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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In patients with coronary artery disease (CAD) the prevalence of obstructive sleep apnoea (OSA) is found to be about 14-65%. In this study, the influence of OSA in 50 patients with CAD was prospectively compared during a follow-up period of 10 years. In the follow-up period 4 of 25 patients with OSA and 5 of the 25 without OSA died by cardiovascular complications. The proportion survival curve showed no significant difference for patients with CAD and with versus without OSA. The results of this rather small 10-year follow-up study failed to give further evidence for an increased mortality in patients with CAD and OSA.
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PMID:Influence of obstructive sleep apnoea in coronary artery disease: A 10-year follow-up. 1611 49

Obesity has emerged as one of the most complex and debilitating diseases affecting the world's population. It is estimated that more than two thirds of Americans are overweight and more than 20% are obese. This disease is associated with many morbid conditions, including hypertension, coronary artery disease, hypoventilation, sleep apnea syndrome, diabetes mellitus, and an increased incidence of certain malignancies. Medical interventions for achieving and maintaining significant weight loss have generally failed, leaving surgery as the only effective treatment for durable weight loss. A number of surgical options are available today and can be grouped into two categories based on the mechanism of how the weight loss is achieved. Restrictive procedures include vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), and Roux-en-Y gastric bypass (RYGB), although the latter does have some altered absorption as well. Largely malabsorptive procedures include biliopancreatic diversion (BPD) and biliopancreatic diversion with duodenal switch (BPD-DS). Whereas VBG has largely fallen out of favor due to inadequate long-term weight loss, the other procedures have proven successful in achieving and maintaining adequate weight loss. In addition, each has proven successful in reversing or ameliorating many of the comorbidities associated with obesity. RYGB is the most common procedure performed in the United States and is considered the gold standard. It has the best short- and long-term results for safety, efficacy, and durability, and it has been proven to be superior in results to those for AGB. In experienced hands, this technically challenging procedure can now be performed laparoscopically. This method has the same weight loss and health benefits as the open procedure while achieving all the added benefits of a minimally invasive approach. Long-term data seem to support the malabsorptive procedures as most effective in the superobese. All the procedures require compliance and long-term nutritional follow-up.
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PMID:Surgical treatment of obesity. 1653 77

An increased incidence of cardiovascular disease has previously been reported in middle-aged males during a follow-up period of 7 yrs. The aim of the present study was to address the incidence of coronary artery disease (CAD) in a larger sample without any heart disease at baseline. The population comprised 308 snorers (245 males and 63 females) with a mean +/- sd age of 49.0 +/- 9.9 yrs in 1991. Data were collected via the Swedish Hospital Discharge Register, National Cause of Death Registry, clinical charts and questionnaires. Over 7 yrs, CAD was observed in 17 (16.2%) of 105 patients with obstructive sleep apnoea (OSA; overnight (6 h) oxygen desaturations > or =30 events) compared with 11 (5.4%) of 203 snorers without OSA. OSA diagnosis at baseline was associated with an increased risk of development of CAD in a multivariate model. In the OSA group, CAD was confirmed in 16 (24.6%) of 65 incompletely treated patients compared with one (3.9%) of 26 efficiently treated subjects. Efficient treatment of OSA reduced this risk. It is concluded that middle-aged sleep apnoeics are at high risk of developing coronary artery disease if they are not treated efficiently, which should be considered in cardiovascular disease prevention models.
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PMID:Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. 1664 Nov 20

The insulin resistance syndrome, also referred to as the metabolic syndrome or syndrome X, is associated with a primary cellular defect in insulin action (insulin resistance) and a compensatory increase in insulin secretion. The combination of insulin resistance and subsequent hyperinsulinaemia causes a number of metabolic and cardiovascular changes that result in a syndrome typically characterised by type 2 diabetes, obesity, dyslipidaemia, coronary artery disease and hypertension. Moreover, disturbances in sleep (sleep apnoea) and ovarian dysfunction are also characterised by insulin resistance. The pathophysiological basis for these disturbances reflects the impact of variable genetic and environmental influences. At a molecular level, insulin resistance involves defects of insulin signalling such as reduced insulin receptor tyrosine kinase activity and reduced post-receptor phosphorylation steps that impinge on metabolic and vascular effects of insulin.
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PMID:The insulin resistance syndrome: physiological considerations. 1746 39

