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

We studied the effects of sleep apnea on neuroendocrine function in a cross-sectional study of 225 consecutive men undergoing sleep studies and in a longitudinal study of 43 men with severe obstructive sleep apnea before and after 3 months of successful treatment with nasal continuous positive airways pressure to eliminate upper airways obstruction. Blood samples were collected at 0600-0630 h on awakening for measurement of plasma insulin-like growth factor I (IGF-I), total and free testosterone, sex hormone-binding globulin (SHBG), LH, FSH, PRL, T4, T4-binding globulin, and cortisol. The plasma hormone levels were analyzed in relation to the severity of sleep apnea, as indicated by the desaturation index (the hourly rate of episodes of arterial oxygen desaturation greater than 4% of the stable baseline) and the mean minimal oxygen saturation during the desaturation episodes. In the cross-sectional study plasma IGF-I, free and total testosterone, and SHBG levels were significantly lower in relation to the severity of sleep apnea, whereas plasma LH, FSH, PRL, T4, T4-binding globulin, and cortisol were not. The decreases in plasma IGF-I and total and free testosterone were independent of the effects of aging and adiposity by covariance analysis. In the longitudinal study plasma IGF-I, total testosterone, and SHBG, but not free testosterone, significantly increased after 3 months of nasal continuous positive airways pressure treatment. We conclude that sleep apnea causes reversible neuroendocrine dysfunction in men, which is manifested by decreased plasma. IGF-I, testosterone, and SHBG levels. This neuroendocrine dysfunction is related to the severity of the sleep apnea, as indicated by the nadir levels of arterial oxygen desaturation and the rate of desaturation episodes. These hormonal measurements may provide biochemical markers for both the severity of sleep apnea and its response to therapeutic intervention. In addition, sleep apnea may be a previously unrecognized confounder of the neuroendocrine correlates of aging.
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PMID:Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. 249 27

The CSF pressure was measured continuously at the lumbar level during nocturnal sleep in 3 patients with sleep apnea hypersomnia syndrome. Nocturnal sleep was very unstable with frequent episodes of obstructive sleep apnea. When the patients were awake and relaxed in the supine position, their CSF pressure was stable and within the normal range. Episodic marked elevations of CSF pressure occurred frequently during sleep, and each elevation was preceded and accompanied by an episode of sleep apnea or hypopnea. Significant correlations were found between the duration of apneic episodes and increase of CSF pressure, and between decrease of SaO2 or TcPO2 and increase of CSF pressure. The duration of sleep apnea was longer, increase of CSF pressure was greater, and decreases of SaO2 and TcPO2 were more marked during REM sleep than during NREM sleep. It is suggested that the frequent marked episodic elevations of CSF pressure are caused by an increase in the intracranial vascular volume occurring mainly in response to transient hypercapnia and hypoxia, which are induced by pulmonary hypoventilation during the episodes of sleep apnea.
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PMID:Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome. 257 29

Part I of this two-part article presents a review of the symptoms, pathophysiology, and diagnosis of the sleep apnea syndrome. The more common obstructive type is characterized by disturbed sleep and daytime hypersomnolence. Subjective signs and symptoms should be correlated with objective findings by way of polysomnography (sleep study) to confirm the diagnosis and determine the severity of obstructive sleep apnea. Electrocardiographic monitoring during polysomnography has revealed potentially life-threatening arrhythmias during sleep. Differential diagnosis should include central sleep apnea and narcolepsy to avoid inappropriate therapy and worsening of symptoms.
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PMID:The sleep apnea syndrome. Part I: Diagnosis. 258 25

