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

Ischemic or hemorrhagic cerebrovascular disease (CVD) produces injury of brain regions important for executive function, behavior, and memory leading to decline in cognitive functions and vascular dementia (VaD). Cardiovascular disease may cause VaD from hypoperfusion of susceptible brain areas. CVD may worsen degenerative dementias such as Alzheimer disease (AD). Currently, the global diagnostic category for cognitive impairment of vascular origin is vascular cognitive disorder (VCD). VCD ranges from vascular cognitive impairment (VCI) to VaD. The term VCI is limited to cases of cognitive impairment of vascular etiology, without dementia; VCI is equivalent to vascular mild cognitive impairment (MCI). Risk factors for VaD include age, hypertension, diabetes, smoking, cardiovascular disease (coronary heart disease, congestive heart failure, peripheral vascular disease), atrial fibrillation, left ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension, cardiac arrhythmias, hyperfibrinogenemia, sleep apnea, infection, and high C-reactive protein. Research on biomarkers revealed increased CSF-NFL levels in VaD, whereas CSF-tau was normal. CSF-TNF-alpha, VEGF, and TGF-beta were increased in both AD and VaD. VaD shows low CSF acetylcholinesterase levels. This condition responds to acetylcholinesterase inhibitors, confirming the central role of cholinergic deficit in its pathogenesis. Evidence strongly suggests that control of vascular risk factors, in particular hypertension, could prevent VaD.
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PMID:Vascular dementia. Advances in nosology, diagnosis, treatment and prevention. 1587 77

Excessive daytime sleepiness (EDS) can affect 20-50% of patients with Parkinson's disease (PD), whereas sleep attacks (SA), which are sleep episodes without prodroma, seem infrequent. EDS is associated with more advanced disease, higher doses of levodopa-equivalent, and sometimes the use of dopamine agonists. Patients at risk for SA have higher Epworth sleepiness scores (ESS) (although an important subset of patients under-score on this scale) and a more frequent use of ergot or non-ergot dopamine agonists. Polysomnography is a valuable tool in patients with PD, because sleep apnea may occur in 20% of patients, whereas a specific narcolepsy-like phenotype, identified on multiple-sleep latency tests, occurs in patients with most severe EDS; this suggests a lesion in sleep-wake systems. Removal or replacement of a recently introduced dopamine agonist may offer some relief for EDS. If not, the adjunction of modafinil has a good benefit-risk ratio in patients with PD. EDS (and sometimes the narcolepsy-like phenotype) may also affect patients with atypical parkinsonism, such as dementia with Lewy bodies, multiple-system atrophy, and progressive supranuclear palsy.
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PMID:Excessive daytime sleepiness in parkinsonism. 1589 49

We report herein a patient with dementia with Lewy bodies (DLB) who presented with severe autonomic failure, dementia and parkinsonism. At onset, the 70-year-old man exhibited dementia and gait disturbance. Over the next 3 years, he developed symptoms of autonomic dysfunction, such as sleep apnea, orthostatic hypotension and bladder and bowel dysfunction. Cranial magnetic resonance imaging revealed moderate frontotemporal atrophy. Single photon emission computed tomography images depicted bilateral hypoperfusion in the parietal lobes. Interestingly, recurrent episodes of cardiopulmonary arrest together with unconsciousness occurred during the 2-year period before the patient died at the age of 74. At autopsy, axial slices of the brainstem showed depigmentation of the substantia nigra and locus ceruleus. Lewy bodies were present in areas of the brainstem such as the substantia nigra, locus ceruleus, solitary nucleus, raphe nucleus and dorsal vagal nucleus and in the intermediolateral column of the spinal cord, sympathetic ganglia, parahippocampal gyrus and cerebral cortex. Neuronal loss was observed in the intermediolateral column, but neurons in the sympathetic ganglia were well preserved. On the basis of the clinical history and pathological findings, we diagnosed this as a case of DLB. There are a few reported cases of DLB associated with various manifestations of autonomic failure. In our patient, autonomic failure including cardiopulmonary arrest may have resulted from widespread impairment of the autonomic nervous system.
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PMID:[Autopsy findings in a case of dementia with Lewy bodies with marked autonomic failure and repetitive cardiopulmonary arrest]. 1618 Jul 9

