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)

In the past 25 years there has been increasing recognition of obstructive sleep apnoea (OSA) as a common condition of childhood. Morbidity includes impairment of growth, cardiovascular complications, learning impairment, and behavioural problems. Diagnosis and treatment of this condition in children differs in many respects from that in adults. We review here the key features of paediatric OSA, highlighting differences from adult OSA, and suggest future directions for research.
Thorax 2005 Jun
PMID:Sleep . 8: paediatric obstructive sleep apnoea. 1592 53

This article provides an overview of the management of the obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Where possible, recommendations are based on a review of the relevant literature. With the exception of nasal continuous positive airway pressure, which is considered in greater detail elsewhere in the series, and certain oral appliances, the efficacy of many proposed treatments for OSAHS is not supported by data from randomised controlled clinical trials. To a considerable extent, treatment recommendations are based on data from uncontrolled studies, case series, consensus guidelines, practice parameters, and other less rigorous forms of evidence.
Thorax 2005 Jul
PMID:Sleep x 9: an approach to treatment of obstructive sleep apnoea/hypopnoea syndrome including upper airway surgery. 1599 69

The prevalence of an echocardiographically visible patent foramen ovale (PFO) is higher in patients with obstructive sleep apnoea syndrome (OSAS) than in normal controls. We report a patient who presented with OSAS and right-to-left shunting (RLS) through the PFO in whom the RLS disappeared after treatment for 1 week with nocturnal continuous positive airway pressure (CPAP). This case shows the role of OSA in generating an awake RLS through a PFO and its possible reversibility by CPAP. The mechanism of reversible awake RLS through PFO in OSAS is discussed.
Thorax 2005 Oct
PMID:CPAP suppression of awake right-to-left shunting through patent foramen ovale in a patient with obstructive sleep apnoea. 1619 68

Obesity is the most common metabolic disease in the world and its prevalence has been increasing over several decades. The World Health Organization (WHO) predicts that, by 2015, around 700 million adults will be obese (at least 10% of the projected global population). This will be a huge health and economic burden with associated increases in diabetes, cardiovascular and musculoskeletal disease, and malignancy. While there has been little focus on the impact of obesity on respiratory disease, there are clear effects on pulmonary function and inflammation which will increase the prevalence and morbidity of lung disease. There is an inverse relationship between body mass index and forced expiratory volume in 1 s. Increases in body weight lead to worsening of pulmonary function. The reasons for this include the mechanical effects of truncal obesity and the metabolic effects of adipose tissue. Obesity is linked to a wide range of respiratory conditions including chronic obstructive pulmonary disease, asthma, obstructive sleep apnoea, pulmonary embolic disease and aspiration pneumonia. It is important for those providing care for people with respiratory disease to appreciate the impact of obesity and to provide appropriate advice for weight reduction. Healthcare planners should consider the impact of obesity for future resources in respiratory care.
Thorax 2008 Jul
PMID:Obesity and the lung: 1. Epidemiology. 1858 31

As the prevalence of obesity increases in both the developed and the developing world, the respiratory consequences are often underappreciated. This review discusses the presentation, pathogenesis, diagnosis and management of the obstructive sleep apnoea, overlap and obesity hypoventilation syndromes. Patients with these conditions will commonly present to respiratory physicians, and recognition and effective treatment have important benefits in terms of patient quality of life and reduction in healthcare utilisation. Measures to curb the obesity epidemic are urgently required.
Thorax 2008 Aug
PMID:Obesity and the lung: 2. Obesity and sleep-disordered breathing. 1866 71

Obesity is a major problem from a public health perspective and a difficult practical matter for intensivists. The obesity pandemic has required treating clinicians to develop an appreciation of the substantial pathophysiological effects of obesity on the various organ systems. The important physiological concepts are illustrated by focusing on obstructive sleep apnoea, obesity hypoventilation syndrome, abdominal compartment syndrome and ventilatory management of the obese patient with acute respiratory distress syndrome.
Thorax 2008 Oct
PMID:Obesity and the lung: 3. Obesity, respiration and intensive care. 1882 Jan 19

