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

Sleep apnea syndrome is a constellation of symptoms resulting from recurrent episodes of apnea during sleep. Often the upper airway becomes obstructed during slumber in this disorder. Symptoms relate to sleep deprivation and include morning headaches, daytime somnolence, personality changes with deteriorating intellectual capacity, nocturnal enuresis, and sexual dysfunction. Diagnosis is assisted by polysomnographic recordings. Therapy is directed at the cause of obstruction when one can be found, weight loss in massively obese patients, tracheostomy in the symptomatic patient. Four patients with documented sleep apnea syndrome are discussed. One patient, a thin adolescent female underwent adenoidectomy without improvement. Two massively obese adult males required tracheostomy with marked amelioration of symptoms. One additional adult male was found to have sleep apnea due to severe, acquired micrognathia; he was significantly improved by tracheostomy. All three adult patients were found by endoscopic visualization to have marked pharyngeal soft tissue collapse with inspiration during apneic episodes. Possible causes of pharyngeal collapse are discussed.
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PMID:Endoscopic findings in sleep apnea syndrome. 23 Nov 20

We investigated whether or not the adaptation of peripheral chemoreceptor (PCR) activity can contribute to hypoxic ventilatory depression (HVD) during sustained hypoxia for 20 min in both healthy subjects and patients with sleep apnea. Effects of HVD on diaphragm (DIA) and genioglossal muscle (GG) were also assessed. Withdrawal test, which is well established to solely represent the function of PCR, was repeatedly conducted at 5 and 20 min during sustained hypoxic condition. The results suggested that PCR did not play an important role in the development of HVD. When HVD ensued during sustained hypoxia, minute ventilation and EMGDIA were suppressed to the same extent in both groups. On the other hand, EMGGG was strongly and consistently attenuated in OSAS, whereas it was not always the case in healthy subjects. We speculate that treatment for hypoxic conditions can induce improvement of impaired regulation of breathing via central mechanisms, and it can be an important factor reducing the incidence and the severity of upper airway occlusion or collapse.
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PMID:[Hypoxic ventilatory response and hypoxic depression]. 130 12

This article describes clinical and laboratory techniques for the fabrication of a sleep apnea prosthesis for a dentate patient. The treatment objective is to posture the mandible at an increased vertical and protrusive position to diminish or eliminate the collapse of the base of tongue into the oropharynx. During fabrication of the prosthesis, cephalograms are used to evaluate spatial change between the base of the tongue and the posterior pharyngeal wall.
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PMID:Sleep apnea prosthesis for dentate patients. 140 96

Muscle biopsies from the palatopharyngeal muscle of eight patients with obstructive sleep apnoea were performed during uvulopalatopharyngoplasty. Control biopsies were performed during tonsillectomy in seven control patients with no history of symptoms suggesting obstructive sleep apnoea. The diagnosis was based on the patient's history and a whole night recording of arterial oxygen saturation and respiration movements. The mean number of oxygen desaturations > or = 4% per sleeping hour was 39 (range 7-80) in patients with obstructive sleep apnoea. In the control patients the occurrence of muscle fibre type and size relation between type I and type II fibres were comparable to what is found in the quadriceps femoris muscle, but the mean size of the fibres was < 25% of what is found in limb muscles. All biopsies from patients with obstructive sleep apnoea showed abnormalities. Atrophy with a fascicular distribution, increased number of angulated atrophic fibres, a twin or multiple peak distribution of the fibre size spectra, and an abnormal distribution of fibre types in many muscle fascicles corresponding to "type grouping" all points to a neurogenic alteration. This neurogenic lesion may be a primary phenomenon or secondary to the trauma of repetitive and prolonged stretching of the pharyngeal structures during apnoeas. A disturbance of the function of the dilating muscles of the upper airway may be important in causing the abnormal airway collapse seen in obstructive sleep apnoea.
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PMID:Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. 143 55

Sleep apnea syndrome (SAS) results from modification in the control of respiration and of upper airway caliber during sleep. Although there is some overlap between central (CSAS) and obstructive (OSAS) sleep apnea syndromes, each syndrome has specific pathological associations. The first part of this review concerns the pathophysiology of OSAS, including periodic breathing and upper airway collapse. In the second part, each specific etiology is examined, and the respective contribution of anatomic narrowing and neuromuscular dysfunction of the upper airway is mentioned. Our experience with about 375 patients with sleep-related breathing disorders is also reported, with regard to the specific etiologies of CSAS and OSAS.
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PMID:Sleep apnea syndromes (SAS) of specific etiology: review and incidence from a sleep laboratory. 147 Aug 4

The mechanisms behind the decrease in heart rate during apnoeas in patients with obstructive sleep apnoea (OSA) are little known. Recent findings in animal experiments indicate that stimulation of the upper airway activates postinspiratory and cardiac vagal neurones in the medullary respiratory centre, causing alterations in heart rate and respiratory rhythm. Since OSA leads to a collapse of the airway and consequent stimulation of upper airway receptors, we studied the interrelations between heart rate and respiratory rhythm during apnoea and during negative intrathoracic pressure generated by the Mueller manoeuvre (MM). Fifteen patients with OSA (apnoea hypopnoea index (AHI) 45 +/- 28.h-1) were studied by polysomnography, during a MM and a Valsalva manoeuvre, each of 15 s duration. The heart rate decrease (delta HRA) and the increase in total respiratory cycle duration (TOT) were evaluated during apnoea in non-rapid eye movement (REM) sleep. Patients with OSA demonstrated a decrease in heart rate during apnoea (-14.4 +/- 9.0 beats.min-1), and during MM (-11.5 +/- 13.5 in OSA vs 3.1 +/- 7.8 beats.min-1 in a control group). TOT increased during apnoea (4.6 +/- 3.1 s). There was a significant correlation between delta HRA and AHI (r = -0.64) as well as between delta HRA and increase in TOT (r = 0.62). These findings indicate that upper airway obstruction may cause an activation of receptors at the site of airway collapse or distortion leading to changes in heart rate and respiratory rhythm.
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PMID:Changes in heart rate during obstructive sleep apnoea. 837 Apr 36

