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)

Sleep hypoventilation (SH) may be important in the development of hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD). The prevalence of SH, associated factors, and overnight changes in waking arterial blood gases (ABG), were assessed in 54 stable hypercapnic COPD patients without concomitant sleep apnoea or morbid obesity. Lung function assessment, anthropomorphic measurements, and polysomnography with ABG measurement before and after sleep were conducted in all patients. Transcutaneous carbon dioxide tension (Pt,CO2) was measured in sleep, using simultaneous arterial carbon dioxide tension (Pa,CO2) for in vivo calibration and to correct for drift in the sensor. Of the patients, 43% spent > or = 20% of sleep time with Pt,CO2 > 1.33 kPa (10 mmHg) above waking baseline. Severity of SH was best predicted by a combination of baseline Pa,CO2, body mass index and per cent rapid-eye movement (REM) sleep. REM-related hypoventilation correlated significantly with severity of inspiratory flow limitation in REM, and with apnoea/hypopnoea index. Pa,CO2 increased mean+/-SD 0.70+/-0.65 kPa (5.29+/-4.92 mmHg) from night to morning, and this change was highly significant. The change in Pa,CO2 was strongly correlated with severity of SH. Sleep hypoventilation is common in hypercapnic chronic obstructive pulmonary disease, and related to baseline arterial carbon dioxide tension, body mass index and indices of upper airway obstruction. Sleep hypoventilation is associated with significant increases in arterial carbon dioxide tension night-to-morning, and may contribute to long-term elevations in arterial carbon dioxide tension.
 ...
PMID:Sleep hypoventilation in hypercapnic chronic obstructive pulmonary disease: prevalence and associated factors. 1279 91

The obstructive sleep apnoea syndrome (OSAS) is caused by upper airway collapse during sleep. These episodes are associated with recurrent oxyhaemoglobin desaturations and arousals which lead to disruption of the sleep pattern and cognitive deterioration. Factors such as age, male sex, menopause, tobacco and alcohol consumption and anatomic abnormalities are demonstrated risk factors for OSAS development. Obesity, specially of abdominal type, is also a very strong predictor of OSAS, increasing the risk of apnoea by ten times. OSAS prevalence may reach 80% and 50% en males and females with morbid obesity respectively. OSAS induces sympathoexcitation, insulin resistance, renin-angiotensin system activation, oxidative stress, endothelial dysfunction, hypercoagulability and reduction of fibrinolysis leading to hypertension and increased cardiovascular risk. The best diagnostic procedure is polysomnography. Obesity treatment is followed by a dramatic improvement in OSAS. Weight loss of 10% results in reductions of apnoea index by 26%. Application of a positive pressure system is a very effective treatment for OSAS which reduces the apnoea index and improves cardiovascular risk and cognitive impairment.
 ...
PMID:[The obstructive sleep apnoea syndrome in obesity: a conspirator in the shadow]. 1538 14

Obesity is an important health problem for the growing elderly segment of the population. Age-related changes in body composition should be taken into account when considering morbidity. Today, sarcopenic obesity, which is defined as excess fat with loss of lean body mass, is a highly prevalent problem. Obesity in the elderly is related to morbidity; e.g., sleep apnea, cancer, osteoarthritis, diabetes and hypertension. The advantages and disadvantages of using BMI, waist circumference, waist: hip ratio, and body weight to measure age-related changes in obesity are discussed. In addition, the merits of treatment options for obesity; e.g., behavioral modifications, diet, and exercise--are described. One important conclusion derived from a review of these treatments is that age itself is not a contraindication for pharmacotherapy or even surgery for morbid obesity.
 ...
PMID:Obesity in the elderly: survival of the fit or fat. 1555 40

Obesity continues to plague our society in epidemic proportions. Surgery for morbid obesity is considered by many as the most effective therapy for this complex disorder. Today, multiple surgical procedures for the treatment of obesity are available. As with most procedures, there are benefits and risks associated with open and laparoscopic gastric bypass surgery, as well as with laparoscopic adjustable gastric banding and partial biliopancreatic bypass with a duodenal switch. The risks and complications associated with bariatric surgery may be serious and in some cases life threatening. However, surgery for obesity has shown remarkable results in helping patients to achieve significant long-term weight control. In addition, it is associated with improvement and often resolution of co-morbid conditions, including type 2 diabetes mellitus, systemic hypertension, obesity hypoventilation, sleep apnea, venous stasis disease, pseudotumor cerebri, polycystic ovary syndrome, complications of pregnancy and delivery, gastroesophageal reflux disease, stress urinary incontinence, degenerative joint disease, and non-alcoholic steatohepatitis.
 ...
PMID:Surgical management of obesity: a review of the evidence relating to the health benefits and risks. 1564 1

Prader-Willi Syndrome (PWS) is a genetic disorder characterized by hypotonia, mental retardation or learning disability, hyperphagia and compulsive eating due to hypothalamic dysfunction. Obesity is a major cause of increased morbidity and mortality among patients with PWS. Gastric restrictive surgery has been associated with partial breakdown of the staple-line in PWS. We report two patients with PWS associated with morbid obesity and obstructive sleep apnea who underwent biliopancreatic diversion (BPD). A 27-year-old male with BMI 52 kg/m(2) and a 20 year-old female with BMI 64 kg/m(2) underwent BPD. No perioperative complications were observed. After BPD, the male's BMI was 36.7 kg/m(2) at 12 months and the female's BMI was 48.4 kg/m(2) at 28 months, with excess weight loss 58% and 48%, respectively. They developed loose stools associated with eating. These patients have shown a considerable improvement in hypersomnia and respiratory difficulties. BPD proved to be an effective approach to weight loss in PWS, resulting in improvement of sleep apnea, behavior problems and quality of life.
 ...
PMID:Results of biliopancreatic diversion in two patients with Prader-Willi syndrome. 1597 69

