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

This study investigates the relationship between nocturnal or morning headache and obstructive sleep apnea syndrome (sleep apnea). It is not known if headache of any type is more common in patients with sleep apnea than in other patients, but morning headache is a symptom of sleep apnea. A method is needed for identifying patients with chronic headache who might benefit from evaluation and treatment of sleep apnea. We performed a retrospective assessment of frequency of morning headache in patients grouped according to final diagnosis: sleep apnea (n = 72), periodic leg movements of sleep (n = 28), and psychophysiologic insomnia (n = 42). Prospective overnight sleep studies were obtained in a different group of 19 patients who presented for evaluation of headache. We selected certain patient characteristics as possibly indicative of sleep apnea-related headache. The retrospective study showed that 24% of patients with sleep apnea had frequent morning headache, which was not different from the other groups. In the separate group of 19 patients with chronic headache and suspected sleep disorder, 17 had sleep apnea. Nasal continuous positive airway pressure was prescribed to 14 patients. Marked improvement in headache occurred and persisted in 4 patients and moderate improvement in 3. Responders to therapy were more likely to have vascular headaches than mixed or tension headaches, more severe sleep apnea, and a nocturnal or morning timing to their headaches. However, there was large overlap in severity of sleep apnea and likelihood of response. We conclude that morning headache is not more common in sleep apnea than in other sleep disorders. However, over 30% of patients with chronic headache and other symptoms of sleep apnea have significant improvement in headache after treatment of sleep apnea.
Headache
PMID:Identification and treatment of sleep apnea in patients with chronic headache. 855 Mar 58

We examined the relationship between daytime symptoms and respiratory disturbance indices during sleep in 60 patients with sleep apnea syndrome who had an apnea index of more than 5/hr for at least one night. Daytime hypersomnolence, morning headache, and a history of traffic accidents did not correlated strongly with apnea index or with nocturnal desaturation. The same was true of daytime blood pressure and nocturnal micturition. Both hemoglobin concentration and the mean pulmonary arterial pressure in the daytime correlated significantly with indices of nocturnal desaturation and not with apnea index, but this might reflect the positive correlation between those variables and the base-line level of daytime PaO2, in which case it would not be a direct consequence of nocturnal desaturation. These data suggest that diagnostic criteria should not be based on apnea index or desaturation alone. Long-term follow-up data on Japanese patients is needed to establish more rational diagnostic criteria and stage classification for sleep apnea syndrome.
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PMID:[Current problems in the Diagnosis and stage classification of sleep apnea syndrome]. 875 84

Sleep apnea and snoring are widely discussed as risk factors for internal and neurological diseases. The prevalence of snoring in an Austrian population survey is about 27.2% (males 36.5%, females 18.9%), and that of apnea (respectively irregularity and/or cessation of breathing) about 8.5% (31% of all snorers). Clinical symptoms like naps, daytime sleepiness, unquiet sleep, hypertonia, headache in the morning and psychological symptoms may be characteristics of sleep apnea. They should lead to further diagnosis and removal of this risk factor for ischemic heart disease and stroke.
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PMID:[Sleep apnea as a risk factor]. 883 23

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30-64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.
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PMID:Headache, snoring and sleep apnoea. 889 61

A 55-year-old obese man was admitted to our hospital because of a severe morning headache. He snored and had recurrent episodes of sleep apnea that began 10 years earlier and had since become much worse. An overnight polysomnographic recording confirmed that he had sleep apnea syndrome, predominantly of the central type. The apneas were more frequent when he lay on his back (apnea index 54.5) than on his side (apnea index 1.2). He was treated with sleep position adjustment and nasal bi-level positive airway pressure, inspiratory positive airway pressure at 5 cmH2O and expiratory positive airway pressure at 2 cmH2O. His snoring, headache, and oxygen desaturation resolved. This case suggests that airway collapse may cause central apnea, and that nasal continuous positive airway pressure, and nasal bi-level positive airway pressure and adjustment of sleep position can be effective in some patients with central-type sleep apnea syndrome.
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PMID:[Central sleep apnea syndrome successfully treated with nasal bi-level positive airway pressure and sleep position adjustment]. 916 57

