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

The distribution of symptoms, physiologic responses, and upper airway structure in members of one family with three generations of subjects with sleep apnea (SA) is reported. Questionnaire data were obtained from ten family members (ages 7 to 66 years), overnight sleep studies were performed in nine subjects, and ventilatory responses to hyperoxic hypercapnia and to eucapnic hypoxia and cephalometry were obtained in five subjects. All ten family members reported habitual snoring or nighttime snorting/gasping; five of ten family members also reported excessive daytime sleepiness. All studied subjects except for a pregnant woman had greater than ten apneas/hypopneas per hour. Ventilatory responses to hypoxia were markedly reduced in all five subjects studied (less than or equal to 0.51 L/min/SaO2); hypercapnic responses were reduced in three of five subjects (less than or equal to 0.61 L/min/mm Hg CO2). No subject was morbidly obese (body mass index less than 29 kg/m2) or demonstrated retrognathia. The posterior airway space was reduced in three subjects, and the mandibular to hyoid distance was increased in four subjects. The two subjects with the longest soft palates and the most inferiorly displaced hyoids had the most severe sleep disorder. Sleep apnea was present, albeit less profound, in the one subject with normal anatomy who had an abnormal hypoxic ventilatory response. The distribution of these physiologic and anatomic measurements in this family provides further support for a genetic basis for SA, and suggests that the disorder may occur as a result of interactions between ventilatory control abnormalities and anatomic risk factors.
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PMID:A family study of sleep apnea. Anatomic and physiologic interactions. 239 35

After shorts general considerations about physiologic and epidemiologic features relative to sleep, snoring and apneas in elderly, authors bring analysis of 30 snorers over sixty years. They all had a sleep recording, a ENT examination, and a pharyngeal C.T. scan. The main results are following: the high frequency of Sleep Apnea Syndrome (SAS) over 60 is to be carefully considered. So, Sleep recording appears necessary in the main part of this population. Cardiovascular, pneumologic and neurologic disease are very often associated, and do constitute elements of therapeutic choice. Velopharyngeal narrowing, without other level of superior airway closure, is the usual case. Therapeutic management is often difficult; there is a choice, in apneic patients, between Uvulo-Palato-Pharyngoplasty (UPP), sometimes impossible because of associated pathology, and nocturnal Continuous Positive Airway Pressure (CPAP), which employment is not always easy.
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PMID:[Snoring and sleep apnea syndrome in the elderly]. 249 19

We have evaluated the influence of nonrapid eye movement (NREM), REM sleep, and arousal on abdominal muscle contractions during snoring and/or obstructive apnea in 10 prepubertal children. All children were known habitual snorers and eight had a sleep apnea index above 10. During stage 3-4 non-REM sleep, non-apneic breathing with snoring was always associated with the presence of expiratory abdominal muscle electromyogram (EMG) discharges. During non-REM sleep apneas, abdominal muscle EMG discharges increased from the beginning to the end of each apnea. Termination of non-REM sleep apnea was marked by an "EEG arousal" in 12% of the apneic events and by a "movement arousal" in the other 88%. The highest abdominal muscle EMG discharge was always observed during the arousal response. During "phasic" REM sleep, abdominal muscle EMG discharges were absent during both nonapneic breathing (with or without snoring) and obstructive apneas. All REM sleep apneas ended with a "movement arousal," during which abdominal muscle EMG discharges were observed. Thus, abdominal muscle EMG discharges associated with "arousal" were seen independent of the immediately preceding sleep state.
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PMID:Sleep-related abdominal muscle behavior during partial or complete obstructed breathing in prepubertal children. 252 75

Sleep apnea syndromes have been identified only relatively recently. Their most frequent form is characterized by a sleep-related upper airway obstruction resulting in apneas which may repeat themselves up to several hundred times during a night's sleep. Their mean duration is about 30 to 40 seconds, but some apneas last over one minute. Breathing resumption requires an arousal, which may be clearly identified on the EEG but usually goes unnoticed by the patient. The most immediate consequence are hypoxemia and sleep fragmentation. There may be associated arrhythmias and hemodynamic changes, especially in the pulmonary circulation. The predominant clinical signs are snoring (during the breathing resumption between the apneas) and daytime somnolence due to sleep fragmentation. In addition to the risks of work and traffic accidents, these patients run a long-term risk of cardiovascular accidents. About 20% develop pulmonary hypertension, a contributing factor to right heart failure. About 50% are hypertensive, which combined with a frequently observed polycythemia, makes them vulnerable to ischemic accidents. The treatment is based upon the use of continuous positive airway pressure (CPAP) during sleep. In case of failure, surgical alternatives may be considered.
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PMID:[Sleep apnea syndromes]. 253 41

