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

OSAS, a common cause of disrupted sleep and EDS, result from repetitive closure of the upper airway during sleep. It probably represents the most severe syndrome related to obstruction of the upper airway; less severe forms include UARS, a syndrome characterized by the need for increased effort to breath but no prominent apneas or hypopneas, and primary snoring. Initial clues to the presence of OSAS and related disorders are derived from the history and include loud snoring, EDS or insomnia, and witnessed apneas. Some patients, especially women, may complain mostly of tiredness or fatigue, and children may present with behavioral abnormalities. Obesity, a large neck circumference, and a crowded oropharynx are common on physical examination. Nonobese patients, in particular, often have retrognathia, a high-arched narrow palate, macroglossia, enlarged tonsils, temporomandibular joint abnormalities, or chronic nasal obstruction. The clinical suspicion of obstructed nocturnal breathing is confirmed by overnight polysomnography, and an MSLT may be used to assess sleepiness. Esophageal manometry during polysomnography facilitates diagnosis of UARS. Treatment most commonly consists of nasal CPAP or BPAP, although problems with compliance make surgical treatment preferable in some cases. Although UPPP eliminates sleep apnea only in a minority of patients, combining UPPP with maxillofacial procedures appears to improve outcomes. Other treatments such as the use of dental appliances or medications, weight loss, and positional therapy may be useful as adjunctive therapy for moderate to severe OSAS or as primary treatments for UARS or mild OSAS.
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PMID:Obstructive sleep apnea and related disorders. 887 78

Obstructive sleep apnea syndrome (OSAS) is increasingly recognized in the pediatric population. It is characterized by a combination of partial upper airway obstruction and intermittent obstructive apnea that disrupts normal ventilation and sleep. It is estimated to occur in 1-3% of children with a peak age of 2 to 5 years. Common symptoms include habitual snoring, difficulty breathing during sleep, restlessness, and witnessed apnea. Adenotonsillar hypertrophy is the most common associated condition in otherwise normal children, but cranialfacial abnormalities, neuromuscular diseases, and obesity are also predisposing factors. Severe OSAS can have serious neurobehavioral and cardiorespiratory consequences including excessive daytime sleepiness, growth failure, school failure, behavioral problems, cor pulmonale, or even death. Diagnosis is based on data from the history, physical exam, and laboratory studies that confirm the presence and severity of the upper airway obstruction. Polysomnography has been the diagnostic tool of choice. Treatment depends on the severity of symptoms and the underlying anatomic and physiologic abnormalities. Since childhood OSAS is usually associated with adenotonsillar hypertrophy, the majority of cases are amenable to surgical treatment. However, there is increasing pediatric experience with CPAP therapy when tonsillectomy and adenoidectomy are either unsuccessful or inappropriate.
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PMID:Obstructive sleep apnea syndrome (OSAS) in children: diagnostic challenges. 908 30

A 29-year-old woman of the bronchial asthma was admitted to our hospital. Her asthmatic symptoms were refractory in spite of the administration of 30 mg of daily-oral prednisolone. During the asthma-attack, marked arterial oxygen desaturation was noted. So we doubted that she had obstructive sleep apnea complicated with obesity. Sleep Apnea Monitor revealed her nocturnal desaturation and frequent sleep apnea. To avoid the desaturation, we recommended her to keep prone position during the sleep. And both desaturation and asthmatic symptoms were dramatically improved. Nasal-CPAP also had been effective for them. These findings suggest that sleep apnea mediated oxygen desaturation may be one of the promotor of asthmatic symptoms.
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PMID:[A case of refractory bronchial asthma improving with treatments of sleep apnea syndrome]. 952 63

Two cases of sick sinus syndrome with asystole in patients with obstructive sleep apnea syndrome are reported. Management of such patients using CPAP therapy is detailed. The apnea symptoms and somnological history are important in evaluation of the condition of patients with sleep cardiac arrhythmia especially in patients with day sleepiness, night snore and obesity.
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PMID:[The cardiological manifestations of the obstructive sleep apnea syndrome. Clinical cases]. 957 89

Nasal continuous positive airway pressure (nCPAP) is the current treatment of obstructive sleep apnoea syndrome (OSAS). The indications of bilevel pressure support ventilation (BIPAP PSV) in OSAS patients remain controversial. The purpose of this investigation was to verify the frequency of prescription of BIPAP PSV in a group of OSAS patients when CPAP was ineffective or not tolerated during titration. The study included 286 consecutive patients > or = 18 years of age referred to two Sleep laboratories for sleep related breathing disorders (SRBD) between December 1994 and November 1995. Of these, 130 patients were enrolled and 105 (88 males, 77 females) with moderate to severe OSAS completed the study and were finally analysed. After a full night diagnostic polysomnography (PSGD), patients had a second full night PSG under nCPAP (PSGT). If nCPAP was not tolerated, or failed to correct breathing abnormalities during sleep, a second PSGT was performed, using a BIPAP PSV. Our study shows that nCPAP (mean 8.5 +/- 2.0 cmH20) was considered a satisfactory therapy in 81 patients (77%). Twenty four (23%) required BIPAP PSV (mean IPAP 13.9 +/- 2.9 cmH20). We found the highest prevalence of BIPAP in patients with OSAS associated to obesity hypoventilation syndrome (OHS) (11 of 17) and in OSAS associated to chronic obstructive pulmonary disease (COPD) (nine of 16). Patients treated with BIPAP PSV were more obese and had a higher PaCO2 and sleep-related desaturations and a lower FEV1, FVC, FEV1/FVC and PaO2. In conclusion our study shows that CPAP therapy in the effective therapeutic option in the majority of patients with OSAS. There is a subset of patients with OSAS associated to COPD or to OHS in whom BIPAP PSV may be a better treatment modality.
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PMID:Prescription of nCPAP and nBIPAP in obstructive sleep apnoea syndrome: Italian experience in 105 subjects. A prospective two centre study. 985 Mar 65