Parkinson's disease is a progressive disorder of the central nervous system. Degeneration of the dopaminergic neurons is the main cause of the disease. The basic symptoms of Parkinson's disease are bradykinesia, rigidity and resting tremor. Disturbances of the autonomous nervous system, depression, dementia and sleep disorders are common, too. People with Parkinson's disease suffer from insomnia, excessive daytime sleepiness, "sleep attacks", nightmares, REM sleep behaviour disorder, periodic limb movement in sleep, restless legs syndrome and sleep apnea syndrome. The main cause of sleep disorders in Parkinson's disease are age-connected changes in sleep architecture, disturbances of neurotransmission, movement disturbances in sleep, medications and concomitant diseases. The authors present the current state of knowledge on sleep disorders in Parkinson's disease, especially, the role of dopaminergic therapy, methods of diagnostics and treatment as well as the influence of sleep disturbances on patient's quality of life.
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PMID:[Sleep disturbances in Parkinson's disease]. 1627 62

Brain injury from ischemic or hemorrhagic cerebrovascular disease (CVD) produces decline in cognitive functions and vascular dementia (VaD). Likewise, CVD may cause VaD from hypoperfusion of susceptible brain areas. CVD may also worsen degenerative dementias such as Alzheimer's disease. Significant advances have been made in the identification and control of risk factors for stroke and cardiovascular disease. The main risk factors for VaD include age, hypertension and absence of antihypertensive medication, diabetes, cigarette smoking, history of cardiovascular disease (coronary heart disease, congestive heart failure, peripheral vascular disease), atrial fibrillation, left ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension, cardiac arrhythmias, hyperfibrinogenemia, and sleep apnea. Recently identified risk factors include chronic infection and elevation of C-reactive protein, particularly in patients with diabetes. Evidence from controlled clinical trials strongly suggests that control of vascular risk factors, in particular hypertension, could prevent the development of dementia.
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PMID:Vascular dementia prevention: a risk factor analysis. 1632 58

Patients with Parkinson's disease and parkinsonian syndromes (eg, dementia with Lewy body disease, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. This sleepiness is common and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, namely narcolepsy/cataplexy. Physicians need to be vigilant in assessing parkinsonian patients for sleepiness because treatment can dramatically enhance quality of life and prevent the significant morbidity and mortality that attends daytime sleepiness. Male patients with advanced disease, cognitive impairment, drug-induced psychosis, and orthostatic hypotension are most at risk for developing pathologic sleepiness. Because primary sleep disorders can coexist with parkinsonism (eg, sleep apnea, insufficient or interrupted sleep), these potential causes should be carefully assessed with polysomnography and treated appropriately. Dopaminomimetics exacerbate sleepiness in a small subset of patients in a dose-dependent fashion. Nonetheless, the primary pathologies involved in parkinsonism appear to be the greatest contributors to daytime sleepiness. Sleepiness in parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents such as bupropion, modafinil, or traditional psychostimulants.
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PMID:Excessive daytime sleepiness and unintended sleep in Parkinson's disease. 1652 72

Drivers' sleepiness and falling asleep while driving account for a considerable proportion of vehicle accidents (studies show different results from 1% to 30%). Sleepiness is rarely well recognised as a causing factor of traffic accidents. 2.5% up to 20% people suffer from excessive daytime sleepiness (EDS) with sleep deprivation as its most frequent cause. There is a strong association between sleep deprivation and medical problems--especially sleep disturbances. The sleep apnoea syndrome (SAS) has been identified as the most common cause of habitual drowsy driving. Patients with SAS (apart from other health problems) are 6 times more likely to have accidents. After adequate treatment of severe SAS with continuous positive airway pressure the risk of accident lowered 5 x. Other important sleep disturbances include chronic insomnia, narcolepsy, restless legs syndrome and periodic limb movement in sleep. Sleepiness was described in Parkinson's disease, dementia, epilepsy, in chronic cardiacs and in people with complex internal health problems. Regular or single intake of drugs (benzodiazepines, antidepressants, antihistaminics, antipsychotics and others) can itself induce sleep problems. Sleepiness in persons without sleep disorder may occur due to preventable causes such as poor sleep habits which lead to sleep deprivation.
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PMID:Medical factors of falling asleep behind the wheel. 1738 1