Sleep apnea syndrome is a condition characterized by recurrent interruption of breathing during sleep. Triad of symptoms for the disease are insomnia, daytime sleepiness and snoring. Recently, the patients complained of these symptoms have progressively increased. And so serious attention has been given to investigate the entity of this new clinical syndrome in medical and dental aspects. Three types of sleep apnea are classified; central, obstructive and mixed type. Most of patients identified this syndrome include obstructive or mixed types of sleep apnea. Obstructive sleep apnea has been presumed to have close relationships with obesity, micrognathia, retrognathia, tonsillary hypertrophy, tongue hypertrophy and so on. This study was designed to evaluate the characteristics of the dentofacial morphology in the obstructive, included mixed, sleep apnea syndrome (OSA) patients. The samples consisted of 25 adult male patients (average age of 48 years 2 months) with OSA as diagnosed by the division of respiratory disease, department of internal medicine, Kanazawa Medical University Hospital. One lateral radiographic cephalogram with the teeth in occlusion and the recording of somatic measurements, body weight and height, were obtained for each patient at visiting our orthodontic clinic. On the lateral cephalograms of whole samples, 10 angular and 6 linear measurements were carried out. Simultaneously, the body mass index (BMI) was assessed for each patient. Based on the cephalometric and somatometric measurements, the pathogenesis of obstructive sleep apnea was discussed in association with the obesity and dentofacial morphology. Results were summarized as follows: 1. The body mass index (kg/m2) ranged between 21.0 to 45.7, with a mean value of 31.0 for OSA patients. Of whom, 3 patients were mildly obese (25 or more of BMI) and 12 patients severely obese (exceeding 30 of BMI). 2. Compared with normal control samples, the means of cephalometric variables of whole samples showed the tendency of micrognathia, large gonial angle, protruded maxilla and large cranial base. 3. By principal component analysis, it was revealed that the components for the shape and position of the mandible were of more importance in OSA patients than controls. 4. Discriminatory analysis clarified significant differences in dentofacial morphology between 12 obese and 13 non-obese patients. 5. The dentofacial morphology in non-obese patients were characterized by retrognathia, micrognathia, large gonial angle and small maxilla. In accordance with previous reports, the patients with OSA were presented the tendency of obesity and micrognathia. Furthermore it was revealed that particularly in non-obese OSA patients the morphological abnormalities might be the major contributor to the pathogenesis of sleep apnea.
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PMID:[Dentofacial morphology of obstructive sleep apnea syndrome patients]. 264 Sep 22

Obstructive sleep apnea (OSA) may result in neuropsychiatric complications. Psychiatrists need to be alert to the possibility that patients who present to them with cognitive and/or affective disorders, who also have sleep related complaints such as snoring and significant daytime hypersomnolence, may have OSA. Clinical suspicion needs to be reinforced by obtaining a history from the bed partner. A polysomnogram will establish the diagnosis. Once the diagnosis is made, several treatment options are available. Treatment of sleep apnea usually leads to a resolution, or at least improved control, of the complicating neuropsychiatric disorder. Physicians must be aware that sedating neuroleptic or antipsychotic agents may worsen sleep apnea and, thereby, aggravate the neuropsychiatric disturbance.
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PMID:Neuropsychiatric manifestations of obstructive sleep apnea: a review. 265 64

A case of severe obstructive sleep apnea developing during pregnancy is reported. A 27-year-old primigravida was well until the sixth month of pregnancy, when she developed loud snoring and excessive daytime sleepiness. Polysomnography was performed at 36 weeks' gestation and revealed severe obstructive sleep apnea. The patient was treated successfully during pregnancy with nasal continuous positive airway pressure, but continued to suffer from moderate obstructive sleep apnea after delivery. This case suggests that sleep apnea may be either precipitated or exacerbated during pregnancy.
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PMID:Precipitation of obstructive sleep apnea during pregnancy. 266 22

In patients with obstructive sleep apnea and associated rapid-eye-movement (REM) sleep deprivation and disruption, the first night of nasal continuous positive airway pressure (CPAP) is often associated with increases in REM sleep time and REM density (REM rebound). The amount of REM rebound, however, varies considerably. We sought to characterize the magnitude of REM rebound and to determine what factors determine individual differences in REM rebound with initial CPAP treatment. Twenty-six patients with sleep apnea had a baseline nocturnal polysomnogram and a second night with a trial of CPAP. REM sleep time increased by 69% with CPAP, REM density increased by 73%, and REM activity by 169%. REM density was highest in the second REM period. Improvement in respiratory disturbance index with CPAP correlated significantly with increased minutes of REM sleep with CPAP. Of polysomnographic measures on the baseline night, change in minutes of REM sleep with CPAP correlated best with minimum oxygen saturation and to a lesser degree with respiratory disturbance index, and minutes of Stage 1 sleep. One possible explanation for the effect of hypoxemia on subsequent REM rebound is that some physiological functions of REM sleep may fail when oxygen saturation falls below a certain level.
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PMID:Effects of continuous positive airway pressure on phasic events of REM sleep in patients with obstructive sleep apnea. 267 3

