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

While many physiological control models exist in the literature, none thus far has focused on characterizing the interactions among the respiratory, cardiovascular and sleep-wake regulation systems that occur in sleep-disordered breathing. The model introduced in this study integrates the autonomic control of the cardiovascular system, chemoreflex and state-related control of respiration, including respiratory and upper airway mechanics, along with a model of circadian and sleep-wake regulation. The integrative model provides realistic predictions of the physiological responses under a variety of conditions including: the sleep-wake cycle, hypoxia-induced periodic breathing, Cheyne-Stokes respiration in chronic heart failure, and obstructive sleep apnoea (OSA). It can be used to investigate the effects of a variety of interventions, such as isocapnic and hypercapnic and/or hypoxic gas administration, the Valsalva and Mueller maneuvers, and the application of continuous positive airway pressure on OSA subjects. By being able to delineate the influences of the various interacting physiological mechanisms, the model is useful in providing a more lucid understanding of the complex dynamics that characterize state-cardiorespiratory control in the different forms of sleep-disordered breathing.
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PMID:An integrative model of respiratory and cardiovascular control in sleep-disordered breathing. 2054 48

Sleep disordered breathing (SDB) including obstructive sleep apnea (OSA), central sleep apnea (CSA), and Cheyne-Stokes breathing is common in patients with congestive heart failure (CHF). In a study of 81 males with an ejection fraction (EF) < 45%, 51% of patients had documented SDB with the majority of cases representing CSA. Studies suggest that SDB is an independent risk factor for increased morbidity and mortality in the setting of CHF. Like OSA, CSA frequently presents with nighttime awakenings, nocturnal hypoxia, and daytime somnolence, but only OSA has been reported to present with delirium. We present a patient with clear manifestations of CSA with frank delirium that improved only after BPAP therapy.
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PMID:An unusual cause of delirium. 2057 24

Sleep-related breathing disorders are common adult illnesses in Western countries and classified as either dominant obstructive sleep apnoea or dominant central sleep apnoea. Cheyne-Stokes Respiration is part of the spectrum of CSA. The earliest descriptions of patients who presumably suffered from sleep apnoea were made in the 19th century. The term ''Pickwickian'' in connection with sleepy patients was introduced in 1889. The first electrophysiological sleep recordings of Pickwickian patients and the understanding of the syndrome as disordered breathing in sleep, were made during the late 1950s and 1960s at the universities of Heidelberg and Freiburg in Germany. The term sleep apnoea syndrome was introduced by Guilleminault from Stanford. The introduction of continuous positive airway pressure (CPAP) therapy by C. E. Sullivan and co-workers gave an enormous impetus to the field of sleep-disordered breathing. Its recognition as a public health problem was facilitated by the Wisconsin study, investigating the prevalence of sleep apnoea in the middle-aged general population. Nowadays obstructive sleep apnoea (OSA) is recognised as an independent risk factor for a wide range of clinical conditions, such as atherosclerosis, hypertension, heart failure, arrhythmias, stroke, diabetes, and depression. This article focuses on issues related to OSA and CSA/CSR, their pathogenesis, interaction with other comorbidities including cardiovascular diseases. Future research will focus on treatment effects on cardiovascular and metabolic outcomes in sleep apnoea and on the pathophysiological mechanisms responsible for the inflammatory state and cardiovascular morbidity in the syndrome. Other potential areas of research include biochemical markers, new diagnostic and therapeutic modalities.
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PMID:[Sleep-related breathing disorders - historical development, current status, future prospects]. 2082 43

Aging effects on sleep are important to consider for the practicing pulmonologist due to the increase in prevalence of major respiratory disorders as well as the normal changes that occur in sleep patterns with aging. Typically, aging is associated with decreases in the amount of slow wave sleep and increases in stage 1 and 2 non-rapid eye movement sleep, often attributed to an increased number of spontaneous arousals that occur in the elderly. Elderly individuals tend to go to sleep earlier in the evening and wake earlier due to a phase advance in their normal circadian sleep cycle. Furthermore the development of sleep-related respiratory disorders such as obstructive sleep apnea (OSA) and central sleep apnea or Cheyne-Stokes respiration (CSA-CSR) associated with congestive heart failure (CHF) occur with increasing prevalence in the elderly. The development of such disorders is often of major concern because they are associated with systemic hypertension and cardiovascular disease, metabolic disorders such as diabetes, and impaired neurocognition. The present review reflects the current understanding of the normal changes in sleep patterns and sleep needs with advancing age, in addition to the effect that aging has on the predisposition to and consequences of OSA and CSA-CSR associated with CHF.
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PMID:Aging and sleep: physiology and pathophysiology. 2094 62

In patients with cardiac disease growing interests have been centered on concomitant co-morbidities such as sleep disordered breathing (SDB). Obstructive sleep apnoea (OSA) as well as Cheyne-Stokes Respiration (CSR) have been recognized as relevant co-morbidities that are highly prevalent and associated with an impaired prognosis. As a known consequence from recurrent hypoxaemias and an increased sympathetic activity, SDB promotes structural myocardial changes and potentially triggers cardiac arrhythmias. Several investigations thus reported an increasing frequency of cardiac arrhythmias among patients with either OSA or CSR. Sufficiently suppressing SDB by adequate therapies seems to ameliorate its arrhythmogenic impact. However, especially for CSR data from randomized, controlled trial are urgently awaited to definitely answer this question.
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PMID:[Sleep disordered breathing and cardiac arrhythmias: mechanisms, interactions, and clinical relevance]. 2134 58

