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

Fifty patients with chronic obstructive lung disease were questioned about their sleep quality and their responses were compared with those of 40 similarly aged patients without symptomatic lung disease. Patients with chronic obstructive lung disease reported more difficulty in getting to sleep and staying asleep and more daytime sleepiness than the control group. More than twice as many patients (28%) as controls (10%) reported regular use of hypnotics. In a subgroup of 16 patients with chronic obstructive lung disease (mean FEV1 0.88 (SD 0.44) sleep, breathing, and oxygenation were measured to examine the relationship between night time hypoxaemia and sleep quality. Sleep architecture was disturbed in most patients, arousals occurring from three to 46 times an hour (mean 15 (SD 14)/h). Arterial hypoxaemia during sleep was common and frequently severe. The mean (SD) arterial oxygen saturation (SaO2) at the onset of sleep was 91% (7%). Nine patients spent at least 40% of cumulative sleeping time at an SaO2 of less than 90% and six of these patients spent 90% of sleeping time below this level. Only four of 15 patients did not develop arterial desaturation during sleep. The mean minimum SaO2 during episodes of desaturation was less in rapid eye movement (REM) sleep (72% (17%)) than in non-REM sleep (78% (10%), p less than 0.05). The predominant breathing abnormality associated with desaturation was hypoventilation; only one patient had obstructive sleep apnoea. Arousals were related to oxygenation during sleep such that the poorer a patient's arterial oxygenation throughout the night the more disturbed his sleep (arousals/h v SaO2 at or below which 40% of the total sleep time was spent: r = 0.71, p less than 0.01). Hypoxaemia during sleep was related to waking values of SaO2 and PaCO2 but not to other daytime measures of lung function.
Thorax 1986 Nov
PMID:Nocturnal hypoxaemia and quality of sleep in patients with chronic obstructive lung disease. 382 71

Seven patients with the severe obstructive sleep apnoea syndrome were treated with nasal continuous positive airway pressure for from three to 22 months. This treatment reversed all symptoms due to the syndrome in every patient and continued to be used in five patients. One patient stopped treatment after eight months and subsequently remained incapacitated and another underwent tracheostomy at the time of transphenoidal hypophysectomy. Nasal continuous positive airway pressure is a safe, non-invasive treatment, which may be used in the presence of cardiac and respiratory failure. It is able fully to reverse upper airway obstruction and can be used at home on a long term basis.
Thorax 1985 Jan
PMID:Severe obstructive sleep apnoea treated with long term nasal continuous positive airway pressure. 388 41

We evaluated the effect of posture on the sensitivity and specificity of abnormalities in the flow-volume loop in 30 patients with suspected obstructive sleep apnoea. Flow-volume loops were judged as abnormal if the FEF50/FIF50 ratio was greater than 1 or if the sawtooth sign was judged to be present by at least two of three chest physicians. Detailed nocturnal recordings confirmed the presence of obstructive sleep apnoea in 17 of the 30 patients. Our results showed that both the sensitivity and the specificity of each of the flow-volume criteria for the diagnosis of obstructive sleep apnoea were higher when the loops were recorded in the supine than when they were recorded in the sitting position. The sensitivities were low, however, even with the supine posture--sawtoothing 41% and FEF50/FIF50 ratio greater than 1 47%. The highest sensitivity (71%) was obtained by considering a positive result as being the presence of either of the abnormalities in either the sitting or the supine posture. This sensitivity of the flow-volume loop was too low to recommend it as a routine screening test for the diagnosis of obstructive sleep apnoea but the presence of the sawtooth sign had a high specificity (92%) for the diagnosis of obstructive sleep apnoea. Furthermore, there was a greater fall in oxygen saturation in patients with apnoea who had sawtoothing than in those without sawtoothing. The presence of the sawtooth sign should increase the suspicion of sleep apnoea and suggest the need for further investigation. The effect of posture on the occurrence of abnormalities in the flow-volume loop suggests that position alters the configuration of the upper airway.
Thorax 1984 Oct
PMID:Abnormalities in the flow-volume loop in obstructive sleep apnoea sitting and supine. 649 46

To assess the relationship of abnormal flow-volume curves during awake periods to the clinical severity of sleep-disordered breathing and the need for surgical treatment of obstructive sleep apnoea, flow-volume curves were measured in 72 adults with obstructive apnoea. Patients in whom surgery was recommended for standard clinical indications had significantly lower inspiratory flow rates (p less than 0.01) and a higher incidence of flow-volume curves indicating extrathoracic airway obstruction (p less than 0.01) than did non-surgical patients. These abnormal flow-volume curves correlated with an increased severity of nocturnal oxygen desaturation (p less than 0.01). Furthermore, increases in inspiratory flow rates measured serially in 22 patients were related to improvement in their polysomnography (p less than 0.05), suggesting that alterations of airway function during awake periods correlate with changes in the severity of sleep apnoea.
Thorax 1983 Aug
PMID:Flow-volume curves and sleep-disordered breathing: therapeutic implications. 661 53

