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

Obstructive sleep apnea is an increasingly well-recognized disease characterized by periodic collapse of the upper airway during sleep. This leads to either complete or partial obstruction of the airway, resulting in apneas, hypopneas, or both. This disorder causes daytime somnolence, neurocognitive defects, and depression. It affects almost every system in the body, resulting in an increased incidence of hypertension, cardiovascular disease, stroke, pulmonary hypertension, cardiac arrhythmias, and altered immune function. It also increases the risk of having an accident, presumably as a result of associated somnolence. The gold standard for the diagnosis of sleep apnea is an overnight polysomnogram. Split-night studies are becoming increasingly common and allow for quicker implementation of therapy at a reduced cost. Treatment options for sleep apnea include weight loss, positional therapy, oral devices, continuous positive airway pressure (CPAP), and upper airway surgery. CPAP is the most efficacious and widely used therapy. Its complications include nasal congestion or dryness, mask discomfort, and claustrophobia. Heated humidifiers, newer types of masks, and nasal steroids have improved tolerance of this therapy. Bilevel positive-pressure therapy can be considered for patients who find it difficult to exhale against the consistently increased pressure of CPAP. The disease requires aggressive treatment to improve quality of life and prevent its complications.
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PMID:Obstructive sleep apnea. 1456 40

Previous reports have shown an association between snoring and stroke but it is not clear whether this reflects confounding factors nor whether the association is attributable to obstructive sleep apnoea (OSA). We performed a case-control study of 181 patients admitted to hospital with first-ever stroke and community control subjects matched individually for age, sex and general practitioner. Subjects were interviewed with a structured questionnaire to identify snoring, daytime sleepiness and stroke risk factors. The association between snoring alone and stroke was not statistically significant: odds ratio (95% CI) 1.44 (0.88, 2.41). Daytime sleepiness was, however, significantly associated with stroke: odds ratio 3.07 (1.65, 6.08). Multiple logistic regression showed that hypertension, current smoking, taking alcohol regularly (negatively) and a higher Epworth sleepiness score were independently associated with stroke. The results suggest that the previously reported association between 'simple' snoring and stroke might have been due to poor controlling for confounding variables. Our study suggests an association with greater sleepiness prestroke, the cause of which is unclear, although OSA is a possible candidate.
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PMID:Snoring, daytime sleepiness and stroke: a case-control study of first-ever stroke. 1463 43

Obstructive sleep apnea is common and considered to be a risk factor for hypertension, stroke and coronary disease. Accordingly, the presence of sleep apnea is probably a predictor of premature death. Continuous positive airway pressure is an effective treatment of obstructive sleep apnea. It has been demonstrated that such treatment improves daytime sleepiness and quality-of-life. To determine mortality in obstructive sleep apnea patients treated with nasal continuous positive airway pressure, we followed 296 patients given continuous positive airway pressure for 11 years 6 months. At the end of the study 26 of the 296 patients had died, mainly from cardiovascular disease. Mortality was 7% (95% confidence interval: 3%-9%) at 5 years. Three independent factors of death identified by forward stepwise selection were included in a Cox analysis. These factors were 1) smoking as a categorical covariate (>30 pack-years), 2) age and 3) forced expiratory volume in 1 s. When the 52 patients with an associated chronic obstructive pulmonary disease (forced expiratory volume in 1 s/vital capacity<0.65) with obstructive sleep apnea were excluded form analysis, mortality of the 244 remailing patients was 2% at 5 years, a rate observed in the general population. Subsequently, it appears that nasal continuous positive airway pressure corrects for the risk of premature death suspected in obstructive sleep apnea patients. Mortality in obstructive sleep apnea patients treated with continuous positive airway pressure is near to that of the general population, particularly when patients with an associated chronic respiratory disease are excluded.
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PMID:[Mortality in treated sleep apnea syndrome]. 1464 8

Breathing-related sleep disorders, particularly obstructive sleep apnea, have been largely undiagnosed in people with cardiovascular disease, probably due to limited health care provider awareness of the association between the two conditions. Solid evidence is emerging that the apneic events that occur during sleep lead to acute and chronic hemodynamic changes during wake time, including elevated sympathetic tone, decreased stroke volume and cardiac output, increased heart rate, and changes in circulating hormones that regulate blood pressure, fluid volume, vasoconstriction, and vasodilation. Obstructive sleep apnea is associated with known cardiovascular risk factors such as obesity and hyperlipidemia, and is considered by many sleep clinicians to be an independent risk factor for hypertension. Additionally, sleep apnea has been implicated in the pathogenesis of heart failure and stroke. Treatment with positive airway pressure during sleep eliminates the apneic events and the ensuing acute hemodynamic changes. Improvements in daytime blood pressure and left ventricular function also have been noted in persons with hypertension and heart failure. Because effective treatment is available for sleep apnea, this condition needs to be diagnosed and treated in persons with cardiovascular disease.
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PMID:Sleep-disordered breathing and the association with cardiovascular risk. 1501 52

Postoperative pulmonary complications greatly contribute to peri-operative morbidity and mortality. Parkinson's disease, sleep apnea, stroke and neuromuscular disorders significantly increase the risk for pulmonary postoperative complications that result from associated changes in respiratory function. This article discusses perioperative pulmonary evaluation and management of the surgical patient who has neurologic disease.
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PMID:The pulmonary consultation in the perioperative management of patients with neurologic diseases. 1506 12

