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

Sleep apnea is worse in the supine posture and is associated with retropalatal airway narrowing or occlusion. We have, therefore, examined the effects of posture, negative pressure, and route of respiration on palatal muscle activity in 13 nonsnoring awake male subjects by using electromyography. Electromyographic activity of the levator palatini and palatoglossus was expressed as a percentage of maximum activity. Both the levator palatini (P = 0.002) and palatoglossus (P = 0.002) exhibited phasic inspiratory activity. Overall, posture did not affect the levator palatini (F = 1.58; P = 0.23) or palatoglossus (F = 0.98; P = 0.34) activity, but analysis by route of respiration showed the palatoglossus to be more active when the subjects were nose breathing supine (F = 6.64; P = 0.02). Levator palatini activity was lower when nose breathing was compared with mouth breathing in both the erect and supine postures (F = 6.67; P < 0.02). Nose breathing with the mouth held open caused an increase in palatoglossal activity (P = 0.04). Negative-pressure application (0 to -12.5 cmH2O) caused significant increases in levator palatini (P < 0.001) and palatoglossus (P < 0.001) activity, 100 ms after pressure stimulus, irrespective of route. However, the palatoglossus required significantly greater negative pressures to cause activation when applied via the nose compared with the mouth (P < 0.05). These observations indicate that the levator palatini and palatglossus have respiratory activity and are reflexly activated by negative pressure.
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PMID:Effect of posture, route of respiration, and negative pressure on palatal muscle activity in humans. 759 1

The currently available data suggest that sleep apnea occurs commonly. Prevalence, however, varies markedly according to definitions utilized to characterize the disorder and the population studied; and has been reported to range from 1% (in an industrial working Israeli population) to 42% (in an elderly nursing home population). The degree to which sleep apnea contributes to the pathogenesis of other diseases is not entirely clear. Data from a number of sources suggest that sleep apnea may increase vascular morbidity and that excess mortality may occur in untreated patients. However, the degree to which mortality and morbidity may be influenced by more aggressive treatment of subjects with sleep apnea is not known. In particular, there is a need to better distinguish "clinically" significant sleep apnea from levels of apnea that may have few acute or chronic effects, and to define which segments of the population are at greatest risk for such adverse outcomes.
Ear Nose Throat J 1993 Jan
PMID:Epidemiology and natural history of obstructive sleep apnea. 844 22

Pharyngeal muscles are the effector organ by which the brainstem regulates pharyngeal airway size and patency during breathing. These muscles have fast contractile rates, and may be susceptible to develop fatigue when driven at the high levels required to overcome structural pharyngeal narrowing, especially under hypoxic conditions. Diseases with an increased prevalence of sleep apnea are associated with changes in pharyngeal muscle properties, and conversely diseases which primarily alter neuromuscular function have a significant prevalence of sleep apnea. However, further studies are needed to define the precise role of pharyngeal muscle fatigue, and of changes in pharyngeal muscle properties with disease, in the pathophysiology of obstructive sleep apnea.
Ear Nose Throat J 1993 Jan
PMID:Muscles of the pharynx: structural and contractile properties. 844 23

Research efforts to date have identified that both anatomic and physiologic variables may contribute to the pathophysiology of obstructive sleep apnea. Whether specific factors within either of these two categories will be shown to predominate remains to be seen. Surely, experience with sleep apnea patients teaches us that different variables are important in different OSA patients. In the area of anatomy, investigators are just beginning to try surgical approaches designed specifically for the pharyngeal site of obstruction found in a given patient. Possible new physiologic and pharmacologic treatments are being explored. Hopefully, such treatments will be as effective and more convenient than continuous positive airway pressure.
Ear Nose Throat J 1993 Jan
PMID:Properties of the upper airway during sleep. 844 25

