Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstructive sleep apnea is a chronic disease whose treatment may require long-term nightly use of relatively cumbersome and expensive breathing equipment that provides continuous positive airway pressure (CPAP) via nasal mask. Compliance with this treatment may be influenced not only by the objective improvement in sleep apnea but also by the patient's subjective perception of the benefit, bed mate or family support, side effects, and cost. The last factor may not be important in Ontario, where 75% of the cost is paid by the Ministry of Health. The goal of this study was to analyze the factors that may influence patient acceptance of nasal CPAP. This was done by tabulating the responses to a detailed questionnaire mailed to 148 patients with obstructive sleep apnea (OSA). There were 96 replies. We were able to contact by telephone an additional 42 patients. The results showed that 105 patients continued to use CPAP at a mean follow-up time of 17 +/- 11 months, some for as long as 6 yr. The majority of patients (81%) perceived CPAP as an effective treatment of the disorder, 5% were unsure, and 14% believed that CPAP was ineffective, despite the resolution of sleep apnea on polysomnography. Subjective improvement reported by the patients was also observed by the family members in 83% of the patients. The most common complaint, voiced by 46% of the patients, was nocturnal awakenings. Nasal problems, such as dryness, congestion, and sneezing, were the second most frequent complaint present in 44% of the responders.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. 155 12

Nasal continuous positive airway pressure (N-CPAP) is now the treatment of choice for patients with sleep apnea syndrome (SAS). Side effects and adverse reactions have been described with this device. We have therefore systematically studied side effects of N-CPAP in 193 patients recruited consecutively from two French sleep centers (Lyon and Grenoble). Patients were followed up with repeated polysomnography, clinical assessment, and a formal questionnaire about subjective benefits and side effects of treatment. The patients (mean age, 59 +/- 12 years) were obese (body mass index, 32 +/- 7 kg/m2) and had been using N-CPAP for 19 +/- 17 months for moderate to severe SAS (respiratory disturbance index [RDI] = 53 +/- 25/h). The clinical presentation was the same in the two sleep centers. Fifty percent of the patients complained of at least one side effect due to the nasal mask (allergy to the face, air leaks, abrasions of the ridge of the nose). Using individually molded masks, the patients exhibited fewer abrasions of the bridge of the nose (p < 0.01) and had red eyes every morning in only 9% of cases vs 24% for the patients using industrial silicone nasal masks (p < 0.025). Patients with silicone nasal masks also had more allergic reaction to the face (13% vs 5%), but this difference did not reach significance. Dry nose or mouth in the morning affected 65% of the patients. Sneezing and nasal drip were present in more than 35% of the subjects and nasal congestion in 25%. When the patients were separated in two groups, whether or not using a humidifier, no difference was found for any of the side effects described. The clinical presentation as to the clinical benefits obtained from N-CPAP were different when comparing mild vs moderate-to-severe SAS. However, no differences were shown in the two subgroups regarding the side effects due to the nasal mask. The discomfort of the N-CPAP apparatus in terms of noise was described more frequently in the subgroup with mild SAS. We did not observe any correlation between the side effects and the level of pressure used during N-CPAP. The rate of compliance remains high with a daily use of 6.5 +/- 3 h, with 88% of the patients using their device every night. This could be explained by the clinical benefit obtained: only 1% of the patients had no subjective benefit induced by their therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. 758 73

Nasal problems are often reported during the treatment of obstructive sleep apnoea syndrome (OSAS) with nasal continuous positive airway pressure (nCPAP) and may jeopardize the use of nCPAP. This retrospective study evaluated the frequency of nasopharyngeal symptoms in OSAS patients before and during nCPAP treatment. A questionnaire was sent to all patients (n = 194) with OSAS for whom nCPAP had been prescribed during the years 1990-1995 at the authors' hospital, enquiring about nasopharyngeal symptoms both before and during treatment and nCPAP use. The study population consisted of the 151 patients [128 men and 23 women, median (range) age 54 (31-76) years and body-mass index 34 (17-54) kg/m2] who responded to the questionnaire. Seventy-one percent of patients were still using nCPAP after a median treatment duration of 30 months. The most commonly reported nasopharyngeal symptoms were nasal stuffiness, which was reported by 46% of patients before nCPAP and by 37% during nCPAP, dry nose (39% before and 46% during nCPAP), sneezing (36% and 35%) and rhinorrhoea (21% and 27%). The frequency of nasopharyngeal symptoms did not change with nCPAP treatment. The frequency of nasopharyngeal symptoms before and during nCPAP treatment was similar in those patients who discontinued the treatment (n = 44, 29%) compared with those who continued with nCPAP (n = 107, 71%). Skin problems caused by the mask (50%), airleak from mouth (44%), difficulty in exhaling (29%) and a sensation of suffocation (26%) were also problems associated with nCPAP treatment. Nasopharyngeal symptoms were common in patients with OSAS before nCPAP was started. There was no significant change in the frequency of these symptoms during nCPAP treatment. Nasopharyngeal symptoms did not seem to affect treatment continuation.
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PMID:Nasopharyngeal symptoms and nasal continuous positive airway pressure therapy in obstructive sleep apnoea syndrome. 1044 68

