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)

The usual treatment of snoring in the absence of sleep apnea has been uvulopalatopharyngoplasty (UPPP). Patients are often reluctant to undergo this painful procedure, which must be performed under general anaesthesia. A new procedure, introduced 5 years ago by the author, called LAUP (laser-assisted uvulopalatoplasty), can be used to treat the pharyngeal airway obstruction that produces snoring during sleep. LAUP is performed with CO2 laser under local anaesthesia. LAUP produces a progressive enlargement of the oropharyngeal airspace that reduces or eliminates airway collapse during sleep, and it allows surgery for the relief of snoring to be performed in the office under local anaesthesia. LAUP has many advantages over the traditional UPPP. It is simple, reliable, hemostatic, and less painful. It is also less expensive, as it can be performed on an outpatient basis. This makes the LAUP more accessible to patients. Our experience with LAUP in 741 patients treated from December 1988 to December 1993 (121 women and 620 men) is described. Good results were obtained in 95% of patients, and there were no complications. This new technique can be easily performed by other otolaryngologists after suitable training. LAUP provides a simple alternative for many patients who do not wish to undergo a traditional UPPP. The method and its results are discussed.
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PMID:Outpatient treatment of snoring with CO2 laser: laser-assisted UPPP. 789 66

Airway patency in conscious, normal humans is maintained by a complex orchestration of airway dilator muscles and reflex pathways yet is easily perturbed. Using patients at high risk for airway obstruction during anesthesia, as well as matched controls, this study sought (1) to determine if selected observations would contribute to our understanding of upper airway obstruction, and (2) to scientifically ground our clinical airway management interventions. The "at risk" patients tended to differ significantly from the controls with respect to a number of anthropometric and subjective measures which sought to describe the obstructive phenomena. At risk subjects were characterized as having a much greater incidence of induction and emergence obstruction, an abbreviated mental-hyoid distance, a flattened, compressed anterior-posterior craniofacial architecture, retrognanthism, relative macroglossia, and a narrower, bulky oropharynx. A theoretical model of airway obstruction was proposed characterizing the pharynx as a "collapsible tube" especially vulnerable in conditions such as sleep disordered breathing.
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PMID:Orocephalometry and airway control in obese sleep-disordered breathers, obese normals, and matched controls undergoing general anesthesia. 795 Oct 2

Ten patients undergoing major abdominal surgery under general anaesthesia were monitored with a pulse oximeter, electroencephalogram, electromyogram, electrocardiogram and eye and hand movement sensors two nights before and three nights after surgery. Episodic hypoxaemic events were increased significantly after surgery (P < 0.05). Rapid eye movement (REM) sleep decreased significantly on the first night after operation (P < 0.05). Seven patients had increased amounts of REM sleep (rebound) on the second, third or both nights after operation compared with the preoperative night. Slow wave sleep was depressed significantly on the first two nights after operation (P < 0.05). REM sleep-associated hypoxaemic episodes for individual patients increased about three-fold on the second and third nights after operation compared with the night before operation (P < 0.05). We conclude that postoperative sleep pattern is disturbed severely with early depression of REM and slow wave sleep and with rebound of REM sleep on the second and third nights. Postoperative rebound of REM sleep may contribute to the development of sleep disordered breathing and nocturnal episodic hypoxaemia.
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PMID:Late postoperative nocturnal episodic hypoxaemia and associated sleep pattern. 811 May 63

Obstructive Sleep Apnea Syndrome (OSAS) is children is commonly caused by upper airway obstruction, such as that caused by adeno-tonsillar hypertrophy. We report a rare case of SAS due to a nasopharyngeal tumor. The patient was a 10-year-old boy who complained of snoring and sleep apnea. The tumor was found in the nasopharynx and mesopharyngeal space. We diagnosed this case as OSAS by overnight sleep study (Apnea Hypopnea Index: AHI = 19.67). The tumor was removed under general anesthesia. Histopathology revealed features of nasopharyngeal angiofibroma. After removal of the tumor, his symptoms resolved completely. A follow-up overnight sleep study confirmed resolution of OSAS. At the last follow up, conducted 17 months after the operation there were no signs of tumor recurrence.
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PMID:[A case of sleep apnea syndrome due to a nasopharyngeal tumor]. 882 49

A new surgical approach for treating patients suffering from heavy snoring or obstructive sleep apnoea is introduced. This procedure includes the use of a laser and is called laser-assisted uvulopalatoplasty (LUPP). However, the technique described here is unlike the laser-assisted uvulopalatoplasty (LAUP) as described by Kamami in 1990. LUPP is performed under local anaesthesia and in an out-patient setting. Muscle resection is minimal and includes only the distal part of the uvula muscle and some fibres of the palatopharyngeal muscles. The LUPP procedure and the subjective results in 100 patients who have had LUPP performed are presented.
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PMID:Laser-assisted uvulopalatoplasty: description of the technique and pre- and postoperative evaluation of subjective symptoms. 893 72