It is estimated that 60%-7% of women of reproductive age have polycystic ovarian syndrome (PCOS). Women with this condition exhibit an adverse cardiovascular risk profile, characteristic of the cardiometabolic syndrome and given the high prevalence of PCOS in the female population, this condition may contribute towards the acceleration of cardiovascular disease among young women. This article summarizes the recent development and findings in the cardiometabolic abnormalities in patients with PCOS. Patients with PCOS have the clinical features of oligomenorrhoea, hirsutism and infertility; however, they also exhibit hyperinsulinemia, obesity, hypertension, dyslipidemia, and an increased pro-thrombotic state. They have an increased risk of type 2 diabetes and impaired glucose tolerance, and sleep apnea is also found more commonly in this population. However, despite the presence of cardiovascular risk factors and increased surrogate markers of cardiovascular disease it is unclear if they have accelerated atherosclerosis. End point studies are currently lacking and the available evidence are conflicting. Adipose tissue has emerged as an important endocrine organ over the last decade and gained recognition in having an important role in the cardiometabolic syndrome. Adiponectin that is secreted exclusively by adipocytes has recently been recognized as an important marker of cardiometabolic syndrome, obesity, type 2 diabetes, and coronary artery disease. Other adipocytokines like leptin and resistin have also recently been recognized. This article will address the current evidence for the adverse cardiovascular risk in PCOS and the other factors that may be implicated. Finally the therapeutic options for treatment will be discussed.
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PMID:Cardiometabolic aspects of polycystic ovarian syndrome. 1758 75

Obesity and overweight, as a part of the metabolic syndrome, are well known risk factors for the development of diabetes, hypertension, coronary heart disease, hyperlipidemia, stroke, sleep apnea syndrome, osteoarthritis and certain forms of cancer. Cardiovascular disease remains the leading killer in industrialized countries, where it accounts for 40% of deaths. Obesity is defined either by increased waist circumference, waist to hip ratio, or body mass index. Obesity results from an interaction of genes and lifestyle. As people in both developed and developing countries eat more and more energy dense food, and have ever less physical activity, the number of overweight and obese people increases to epidemic proportions. Abdominal obesity plays a key role in the pathophysiology of metabolic disorders, is associated with insulin resistance, and predicts the development of type 2 diabetes and subsequent coronary artery disease. In the general population, obesity is associated with an increased mortality, but paradoxically, a positive correlation between body mass index and survival in congestive heart failure has been reported. In secondary prevention, obesity is underrecognized, underdiagnosed and undertreated in persons with cardiovascular diseases. Weight loss and prevention of weight gain have to be considered one of the most important strategies to reduce the incidence of cardiovascular disease. Increased physical activity and appropriate diet are the cornestones of treatment. Considering the high prevalence of overweight and obesity in Croatia, there is urgent necessity to improve the level of knowledge and skills in understanding obesity by health care services, and to implement appropriate professional strategy to achieve the desired lifestyle modifications.
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PMID:[Obesity--a global public health problem]. 1758 71

Over the past 20 years obesity has become a worldwide concern of frightening proportion. The World Health Organization estimates that there are over 400 million obese and over 1.6 billion overweight adults, a figure which is projected to almost double by 2015. This is not a disease restricted to adults - at least 20 million children under the age of 5 years were overweight in 2005 (WHO 2006). Overweight and obesity lead to serious health consequences including coronary artery disease, stroke, type-2 diabetes, heart failure, dyslipidemia, hypertension, reproductive and gastrointestinal cancers, gallstones, fatty liver disease, osteoarthritis and sleep apnea (Padwal et al 2003). Modest weight loss in the obese of between 5% and 10% of bodyweight is associated with improvements in cardiovascular risk profiles and reduced incidence of type 2 diabetes (Goldstein 1992; Avenell et al 2004; Padwal and Majumdar 2007). Orlistat, a gastric and pancreatic lipase inhibitor that reduces dietary fat absorption by approximately 30%, has been approved for use for around ten years (Zhi et al 1994; Hauptman 2000). There is now a growing body of evidence to suggest that Orlistat assists weight loss and that it may also have additional benefits. The aim of this review is to provide a brief update on the current literature studying the efficacy, safety and significance of the use of Orlistat in clinical practice.
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PMID:Obesity management: update on orlistat. 1820 Aug 2

Sleep-disordered breathing (SDB) describes a group of disorders characterised by abnormalities in the frequency and/or depth of breathing while asleep. The most common type is the obstructive sleep apnoea/hypopnoea syndrome (OSAHS); it affects 2-4% of the adult population and is an independent risk factor for hypertension. Another type is central sleep apnoea (CSA), which includes Cheyne-Stokes respiration; it is most commonly seen in patients with congestive heart failure and other critical illnesses including cerebrovascular accidents. There is accumulating evidence that both these types of SDB are associated with cardiac failure, arrhythmias and coronary artery disease. Treatment of OSAHS with continuous positive airway pressure (CPAP) has lowered blood pressure, reduced the frequency and severity of some arrhythmias, and improved markers of endovascular inflammation. CPAP has had a mild positive effect on left ventricular function in chronic heart failure by treating co-existent SDB, but it has not improved mortality, possibly because it does not fully treat associated CSA. Clinicians need to be aware of the increasing associations of SDB, especially OSAHS, with cardiovascular dysfunction, as treatment of co-existent SDB will not only improve sleepiness, quality of life, and driving risk, but there is growing evidence that it may also improve cardiovascular risk itself, even in non-sleepy subjects.
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PMID:Sleep-disordered breathing and cardiovascular disease. 1823 Jul 47

