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

Upper airway obstruction is common during both anaesthesia and sleep, as a result of loss of muscle tone present during wakefulness. Patients with obstructive sleep apnoea (OSA) are vulnerable during anaesthesia and sedation as the effects of loss of wakefulness are compounded by drug-induced depression of muscle activity and of arousal responses, so that they cannot respond to asphyxia. Conversely, those with 'difficult' airways during anaesthesia, either because of problems with maintenance of airway patency without tracheal intubation or because intubation itself is problematic, are at increased risk of OSA. These relationships have clinical importance. On the one hand identification of patients with OSA forewarns the anaesthetist of potential difficulty with airway maintenance intra- and postoperatively, influencing choice of anaesthetic technique and postoperative nursing environment. On the other hand difficulty with airway maintenance during anaesthesia should prompt further investigation for the possibility of OSA.
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PMID:Obstructive sleep apnoea and anaesthesia. 1555 78

The sleep apnoea-hypopnoea syndrome is characterised by recurrent obstructions of the upper airway, resulting in sleep disruption and arterial oxygen desaturations. Noninvasive assessment of respiratory mechanics during sleep is helpful in facilitating the diagnosis and treatment of patients with sleep apnoea-hypopnoea syndrome. This series summarises the different tools that are currently available to noninvasively assess respiratory mechanics during sleep breathing disturbances. These techniques are classified according to the main variable monitored: ventilation, breathing effort or airway obstruction. Changes in patient ventilation are assessed by recording flow or volume signals by means of pneumotachographs, thermistors or thermocouples, nasal prongs or thoraco-abdominal bands. Common tools to noninvasively assess breathing efforts are the thoraco-abdominal bands and the pulse transit time technique. Upper airway obstruction is noninvasively characterised by its upstream resistance and its critical pressure or by means of the forced oscillation technique. Given the technical and practical limitations of each technique, combining different tools improves the reliability and robustness of patient assessment during sleep.
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PMID:Noninvasive monitoring of respiratory mechanics during sleep. 1557 52

Upper airway obstruction (UAO) can elicit neuromuscular responses that mitigate and/or compensate for the obstruction. It was hypothesised that flow-limited breathing elicits specific timing responses that can preserve ventilation due to increases in inspiratory duty cycle rather than respiratory rate. By altering nasal pressure during non-rapid eye movement (non-REM) sleep, similar degrees of UAO were induced in healthy males and females (n = 10 each). Inspiratory duty cycle, respiratory rate and minute ventilation were determined for each degree of UAO during non-REM sleep and compared with the baseline nonflow-limited condition. A dose-dependent increase in the inspiratory duty cycle and respiratory rate was observed in response to increasing severity of UAO. Increases in the inspiratory duty cycle, but not respiratory rate, helped to acutely maintain ventilation. Heterogeneity in these responses was associated with variable degrees of ventilatory compensation, allowing for the segregation of individuals at risk for hypoventilation during periods of inspiratory airflow limitation. Upper airway obstruction constitutes a unique load on the respiratory system. The inspiratory duty cycle, but not the respiratory rate, determine the individual's ability to compensate for inspiratory airflow limitation during sleep, and may represent a quantitative phenotype for obstructive sleep apnoea susceptibility.
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PMID:Inspiratory duty cycle responses to flow limitation predict nocturnal hypoventilation. 1912 90

Diamond-Blackfan anemia (DBA) is a congenital erythroid aplasia or hypoplasia presenting in infancy as a macrocytic anemia. It has been linked to a gene defect resulting in the absence of specific ribosomal proteins that enable erythroid maturation. Treacher Collins syndrome is also associated with defective ribosomal biogenesis. Fifty percent of patients with DBA also present with additional physical abnormalities including growth delay, craniofacial abnormalities, upper limp abnormalities, cardiac defects, urogenital malformations, and cleft palate. Upper airway obstruction may be a complication from craniofacial disorders and may be responsible for life-threatening sleep apnea that may result in pneumonia or respiratory failure. This report is of a patient with DBA who presented at birth with respiratory distress secondary to tongue-based obstruction of the airway due to mandibulofacial dysostosis leading to need for intubation. In an effort to avoid a tracheostomy, the patient underwent bilateral internal mandibular osteodistraction on day 4 of life with a latency period of 0 days and a distraction at a rate of 2 mm/d for 10 days until a class 3 dental occlusion existed with 5 mm of overcorrection. In addition, the patient was born with choanal atresia that was repaired at day 30 of life. After completion of the mandibular distraction, the patient has avoided tracheostomy and is now 6 months of age. Recent polysomnogram has demonstrated no significant apnea or hypopnea.
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PMID:Curvilinear mandibular distraction in a patient with mandibulofacial dysostosis associated with Diamond-Blackfan anemia. 1981 70

Upper airway obstruction during anesthesia is the leading cause of complications during sedation, intubation, and emergence. Devices to support oxygenation and ventilation are costly, require capital equipment, and cannot be used during transport. We present a 46-year-old man with sleep apnea and anticipated difficult airway undergoing a cardiac ablation under general endotracheal intubation. The SuperNO2VA nasal mask provided high-flow nasal oxygen and positive pressure during awake fiberoptic intubation and on extubation, maintaining airway patency in the operating room, during transport, and in recovery. The SuperNO2VA is inexpensive and portable and should be considered for high-risk patients with difficult airways.
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PMID:Using the SuperNO2VA Device on a Patient With a Known Difficult Airway: A Case Report Facilitating Fiberoptic Intubation and Postoperative Nasal Positive Pressure. 3023 16


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