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

Periodic sleep apnea may be due to repeated episodes of upper airway obstruction in patients who have a short thick neck and/or large jowls. Apnea due to complete cessation of breathing may occur to a lesser extent. Anaylsis of the sleep electroencephalogram shows that these patients rarely achieve deep sleep and have less stage 1-REM sleep than normal subjects of comparable age. They are chronically sleep-deprived, a manifestation expressed by daytime somnolence, chronic fatigue and often by personality disturbances marked by paranoia, agitated depression and hostility. The definitive diagnosis of this syndrome may be established by monitoring during sleep, the electroencephalogram, measuring abdominal excursions through a mercury-in-Silastic-strain gauge and recording air flow at the nose by means of a thermocouple. As demonstrated by other investigators, chronic hypoventilation during sleep leads to both pulmonary and systemic arterial hypertension, which may produce generalized cardiac enlargement and congestive heart failure. The abnormalities in the periodic sleep apnea syndrome are abolished by establishing a patent airway either through tracheostomy or weight reduction.
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PMID:Periodic sleep apnea: chronic sleep deprivation related to intermittent upper airway obstruction and central nervous system disturbance. 111 91

A series of investigations suggest a specific role for BCAA in the regulation of respiration. In vitro incubation studies have shown that BCAAs improve the recovery of muscle force after fatigue. Further investigations revealed that leucine plays a key role in this action and acts in a manner not dependent on its use as an energy substrate. In humans, solutions enriched with BCAA have decreased PCO2 and stimulated the ventilatory response to hypercapnia, thereby corresponding to an enhanced ventilatory sensitivity with the administration of BCAA. The mechanisms for these actions are unknown. The most viable hypothesis is based on the ability of BCAA to decrease the synthesis of serotonin due to altered transport of AAs, including tryptophan, to the brain. Clinical studies have suggested a potency of BCAA in the treatment of respiratory dysfunction of preterm infants, as well as of patients with sleep apnea related to various disease states. The clinical applications of BCAA-enriched mixtures in respiratory diseases are still experimental, and many controversies exist concerning the validity of BCAA in clinical practice. Most TPN regimens contain BCAA approximating the average intake of BCAA in the Western diet. The question therefore remains whether additional BCAA supplementation is useful to achieve the suggested metabolic and pharmacological effects. Meticulous future studies are needed to establish the therapeutic value of BCAA in the treatment of various respiratory functions.
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PMID:Branched-chain amino acids and respiration. 142 77

Two patients with obstructive sleep apnoea syndrome are reported where the initial presenting complaint was of lingual ulceration. This unusual presentation has not been reported previously. Both patients experienced frequent apnoeic episodes during sleep with a profound fall in the arterial oxygen saturation. It is postulated that the lingual ulceration resulted from repeated trauma to the tongue by the teeth as the patient made violent inspiratory efforts at the termination of an apnoeic episode. The diagnosis of sleep apnoea syndrome was based upon suggestive symptoms of snoring, morning fatigue and day-time somnolence plus a minimum of 15 apnoeic episodes per hour of sleep. The first-line investigations of this condition are available in all district general hospitals and a diagnosis of sleep apnoea syndrome obtained. Referral to a regional sleep study centre may be appropriate prior to the commencement of therapy. Management is predominantly medical, consisting of weight loss and the administration of nocturnal nasal continuous positive airways pressure.
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PMID:Obstructive sleep apnoea syndrome presenting as lingual ulceration. 151 Sep 3