An 18-year-old student presented with a two-year history of daytime sleepiness and noisy breathing during sleep. Both he and his brother, aged 25 years, had Scheie's syndrome, a mucopolysaccharidosis characterised by small stature, micrognathia, corneal clouding, hepatosplenomegaly, raised urinary mucopolysaccharides, and undetectable levels of alpha-L-iduronidase assayed in cultured fibroblasts. Both brothers had sleep apnoea (apnoea index, 59 and 35 respectively) during which there was a significant fall in heart rate and arterial oxygen saturation. One brother had EEG changes suggestive of cerebral hypoxia and the other had ventricular extrasystoles at the end of several episodes. Tracheostomy in the younger brother produced a dramatic symptomatic improvement and reduced the number and severity of apnoeic episodes (post-tracheostomy apnoea index 2.4).
Thorax 1980 Feb
PMID:Sleep apnoea in Scheie's syndrome. 676 75

Nine patients with obstructive sleep apnoea were treated with 5 to 20 mg of protriptyline each night for two to 18 months. In four patients, there was dramatic, sustained improvement in symptoms and measured sleep quality and apnoea frequency and duration. There was no improvement in two patients and three developed intolerable side-effects preventing adequate treatment. Apnoea frequency was the only apparent predictor of responsiveness. Those with fewer than 30 episodes of apnoea per hour consistently improved. Only two of four patients with more than 60 episodes per hour improved. These results provide additional evidence that a carefully monitored trial of protriptyline may benefit selected patients with mild to moderate obstructive sleep apnoea.
Thorax 1982 Jan
PMID:Protriptyline in the treatment of sleep apnoea. 707 94

Sleep apnoea was combined with glaucoma in five members of two generations of a family The three surviving members with heavy snoring and glaucoma with intraocular pressure maxima in the morning and a fourth with heavy snoring only all had clinical sleep apnoea. The more severe glaucoma, resistant to surgery and medication, correlated with a greater number and duration of episodes of sleep apnoea. In all those who had recordings made episodes of sleep apnoea tended to occur and be more prolonged in rapid-eye-movement sleep. Oxygen desaturation was greater in rapid-eye-movement sleep and could occur without evidence of impaired respiration. In the third generation of this family there is as yet no evidence of impaired respiration in sleep or of glaucoma.
Thorax 1982 Nov
PMID:Familial glaucoma with sleep apnoea: a new syndrome? 716 3

CPAP should be considered the first line of treatment in patients with moderate to severe obstructive sleep apnoea. In our centre in Sydney this generally means patients with more than 20 apnoea/hypopnoeas per hour with repeated dips in oxyhaemoglobin saturation and usually some symptomatology. Despite this first line role of nasal CPAP, recent objective studies question whether earlier enthusiastic reports on adherence to CPAP are correct. The role of technical innovations in new CPAP machines in improving usage remains to be tested. The "drop out" rate from physician selection for a CPAP trial to highly compliant user is certainly more than 50% of patients. What happens to these patients? Data from some studies suggest that surgical treatments are used, at least in the USA, but in all probability many of these patients remain untreated. The challenge in the next decade is either to improve CPAP devices to increase usage in this group or to develop other treatment options. The role of intensive inhospital "acclimatisation" to CPAP also has yet to be objectively tested. It is unclear whether "intelligent" CPAP will make huge inroads in increasing the number of patients who accept CPAP trials, prescriptions, or compliance. It will have minimal impact on patients with mask problems or claustrophobia or those who feel that CPAP is inconvenient. There is a high likelihood that it will reduce technologist workload during CPAP titration studies. "Intelligent" CPAP may help to reduce total overnight mouth leakage and therefore reduce nasal side effects. The current expense of developing such devices will mean that they are unlikely to supersede much cheaper standard "one pressure" CPAP machines in the next few years.
Thorax 1995 Oct
PMID:Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea. 749 63

A case of obstructive sleep apnoea associated with the Arnold-Chiari malformation is described, in which the loss of pharyngeal sensation seems to have played an important part in the aetiology of the obstruction of the upper airway.
Thorax 1995 Jun
PMID:Obstructive sleep apnoea with Arnold-Chiari malformation. 763 17

A patient who developed severe sleepiness and sleep apnoea in association with adult acquired retrognathia and subluxation of the cervical spine at the level of C3-C4, both resulting from rheumatoid arthritis, is described. The possible causative factors of the association between sleep apnoea and rheumatoid arthritis include reduction of the size of the upper airway by temporomandibular joint destruction, brainstem compression due to rheumatoid arthritis affecting the cervical spine, sleep fragmentation, and drug effects.
Thorax 1995 Jun
PMID:Sleep apnoea syndrome secondary to rheumatoid arthritis. 763 18


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