A 72-year-old man was admitted to our hospital due to dysuria and frequent syncope. The patient had been well until the age of 70 years, when he began with these symptoms and neurogenic bladder was diagnosed in the other hospital. On admission, neurological examinations revealed no abnormal findings except blepharoptosis, anisocoria and orthostatic hypotension. Frequent apnea was evident during sleep. Autonomic function tests showed mainly sympathetic postganglionic dysfunction. Brain magnetic resonance imaging showed lacunar infarctions without cerebello-pontine atrophy or abnormal signals of the basal ganglia. We diagnosed pure autonomic failure (PAF) with sleep apnea syndrome (SAS). After starting nasal continuous positive airway pressure (CPAP) for SAS, his sneezing and sleep apnea drastically improved. Interestingly, CPAP also decreased the severity of orthostatic hypotension and syncope. Ambulatory blood pressure monitoring (ABPM) showed remarkable improvement in diurnal fluctuation of blood pressure after CPAP therapy. Although SAS is frequently associated with Shy-Drager syndrome but not with PAF, patients with PAF had been reported to have degenerative changes in the central nervous system overlapping with Shy-Drager syndrome or Lewy body disease. This case raised the possibility that nasal CPAP may be useful for orthostatic hypotension as well as SAS in neurodegenerative diseases.
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PMID:[A case of pure autonomic failure (PAF) with sleep apnea syndrome (SAS) and successful treatment of dysautonomia with nasal continuous positive airway pressure (CPAP)]. 1514 64

Patients with chronic diseases, including chronic respiratory diseases, usually have considerably impaired sleep quality that may increase the frequency of exacerbations and severity of symptoms, lead to difficulty in patient management, and reduce quality of life (QOL). During the last few decades, several studies have shown that, in addition to the classic signs of sneezing, nasal itching, rhinorrhea, and nasal obstruction, allergic rhinitis has an important impact on the QOL of adults and children. In 2001, the ARIA (Allergic Rhinitis and its Impact on Asthma) report based its new severity classification on the impact of rhinitis on QOL, with the inclusion of sleep disturbances. Thus, allergic rhinitis patients may also suffer from sleep disorders, emotional problems, as well as impairment in daily activities and social functioning. Given that sleep is fundamental for physical and mental health, the present document reviews the methods and questionnaires used to assess the quality of sleep, the importance of sleep in allergic rhinitis, impairment and improvement of sleep in allergic rhinitis by using medications (antihistamines, topical nasal corticosteroids, nasal decongestants, antileukotrienes) and, finally, the relationship between the sleep apnea syndrome with allergic rhinitis and its treatment.
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PMID:Sleep and allergic rhinitis. 1912 31

Rhinitis is a symptomatic inflammatory disorder of the nose with different causes such as allergic, nonallergic, infectious, hormonal, drug induced, and occupational and from conditions such as sarcoidosis and necrotizing antineutrophil cytoplasmic antibodies positive (Wegener's) granulomatosis. Allergic rhinitis affects up to 40% of the population and results in nasal (ocular, soft palate, and inner ear) itching, congestion, sneezing, and clear rhinorrhea. Allergic rhinitis causes extranasal untoward effects including decreased quality of life, decreased sleep quality, obstructive sleep apnea, absenteeism from work and school, and impaired performance at work and school termed "presenteeism." The nasal mucosa is extremely vascular and changes in blood supply can lead to obstruction. Parasympathetic stimulation promotes an increase in nasal cavity resistance and nasal gland secretion. Sympathetic stimulation leads to vasoconstriction and consequent decrease in nasal cavity resistance. The nasal mucosa also contains noradrenergic noncholinergic system, but the contribution to clinical symptoms of neuropeptides such as substance P remains unclear. Management of allergic rhinitis combines allergen avoidance measures with pharmacotherapy, allergen immunotherapy, and education. Medications used for the treatment of allergic rhinitis can be administered intranasally or orally and include oral and intranasal H(1)-receptor antagonists (antihistamines), intranasal and systemic corticosteroids, intranasal anticholinergic agents, and leukotriene receptor antagonists. For intermittent mild allergic rhinitis, an oral or intranasal antihistamine is recommended. In individuals with persistent moderate/severe allergic rhinitis, an intranasal corticosteroid is preferred. When used in combination, an intranasal H(1)-receptor antagonist and a nasal steroid provide greater symptomatic relief than monotherapy. Allergen immunotherapy is the only disease-modifying intervention available.
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PMID:Chapter 5: Allergic rhinitis. 2279 78

Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnoea, which affects millions of people worldwide. However, this therapy normally results in symptoms such as dryness, sneezing, rhinorrhoea, post-nasal drip, nasal congestion and epistaxis in the upper airways. Using bronchial epithelial (Calu-3) and nasal epithelial (RPMI 2650) cells in an in vitro respiratory model, this study, for the first time, investigates the effect of CPAP positive pressure on the human respiratory epithelial mechanisms that regulate upper airways lubrication characteristics. To understand how the epithelium and mucus are affected by this therapy, several parameters were determined before and after positive pressure application. This work demonstrates that the positive pressure not only compresses the cells, but also reduces their permeability and mucus secretion rate, thus drying the airway surface liquid layer and altering the mucus/water ratio. It is also observed that the respiratory epithelia is equally inflamed without or with external humidification during CPAP application. These findings clearly identify the causes of the side-effects reported by patients under CPAP therapy.
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PMID:Effect of continuous positive airway pressure treatment on permeability, inflammation and mucus production of human epithelial cells. 3253 64