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

Insomnia, daytime sleepiness, and nocturnal wandering, so common in the elderly, are caused largely by two specific pathophysiologic processes. Sleep apnea is a condition where respiration pauses during sleep, leading to arousal. Sleep apnea is due either to obstruction in the throat or failure of the central respiratory center. Periodic movements in sleep are characterized by frequent ankle and leg flexions, leading to arousal. Sleep apnea and periodic movements in sleep require specific diagnoses and treatments. Each process occurs in 20%-30% of people over 65, and perhaps the majority of older people have one or the other condition or both. Because of possible interactions with these sleep disorders, the widespread prescribing of sleeping pills to elderly patients is irrational and often dangerous. In the future, large-scale clinical trials will be needed to define effective long-term treatments for these conditions and to define when treatment is worthwhile.
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PMID:Sleep apnea and nocturnal myoclonus in the elderly. 717 50

Symptoms suggesting autonomic instability and increased adrenergic effect were identified in 53 patients with primary disorders of impaired wakefulness. Urine and plasma catecholamine concentrations were significantly increased in patients with sleep apnea. Excessive increases in heart rate during isoproterenol infusions suggested adrenergic hyperresponsiveness as an alternative explanation for symptoms of catecholamine excess in some individuals. Twenty-two patients demonstrated mitral valve prolapse (MVP), implicating primary neurologic disturbances as potential factors in the fatigue and lassitude often associated with MVP. The catecholamine abnormalities may explain some of the difficulties frequently encountered in using stimulants to treat sleep disorders.
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PMID:Adrenergic hyperactivity and cardiac abnormality in primary disorders of sleep. 718 91

The experience with 83 patients aged 60 or older from the Stanford Sleep-Wake Disorders Clinic is compared with that in 423 younger clinic patients seen during the same two-year period. Each patient received a medical, psychologic and polysomnographic evaluation. The final diagnoses were recorded according to the Diagnostic Classification System of the Association of Sleep Disorders Centers. The most common major diagnoses in the elderly group were sleep apnea syndrome (39 percent) and periodic movements-restless legs syndrome (18 percent). These syndromes showed a significantly greater prevalence in the older than in the younger patients (p less than .001), and were found in 68 percent of the elderly group. The elderly manifested more objective signs of sleep disturbance, including more wake time after sleep onset, and more frequent and longer awakenings; moreover, fewer of them experienced stage-4 sleep. The diagnostic findings seemed to indicate that complaints about sleep-wake functioning in many elderly patients may be a result of specific pathologic sleep disturbances.
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PMID:Sleep-wake disorders in the elderly: polysomnographic analysis. 724 Jun 17

We have applied a diagnostic classification of sleep and arousal disorders (Association of Sleep Disorders Centers - ASDC) to a group of 174 patients in order to assess its usefulness. In our population, there were over twice as many disorders of initiating and maintaining sleep (DIMS) as there were disorders of excessive sleepiness (DOES). We found that 68.1% of diagnoses in DIMS were psychiatric (particularly affective disorders) and that 37.8% of diagnoses in DOES were either sleep apnea or narcolepsycataplexy. Furthermore, drug/alcohol abuse was much more strongly associated with DIMS, while medical disorders were more often found to be associated with DOES. Since only 58% of our sample could be adequately classified with one diagnosis, we expect that the ASDC nosology will need to evolve further. Nevertheless, the nosology should facilitate comparability and pooling of data across centers.
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PMID:Diagnostic classification of sleep disorders: implications for psychiatric practice. 725 64

The Sleep Disorders Clinic at the San Diego Veterans Administration Medical Center provides a diagnostic service within a public hospital. Case records of the first 117 patients receiving polysomnograms in our clinic were reviewed. Of these patients, 44 percent were found to have sleep apnea, 24 percent nocturnal myoclonus and 8 percent narcolepsy. Our experience shows that in a health maintenance organization, a sleep disorders clinic provides diagnostic information (based on a polysomnogram and a sleep history) which is very helpful in the final diagnosis of medical disorders. Very few recordings were noncontributory. In this setting, a sleep disorders clinic is justified by its rich diagnostic yield.
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PMID:Benefits of a sleep disorders clinic in a Veterans Administration Medical Center. 725 75

