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

To determine whether oxygen desaturation occurs during sleep in high tetraplegics, 10 neurologically stable male patients (aged 17 to 55 years) with complete motor lesions (C4 to C6) had continuous pulse oximetry recordings and sleep observations on two nights. The patients were studied during admissions for nonrespiratory problems (eg, pressure sores, urinary infection, respite). Lung function tests and daytime arterial blood gases were also measured. Mean forced vital capacity was 46% of predicted, but mean awake PaO2 and PaCO2 were normal (95.0 mmHg and 42.8 mmHg, respectively). Three subjects showed severe nocturnal oxygen desaturation spending greater than 10% of the time overnight with arterial oxyhaemoglobin saturation (SaO2) levels of less than 90%. For the group as a whole, the percentage of time spent under 90% SaO2 correlated with body mass index. Mean overnight SaO2 correlated inversely with body mass index and directly with maximal expiratory pressure, a measure of respiratory muscle strength. Low overnight SaO2 was also associated with higher levels of injury. The pattern of nocturnal oxygen desaturation observed was episodic and was suggestive of obstructive sleep apnoea during rapid eye movement (REM) sleep. Levels of nocturnal oxygen desaturation similar to those observed in the three most severely affected patients have been shown, in other disorders, to be associated with cognitive impairment, cardiovascular disease and increased mortality. Our results suggest up to a third of high tetraplegics may be at risk of potentially serious nocturnal hypoxic episodes.
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PMID:Hypoxia episodes during sleep in high tetraplegia. 162 16

This article reviews the essential features, types, prevalence, pathophysiology, and neuropsychological correlates associated with the sleep apnea syndrome. Persons who experience the intermittent hypoxia and fragmented sleep characteristic of the sleep apnea syndrome tend to exhibit moderate symptoms of diffuse cognitive dysfunction as well as multiple emotional and psychosocial sequela. It is concluded that more research is required in order to elucidate the relationship between the hypoxic parameters and neurocognitive deficits seen in the sleep apnea syndrome, and that neuropsychological assessment might represent a means whereby the effectiveness of various treatments for sleep apnea may be evaluated.
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PMID:Sleep apnea syndrome: symptomatology, associated features, and neurocognitive correlates. 215 34

Eight patients with myotonic dystrophy underwent comprehensive neuropsychological testing and overnight polysomnography to assess whether the waking cognitive impairment might be attributable to sleep structure abnormalities or to sleep-related respiratory problems. Patients showed substantial neuropsychological deficits, fragmented nocturnal sleep and, in half the patients, sleep apnea and/or hypopnea both mainly of central type. There was no statistically significant correlation between the degree of daytime cognitive deficit and the degree of sleep fragmentation or of respiratory problems at night. It was concluded that the neuropsychological deficit in mytonic dystrophy cannot be attributed to a secondary effect of nocturnal sleep apnea or sleep disruption but probably represents a direct effect of CNS lesions.
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PMID:Neuropsychological deficits and sleep in myotonic dystrophy. 227 99

In 1984-85, 1855 elderly residents of an urban community responded to a comprehensive baseline interview that included questions regarding an extensive set of sleep characteristics and problems. During the subsequent 3 1/2 years of follow-up, 16.7% of the respondents died and 3.5% were placed in nursing homes. The predictive significance of each sleep characteristic for mortality and for nursing home placement was determined separately for males and females, using Cox proportional hazards models. Selected demographic and psychosocial variables were also entered into the models. Age, problems with activities of daily living (ADL), self-assessed health, income, cognitive impairment, depression and whether respondents were living alone were controlled for statistically. Of the many variables analyzed, in males insomnia was the strongest predictor of both mortality and nursing home placement. For mortality, the relative hazard associated with insomnia exceeded the hazards associated with age, ADL problems, fair-poor health and low income. For nursing home placement, the hazard associated with insomnia exceeded that associated with cognitive impairment. The relationships of insomnia to mortality and nursing home placement were U-shaped, with a worse outcome if insomnia complaints over the preceding 2 weeks were either prominent (numerous or frequent) or absent. For females, insomnia was a borderline predictor of mortality and did not predict nursing home placement at all. Symptoms of the restless legs syndrome predicted mortality for females in some Cox regression models. Reported sleep duration, symptoms of sleep apnea and frequent use of hypnotic drugs did not predict mortality or nursing home placement in either sex.
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PMID:Sleep problems in the community elderly as predictors of death and nursing home placement. 235 10

We describe a familial disorder consisting of sleep apnea, anosmia, colorblindness, partial complex seizures, and cognitive dysfunction. The phenotypic expression of the syndrome suggests an autosomal dominant inheritance with incomplete penetrance.
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PMID:Familial 'sleep apnea plus' syndrome: report of a family. 325 50