In summary, the evaluation of the tired patient requires an awareness of the various meanings of tiredness. Furthermore, it is important to differentiate normal sleepiness that is a product of circadian rhythm variation in vigilance from pathologic sleepiness. Sleepiness that results from faulty habits, e.g., altered sleep scheduling, drugs, or sleep restriction, can be readily discerned with the aid of a sleep-wake diary. Because subjective sleepiness is often unappreciated, especially in patients with sleep apnea, methods that rely on self-ratings of the severity of sleepiness, e.g., visual analogue scale, 10-cm line, or SSS may not coincide with performance tasks, observer assessments, or such physiologic methods as the MSLT. Less commonly employed neurophysiologic methods include pupillometry and averaged evoked potentials. On the other hand, the MSLT is commonly used for the detection of physiologic sleepiness. Moreover, it is helpful in evaluating response to treatment. A variation of the MSLT, the MWT, which instructs the individual to remain awake, does not discriminate between sleep onset times for wakefulness and the MSLT for sleepiness in normal subjects. The MWT may be useful for the assessment of treatment responses for excessive daytime sleepiness, e.g., narcolepsy, and for determining the frequency of daytime sleep episodes. The differences that have been observed between behavioral measures and physiologic measures of sleepiness suggest that these techniques assess different aspects of sleepiness. HLA typing (DR2, DQw1) has been shown to be a useful method for corroborating narcolepsy-cataplexy, but the antigens are neither specific for the disorder nor for sleepiness alone.
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PMID:Evaluation of daytime sleepiness. 152 10

Two hundred one patients diagnosed as having obstructive sleep apnea (OSA) were interviewed 12-24 months after their evaluation regarding those daytime symptoms associated with sleep apnea: sleepiness, fatigue, impaired memory, and snoring. Continuous positive airway pressure (CPAP) was the treatment most often used by severe sleep apnea patients, and this improved daytime alertness in 84% of the patients. Patients with moderate obstructive sleep apnea often had surgery which led to 85% reporting improved daytime alertness. Patients with mild obstructive sleep apnea usually were treated with weight loss or changing sleep position and also improved 64% and 66%. Patients who declined or failed treatment did not improve. Guidelines for the treatment of sleep apnea are suggested.
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PMID:Treatment outcome of sleep apnea. 158 4

In order to determine whether the clinical features of obstructive sleep apnoea (OSA) are the same in men and women we reviewed the records of 22 women with OSA. The women were matched with 44 men of similar age (+/- 5 years) and frequency of respiratory events (less than or equal to 15/hr, 16-40/hr, 41-70/hr and greater than 70/hr). The degree of daytime somnolence was similar in men and women. Women are more likely than men to complain of morning fatigue and morning headache, and less likely to report restless sleep or to have been told of apnoea during sleep. Difficulty initiating sleep (DIS) was twice as common in women as in men (p less than 0.05). Most of these differences were also seen when women and men who snored but did not have OSA were compared. Arterial hypertension was less common in women (3/22) than in men (18/44), (p less than 0.001). More striking than the differences between men and women in the prevalence of single symptoms was the existence of a subgroup of women (9/22) with no complaint of either apnoea, choking arousals or restless sleep, and normal blood pressure, complaining only of fatigue and morning headache, and in three cases DIS as well. We concluded that OSA may be commoner in women than previous reports suggest, and that the clinical features may be misleading in women.
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PMID:Differences in the symptoms of men and women with obstructive sleep apnoea. 181 45

Excessive daytime sleepiness is one of the main symptoms of sleep apnoea, which can, especially in monotonous situations, lead to real nodding off. Since driving a motor vehicle can also be monotonous, patients suffering from untreated sleep apnoea may be a possible traffic risk. Before undergoing a polysomnographic examination, 123 patients filled in a questionnaire inquiring about fatigue and sleepiness while driving a vehicle as well as accidents during the past three years. Five groups were formed according to severity of sleep apnoea. Right through these groups, the increase in heavy fatigue during driving (median) was significant: from "seldom" (AI less than 5) via "sometimes" to "often" (AI greater than or equal to 35). Occurrences of short periods of falling asleep (means) were practically not reported (0.02) by the group without sleep apnoea but increased considerably to 3.37 times per 1000 km for the group with an AI greater than or equal to 35. The frequency of accidents due to sleepiness rises significantly in concurrence with the seriousness of sleep apnoea. Besides, patients with an AI greater than or equal to 5 attribute 23 out of 28 accidents to sleepiness, whereas patients without sleep apnoea attribute all four accidents to other reasons (p = .0035). These findings emphasise the importance of an early diagnosis and effective therapy of sleep apnoea - which is available as nasal continuous positive airway pressure ventilation (nCPAP). Sleep medicine can thus not only help patients suffering from sleep apnoea but may also reduce the health risk of other traffic participants and be cost-saving.
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PMID:[Risk of accidents in patients with nocturnal respiration disorders]. 186 6