The authors describe a multidisciplinary approach for patients with sleep apnea syndrome. During the first year 40 patients with obstructive sleep apnea documented by polysomnographic recordings were managed. Therapy proposed to the patient included weight loss and abstention from sedatives at night as sole treatment (n = 12) or, more often, combined with nasal and/or throat surgery (n = 21) or nasal continuous positive airway pressure (NCPAP) during sleep (n = 7). NCPAP was by far the most effective in reversing apneas but in view of its cost for the patient and its constraining aspects was proposed solely to those patients with the most severe apnea syndromes.
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PMID:[Sleep apnea syndrome : multidisciplinary management. Apropos of a preliminary experience]. 268 15

Recently, it was shown that under certain conditions, there is a linkage between oxygen delivery (DO2) and oxygen consumption (VO2) so that any increase in DO2 is accompanied by an increase in VO2. We investigated this phenomenon in 10 patients with severe obstructive sleep apnea who had nocturnal oxygen desaturations to less than 85% (Group I), 10 patients with mild sleep apnea and no significant desaturations (Group II), and six obese control subjects (Group III). VO2 was measured by respired gas analysis before and after passive leg raising, which has been shown to increase DO2 by 10 to 12%. This was verified by thermodilution cardiac output measurements in four obese patients. In patients with severe sleep apnea, mean apnea index was 53 +/- 11, and supine VO2 was 141 +/- 40 ml/min/m2, whereas with leg elevation it rose to 163 +/- 41 ml/min/m2 (p less than 0.005). In patients with mild sleep apnea and in obese control subjects (mean apnea indices of 24 +/- 6 and 4 +/- 1, respectively), supine VO2 was 144 +/- 11 and 152 +/- 10 ml/min/m2, respectively; with leg elevation, VO2 was 144 +/- 13 and 151 +/- 6 ml/min/m2, respectively (p greater than 0.6). The study was repeated in nine of the Group I patients after 8 wk of treatment with nasal CPAP (Group IA). The repeated supine VO2 in these patients was 138 +/- 28 ml/min/m2, and a significant difference was not observed after leg raising (140 +/- 29 ml/min/m2; p greater than 0.5).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Oxygen supply dependency in patients with obstructive sleep apnea and its reversal after therapy with nasal continuous positive airway pressure. 268 7

In order to study blood pressure, adrenergic, and cholinergic activity in severe obstructive sleep apnea (OSA), 14 patients with apnea index (AI) greater than 30 apneas/h, mean apnea time index greater than 20 sec were studied before and with nasal Continuous Positive Airway Pressure (nCPAP). Sleep, respiration, arterial blood pressure, arterial plasma catecholamines [norepinephrine (NE) and epinephrine (E)], and plasma pancreatic polypeptide (PP) were measured without and after seven days treatment with nCPAP. Initially in the apnea, arterial blood pressure decreases, and thereafter steadily increases and shows a maximum during the first breath terminating the apnea. With nCPAP the arterial pressure variations disappeared. Awake morning systolic (SBP) and diastolic (DBP) blood pressure decreased the nCPAP treatment. A significant relation between the reduction in AI and the reduction in morning awake SBP and DBP with nCPAP treatment was observed. No significant changes in NE were observed with nCPAP treatment. Epinephrine decreased and PP increased significantly with nasal nCPAP treatment. The systolic and diastolic blood pressure reduction was significantly related to the decrease in E and the increase in PP. No association between sleep stages and plasma NE, E, and plasma-PP was found before treatment. With nCPAP treatment plasma-PP was higher during non-rapid eye movement (NREM) stage 2 to 4 sleep than during rapid eye movement (REM) sleep. Thus, morning awake arterial blood pressure and nocturnal arterial blood pressure decrease with nCPAP treatment in sleep apnea patients. These hemodynamic changes are related to the decrease in AI and sympathetic activity and the increase in parasympathetic activity.
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PMID:Blood pressure, catecholamines, and pancreatic polypeptide in obstructive sleep apnea with and without nasal Continuous Positive Airway Pressure (nCPAP) treatment. 268 12


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