There are many causes leading to breathing disorders in children. In the newborn period the immature central regulation of breathing can result in a pattern with apneas and bradycardias most commonly seen in the very premature infant. Therefore, during hospital stay many of these very tiny preterms and some of the very ill term infants do have severe apneas and do need medication and or mechanical support (nasal CPAP, positive pressure ventilation). In the first two to three months of life central dysmaturity can persist in some infants and apneas of infancy can occur further on. Infants with prolonged apneas and symptoms like paleness, cyanosis, stiffness or limpness are often investigated, treated or monitored. At the age of two to six, every tenth child is a loud snorer. Every fifth snorer at this age suffers from a severe upper airway obstruction. Factors that decrease pharyngeal size or increase pharyngeal compliance may lead to obstruction. Adenotonsillar hypertrophy is the most common associated condition, craniofacial disorders, central nervous system and neuromuscular problems and less obesity are disposing factors. Children may present nocturnal symptoms like snoring, difficult breathing or disturbed sleep, but most of them have daytime problems as initial complaint such as hyperactivity, behavioral problems, growth failure, poor school performance. Excessive daytime sleepiness is not so common in young children. The childhood obstructive sleep apnea syndrome is a common and serious problem. Children with symptoms suggesting severe obstruction should be evaluated and treated. Most children are cured by adenotonsillectomy whilst some require further therapy.
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PMID:[Sleep apneas in children]. 1095 55

Objective: We investigated glucose metabolism and insulin resistance in non-obese and moderately overweight sleep apnea patients, as well as their response to nasal CPAP treatment.Methods: A group of subjects with glucose intolerance was screened for sleep disordered breathing by clinical interview and ambulatory recordings. Ten subjects were found to have untreated sleep apnea and were asked to participate in further investigation. This included nocturnal polysomnography, oral glucose tolerance test and indirect calorimetry. Subjects then had calibration of nasal CPAP with polysomnography. Two months after start of treatment, all subjects were restudied as at baseline. In parallel, six obstructive sleep apnea syndrome (OSAS) subjects, diagnosed through the sleep clinic, were matched for gender, age and oxygen desaturation index with the other group, and had a euglycemic hyperinsulinemic clamp at baseline and after 2 months of nasal CPAP.Results: The first ten patients showed no change in total glucose oxidation, glucose oxidation by weight or by fat free mass, or insulin energetic expenditure, despite nocturnal usage of nasal CPAP. Similarly, when comparing baseline to the treatment at 2 months, the six OSAS patients had no change in mean glycemia, insulin, C peptide and hemoglobin (Hgb) A1C measurements. No difference in the amount of glucose infused during the duration of the clamp was noted either.Conclusion: Our data do not support the existence of a significant relationship between glucose and insulin metabolism and obstructive sleep apnea. Obesity, when present, is the important variable.
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PMID:CPAP treatment does not affect glucose-insulin metabolism in sleep apneic patients. 1131 83

Sleep apnea syndrome must be exactly confirmed by the standard set or collection of examinations from rhonchopathy. The diagnosis is distinguished and identify by ENT examination, nocturnal recording by polyMESAM or by complete polysomnography. Then is performed neurological and maxillomandibular examination, X-rays pictures (cephalometric data), and CT of pharynx. Part of patient is indicated to undergo surgery. In region of velopharyngeal space we performed classical uvulopalatopharyngoplasty (UPPP), described first time by Fujita 1981 in Detroit [4]. It means, that we take out both tonsils and then remove part of soft palate to enlarging the velopharyngeal space. The findings of retrobasilingual obstruction and obesity are negative predictors for success of UPPP. Narrowing of posterior airway space is indication for the alternative therapy called maxillomandibular advancement. We prefer the surgery by classical method without laser. Adenotomy is performed in children population since residuum of adenoids, and sometimes tonsillectomy should be added for good postoperative results. Part of patient should undergo septoplasty due to local findings of obstruction or another anatomical abnormalities on the level of nasal cavity or nasopharynx. This surgery is very important for this reason of treatment by CPAP.
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PMID:[Surgical treatment of sleep apnea syndrome in otorhinolaryngology]. 1244 43