The generally accepted polysomnographic criteria for diagnosis of sleep apnea is exceeded by elderly subjects with such frequency that the validity of its application to this age group has been questioned. We studied a group of elderly volunteers with nocturnal polysomnography and partitioned them into 2 groups based upon an apnea index of greater than or less than 5 per hour. The results of a protocol evaluating the presence of potential complications of sleep apnea including cardiac arrhythmias, systemic hypertension, cor pulmonale, daytime sleepiness, and cognitive impairment were compared for the 2 groups. No excess incidence of cardiovascular complications was found. Although an increase in daytime sleep tendency was shown for the group with more frequent apneas, no appreciable deficits in cognitive performance were demonstrated. Although apnea during sleep in the elderly may be associated with an increase in daytime sleepiness, it may not necessarily result in other physiologic or neuropsychologic consequences. Therapeutic intervention for these abnormalities should be carefully considered prior to the institution of treatment in light of these observations.
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PMID:Clinical significance of sleep apnea in the elderly. 366 38

In a study of sleep-disordered breathing among 139 elderly individuals, sleep apnea (defined as 5 or more apneas per hour) occurred in 34 (41.7%) Alzheimer's subjects compared with 56 (5.4%) healthy controls, 35 (11.4%) depressive subjects, and 24 (16.7%) patients with mixed symptoms of both cognitive impairment and depression (p less than .001). Alzheimer's patients had a significantly higher proportion of NREM-related than REM-related apnea. Moreover, a significant (p less than .01) positive correlation between the apnea index and severity of dementia, as measured by the Blessed Dementia Rating Scale, was found in apnea-positive Alzheimer's patients, as well as in the entire sample of Alzheimer's patients (p less than .05). No such correlation was found in the mixed-symptoms group. Possible clinical and neuropathologic implications are discussed.
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PMID:Sleep-disordered breathing in normal and pathologic aging. 375 14

Twenty-six patients with sleep apnea had neuropsychologic testing prior to nocturnal sleep study in a sleep disorders clinic. The cognitive functioning of patients who had sleep apnea with associated hypoxemia was compared to nonhypoxemic patients with sleep apnea. The patients who had sleep apnea with hypoxemia had more severe cognitive impairment than those with sleep apnea without hypoxemia. The hypoxemic patients with sleep apnea had significantly poorer cognitive functioning on four of eight tests (p less than 0.05). In addition, the patients who had sleep apnea with hypoxemia had mean performance scores in the impaired range on measures of attention, concentration, complex problem-solving, and short-term recall of verbal and spatial information. In contrast, the patients who had sleep apnea without hypoxemia had no mean performance score in the impaired range. The degree of hypoxemia during sleep and wakefulness significantly correlated with the degree of overall cognitive impairment as rated by a neuropsychologist; however, measures of sleep fragmentation did not significantly correlate with overall cognitive impairment in patients with sleep apnea. We conclude that patients who have sleep apnea with associated hypoxemia have cognitive impairment which is more severe than those with sleep apnea without hypoxemia.
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PMID:Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia. 376 69

Personality patterns, signs of mental impairment, mental health correlates, and psychosocial consequences were assessed in 50 patients who had obstructive sleep apnea of sufficient severity to warrant recommendation for tracheostomy. The personality patterns of sleep apnea patients were consistently those of a somatic-neurotic type, similar to typical patterns for medical outpatients. The high level of psychologic distress demonstrated was clearly a consequence rather than a cause of the disorder. Most patients showed cognitive impairment; 76% had suspected or mild to severe deficits in terms of thinking, perception, memory, communication, or the ability to learn new information, resulting in a greater potential for being distractible, confused, and irritable. Finally, another striking finding was the high incidence of patients' reports of frequent, severe psychosocial disruption in their lives--involving the family, social interactions and work situations.
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PMID:Severe obstructive sleep apnea--II: Associated psychopathology and psychosocial consequences. 399 57

The objective of the study was to evaluate the relation between every-night (habitual) snoring, sleep apnoea and cognitive complaints (concentration and memory complaints) in an adult population-based sample. In the DAN-MONICA (MONItoring trends in CArdiovascular iseases) 1504 males and females aged 30, 40, 50 and 60 years were classified according to their snoring habits. Nocturnal respiration was measured in 748 participants. The following measures were regarded as potential confounders: age, gender, unintended sleepiness, insomnia, depression, hypnotic use, alcohol consumption by questionnaire, body mass index (BMI) and blood pressure. Concentration and memory problems were both related to depression, insomnia and unintended sleepiness. Snoring and sleep apnoea (defined as a respiratory distress index-RDI > or = 5) were associated with concentration problems and unintended sleepiness. The odds ratios (95% confidence intervals) between snoring, concentration and memory problems, calculated by logistic regression analysis after adjustments for the above confounders, were 1.90 (1.23-2.91, p < 0.01) and 1.38 (0.97-1.99, NS). For those with sleep apnoea, the odds ratios were 3.53 (1.42-8.73. p < 0.001) and 1.51 (0.81-2.14, NS) for concentration and memory problems, respectively. The main conclusion drawn from this study is that cognitive complaints show a high correlation to mood, insomnia and hypersomnia. Habitual snoring and sleep apnoea show a correlation to concentration problems, but not to memory problems. This suggests that part of the association between snoring, sleep apnoea and cognitive dysfunction is related to the presence of sleep disturbances and daytime sleepiness.
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PMID:[Cognitive symptoms in persons with snoring and sleep apnea. An epidemiologic study of 1.504 women and men aged 30-60 years. The Dan-MONICA II study]. 860 12


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