A major problem with studying the prevalence of sleep disorders is the high cost. We tested a portable home recording system which can decrease the cost of screening sleep recordings. Twenty-four senior volunteers and 12 patients referred to our sleep disorders clinic were studied for two nights. On one night, recordings were done in the laboratory with a traditional polysomnogram and the portable home recorder. On another night, portable home recorders were used in the subjects' homes. Of 36 subjects, 42% had sleep apnea and 39% had nocturnal myoclonus. Intermethod correlations were highly significant for sleep apnea index, nocturnal myoclonus index, total sleep period (TSP), total sleep time (TST), and wake time after sleep onset (WASO). The portable home recorder detected sleep apnea on 100% of nights during which sleep apnea was diagnosed by polysomnogram. The labor-saving and cost-saving benefits of home recordings as well as the increased comfort, privacy, and convenience will make the portable home recording the preferred method for many research and clinical applications.
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PMID:Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders. 730 59

Although flow-volume curves are valuable in detecting extrathoracic airway obstruction, their role in testing patients with sleep-disordered breathing is undefined. To determine whether patients with sleep-disordered breathing have abnormal flow-volume curves consistent with variable extrathoracic obstruction, 60 subjects referred with suspected sleep disorders prospectively underwent spirometry and assessment of flow-volume curves. These tests were interpreted independent of the outcome of polysomnography. Fourteen of 35 subjects (40%) with sleep-disordered breathing had abnormal flow-volume curves consistent with variable extrathoracic airway obstruction, and 2 of 25 (8%) with no breathing disorder had extrathoracic obstruction (p less than 0.02). The presence of extrathoracic airway obstruction in subjects with mixed or obstructive sleep apnea did not correlate with age, the presence of snoring, excessive daytime hypersomnolence, obesity, or the severity of sleep apnea. Abnormal flow-volume curves were found more frequently in women who had no obvious structural upper airway abnormality. Because of the high specificity (92%) of the flow-volume curve, the finding of extrathoracic obstruction in patients with a history consistent with sleep-disordered breathing substantially increases the likelihood that sleep apnea is present.
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PMID:Abnormal inspiratory flow-volume curves in patients with sleep-disordered breathing. 730 12

Studies have suggested that sleep apnea is especially prevalent among seniors. We recruited and recorded senior volunteers who reported symptoms raising suspicion of sleep apnea or nocturnal myoclonus. Of 24 subjects, 62.5% had one of these disorders-six had sleep apnea alone, three had sleep apnea and nocturnal myoclonus, ans six had nocturnal myoclonus alone. Sleep stages were also analyzed. Subjects with sleep apnea and/or nocturnal myoclonus had significantly less rapid eye movement sleep, significantly more stage 1 sleep, and significantly more awakenings than other subjects. This sample suggests that the prevalence of sleep apnea and nocturnal myoclonus may be very substantial among seniors. Because of this high prevalence, extreme caution is needed in prescribing hypnotics for older patients with sleep complaints, since most hypnotics are respiratory depressants. We must rethink our approach to treating sleep disorders in the older population.
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PMID:Sleep apnea and nocturnal myoclonus in a senior population. 731 89

The effect of ageing on the sleep of insomniacs was studied by comparing objective insomnia characteristics from polygraphic recordings made during two successive nights in two groups of different ages : 14 patients aged 19 to 39 years (mean 31 years) and 11 aged 42 to 65 years (mean 50 years). All of them had severe insomnia causing them to request consultation for sleep disorders. Their only clinical symptom was chronic primary insomnia, persisting following withdrawal of hypnotics, no other physical (particularly no sleep apnea) or psychological disorder being present. Parameters studied during the first and the second night were the number and duration of intra-sleep awakenings, and the proportions of the sleep and wakefulness periods.
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PMID:[Nocturnal awakenings as a function of age in insomniacs (author's transl)]. 733 21

In the past 30 years, numerous studies have increased our knowledge of the physical process of sleep. One sleep disorder, sleep apnea, has been studied and found to be a serious and life-threatening condition. Diagnosis of sleep disorders is very difficult and requires the use of sophisticated equipment, highly trained personnel, and a unique environment. To confirm the most dangerous form of sleep apnea, obstructive sleep apnea, fluoroscopic evaluation of the upper airway during sleep was performed. This fluoroscopic evaluation of the upper airway during sleep has been termed "somnofluoroscopy."
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PMID:Somnofluoroscopy. 733 97


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