Uvulopalatopharyngoplasty (UPPP) was the first surgical procedure specifically designed to address the palatal abnormalities seen in many patients with obstructive sleep apnea syndrome (OSAS). For adult apneic patients, UPPP remains the most commonly performed operation. Beginning in 1993, laser-assisted uvulopalatoplasty (LAUP) was introduced for the treatment of snoring and sleep apnea. LAUP differs from UPPP because it is performed in the office using only local anesthesia, thus being very cost-effective. Seventy-nine patients with OSAS underwent surgical treatment: 38 treated with LAUP and 41 with UPPP. The overall surgical response rate, defined as a >50% reduction in the postoperative respiratory disturbance index (RDI), was achieved in 21 (51.2%) of UPPP-treated and 18 (47.4%) of LAUP-treated patients. The RDI decreased from 30.3 +/- 3.7 to 22.2 +/- 4.4 events/h in the LAUP patients and from 52.1 +/- 5.0 to 25.5 +/- 2.7 events/h in the UPPP patients. The lowest oxyhemoglobin saturation (LS(aO2)) increased from 72.8 +/- 2.1 to 80.9 +/- 1.3% in the UPPP patients; there was no change in the LAUP patients. Postoperative complications in this series included minor bleeding, oral candidiasis, and temporary velopalatal insufficiency in both groups. In the carefully selected OSAS patient, LAUP should be considered a surgical alternative to UPPP. LAUP may actually be preferable to UPPP in certain cases because LAUP is cost-effective, does not require a general anesthetic or hospitalization, has very few associated complications, and time lost at work is minimal.
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PMID:Uvulopalatopharyngoplasty versus laser-assisted uvulopalatoplasty for the treatment of obstructive sleep apnea. 900 Dec 69

We describe the effects of accidental intra-arterial injection of suxamethonium and atracurium into the femoral artery of an infant. An 11-month-old boy with Downs Syndrome and obstructive sleep apnoea presented for tonsillectomy. Peripheral venous cannulation proved impossible. A femoral venous line was sited following inhalational induction of anaesthesia. Suxamethonium was given through this line and produced no adverse effect. Subsequently, atracurium was given through the line causing an instant cutaneous flush in the leg followed by a marked ischaemic appearance. The femoral line was assumed to be sited in the femoral artery and was removed. At the end of the operation a caudal injection of 10 ml of 0.25% bupivacaine was performed. Within 30 min there was marked vasodilation of both legs with easily felt peripheral pulses. In view of the tonsillectomy anticoagulant and thrombolytic therapy were contra-indicated. There were no adverse sequelae.
Anaesthesia 1996 Dec
PMID:Leg ischaemia in an infant following accidental intra-arterial administration of atracurium treated with caudal anaesthesia. 903 55

Thirty patients suffering from habitual snoring were subjected to laser-assisted uvulopalatoplasty with a KTP/532 laser under local anesthesia. The patients selected for the present study had no complaints of severe sleep apnea. The surgical procedure included bilateral vertical incision through the palate at the base of the uvula with or without removal of the lower half of the uvula. Ninety-three percent of the patients showed apparent improvement of snoring following the operation. However, other sleep-related symptoms such as sleep quality and daytime sleepiness were not significantly improved. No major or critical complications such as massive bleeding and asphyxia occurred. Post-operative pain on deglutition disappeared in most patients 2 weeks after the operation. This procedure is safe, minimally invasive and effective for habitual snoring without apnea.
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PMID:Laser-assisted uvulopalatoplasty for habitual snoring without sleep apnea: outcome and complications. 910 49

We hypothesize that stimulation of upper-airway mechanoreceptors during obstructive apnea augments upper airway muscle activity. If so, upper-airway anesthesia (UAA) should reduce mechanoreceptor output and therefore upper-airway muscle activity. To test this hypothesis, we studied the effect of UAA on the relationship between the phasic activity of the moving-time average (MTA) of the genioglossus electromyogram (EMG-GG) and the esophageal pressure deflection (DP) during obstructive apneas in non-rapid-eye-movement (NREM) sleep in a group of six men with severe sleep apnea. Before UAA, the phasic EMG-GG was linearly related to the deflections in esophageal pressure (DP) during the last three occluded breaths (both progressively increased). After UAA, the mean ratio of EMG-GG to DP decreased to 23% of the control value, from 0.17 +/- 0.04 to 0.04 +/- 0.01 (mean +/- SEM) arbitrary units/cm H2O (p < 0.05). The mean slope of the EMG-GG-versus-DP regression lines also decreased to 23% of the control value, from 0.22 +/- 0.03 to 0.05 +/- 0.01 arbitrary units/ cm H2O (p < 0.01). These findings suggest that stimulation of upper-airway mechanoreceptors during obstructive apnea in NREM sleep augments phasic genioglossus activity.
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PMID:Upper airway anesthesia reduces phasic genioglossus activity during sleep apnea. 923 Jul 36

A 2-year-old boy with Hunter syndrome was scheduled for adenotomy under general anesthesia. Preoperative examinations of this patient revealed that he had stridor, sleep apnea, short neck, and a hypertrophic pharyngeal structure as revealed by fiberoptic pharyngoscopy, from which we expected to encounter difficulty in mask ventilation and tracheal intubation. On standby with settings for an emergency fiberoptic laryngoscopy and an emergency tracheotomy, we first attempted slow induction technique preserving spontaneous breathing. Thereafter mask ventilation was possible and a muscle relaxant was administered. On the second trial, almost blind orotratcheal intubation was successful. Postoperatively, mechanical ventilation was performed for 12 hours, in consideration of the airway obstruction due to pharyngeal bleeding and edema. The most severe anesthetic complication in the case of Hunter syndrome is the difficulty of intubation and respiratory disorder. Preoperative evaluation of the upper airway and careful perioperative monitoring and observation of respiration are of the greatest importance.
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PMID:[Anesthetic management of a child with Hunter syndrome associated with sleep apnea]. 925 12


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