Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstructive sleep disordered breathing (OSDB) is a spectrum of disease resulting from changes in the upper airway. It affects a large proportion of the adult population, and in its most severe form, obstructive sleep apnea syndrome (OSAS), patients suffer the adverse effects of sleep disturbance and oxygen desaturation. Daytime somnolence leads to a significantly higher incidence of automobile and work-related accidents, while nocturnal hypoxia is associated with multiple physiological derangements. Patients with OSAS have higher incidences of hypertension, coronary artery disease, congestive heart failure, and arrhythmias. Noninvasive testing is used to confirm the diagnosis, and treatment may be conservative, medical, or surgical. Treatment is designed to improve daytime somnolence and has been shown to improve morbidity and mortality among patients with OSDB.
 ...
PMID:Obstructive sleep apnea: Part I. Pathophysiology, diagnosis, and medical management. 1530 61

A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.
 ...
PMID:Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment. 1532 13

Sleep apnea encompasses 2 forms of sleep disordered breathing, namely obstructive and central sleep apnea. Both these conditions are prevalent in patients with congestive heart failure (CHF) despite quite different etiology and pathogenesis. The last 15 years have seen the development of a large database of mechanistic data implicating both these conditions in the progression of cardiac dysfunction in patients with heart failure. Epidemiological data have also revealed that obstructive sleep apnea may be an independent risk factor for the development of cardiac diseases. Central sleep apnea, conversely, is more likely to emerge as a consequence of severe cardiac dysfunction, but through an elaborate vicious cycle could potentially lead to augmentation of sympathetic activity and contribute to further cardiac decline. In recent years a number of randomized controlled trials suggests secondary endpoints such as symptoms, sympatho-excitation and left ventricular function can be improved with the effective therapies available for both central and obstructive sleep apnea in patients in which these conditions co-exist. Mortality data is emerging also, and the first of a large scale mortality trial assessing the effect of attenuating central sleep apnea with continuous positive airway pressure in patients with moderate to severe CHF, is well underway. This review summarizes the important mechanistic, epidemiological and interventional studies in relation to sleep apnea and congestive heart failure with some commentary on the future direction of this rapidly growing field.
 ...
PMID:Sleep apnea and congestive heart failure. 1533 41

In patients with congestive heart failure (CHF), sleep disordered breathing (SDB)--including obstructive and central sleep apnoea as well as periodic breathing--is a common condition and is believed to increase the risk of mortality. Treatment of SDB is considered important in the management of CHF. Improvements in SDB have a positive effect on cardiac output, measured with left ventricular ejection fraction (LVEF); on neurohormonal activity, measured as brain natriuretic peptide (BNP); and on the quality of life. Continuous positive airway pressure has been the traditional method used to treat SDB in patients with CHF, but compliance and tolerability are poor. A mandibular advancement device (MAD) is a dental device recommended for the treatment of sleep apnoea, but the method has never been evaluated in patients with CHF. The aims of the present studies were to evaluate the practical use of the MAD for the treatment of SDB in patients with CHF and to test the hypothesis that this intervention increases the dimensions of the pharyngeal airway (PAW), reduces SDB and BNP, and improves LVEF and the quality of life. Patients with mild to moderate CHF and SDB were evaluated using a portable polysomnographic device, lateral radiographs, cardiological and odontological examinations, and quality of life measures prior to and following intervention with an custom-made MAD. At the short-term follow-up 4-6 weeks after habituation with the MAD, the severity of SDB according to the apnoea-hypopnoea index had decreased from 25.1 +/- 9.4 (mean +/- SD) to 14.7 +/- 9.7 (p = 0.003). An increase in the inferior region of the PAW (7 +/- 5 mm) was observed on radiographs (p = 0.0001). However, no correlation between the effect of the MAD on the dimensions of the PAW and its effect on SDB was found. At the 6-month follow-up, the sleep apnoea-related symptoms had decreased by 31% (p = 0.003). Quality of life remained stable. BNP were reduced from 195.8 +/- 180.5 pg/ml to 148.1 +/- 139.9 pg/ml (p = 0.035). LVEF, however, remained unchanged. At the 12-month follow-up, 64 % of the patients were still using the MAD. Three patients withdrew from the study because of discomfort with the MAD. In most patients, MAD treatment had no severe side effect on the signs or symptoms of temporomandibular disorders. However, dental complications were observed. In conclusion, in patients with stable CHF who are experiencing problems with SDB, MAD intervention appears to reduce the severity of SDB, sleep apnoea-related symptoms, and neurohormonal activity. A lower tendency for PAW collapse may explain the effect observed on SDB. The reduction in plasma BNP may indicate decreased cardiac strain as a result of treatment of SDB. The 5-year survival rate, measured from the start of MAD intervention, was higher in the group that used a MAD than in the group that did not use a MAD (p = 0.036). No severe side effects on the stomatognathic system were observed during the intervention, and most patients--edentulous included--tolerated the treatment well. Impaired oral health, including reduced dentition and edentulousness, seemed to limit the use of the MAD in this group of elderly patients, both because of technical difficulties and because of the increased risk of dental complications. However, because the treatment of SDB is important in the management of CHF, the MAD intervention seems to be a valuable method in the treatment arsenal of SDB.
 ...
PMID:Sleep apnoea in patients with stable congestive heart failure an intervention study with a mandibular advancement device. 1563 33