Stroke in the elderly has more major differences compared to young people: it is the first complication of atherothrombosis disease associated with the following risk factors: hypertension, diabetes, hypercholesterolemia, tobacco consumption and sleep apnea syndrome; AVC is the first consequence of atrial fibrillation; from a clinical point of view, seizure at the onset of the stroke is more frequent; prognosis is characterized by a high risk of dementia (20%); primary and secondary prevention is very efficacious even in very old patients, not only on the risk of stroke, but also on the risk of dementia; time trends at Dijon show a slight decrease of incidence rates of stroke only over 85 years, while prevention of stroke has taken advantage of real progress in precocious diagnosis and innovative treatments. In contrast, we observed a decrease of case-fatality rates at any day with a delay in age of onset of stroke, reaching five years in men and eight years in women, suggesting an increase of life expectancy without stroke, reflecting a certain efficacy of prevention.
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PMID:[Stroke in elderly: what have we learned from stroke epidemiology in younger people]. 1878 83

Sleep apnea is prevalent among patients with traumatic brain injuries (TBIs), and initial studies suggest it is associated with cognitive impairments in these patients. Recent studies found that the apolipoprotein epsilon 4 (APOE epsilon 4) allele increases the risk for sleep disordered breathing, particularly sleep apnea. The APOE epsilon 4 allele is associated with cognitive decline and the development of dementia in the general population as well as in patients with TBI. These findings raise the question of whether patients with TBI who are APOE epsilon 4 allele carriers are more vulnerable to the negative effects of sleep apnea on their cognitive functioning. While few treatments are available for cognitive impairment, highly effective treatments are available for sleep apnea. Here we review these different lines of evidence, making a case that the interactive effects of sleep apnea and the APOE epsilon 4 allele represent an important mechanism by which patients with TBI may develop a range of cognitive and neurobehavioral impairments. Increased understanding of the relationships among sleep apnea, the APOE epsilon 4 allele, and cognition could improve our ability to ameliorate one significant source of cognitive impairment and risk for dementia associated with TBI.
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PMID:Sleep apnea, apolipoprotein epsilon 4 allele, and TBI: mechanism for cognitive dysfunction and development of dementia. 2010 7

Sleep disordered breathing (SDB) is a frequent finding in the elderly. SDB is related to morbidity, mortality, quality of life, disability, and cognitive impairment. Treatment of choice for SDB is nasal positive airway pressure breathing (nCPAP). The impact of treatment for SDB on activities of daily living (ADLs) is unclear. We therefore investigated the relationship between SDB and ADLs in a sample of elderly in-hospital patients with severe SDB defined as a oxygen desaturation index of 30 events per hour. All patients eligible were assigned to nCPAP therapy. Patients with refusal of nCPAP were offered nocturnal oxygen supply via nasal prongs. The Barthel-index (BI) at admission and discharge was used to measure ADLs. Two hundred patients with a mean age of 81+/-7 years were included. 22 (11%) patients accepted nCPAP therapy, 42 (21%) patients accepted oxygen therapy and 136 (68%) patients refused both treatment options. The subgroups did not differ significantly in BI at admission and length of stay in hospital. BI increased from 42+/-28 to 49+/-30 in patients with refusal of any treatment, from 39+/-23 to 61+/-20 in patients with oxygen therapy and from 48+/-35 to 72+/-28 in patients with nCPAP therapy. The BI at discharge differed significantly between all three patients groups (p< 0.03). Logistic regression analysis revealed that Barthel Index at admission and treatment with nCPAP or treatment with oxygen were independently associated with a gain in BI of at least 30 points. Age, dementia or length of in-hospital stay showed no association with gain in BI. This is the first study that shows an impact of treatment for severe SDB on ADLs in elderly patients. Furthermore, treatment with nCPAP and oxygen supply nearly had the same impact on ADLs. Since the higher rate of acceptance of oxygen therapy and the important impact of oxygen supply on BI, administration of oxygen seems to be a rational alternative in elderly subjects with severe sleep apnea and refusal of nCPAP.
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PMID:Influence of type of treatment for sleep apnea on activities of daily living in a sample of elderly patients with severe sleep apnea. 2013 39


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