Postpolio syndrome is a group of related signs and symptoms occurring in people who had paralytic poliomyelitis years earlier. New weakness, fatigue, poor endurance, pain, reduced mobility, increased breathing difficulty, intolerance to cold, and sleep disturbance in various degrees and expressions make up the syndrome. The reported incidence is between 25% and 80%. The origins are multifactorial and can be associated with underexertion, overexertion, inactivity due to intercurrent illness or injury, hypo-oxygenation, sleep apnea, deconditioning, and the failure of sprouted, compensatory large motor units. The exercise question in postpolio syndrome is related to the experience of new weakness or loss of muscle function due to overuse, which is often associated with injudicious repeated challenges to weakened musculature. Carefully prescribed exercise can be used for increasing strength and endurance and improving cardiopulmonary conditioning.
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PMID:Postpolio syndrome and cardiopulmonary conditioning. 186 50

Sleep apnea and other respiratory diseases produce hypoxemia and hypercapnia, factors that adversely affect skeletal muscle performance. To examine the effects of these chemical alterations on force production by an upper airway dilator muscle, the contractile and endurance characteristics of the geniohyoid muscle were examined in situ during severe hypoxia (arterial PO2 less than 40 Torr), mild hypoxia (PO2 45-65 Torr), and hypercapnia (PCO2 55-80 Torr) and compared with hyperoxic-normocapnic conditions in anesthetized cats. Muscles were studied at optimal length, and contractile force was assessed in response to supramaximal electrical stimulation of the hypoglossal nerve (n = 7 cats) or geniohyoid muscle (n = 2 cats). There were no significant changes in the twitch kinetics or force-frequency curve of the geniohyoid muscle during hypoxia or hypercapnia. However, the endurance of the geniohyoid, as reflected in the fatigue index (ratio of force at 2 min to initial force in response to 40-Hz stimulation at a duty cycle 0.33), was significantly reduced by severe hypoxia but not by hypercapnia or mild hypoxia. In addition, the downward shift in the force-frequency curve after the repetitive stimulation protocol was greater during hypoxia than hyperoxia, especially at higher frequencies. In conclusion, the ability of the geniohyoid muscle to maintain force output during high levels of activation is adversely affected by severe hypoxia but not mild hypoxia or hypercapnia. However, none of these chemical perturbations affected muscle contractility acutely.
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PMID:Effects of hypoxia and hypercapnia on geniohyoid contractility and endurance. 193 46

Daytime somnolence and fatigue are frequently ignored symptoms in acromegaly. To examine whether sleep apnea or other abnormalities in the sleep structure is the underlying cause, 9 young patients with active untreated acromegaly for 2-7 years were studied with all night polysomnography. It revealed a decrease in REM sleep time in all the acromegalics compared to age- and sex-matched normal subjects (p less than 0.001) and also a reduction in delta sleep (p less than 0.05). None had obstructive sleep apnea. At reexamination 12-15 months posttreatment the daytime sleepiness had disappeared in all patients. REM sleep time increased in all patients (p less than 0.001) to normal level; delta sleep time increased moderately (p less than 0.05). Thus sleepiness in patients with high fasting level of growth hormone (GH) is not related to sleep apnea but more likely to a reduced amount of REM sleep time. By normalizing the GH concentration, REM sleep time became normal and the daytime sleepiness disappeared in all patients.
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PMID:Sleep in acromegaly before and after treatment with adenomectomy. 204 66


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