Eight studies that examined the relation between snoring and vascular disease were identified. The prevalence of habitual snoring, measured by questionnaire or interview, varied from 3% to 29% of adults and was dependent on age, sex, obesity, and smoking habit. In men, habitual snoring was associated with hypertension and ischaemic heart disease, with adjusted relative risks in the range 1.3-2.0. For women, only one study provided adjusted estimates of relative risk, which were 2.8 for hypertension and 1.2 for angina. Adequately adjusted relative risks for cerebrovascular disease have not been reported, but unadjusted estimates varied from 1.6 to 10.3. These studies had several limitations, including the lack of a standard definition of snoring, the use of unvalidated questionnaires, and failure to account for confounding variables and the possibility of reporting bias. Only one study was prospective. Epidemiological criteria for a causal association between snoring and vascular disease have not been satisfied. The apparent excess risk is probably due to the consequences of sleep apnoea rather than snoring itself.
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PMID:Is snoring a cause of vascular disease? An epidemiological review. 256 56

We studied the influence of hypoxia due to sleep apnea on testosterone (T) secretion. It was conducted on the basis of an idea that sustained hypoxia may depress T secretion. The subjects consisted of 15 male patients with no drug administration whose complaints were snoring and/or obesity. The subjects participated in a sleep study on two consecutive nights. During the first night we collected blood samples starting every 4 hours from 10 PM via a catheter and measured T. From the data of the second night, we calculated total desaturation time with more than 4% from the baseline SaO2. According to the amount of this desaturation time, the subjects were divided into 2 groups; desaturation time less than 80 min in group 1 and longer in group 2, respectively. The peak value was seen at 6 AM in group 1 and at 10 AM in group 2. We investigated the correlation between the ratio of T10/T6, which is the ratio of T level at 10 AM to that at 6 AM, and parameters of sleep disorders related to oxygen desaturation. Total 4% desaturation time in total sleep period and non REM period significantly correlated with this ratio. From the diagram illustrating the correlation between the ratio and total 4% desaturation time in total sleep period, we could assume that if the ratio is beyond 1, the subject may have had more than about 80 min of total 4% desaturation time.
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PMID:[Prediction of the degree of nocturnal oxygen desaturation in sleep apnea syndrome by estimating the testosterone level]. 261 9

Thirty-four patients (32 male, 2 female; mean age 53 +/- 7 years) with confirmed sleep apnea syndrome (SAS) were studied before and after uvulopalatopharyngoplasty (UPPP). Clinical symptoms were tiredness, excessive daytime sleepiness and snoring. All patients were overweight. Patients underwent a thorough physical and oropharyngeal examination and polysomnography before and 3 months after surgery. On the basis of post-operative results, patients are divided into 3 groups: --group 1: 16 cured patients: apnea index (A.I./h) 38 +/- 17 before and 4.4 +/- 4 apneas/h sleep after surgery. Improved nocturnal hypoxemia: mean minimum oxyhemoglobin saturation (SAO2) before and after UPPP in NREM sleep 83 +/- 4% v. 90 +/- 4% in REM sleep 76 +/- 11% v. 85 +/- 7%. Uninterrupted sleep is restored; --group 2: 8 improved patients: A.I./h of 64 +/- 11 before and 20 +/- 6 after UPPP: improved nocturnal hypoxemia: mean minimum SAO2 in NREM sleep 74 +/- 10% before and 86 +/- 6% after UPPP: in REM sleep 59 +/- 9% before and 79 +/- 6% after UPPP, lower amount and percentage of fragmented sleep; --group 3: 10 non-improved patients: A.I./h unchanged 55 +/- 22% before and 50 +/- 20% after UPPP. Persistent nocturnal hypoxemia: mean minimum SAO2 in NREM sleep 76 +/- 13 before and 81 +/- 12% after UPPP: in REM sleep 63 +/- 16% before and 65 +/- 24% after UPPP. Sleep remains fragmented. In this last group patients are more overweight and all suffer from severe SAS with greater nocturnal oxyhemoglobin desaturation. Surgical treatment by UPPP is shown to be effective for 70% of our patients. Better results are obtained when SAS is less severe and overweight less important.
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PMID:[Efficacy of uvulopalatopharyngoplasty (UPPP) and modifications in sleep structure in the sleep apnea syndrome (SAS)]. 261 54