The results of the study of sleep apnea (SA) in different forms of neurological disorders (cerebral stroke, diabetic polyneuropathy, neuromuscular diseases and amyotrophic lateral sclerosis--ALS) are presented. Two hundred and two patients, 103 male and 99 female, aged 17-84 years, have been investigated, using questionnaires and polysomnography. Nocturnal recording of EEG, EMG, electrooculography, oronasal air flow, respiratory thorax and abdomen movements, oxyhemoglobin saturation and breathing sounds has been performed. Clinical features of sleep apnea (SA) were most prominent in patients with neuromuscular diseases (58%) and ALS (54%), however the nocturnal study confirmed the presence of SA in patients with diabetic polyneuropathy (53%, mean RDI 15.7 +/- 18.7 epis./h) and cerebral stroke (41%, mean RDI 12.6 +/- 15.6 epis./h). A comparison of the patient's characteristics and sleep breathing indices revealed that factors of neurological damage contribute most significantly to ALS, but in diabetic neuropathy, age and obesity play a greater role.
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PMID:[Sleep apnea in neurological disorders]. 1507 37

Sleep apnoea is associated with increased cardiovascular risk. Sleep apnoea is common after stroke and associated with increased blood pressure variability as described by Turkington and co-workers in this issue of Clinical Science. Both sleep apnoea and blood pressure variability confer a poor prognosis after stroke and are potentially treatable. Many studies of CPAP (continuous positive airway pressure) demonstrate decreases in cardiovascular risk markers in other patient groups. Although difficult to apply in these patients in the short term, CPAP has some potential benefits in medium-term rehabilitation and secondary prevention following stroke, which warrants further study.
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PMID:Stroke and blood pressure variability. 1499 80

My aim is to examine the relation between some sleep disorders and neurological diseases; to analyse their mutual interactions in order to achieve new practical data for clinical use. In the theoretical part I summarise some main points of sleep physiology concentrating on the associations of sleep regulation and neurological diseases. In my examinations, besides clinical methods, the most important tools used are sleep analyses performed by polysomnography and MESAM IV as well as brain imaging methods. To assess clinical state of my stroke patients I utilised NIH Stroke Scale. I found pathological sleep apnoea frequency in more than half of the patients in any type (bleeding/infarction) of acute stroke. In a prospective study, sleep apnoea parameters remain permanent during 3 months in the ischaemic group; on the other hand, sleep apnoea improves during follow up after brain haemorrhages. I showed pathological sleep apnoea frequency in myasthenia gravis among male patients without daytime respiration complaint. I looked for the link between the mechanism of the sleep disorder and the underlying organic lesion in two cases. In this analyses I took into account the function of the affected structure in sleep regulation. I found a basal forebrain tumour, affecting sleep regulating centres underlying severe insomnia and I suggest a neuro-vascular compression of the lateral preoptic area of the hypothalamus being the reason of sleep related painful erection, a parasomnia of unknown origin.
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PMID:Neurological aspects of some sleep disorders. 1513 14

Many patients with stroke have concomitant sleep apnoea, which can affect recovery potential. Although stroke can lead to the development of sleep-disordered breathing, the current evidence suggests that sleep-disordered breathing may function as a risk factor for stroke. In this review, we focus on the association between obstructive sleep apnoea and stroke reviewing both the epidemiological data with respect to causation and the biological data, which explores pathogenesis. There is convincing evidence to believe that sleep apnoea is a modifiable risk factor for stroke; however, prospective studies are needed to establish the cause-and-effect relationship.
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PMID:Obstructive sleep apnoea and stroke. 1515 48

Nocturnal hypoxia is a major pathological factor associated with cardiorespiratory disease. During wakefulness, a decrease in arterial O2 tension results in a decrease in cerebral vascular tone and a consequent increase in cerebral blood flow; however, the cerebral vascular response to hypoxia during sleep is unknown. In the present study, we determined the cerebral vascular reactivity to isocapnic hypoxia during wakefulness and during stage 3/4 non-rapid eye movement (NREM) sleep. In 13 healthy individuals, left middle cerebral artery velocity (MCAV) was measured with the use of transcranial Doppler ultrasound as an index of cerebral blood flow. During wakefulness, in response to isocapnic hypoxia (arterial O2 saturation -10%), the mean (+/-SE) MCAV increased by 12.9 +/- 2.2% (P < 0.001); during NREM sleep, isocapnic hypoxia was associated with a -7.4 +/- 1.6% reduction in MCAV (P <0.001). Mean arterial blood pressure was unaffected by isocapnic hypoxia (P >0.05); R-R interval decreased similarly in response to isocapnic hypoxia during wakefulness (-21.9 +/- 10.4%; P <0.001) and sleep (-20.5 +/- 8.5%; P <0.001). The failure of the cerebral vasculature to react to hypoxia during sleep suggests a major state-dependent vulnerability associated with the control of the cerebral circulation and may contribute to the pathophysiologies of stroke and sleep apnea.
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PMID:Cerebral blood flow response to isocapnic hypoxia during slow-wave sleep and wakefulness. 1519 78


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