Sleep related breathing disorders are common conditions and the management of patients with sleep apnea is an essential component of routine patient care. Daytime sleepiness is the leading symptom of sleep apnea but not mandatory. Especially patients with cardiac, pulmonary or metabolic comorbidities can benefit from treatment of sleep apnea and those patients should be considered for cardio-respiratory screening even with mild clinical symptoms. Continuous positive airway pressure therapy is still the most efficient treatment for sleep apnea and standard treatment for severe forms. With patient education, training and close follow-up a reasonably good compliance can be achieved in adequately selected patients. In mild forms of sleep apnea oral appliances may be efficient and in highly selected lean patients with anatomic risk factors upper airway surgery may be considered. Central sleep apnea, especially Cheyne-Stokes respiration, is highly prevalent in patients with severe cardiac insufficiency. If this disorder persists after cardiac treatment special ventilation modes like adaptive servo ventilation can be used.
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PMID:[Sleep related breathing disorders]. 2150 81

Respiratory disorders in sleep are highly prevalent and increasingly recognized. Among these, obstructive sleep apnea, resulting in daytime fatigue and somnolence, increased risk of workplace and traffic accidents but also psychosocial dysfunction, is most often diagnosed. As an independent risk factor for cardiovascular and metabolic disease, obstructive sleep apnea has recently attracted even more attention. Apart from continuous positive airway pressure, only a few alternative treatment options are available. Individual history is still most important for selecting patients for sleep studies. Fatigue and a high subjective propensity to fall asleep during the daytime, a history of snoring and breathing pauses during sleep combined with anthropometric risk factors make a diagnosis very likely. Other night-time respiratory disorders include central sleep apnea, Cheyne-Stokes respiration, obesity hypoventilation syndrome and mixed sleep apnea syndromes. The diagnosis of sleep-disordered breathing can be made by comprehensive sleep studies in a sleep laboratory, but also using portable equipment for cardiorespiratory monitoring and measurement of oxygen desaturation at home, according to pretest probabilities, individual experience and local preferences.
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PMID:Diagnostic approach to sleep-disordered breathing. 2185 76

Positive airway pressure (PAP) is the therapy of choice for most sleep-related breathing disorders (SRBD). A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV) must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP), most commonly used for symptomatic obstructive sleep apnoea (OSA) without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP). Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV), which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal PAP device must be carefully selected, taking into account side effects that influence compliance.
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PMID:Selective indication for positive airway pressure (PAP) in sleep-related breathing disorders with obstruction. 2207 75

THREE CLASSES OF CENTRAL SRBD ARE DISTINGUISHED: 1. Central sleep apnea (CSA), 2. Cheyne-Stokes Respiration as a subgroup of CSA and 3. central hypoventilation syndromes. Reduced or completely absent central respiratory drive without upper airway obstruction is the common feature of central SRBD. Hypoventilation syndromes most often occur secondary in patients with neuromuscular, pulmonary or sceletal diseases or in patients with massive obesity. In patients with hypoventilation during sleep nocturnal and exertional dyspnea and headaches are frequently reported symptoms. Excessive daytime sleepiness is the key symptom in patients with central sleep apnea syndrome. Cheyne-Stokes Respiration is frequent in heart failure patients but in many cases does not cause symptoms specific for the breathing disorder. If there are symptoms or if ambulatory recording of breathing during sleep suggests a sleep related breathing disorder, polysomnography is then performed to definitively rule out or confirm the diagnosis and to initiate treatment, if needed. The indication for treatment in asymptomatic patients with central sleep apnea and Cheyne-Stokes Respiration may be difficult, as there are very little data concerning the long-term benefit in these patients. Symptomatic patients and those with severe central sleep apnea should be treated. Oxygen and CPAP may be effective in 20-30% of patients each. If these treatment options are ineffective, non-invasive pressure support ventilaiton can be used. In patients suffering from hypoventilation syndromes the treatment of choice is non-invasive pressure support ventilaiton combined with supplemental oxygen, if required.
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PMID:Central sleep related breathing disorders - diagnostic and therapeutic features. 2207 76

Obstructive sleep apnea and central sleep apnea with Cheyne-Stokes respiration are associated with an increased risk of cardiac arrhythmia. Apnea- associated arrhythmia may contribute to sudden cardiac death and premature mortality in those patients. Both forms of sleep apnea excert strong modulatory effects on the autonomic system with a special autonomic profile. Profound vagal activity is leading to bradyarrhythmias, and sypathico-excitation to tachyarrhythmias. Atrial fibrillation and ventricular arrhythmias in obstructive and central sleep apnea patients are mainly found in combination with cardiovascular comorbidity (coronary heart disease, hypertensive heart disease, chronic heart failure). Bradyarrhythmias in OSA are induced by a cardioinhibitory vagal reflex due to obstructed airway. CPAP-therapy has been demonstrated to reduce arrhythmias.
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PMID:[Autonomic dysfunction and cardiac arrhythmia in patients with obstructive and central sleep apnea]. 2216 Sep 56


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