Forms of sleep apnea syndrome: Interrupted breathing and hypoventilation during sleep lead to sleep disorders and to cardiovascular sequelae. In the common obstructive sleep apnea syndrome (OSAS) apneas are related to intermittent obstruction of the upper airways. In the rarer central sleep apnea syndrome certain cardiovascular or central nervous system disorders lead to disturbed regulation of respiration connected with periodic breathing. Signs indicating OSAS: Loud, cyclic snoring, interrupted by cessation of breathing during sleep observed by relatives and excessive daytime to diurnal sleepiness indicate OSAS. Furthermore alteration of personality, headache in the morning, non-refreshing sleep and nocturnal choking sensations may indicate OSAS. When is evaluation necessary? Patients with complaints possibly induced by OSAS should be further evaluated since nocturnal application of continuous positive airway pressure (CPAP) by means of a nose mask and other treatment forms often lead to significant improvement of OSAS. In addition patients with untreated OSAS have an increased risk for car accidents and premature death as consequence of cardiovascular diseases. The type and extent of a supposed respiratory disorder is evaluated by means of a sleep study.
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PMID:[Indications in sleep-apnea syndrome. When and why is further assessment meaningful?]. 919 Jun 46

Some patients with chest wall diseases (CWD) without respiratory failure manifest important alterations in nocturnal gas exchange, as a previous stage to the future development of daytime respiratory failure. The purpose of this study was to evaluate the efficacy of nasal intermittent positive pressure ventilation (NIPPV) during sleep in a group of obese patients and in another group with restrictive thoracic diseases (RTD), comparing the results with those obtained from conventional nocturnal oxygen therapy. From a total of 42 patients with CWD free of daytime respiratory failure, 27 (64%) were considered nocturnal oxygen desaturators without sleep apnea and were included in the study. The study protocol was completed by 21 of these patients. After 2 weeks of treatment, symptoms of dyspnea, morning headaches, and morning obnubilation improved significantly (p<0.05) in both groups of patients after NIPPV but not with oxygen. Baseline daytime PaO2 was 68+/-7 mm Hg in the obese group of patients and 73+/-11 mm Hg in the RTD group. It improved significantly with NIPPV to 73+/-5 mm Hg in obese patients (p<0.05) and to 77+/-12 mm Hg in the RTD group (p<0.05) but did not change with oxygen (68+/-8 mm Hg in the obese group and 73+/-12 mm Hg in the RTD group). Both treatments improved oxygen saturation during sleep, but oxygenation tends to be higher with oxygen than with NIPPV. Only NIPPV was able to normalize the baseline nocturnal alveolar hypoventilation. From the 21 patients treated, 19 decided to continue with long-term NIPPV, one with oxygen, and one refused treatment. We conclude that in patients with CWD who manifest nighttime oxygen desaturation and hypoventilation, early initiation of NIPPV is preferable to supplemental oxygen. Our results also suggest that NIPPV initiated before overt ventilatory failure could prevent its onset.
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PMID:Noninvasive positive pressure ventilation and not oxygen may prevent overt ventilatory failure in patients with chest wall diseases. 922 78