Untreated sleep apnea is a risk factor for hypertension, and CPAP treatment effects a blood pressure reduction comparable to that of pharmacologic monotherapy. Nevertheless, many current papers addressing the rapid increase in prevalence of hypertension and purporting to outline its management do not mention looking for or treating sleep apnea as a strategy. In addition to hypertension, virtually every adverse cardiovascular condition has been strongly associated with sleep disordered breathing in cross-sectional studies. There are also small prospective studies of the relationship between sleep-disordered breathing (SDB) and coronary heart disease and atrial fibrillation. Further, treatment studies show improvement or reduced risk of most cardiovascular sequelae of SDB with CPAP treatment. Beyond hypertension, which is well established, the strongest relationships between SDB and cardiovascular disease appear to be with congestive heart failure and bradyarrhythmias. Prospective studies are needed to confirm these relationships and to further delineate the risk.
 ...
PMID:Sleep-disordered breathing and cardiovascular disease. 1573 91

Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunction and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.
 ...
PMID:A mandibular advancement device reduces sleep disordered breathing in patients with congestive heart failure. 1577 92

Five adult patients with congestive heart failure (CHF) due to dilated cardiomyopathy complicated by Cheyne-Stokes respiration/central sleep apnea (CSR/CSA) were treated with continuous positive airway pressure (CPAP) with an initial pressure of 5 cm H2O. Four patients were followed up for 12 months with CPAP of 5 cm H2O. The rest, a 93-year-old patient, was followed up for 30 months, and the CPAP was reset at 8 cm H2O due to worsened cardiac function after 6 months and it was reset at 6 cm H2O due to dryness of the nose after 23 months. For all the patients with nightly CPAP use for 6.0+/-1.4 h per day for a year, frequency of CSR/CSA was significantly reduced after 3 and 12 months with CPAP (p<0.05). Moreover, their symptoms, cardiac function and sleep quality were significantly improved after 3 months (p<0.05), and were maintained above the pre-CPAP levels after 12 months, except for the oldest patient whose cardiac function tended to deteriorate. The results suggest that CSR/CSA in CHF can be treated with CPAP set at a lower pressure than the conventional method, and that CPAP at 5-8 cm H2O is often effective in eliminating CSR/CSA, improving sleep quality, and presumably maintaining cardiac function.
 ...
PMID:Cheyne-Stokes respiration in congestive heart failure: continuous positive airway pressure of 5-8 cm H2O for 1 year in five cases. 1726 69

Sleep apnea has been increasingly recognized for its prevalence and its impact on cardiovascular health. The disorder has considerable impact on cardiovascular disease states, particularly congestive heart failure. Implantable cardiac pacing devices may have a role in both the diagnosis and therapy of sleep apnea, which may be of particular importance given the seemingly wide coprevalence of cardiac disorders and sleep apnea.
 ...
PMID:Implantable pacing devices and sleep apnea: implications for diagnosis and therapy. 1586 Sep 73

Ischemic or hemorrhagic cerebrovascular disease (CVD) produces injury of brain regions important for executive function, behavior, and memory leading to decline in cognitive functions and vascular dementia (VaD). Cardiovascular disease may cause VaD from hypoperfusion of susceptible brain areas. CVD may worsen degenerative dementias such as Alzheimer disease (AD). Currently, the global diagnostic category for cognitive impairment of vascular origin is vascular cognitive disorder (VCD). VCD ranges from vascular cognitive impairment (VCI) to VaD. The term VCI is limited to cases of cognitive impairment of vascular etiology, without dementia; VCI is equivalent to vascular mild cognitive impairment (MCI). Risk factors for VaD include age, hypertension, diabetes, smoking, cardiovascular disease (coronary heart disease, congestive heart failure, peripheral vascular disease), atrial fibrillation, left ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension, cardiac arrhythmias, hyperfibrinogenemia, sleep apnea, infection, and high C-reactive protein. Research on biomarkers revealed increased CSF-NFL levels in VaD, whereas CSF-tau was normal. CSF-TNF-alpha, VEGF, and TGF-beta were increased in both AD and VaD. VaD shows low CSF acetylcholinesterase levels. This condition responds to acetylcholinesterase inhibitors, confirming the central role of cholinergic deficit in its pathogenesis. Evidence strongly suggests that control of vascular risk factors, in particular hypertension, could prevent VaD.
 ...
PMID:Vascular dementia. Advances in nosology, diagnosis, treatment and prevention. 1587 77

Extensive evidence links cardiovascular disease and sleep disordered breathing. OSA has adverse effects on blood pressure, cardiovascular status,and mortality. Effective CPAP therapy can improve blood pressure and cardiac function in patients who have OSA. Patients who have congestive heart failure have a high prevalence of sleep-disordered breathing, with OSA occurring in 30% of such patients and Cheyne-Stokes respiration in 40%.CPAP is the preferred mode of therapy for both types of sleep-disordered breathing in patients who have coexistent congestive heart failure. Nocturnal worsening of asthma is a common manifestation of this disease that indicates increased disease severity. Therapy focuses on judicious use of long-acting bronchodilators, and the presence of OSA should also be considered. COPD is frequently associated with impaired sleep, likely because of chronic dyspnea and sleep-associated hypoxemia. Appropriate therapy again includes long-acting bronchodilators and possibly nocturnal supplemental oxygen. Gastroesophageal reflux during sleep may lead to prolonged episodes of esophageal acid exposure and may be a common sequela of OSA, perhaps triggering nocturnal worsening of asthma. Endstage renal disease and chronic dialysis are commonly associated with a host of troublesome sleep problems,including OSA, RLS, PLMD, and daytime sleepiness.
 ...
PMID:Sleep and medical disorders. 1593 98


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>