Sleep apnea syndrome is a condition characterized by recurrent interruption of breathing during sleep. Triad of symptoms for the disease are insomnia, daytime sleepiness and snoring. Recently, the patients complained of these symptoms have progressively increased. And so serious attention has been given to investigate the entity of this new clinical syndrome in medical and dental aspects. Three types of sleep apnea are classified; central, obstructive and mixed type. Most of patients identified this syndrome include obstructive or mixed types of sleep apnea. Obstructive sleep apnea has been presumed to have close relationships with obesity, micrognathia, retrognathia, tonsillary hypertrophy, tongue hypertrophy and so on. This study was designed to evaluate the characteristics of the dentofacial morphology in the obstructive, included mixed, sleep apnea syndrome (OSA) patients. The samples consisted of 25 adult male patients (average age of 48 years 2 months) with OSA as diagnosed by the division of respiratory disease, department of internal medicine, Kanazawa Medical University Hospital. One lateral radiographic cephalogram with the teeth in occlusion and the recording of somatic measurements, body weight and height, were obtained for each patient at visiting our orthodontic clinic. On the lateral cephalograms of whole samples, 10 angular and 6 linear measurements were carried out. Simultaneously, the body mass index (BMI) was assessed for each patient. Based on the cephalometric and somatometric measurements, the pathogenesis of obstructive sleep apnea was discussed in association with the obesity and dentofacial morphology. Results were summarized as follows: 1. The body mass index (kg/m2) ranged between 21.0 to 45.7, with a mean value of 31.0 for OSA patients. Of whom, 3 patients were mildly obese (25 or more of BMI) and 12 patients severely obese (exceeding 30 of BMI). 2. Compared with normal control samples, the means of cephalometric variables of whole samples showed the tendency of micrognathia, large gonial angle, protruded maxilla and large cranial base. 3. By principal component analysis, it was revealed that the components for the shape and position of the mandible were of more importance in OSA patients than controls. 4. Discriminatory analysis clarified significant differences in dentofacial morphology between 12 obese and 13 non-obese patients. 5. The dentofacial morphology in non-obese patients were characterized by retrognathia, micrognathia, large gonial angle and small maxilla. In accordance with previous reports, the patients with OSA were presented the tendency of obesity and micrognathia. Furthermore it was revealed that particularly in non-obese OSA patients the morphological abnormalities might be the major contributor to the pathogenesis of sleep apnea.
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PMID:[Dentofacial morphology of obstructive sleep apnea syndrome patients]. 264 Sep 22

We present the case of a 63 years old man (177 cm height, 111 kg weight) with autoimmune thyroiditis. He had a long term history of hypersomnolence and heavy snoring. Two years ago, because of a bifascicular block and sinus pauses, a cardiac pace-maker was placed. Polysomnography recording showed a systematic periodic breathing characterized by profound desaturation waves (often 92% Sa O2 to 60% Sa O2) every 60 seconds, secondary to prolonged mixed apneas. Hormone replacement therapy and a 17 kg weight loss completely suppressed the sleep apnea syndrome within five months. We conclude that SAS is a major component of the respiratory depression in hypothyroidism and that normalisation of thyroid function can definitely cure the patient.
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PMID:[Sleep apnea syndrome and hypothyroidism: apropos of a new case and a review of the literature]. 265 40

Obstructive sleep apnea (OSA) may result in neuropsychiatric complications. Psychiatrists need to be alert to the possibility that patients who present to them with cognitive and/or affective disorders, who also have sleep related complaints such as snoring and significant daytime hypersomnolence, may have OSA. Clinical suspicion needs to be reinforced by obtaining a history from the bed partner. A polysomnogram will establish the diagnosis. Once the diagnosis is made, several treatment options are available. Treatment of sleep apnea usually leads to a resolution, or at least improved control, of the complicating neuropsychiatric disorder. Physicians must be aware that sedating neuroleptic or antipsychotic agents may worsen sleep apnea and, thereby, aggravate the neuropsychiatric disturbance.
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PMID:Neuropsychiatric manifestations of obstructive sleep apnea: a review. 265 64


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