The success of Uvulopalatopharyngoplasty (UPPP) for Obstructive Sleep Apnea (OSA) can be assessed by a variety of parameters including clinical evaluation and polysomnography (PSG). Patients are often reluctant to undergo post-operative testing and insurance companies are often unwilling to reimburse for expensive overnight sleep studies. Due to the reality of these medical and economical problems, can a clinician be confident of the success of UPPP based solely on clinical evaluation? Sixty patients underwent UPPP for the treatment of OSA from July 1987 through June 1992. Patients treated with tracheostomy or other methods were not included in this study. Fifty-three patients (88%) reported an improvement in their symptoms of snoring, daytime somnolence, morning headache and apnea. Twenty-one patients (35%) had post-operative PSG. Eighteen of 21 patients (85%) reported improvement in their symptoms. Eleven of 21 patients (57%) showed objective improvement in their sleep apnea. The objective findings of PSG do not correlate, in a significant number of patients, with subjective clinical improvement of patients treated with UPPP.
Ear Nose Throat J 1993 Jan
PMID:Uvulopalatopharyngoplasty for obstructive sleep apnea in adults: clinical correlation with polysomnographic results. 844 31

It is now widely accepted that snoring causes significant social dysfunction. In the absence of obstructive sleep apnoea syndrome, palatal surgery offers a very good chance of eliminating or reducing snoring. The traditional operation of uvulopalatopharyngoplasty remains the 'gold standard', but may be complicated by velopharyngeal incompetence, severe post-operative pain and even nasopharyngeal stenosis. A newer technique to reduce snoring caused by palatal flutter by using a neodymnium:yttrium aluminum garnet laser to stiffen the soft palate has been introduced recently by another unit. We show that this procedure can be carried out using a CO2 laser, and present the initial results of the first 29 patients operated on at The Royal National Throat, Nose and Ear Hospital.
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PMID:CO2 laser palatoplasty: early results. 886 9

We studied the outcomes of 76 children, aged 3 to 12 years, with large tonsils and/or large adenoids who underwent surgery to relieve upper airway obstruction over a 1-year period. Following surgery, nearly all patients experienced an alleviation of all symptoms, except for enuresis. We suggest that children who have large tonsils and/or adenoids will gain substantial benefit if they are removed, even children who do not have a history of severe sleep apnea or objective evidence from polysomnography.
Ear Nose Throat J 1999 Aug
PMID:Tonsil and adenoid surgery for upper airway obstruction in children. 1048 57

As otolaryngologists play increasingly important roles in the evaluation and treatment of sleep disordered breathing, it is important that all practitioners systematically study the field of sleep. The curriculum outlined in this article has been developed for resident training at the University of California, San Diego, School of Medicine. It is divided into goals and objectives, curriculum, differential diagnosis of sleep disordered breathing, international classification of sleep disordered breathing, a glossary of sleep terms, and a list of resources.
Ear Nose Throat J 1999 Sep
PMID:A sleep medicine curriculum for otolaryngology-head and neck surgery. 1050 91

Sleep disordered breathing was first described in ancient times. It is the result of a three-way interaction between the sleep/wake state-specific mechanisms of respiratory control, the interfacing of these mechanisms during times of state change, and the physical properties of the head and neck. Sleep disordered breathing results in pathological daytime sleepiness and is associated with significant cardiovascular morbidity. This paper reviews the history of the field, the physiologic and structural factors that result in sleep disordered breathing, and the implications of these factors for therapy.
Ear Nose Throat J 1999 Sep
PMID:An overview of sleep disordered breathing for the otolaryngologist. 1050 92

Rapid advancements in technology have expanded the range of available methods for testing patients with sleep disordered breathing. This article reviews the components of a sleep test and the currently available technologies that are used in standard attended, laboratory (level 1) studies. This paper also reviews the advantages and limitations of unattended at-home evaluations (level 2, 3, and 4 studies) for patients with suspected sleep disordered breathing.
Ear Nose Throat J 1999 Sep
PMID:The use of sleep tests for suspected sleep disordered breathing. 1050 94


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