleep apnea syndrome. A personal view based upon evaluation of over 4000 patients. 305 71

Twenty-seven women referred to a sleep disorders clinic for symptoms of obstructive sleep apnea syndrome (OSAS) during one year were systematically analyzed after polygraphic monitoring of sleep and cephalometric x-ray examination. Our subjects, one-third of whom were premenopausal, comprised approximately 12 percent of the total OSAS population seen. Women with OSAS were compared with 110 OSAS men and with a group of 16 women without OSAS but referred to orthodontists for mild dental malocclusion. Women with OSAS were massively obese, much more so than their male counterparts. There was no significant difference between pre- and postmenopausal women, with the exception of the respiratory disturbance index (RDI), which was lower in the postmenopausal group despite similar morbid obesity (seemingly better tolerated by women with OSAS than by men with the same syndrome) and long mandibular plane-hyoid bone distance. The significantly higher RDI noted in premenopausal women, despite equally massive obesity and upper airway abnormalities, is thought to be related to hormonal status and better arousal response. Chronic obstructive lung disease (COLD) seen in a subgroup of women with OSAS did not differentiate this subgroup from the other OSAS patients when oxygen saturation during sleep, frequency of abnormal respiratory events and sleep variables were considered. Massive obesity is the dominant factor for the appearance of OSAS in women.
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PMID:Women and the obstructive sleep apnea syndrome. 333 38

Described is a 67-year-old man whose initial symptoms evoked an obesity-hypoventilation syndrome. Polysomnography showed hypopneas associated with O2 desaturation episodes, and no apnea; maximal changes were noted during REM sleep. A few months later, in spite of marked weight loss, acute alveolar hypoventilation occurred and necessitated mechanical ventilatory support. Tracheostomy was performed. The patient appeared to be dependent on nocturnal ventilatory assistance. Diaphragmatic paralysis was noted in addition to clinical and electrodiagnostic evidence of amyotrophic lateral sclerosis. While the patient was not ventilated, a nocturnal recording of SaO2 again revealed desaturation episodes partly corrected by O2 2 L/min administered through the tracheostomy tube. With volume-controlled ventilation, desaturations completely disappeared, although no oxygen enrichment of the air was provided. We speculate that sleep disorders with hypopneas and O2 desaturation episodes were the initial symptoms of amyotrophic lateral sclerosis. This leads us to suggest that nonspecific respiratory muscle fatigue frequently seen in COPD might be included in the hypothetic causes of nocturnal hypoxemia.
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PMID:Amyotrophic lateral sclerosis presenting with sleep hypopnea syndrome. 337 Nov 13

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

Although flow-volume curves are valuable in detecting extrathoracic airway obstruction, their role in testing patients with sleep-disordered breathing is undefined. To determine whether patients with sleep-disordered breathing have abnormal flow-volume curves consistent with variable extrathoracic obstruction, 60 subjects referred with suspected sleep disorders prospectively underwent spirometry and assessment of flow-volume curves. These tests were interpreted independent of the outcome of polysomnography. Fourteen of 35 subjects (40%) with sleep-disordered breathing had abnormal flow-volume curves consistent with variable extrathoracic airway obstruction, and 2 of 25 (8%) with no breathing disorder had extrathoracic obstruction (p less than 0.02). The presence of extrathoracic airway obstruction in subjects with mixed or obstructive sleep apnea did not correlate with age, the presence of snoring, excessive daytime hypersomnolence, obesity, or the severity of sleep apnea. Abnormal flow-volume curves were found more frequently in women who had no obvious structural upper airway abnormality. Because of the high specificity (92%) of the flow-volume curve, the finding of extrathoracic obstruction in patients with a history consistent with sleep-disordered breathing substantially increases the likelihood that sleep apnea is present.
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PMID:Abnormal inspiratory flow-volume curves in patients with sleep-disordered breathing. 730 12

The National Commission on Sleep Disorders Research, in its report to Congress, concluded that the primary care community generally does not understand sleep disorders. Obstructive sleep apnea carries a risk of substantial morbidity and mortality. Excessive daytime sleepiness results from fragmented sleep and microarousals associated with apneic events. It causes poor work performance and increases the incidence of automobile accidents due to driving while drowsy. The commission estimates that the loss of productivity in the United States from excessive daytime sleepiness is more than $20 billion per year. Obstructive sleep apnea is strongly associated with hypertension, myocardial infarction, and stroke. Risk factors for obstructive sleep apnea include male sex, obesity, older age, craniofacial anomalies, and familial risk. Treatment is based on documenting the disorder by polysomnography. Medical management of the syndrome includes weight loss and nasal continuous positive airway pressure. A network of follow-up and support is necessary to maintain compliance. Surgical treatment is reserved for those for whom nasal airway pressure treatment fails. A surgical protocol is presented that demonstrates efficacy equal to nasal airway pressure treatment. Primary care physicians should assume the responsibility of identifying patients at risk for obstructive sleep apnea and refer them appropriately.
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PMID:Obstructive sleep apnea. Trends in therapy. 772 98

The association between snoring and blood pressure is still a matter for debate, partly because of uncertainty about the definition of snoring and partly because confounding factors may affect systemic blood pressure such as obesity, sleep apnoea, and nocturnal hypoxaemia. To isolate the contribution of each of these factors, 1415 patients (389 females, 1026 males) referred to a sleep disorders centre were studied. A full history was obtained with particular attention to cardiovascular disease and medications. The patients had nocturnal polysomnography including objective measurement of snoring, and blood pressure was measured in the morning. 18% of non-snores had hypertension as did 20% of heavy snores (not significantly different). Multivariate linear regression analysis showed that snoring was not a significant determinant of blood pressure. Only age, male sex, apnoea/hypopnoea index, and body mass index contributed significantly to the variability of blood pressure. We conclude that snoring in the absence of sleep apnoea is not associated with raised blood pressure.
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PMID:Blood pressure, snoring, obesity, and nocturnal hypoxaemia. 791 47

We identified seven patients with refractory partial epilepsy and sleep apnea. Treatment of the sleep apnea with nasal continuous positive airway pressure (CPAP), protriptyline, trazodone, acetazolamide, or tracheostomy reduced seizure frequency and severity in six patients. Success with CPAP depended largely on compliance. Four of five patients had a clear reduction in seizure frequency with the use of CPAP. Sleep apnea may exacerbate epilepsy by causing sleep disruption and deprivation, hypoxemia, and decreased cerebral blood flow. In epilepsy patients with risk factors (eg, obesity) or markers (eg, habitual snoring, daytime somnolence) for sleep apnea, a careful sleep history should be elicited and a polysomnogram obtained when indicated. Treatment of the sleep disorder can improve seizure control.
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PMID:Epilepsy and sleep apnea syndrome. 884 27


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