Some of the clinical features of obstructive sleep apnoea syndrome (OSA) are suggestive of impaired cerebral blood flow. Cerebral blood flow alterations might, for example, be responsible for headaches, which are frequent complaints in patients with OSA. Even the high frequency of ischaemic cerebral complications in patients with OSA might be caused in part by sleep apnoea-associated impairment of cerebral perfusion. Previous studies have demonstrated reduced total cerebral blood flow in patients with OSA, but regional changes of cerebral perfusion have not been studied up to now. We performed SPECT studies using 99mTc-(d,l)-hexamethyl-propylenaminoxim (HMPAO) as a tracer in 14 adult patients with moderate to severe OSA (AHI > 30/h; mean AHI 59.2 +/- 4.3). The injection of the tracer took place between 2:00 and 4:00 a.m. while repeated episodes of obstructive apnoea were detected by polysomnography during stage II sleep. Data acquisition took place at 7:30 a.m. All measurements were repeated some nights later under effective treatment with nCPAP. Visual analysis showed marked frontal hyperperfusion in 5 patients. When regional perfusion indices were calculated for 32 regions of interest statistical analysis showed reduced perfusion of the left parietal region. These changes were completely reversed by effective nCPAP therapy. These data suggest that OSA is associated with reversible changes of regional cerebral perfusion. The underlying pathophysiologic mechanisms are matter of speculation so far. There might be an apnoea-associated effect of local vascular autoregulation mechanisms acting to compensate systemic blood flow alterations or blood gas changes in OSA. The observed frontal hyperperfusion might be caused by activation of the frontal lobe by repetitive cortical arousals.
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PMID:[Changes in regional CNS perfusion in obstructive sleep apnea syndrome: initial SPECT studies with injected nocturnal 99mTc-HMPAO]. 941 46

The first series of children with obstructive sleep apnoea syndrome was reported in 1976. Later it became apparent that children may have breathing disorders during sleep without frank apnoea or 'hypopnoeas'. This pattern could be detected by measuring the oesophageal pressure. This led to the concept of sleep-disordered breathing as a spectrum that combines obstructive sleep apnoea syndrome and the upper airway resistance syndrome. Studies that do not take into account this spectrum may misclassify symptomatic patients as 'primary snorers'. The exact prevalence of sleep-disordered breathing in children is unknown but may be as high as 11%. There is a familial predisposition to sleep-disordered breathing. Nasal obstruction and mouth breathing influence facial growth, which may further lead to difficulty in breathing while asleep. Symptoms include an increase in total sleep time, nonspecific behavioural difficulties, hyperactivity, irritability, bed-wetting and morning headaches. Clinical signs include failure to thrive, increased respiratory effort with nasal flaring and suprasternal or intercostal retractions. Also, abnormal paradoxical inward motion of the chest may occur during sleep. Excessive daytime sleepiness and obesity are not always present. Untreated children may develop cardiovascular complications. The condition is treatable with continuous or bilevel positive airway pressure, and may be cured with surgery.
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PMID:Sleep-disordered breathing in children. 978 33

The response to nasal continuous positive airways pressure (nCPAP) of a wide variety of symptoms recognized to be associated with obstructive sleep apnoea syndrome (OSAS) was examined. Fifty-six consecutive patients with OSAS, confirmed by polysomnography (mean (SD) apnoea-hypopnoea index (AHI) 49.6 (22.6) events x h(-1), Epworth score 15.4 (5.0)), were asked to complete paired symptom evaluation questionnaires, before treatment and again after 4 months of nCPAP. The response rate was 80%. A control group of 21 consecutive OSAS patients of similar age, body mass index (BMI), AHI and Epworth score to the treated group but managed with conservative measures, completed the same questionnaires on two occasions, 4 months apart. The nCPAP-treated group showed significant reductions (Wilcoxon matched pairs test) in the symptoms of daytime sleepiness, restless sleep, heartburn, nocturia, enuresis, headache and nocturnal sweating, whereas controls showed no significant changes in these symptoms. There were no changes in BMI, smoking, alcohol consumption or exercise habits in either group. It was concluded that, in addition to improvements in symptoms of daytime sleepiness and restless sleep, a wide range of other symptoms may improve significantly with nasal continuous positive airways pressure therapy.
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PMID:Subjective efficacy of nasal CPAP therapy in obstructive sleep apnoea syndrome: a prospective controlled study. 1041 8


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