(1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients as possible with sleep apnoea recover, (3) to maintain capacity for work and functional capacity of patients with sleep apnoea, (4) to reduce the percentage of patients with severe sleep apnoea, (5) to decrease the number of sleep apnoea patients requiring hospitalisation and (6) to improve cost effectiveness of prevention and treatment of sleep apnoea. (6) The following means are suggested for achieving the goals: (1) to promote prevention of obesity, weight loss and weight control; (2) to promote securing of nasal respiration in child patients and removal of obstructing redundant soft tissues; (3) to promote the correction of children's malocclusions, (4) to enhance knowledge about risk factors and treatment of sleep apnoea in key groups, (5) to promote early diagnosis and active treatment, (6) to commence rehabilitation early and individually as a part of treatment and (7) to encourage scientific research. (7) On the national level, the occurrence of sleep apnoea can be prevented, for example, by encouraging weight control. The programme gives examples of such measures and appeals to various authorities and voluntary organisations to reinforce their collaboration. Preventive measures should be individualised, and based on due consideration. (8) The efficacy of diagnosing sleep apnoea should be increased. Attention should be paid to the symptoms of risk group patients at different units of the primary and occupational health care. Even mild forms of the disease should be treated appropriately. Diagnosis and treatment of the disease involve cooperation between the primary and specialised health-care sectors. Methods of treatment are (1) treatment of obesity, (2) positional therapy, (3) reduction of the use of medicines impairing the central nervous system, (4) reduction of smoking and the consumption of alcohol, (5) devices affecting the position of the tongue and lower jaw, (6) treatment with Continuous Positive Airway Pressure (CPAP-treatment), (7) surgical methods of treatment and (8) rehabilitation. (9) The hierarchy of referrals in the prevention and treatment of sleep apnoea should be revised to accord a greater role to the primary health-care sector. Good exchanges of information and cooperation between the primary health care and specialised medical-care sectors should be developed. Hospitals districts in cooperation with provincial governments and municipalities should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. (10) Rehabilitation of sleep apnoea should be goal-orientated and cover all forms of rehabilitation: medical, occupational and social. Rehabilitation should prevent the effects caused by the disease. Thus, it is possible to support self-care, increase the patient's resources and improve quality of life. (11) Information and training should be directed primarily towards health-care personnel, patients and their families. Organisations should produce materials for health and patient education as well as organising training events. To support the activities. financing will be needed from organisations such as Finland's Slot Machine Association. The Social Insurance Institution should disseminate information about questions of social security. Regional direction and training will mainly be the responsibilities of hospital districts, provincial governments and local health centres. The media will play an important role in the dissemination in-depth information about prevention and treatment of sleep apnoea.
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PMID:Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012. 1269 95

Although clinical experience has suggested for more than two decades that OSA is associated with impairment of cognition, emotional state, and quality of life and that treatment with nasal CPAP produces significant improvements in these areas, sound empirical evidence to support this view, especially regarding treatment outcome, has been lacking. More recent investigations have begun to provide this support from randomized, adequately controlled studies. These assessments suggest that some degree of cognitive dysfunction is associated with OSA. The effects are most apparent in the severe cases, whereas results in mild cases are more equivocal. Reported impairments include global intellectual dysfunction and deficits in vigilance, alertness, concentration, short- and long-term memory, and executive and motor function. Considerable discrepancy exists across studies with respect to type and degree of dysfunction, however. Disturbances in general intellectual function and executive function show strongest correlations with measures of hypoxemia. Not unexpectedly, alterations in vigilance, alertness, and, to some extent, memory seem to correlate more with measures of sleep disruption. Although many inadequately controlled investigations have demonstrated reversibility of most or all of these deficits with effective treatment, more recent placebo-controlled studies have raised doubts regarding whether the observed changes are truly a function of treatment. This issue requires further systematic exploration with adequate controls and step-wise analysis of treatment duration effects. A similar set of considerations exists with respect to the relationship between psychological disturbance, primarily depression, and OSA. Although several studies suggest significant depression in these patients, the results are mixed. Placebo-controlled treatment trials fail to demonstrate consistently a difference in mood improvement between active treatment groups and controls, although several methodologic considerations suggest that these results should be interpreted with caution. Numerous investigations leave little doubt about the issue of quality of life impairment among persons with OSA. Further characterization of impairment, particularly in areas specific to this population, will provide clearer understanding of the problem. Preliminary investigations of treatment response in controlled studies indicate significantly greater improvement of quality of life in response to CPAP. Although patients with OSA commonly report disturbances in cognitive and psychological function and general quality of life, the increased rates of obesity, hypertension, diabetes, cardiovascular disease, medication use, and related psychosocial complications present a host of potential etiologies that might explain the impairments noted. There can be little doubt that these covariants do, in some cases, contribute to neuropsychological dysfunctions. It is essential that future studies continue to define those disturbances that are specific to OSA, the relationship between levels of severity and impairment, the role of treatment in reversing these dysfunctions, and the correlation between test results and significant day-to-day social and occupational functional impairment.
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PMID:Neuropsychological impairment and quality of life in obstructive sleep apnea. 1280 Jul 82


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