Diagnosed obstructive sleep apnea affects 2-4% of middle aged Americans and represents a substantial health care burden. Despite its prevalence, little is known about the demographic characteristics or clinical management of sleep apnea patients hospitalized for other comorbidities and surgeries. The aim of this study was to provide a broad characterization of the epidemiology of sleep apnea in hospitalized patients in the United States and to describe the trends in the management of their sleep apnea during their hospitalizations. Using the 2004 National Hospital Discharge Survey (NHDS), a nationally representative sample of discharges from nonfederal acute care hospitals in the United States, cases of sleep apnea were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The specific objectives of this study were to: (1) describe the prevalence of hospitalized unspecified sleep apnea individuals according to age, gender, and comorbidities; (2) estimate prevalence of the use of continuous positive airway pressure (CPAP) therapy during hospitalization and describe those uses according to hospital ownership and size. A retrospective analysis of data of hospitalized patients with unspecified sleep apnea from the 2004 National Hospital Discharge Survey (NHDS) was completed. In 2004, the NHDS collected data for approximately 371,000 discharges from a sample of 439 nonfederal short-stay hospitals. An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2004. Patients diagnosed with unspecified sleep apnea were identified using the International Classification of Diseases (Ninth Revision), Clinical Modification (ICD-9-CM) code of 780.57, which, before 2005, was the sole diagnostic code under which obstructive sleep apnea was listed. A subset of these patients, those receiving CPAP therapy, was further identified using the ICD-9-CM procedural code 93.90. Review of weighted discharge data identified a total of 293,478 estimated cases of unspecified sleep apnea. Approximately 64% of these individuals were between the ages 40 and 69 years old with a gender distribution of 55.3% males. The most common diagnoses in hospitalized sleep apnea patients were morbid obesity, congestive heart failure, coronary artery disease, exacerbation of COPD, and pneumonia. Sleep apnea was managed through the standardized therapy, CPAP, in 5.8% of hospitalized patients and CPAP therapy was more likely to be utilized in sleep apnea patients hospitalized in a government hospital than in a for-profit hospital. In conclusion, only a small percentage (5.8%) of patients diagnosed with unspecified sleep apnea in the 2004 NHDS were provided with CPAP therapy during hospitalization. There appear to be institutional differences in the utilization of CPAP therapy in hospitals across the United States. These findings suggest that in the United States, the management of sleep apnea in hospitalized patients is deficient, and the use of CPAP therapy in the hospital warrants further investigation.
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PMID:Prevalence of unspecified sleep apnea and the use of continuous positive airway pressure in hospitalized patients, 2004 National Hospital Discharge Survey. 1823 92

The evidence for a role of sleep-disordered breathing (SDB) in cardiovascular disease (CVD) is inconclusive and limited to clinic-based studies or population-based studies using historical CVD data. The authors investigated cross-sectional association of SDB, assessed by overnight polysomnography and described by frequency of apnea/hypopnea episodes (Apnea-Hypopnea Index, AHI), with screen-detected CVD consisting of cardiologist-confirmed, electrocardiographically indicated coronary artery disease (ECG-CAD), left ventricular hypertrophy (ECG-LVH), arrhythmias, and conduction abnormalities in a general population. Using multiple logistic regression with adjustments for covariables, there was no significant association of AHI with ECG-CAD, ECG-LVH by voltage, arrhythmias, or conduction abnormalities. There was, however, an association between AHI and ECG-LVH by Cornell criteria. Using AHI as categorical variable, the adjusted odds of ECG-CAD in AHI >or= 5 vs <5 was increased, but not significantly, at 1.30, 95% confidence interval (CI) 0.67, 2.51. The adjusted odds of ECG-LVH by Cornell criteria in AHI >or= 15 vs <5 was significant at 3.19, 95% CI 1.16, 8.76. The authors found a weak or no association between screen-detected CVD and sleep apnea, but did find a threefold increased odds of screen-detected LVH, using Cornell criteria, in moderate or worse SDB. These findings contribute to accumulating evidence of possible association between CVD and sleep apnea in the general population and underscore the need to better understand how SDB affects cardiovascular pathology.
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PMID:Electrocardiographically indicated cardiovascular disease in sleep-disordered breathing. 1824 73


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