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

A 56-year-old male was admitted because of respiration arrest during sleep, and precordial crushing sensation which repeatedly occurred early in the morning. He had been hypertensive and aware of daytime sleepiness for ten years. After admission, all night polysomnography was recorded a total of four times. Apnea index was 37.5 times/hour, and central type apnea was predominant. The diagnosis of sleep apnea syndrome was made. In the early morning of the fourteenth day after admission, the patient developed anterior chest pain associated with ST elevation in leads II, III, and aVF of the electrocardiogram. Thus, the case was thought to be complicated by variant angina. There were no anginal attacks during the all night polysomnography recordings. However, a causal relationship between the sleep apnea and variant anginal attacks was suspected. Since both the sleep apnea and the variant anginal attacks tended to occur during the stages of REM sleep, and they are both related to changes in activity of the autonomic nervous system. It was considered that hypoxemia following sleep apnea and/or the hyperventilation after the apneic episodes might be the cause of the variant anginal attacks.
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PMID:[A case of sleep apnea syndrome with variant angina]. 180 88

A 52-year-old man with myxedema was evaluated for anterior chest pain that was considered to be compatible with myocardial ischemia. The night after admission he developed extreme bradycardia, hypotension, and apneic episodes lasting up to 25 s. Continuous positive airway pressure and administration of medroxyprogesterone acetate prevented further episodes and relieved much of the somnolence and lethargy that had contributed to the evidence for myxedema. Alveolar hypoventilation caused by decreased sensitivity to carbon dioxide, inadequate central neural drive, peripheral muscle force, and obesity all may have contributed to the apnea. Chest pain has not recurred, and results of electrocardiography have remained normal following full thyroid hormone replacement. The early recognition of myxedema causing sleep apnea will allow specific treatment to avoid the cardiovascular risks related to prolonged apnea and will help avoid confusion with other etiologies of cardiovascular abnormalities.
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PMID:Extreme bradycardia during sleep apnea caused by myxedema. 363 55

The increased mortality among patients with obstructive sleep apnea syndrome has been explained in part by the increased incidence of arterial and pulmonary hypertension. A decreased heart rate variability (HRV) has been shown to be associated with an increased mortality as well. We investigated 53 patients, admitted to the hospital for chest pain for sleep-related breathing disorders (SRBD) with an ambulatory screening device (MESAM-IV). HRV was recorded simultaneously. All patients received coronary artery catheterization and 36 had significant coronary artery disease (CAD; 67.9%). Standard time domain parameters were compared by a 4-way Anova for patients with an oxygen desaturation index of more and less than 5/hour and the factors CAD, diabetes and beta-blocker use. The percentage of differences between RR intervals that differ more than 50 ms (pNN > 50: 9.0 +/- 11.1 vs. 19.2 +/- 22.2%: p < 0.05) as well as the root mean square of these differences (38.0 +/- 29.0 vs. 59.2 +/- 51.5 ms; p < 0.05) were significantly decreased in patients with SRBD. In an hourly breakdown the number of desaturations was not correlated with a change in HRV. Mean oxygen saturation was significantly decreased in patients with SRBD (95.2 +/- 1.8 vs. 96.2 +/- 1.42%, p < 0.05), and positively correlated with the pNN > 50 (r = 0.34, p < 0.01). This correlation might suggest a more profound pathophysiological interaction between HRV and SRBD than short-term vagal activation alone. The results favor HRV for inclusion in future risk stratification models in patients with sleep apnea syndrome.
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PMID:Heart rate variability in patients with sleep-related breathing disorders. 890 76

This descriptive study describes the frequency and severity of sleep-related breathing disorders in men who are hemodynamically stable who have an acute cardiovascular illness and are hospitalized in a critical care unit. Sixty-four males, aged 55-79 years, with an acute cardiovascular illness, stable hemodynamics, and no ongoing chest pain or history of sleep apnea were studied for 1 night in the critical care unit using polysomnography. Forty-seven percent of the sample had an apnea-hypopnea index > or = 5, with events of both obstructive and central etiologies, including Cheyne-Stokes respiration. Oxygen desaturation to < or = 90% occurred in 61% of the sample. There were no episodes of chest pain, ventricular tachycardia, or heart block associated with apneic or hypopneic events; however, dysrhythmias, including sinus bradycardia, supraventricular tachycardia, and premature ventricular beats, were associated with apneic and hypopneic events.
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PMID:Sleep-related breathing disorders in patients who are critically ill. 1235 92