Patients with morbid obesity undergoing gastric bypass surgery present many unique challenges to the healthcare team. Obstructive sleep apnea (OSA) is a common comorbidity in the postoperative gastric bypass patient. The complexity in the management of these patients during and after anesthesia is immense. Anesthetic agents and analgesics increase the severity of symptoms of OSA. Systemic opioid administration depresses the respiratory drive and decreases oxygen saturation. In addition, normal muscle hypotonia during rapid eye movement sleep increases the chance of respiratory complications during the initial postoperative period. Continuous positive airway pressure can effectively treat sleep apnea in the postoperative gastric bypass patient. There are concerns that pressurized air can inflate the stomach and intestines and result in the disruption of the anastomoses of the gastric bypass patient. If weight loss is sufficient, it can lead to an improvement or even cure of symptoms of OSA.
 ...
PMID:Potential complications of obstructive sleep apnea in patients undergoing gastric bypass surgery. 1604 Dec 30

Morbid obesity and its association with obstructive sleep apnoea syndrome have been increasingly recognised in children. Orthopaedic surgeons are often the primary medical contact for older children with tibia vara, which has long been associated with obesity, but are unfamiliar with the evaluation and treatment of sleep apnoea in children. We reviewed all children with tibia vara treated surgically at one of our institutions over a period of five years. Thirty-seven patients were identified; 18 were nine years of age or older and 13 of these (72%) had morbid obesity and a history of snoring. Eleven children were diagnosed as having sleep apnoea on polysomnography. The incidence of this syndrome in the 18 children aged nine years or older with tibia vara, was 61%. All these patients required pre-operative non-invasive positive-pressure ventilation; tonsillectomy and adenoidectomy were necessary in five (45%). No peri-operative complications related to the airway occurred. There is a high incidence of sleep apnoea in morbidly obese patients with tibia vara. These patients should be screened for snoring and, if present, should be further evaluated for sleep apnoea before corrective surgery is undertaken.
 ...
PMID:Obstructive sleep apnoea syndrome in morbidly obese children with tibia vara. 1636 29

Since its introduction in 1994, laparoscopic Roux-en-Y gastric bypass (LRYGB) has rapidly gained popularity for the treatment of morbid obesity. Historically, the operation is performed in a retrocolic fashion; however antecolic LRYGB has been advocated as a safe alternative. We reviewed our experience with both techniques. From January 2003 to November 2004, the new UCLA Laparoscopic Bariatric Surgery Program performed 341 LRYGBs. In March 2004, our program transitioned from a retrocolic to an antecolic approach for all gastric bypass procedures. Institutional review board approval was obtained, and the data for all patients was collected into a prospective database. The patient characteristics for the two groups were similar. The significant differences between the two groups were average body mass index and the percentage of patients with diabetes and sleep apnea. The complication profiles for the two groups were also similar. There were significant differences between the two groups in the reoperation rate, antecolic 2.0 per cent versus retrocolic 7.8 per cent, and length of stay, antecolic 2.57 versus retrocolic 2.89 days. There were no anastomotic leaks or deaths in either group. Antecolic LRYGB is safe and may be associated with fewer complications. Only long-term weight loss results and complication rates will provide a definitive answer.
 ...
PMID:Antecolic laparoscopic Roux-en-Y gastric bypass is not associated with higher complication rates. 1646 8

Laparoscopic adjustable gastric banding (LAGB) is gaining popularity as a technique for achieving effective weight loss in the severely obese population. It is a minimally invasive procedure and the reported early morbidity is low. However, we have observed at our institution that occasional patients complain of central chest pain, mimicking angina (verbal pain score of > 7 out of 10), within 2 h after the procedure. This is a worrying symptom because obesity is known to be a major risk factor for developing cardiovascular complications. We have now performed 250 LAGB operations at our hospital. The following four case reports document our patients who presented with early chest pain postoperatively. Common characteristics of male gender, morbid obesity and some degree of obstructive sleep apnoea were identified among the cases. The aetiology of the chest pain is uncertain; nevertheless, close monitoring is vital to exclude pathological events such as acute coronary syndrome.
 ...
PMID:Chest pain in the early postoperative period after laparoscopic adjustable gastric banding: four case reports. 1654 61

Morbid obesity is associated with and increased risk of serious comorbidities, including type 2 diabetes, sleep apnoea, cardiovascular diseases, and orthopedic disabilities. Not operative treatments for superobese patients have not been shown to produce reliable long-term benefits, therefore surgical therapy has became the treatment of choice. The number of surgical procedures increased in the last year confirm these data. However, before recommended a specific surgical procedures to a superobese patients it is necessary to consider some variables, such as: patient, health structure, and multidisciplinary equipe. Since there are not recommended or condemned surgical procedures, in this paper the Authors tried to evaluate the effectiveness and limits of the most performed surgical procedures for the treatment of pathologic obesity: gastric by-pass, biliopancreatic diversion (duodenal switch), vertical gastroplasty, banding gastric. The Authors used some pointer of outcome to measure effectiveness and limits: five year post-operative percentage excess weight loss >/< 50, peri-operative >/< 1%, early and late complications >/< 15%, reoperation >/< 3%, improvement of quality of life. Thanks to new surgical technique, restrictive options are losing ground, while malabsorbitive bariatric procedures are collecting successful.
 ...
PMID:[Efficacy and limits of the bariatric surgery]. 1655 Aug 67


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