BACKGROUND Many patients with the obstructive sleep apnoea syndrome (OSA) travel to the mountains for recreational and professional activities while temporarily discontinuing continuous positive airway pressure (CPAP) treatment. A study was undertaken to evaluate the hypothesis that altitude would aggravate their hypoxaemia, sleep-related breathing disturbances and impair daytime performance. METHODS Thirty-four patients with OSA of median age 62 years (IQR 57-65), median apnoea/hypopnoea index (AHI) 47.5 events/h (IQR 32.4-72.8), residing at <600 m were enrolled. A crossover trial randomised for the sequence of altitude exposure was carried out: patients spent 1 day in Zurich (490 m) and 4 days in the Swiss Alps at 1860 m and 2590 m (2 days each) during which continuous positive airway pressure was discontinued. Daily evaluations included polysomnography, symptom questionnaires, physical examination and driving simulator tests. RESULTS Polysomnography revealed median oxygen saturations at 490 m and in the first and second nights at 1860 and 2590 m, respectively, of 94%, 90%, 90%, 86% and 87% (p<0.01 between altitudes). Corresponding median AHI were 47.5, 85.1, 74.6, 90.0 and 90.9 events/h (p<0.01 between altitudes) with ratios of central to obstructive events of 0.1, 0.8, 1.0, 1.9 and 1.9 (p<0.01 between altitudes). Tracking performance during simulated driving was significantly impaired at 2590 m compared with 490 m. Systolic blood pressure and cardiac arrhythmias were increased at altitude. CONCLUSIONS Altitude exposure in untreated patients with OSA aggravates hypoxaemia, increases sleep-related breathing disturbances due to frequent central apnoeas/hypopnoeas, impairs driving simulator performance and induces cardiovascular stress. These findings have implications for counselling and treating patients with OSA planning to travel to high altitude. ClinicalTrials.gov identifier NCT00514826.
Thorax 2010 May
PMID:Exacerbation of sleep apnoea by frequent central events in patients with the obstructive sleep apnoea syndrome at altitude: a randomised trial. 2043 65

Non-invasive ventilation (NIV) has been remarkably effective in the management of chronic respiratory failure, despite initially rudimentary equipment and limited understanding of what was actually happening, minute by minute when ventilation was applied. Modern ventilators, controlled by complex algorithms, and with integrated monitoring allow for sophisticated customisation of ventilatory support to an individual. However, if problems with ventilation are not recognised, and their significance understood, they cannot be fixed. Experience of monitoring during sleep from patients predominantly with sleep apnoea can be transferred and extended to patients receiving NIV. This article, the first in a series, explores the rationale for NIV and how its application to an individual patient can be monitored using simple tools and, when problems are identified, the causes can be identified using sophisticated interpretation of more detailed monitoring. This requires a detailed understanding of how different modes of ventilation work and some knowledge of the algorithms that control each machine. These themes are explored in this article and developed in subsequent articles in the series.
Thorax 2011 Jan
PMID:Non-invasive ventilation during sleep: time to define new tools in the systematic evaluation of the technique. 2072 34

The global epidemic of obesity and the worldwide prevalence of obstructive sleep apnoea (OSA) are both increasing. Epidemiological studies reveal an association between obesity, weight gain and OSA. Metabolic or bariatric operations provide sustained weight loss and resolve or improve the symptoms of OSA in the majority of morbidly obese individuals. These operations also modulate the metabolic profile to improve glycaemic control, to decrease cardiovascular risk and obesity-related mortality. The beneficial effects of metabolic operations on OSA include mechanical weight-dependent and metabolic weight-independent effects that are achieved through the BRAVE effects: (Bile flow alteration; Reduction of gastric size; Anatomical gut rearrangement and altered flow of nutrients; Vagal manipulation; and Enteric gut hormone modulation). These result in an improvement in insulin resistance, adipokines, cytokines and systemic inflammation. A literature analysis was performed with statistical pooling of available surgical and medical studies to determine whether the weighted mean decrease in body mass index and sleep apnoea severity (measured by the apnoea-hypopnoea index) are larger in metabolic surgical studies than in non-surgical weight loss studies (diet, exercise and medication). However, heterogeneity across available trials, poor follow-up measures and a deficiency in comparative studies between surgical and non-surgical therapy precludes definitive statements regarding the relative benefits of surgical therapy. Further research is required to quantify robustly the effects and mechanisms of sleep apnoea resolution by metabolic surgery, which may reveal novel non-surgical treatments or enhanced surgical strategies in the management of this multisystem sleep disorder.
Thorax 2012 May
PMID:Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. 2170 67

We surveyed the UK distribution of five factors commonly associated with obstructive sleep apnoea (OSA) to produce an overall risk map that could be used to predict relative prevalence estimates. The weighting and mapping of selected risk factors associated with OSA highlighted significant regional variation in predicted prevalence estimates. These data provide the first attempt to systematically map the UK for OSA and identify areas where the condition is likely to be more prevalent. The data show a significant mismatch between areas identified as having a high predicted prevalence estimate and the distribution of existing sleep centres.
Thorax 2014 Apr
PMID:Predicted relative prevalence estimates for obstructive sleep apnoea and the associated healthcare provision across the UK. 2406 27


<< Previous 1 2 3 4 5 Next >>