Laparoscopic adjustable gastric banding (LAGB) is gaining popularity as a technique for achieving effective weight loss in the severely obese population. It is a minimally invasive procedure and the reported early morbidity is low. However, we have observed at our institution that occasional patients complain of central chest pain, mimicking angina (verbal pain score of > 7 out of 10), within 2 h after the procedure. This is a worrying symptom because obesity is known to be a major risk factor for developing cardiovascular complications. We have now performed 250 LAGB operations at our hospital. The following four case reports document our patients who presented with early chest pain postoperatively. Common characteristics of male gender, morbid obesity and some degree of obstructive sleep apnoea were identified among the cases. The aetiology of the chest pain is uncertain; nevertheless, close monitoring is vital to exclude pathological events such as acute coronary syndrome.
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PMID:Chest pain in the early postoperative period after laparoscopic adjustable gastric banding: four case reports. 1654 61

Obstructive sleep apnea syndrome (OSAS) is a common disease characterized by repetitive partial or complete closure of the upper airway during sleep. Cardiovascular disturbances are the most important complications responsible for increased morbidity and mortality. It is suggested that daytime somnolence, chronic fatigue, and nocturnal hypoxemia may further impair muscle function and decrease exercise fitness. The aim of this study was to evaluate cardiopulmonary response to exercise in OSAS patients. One hundred and eleven middle aged (50.2+/-10 yr), obese (BMI 31.0+/-4.6 kg/m2) patients (109 M, 2F) with severe OSAS (AHI 47.2+/-23.1 h(-1)) were enrolled into the study. OSAS was diagnosed with overnight polysomnography and a symptom-limited cardiopulmonary exercise test was performed on a treadmill using Bruce protocol. The results showed that the most frequent reason for exercise termination were: muscle fatigue and/or dyspnea (66+/-), increase in systolic blood pressure>220 mmHg (20%), ECG abnormalities, and chest pain (6%). Although the mean VO2 peak was within the reference value (29.6+/-6 mlO2/kg/min), in 52 patients (46%) VO2 peak was <84% of predicted. Hypertensive response to exercise was diagnosed in 39 of patients (35%). Patients with severe sleep apnea (AHI40>or=h(-1)) were characterized by higher mean blood pressure at rest, at 25%, 50% of maximal work load, at peak exercise and at post-exercise recovery. Several significant correlations between hemodynamic responses to exercise and sleep apnea severity were also noted. We conclude that exercise tolerance can be limited due to hypertensive response in about 20% of patients. Patients with severe OSAS have exaggerated hemodynamic response to exercise and delayed post-exercise blood pressure recovery. Cardiopulmonary response to exercise seems to be related to sleep apnea severity.
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PMID:Exercise capacity in patients with obstructive sleep apnea syndrome. 1820 70

Gastro-oesophageal reflux disease has now been definitely associated with pulmonary symptoms and diseases, such as asthma, cough, chronic bronchitis, pneumonia, and pulmonary fibrosis; otolaryngologic symptoms and findings include hoarseness, pharyngitis, cough, laryngitis, subglottic stenosis, globus, and laryngeal cancer. Gastro-oesophageal reflux disease is also associated with noncardiac chest pain, dental erosion, sinusitis and sleep apnoea. This discussion focuses on some of these extra-oesophageal presentations of gastro-oesophageal reflux disease and the general management of these individuals.
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PMID:Extra-oesophageal presentation of gastro-oesophageal reflux disease. 2083 75

Sleep Apnea Syndrome (SAS) constitutes a healthcare issue of major importance at international level with a prevalence of 5% in the active population. Consequentially to the induced co-morbidities, the mortality reaches as high as 39% at eight years time lapse from the initial diagnostic. Seldom undiagnosed, the severity spectrum of SAS, in the absence of therapy, only continues to amplify. Here below, we are presenting the case of a 49 years old patient, railroad controller worker, non-smoker and occasionally alcohol user, who was hospitalized in our Clinic for Occupational Medicine. During last year, the patient was accusing excessive daytime somnolence, breath arrests during sleep, intense snoring, morning headaches, morning oral dryness, pin point chest pain, nocturia (4-5 nocturnal urination), concentration difficulties and an overall reduced work capacity. The presumptive diagnostic of Obstructive Sleep Apnea is being considered based on the correlation between the clinical presentation and the Epworth, Stanford and Berlin questionnaire results. The key diagnostic element was the polygraph recording over an 8 hours sleep period. Positive Diagnosis: Obstructive Sleep Apnea severe form. Management and recommendations: (1) Behavioral therapy (weight loss) and (2) CPAP (Continuous Positive Airway Pressure) therapy which was instituted immediately after the positive diagnosis was made. As a consequence, the respiratory symptoms, the frequent episodes of daytime snoozing and the concentration difficulties at work place diminished considerably.
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PMID:Obstructive Sleep Apnea Syndrome in a Railroad Controller Worker. 2607 66