Obstructive sleep apnoea syndrome (OSAS) is a frequent and severe condition due to repeated obstruction of the upper airways during sleep. Sixty-five patients (57 men, 8 women) with clinical sleep apnoea syndrome were explored by pharyngeal endoscopy during wakefulness and during sleep induced by propofol, this anaesthetic agent enabling the patient to retain automatic respiratory movements. Nocturnal polygraphy was positive (apnoea-hypopnoea index greater than 10) in 60 patients (53 men, 7 women) and negative (less than 10) in 5 patients. The terms narrowing and obstruction were defined from our description of the pharyngeal cavity as seen at endoscopy. Endoscopic exploration during wakefulness displayed 4 pharyngeal lesions (2 cancers and 2 benign tumours) which were not responsible for the patients' OSAS. Forty-eight patients had narrowing of the pharynx (oropharynx in 45, nasopharynx in 3). Endoscopic exploration during sleep revealed inspiratory obstruction of the pharynx in 43 patients and inspiratory bronchial collapse in 1 patient. This study shows that the endoscopic findings can predict the efficacy of continuous positive pressure respiration in 97.3 percent of patients with obstruction of the oro and hypopharynx. The efficacy of uvulo-palato-pharyngoplasty in patients with obstructed oropharynx is questioned. The value of maxillary and/or mandibular surgical protrusion is discussed.
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PMID:[Pharyngeal and bronchial endoscopic study in the diagnosis and treatment of sleep apnea syndrome]. 153 38

Conventional lateral radiography was used in 18 elderly male patients to investigate the changes induced by general anaesthesia in the upper airway. The effect of tongue traction under anaesthesia was studied similarly in another 11 patients. Following induction of anaesthesia, there were highly significant approximations to the posterior pharyngeal wall of the soft palate (median change 1.3 mm, 95% confidence interval (Cl) 0.3-2.6 mm; P = 0.006), tongue base (mean change 6.5 mm, 95% Cl 5.3-7.7 mm; P less than 0.001) and epiglottis (mean change 3.8 mm, 95% Cl 3.1-4.5 mm; P less than 0.001). Apparent radiographic occlusion of the airway occurred most consistently at the level of the soft palate (17 of 18 patients), sometimes at the level of the epiglottis (four patients), but the tongue base did not touch the posterior pharyngeal wall in any patient. Traction on the tongue failed to clear the nasopharyngeal obstruction. Attempted inspiration under anaesthesia caused major secondary collapse of the pharynx, with multiple sites of obstruction, similar to that found in obstructive sleep apnoea.
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PMID:Effect of general anaesthesia on the pharynx. 181 13

This paper describes some of the anatomical and physiological factors affecting the maintenance of upper airway patency in man. Such factors have particular relevance to the mechanisms responsible for maintaining upper airway patency during sleep, and the failure of these mechanisms in patients with the clinical syndrome of obstructive sleep apnoea: a condition in which repeated episodes of sleep-related inspiratory oropharyngeal collapse lead to recurrent hypoxaemia, disturbed sleep patterns and other clinical sequelae. The relationships between upper airway geometry, negative intrapharyngeal pressure, activation of upper airway dilator muscles, and sleep state are important factors affecting the maintenance of upper airway patency. The aim of this paper is not to consider such factors in isolation but to consider their interaction in affecting the adequacy of the upper airspace as a conduit for airflow.
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PMID:Some factors affecting the maintenance of upper airway patency in man. 203 32

The OSA syndrome, described over 100 years ago, was rediscovered in 1966. It is a common disorder, especially among fat, middle-aged men. Stentorian snoring and diurnal somnolence are the cardinal manifestations and should always lead to an examination during sleep. That examination (polysomnography) can demonstrate the pathognomonic events--repetitive apneas occurring in sleep--which signal the failure of the sleeping brain to maintain the patency of the supraglottic airway. All evidence points to the problem being an abnormal pharyngeal airway, one which has a shape or size or compliance that allows inspiratory collapse as the normal loss of pharyngeal dilator muscle tone occurs with sleep. The apneas are asphyxic events terminated by arousals which fragment sleep continuity and lead to the daytime sleepiness. Because the snoring occurs during sleep, the arousals are unremembered, and the sleepiness can develop so gradually that the patient may forget what normal alertness is like. It is important to interview the patient's spouse or partner. Besides obesity and maleness, other risk factors for OSA are diseases that have an impact on the configuration or effective compliance of the pharyngeal passageway. Recent studies support the clinical intuition that sleep apnea is undesirable. Sleepiness leads to accidents. The hypoxemia occurring during apnea can lead to potentially fatal cardiac dysrhythmias. A number of reports suggest that snoring and sleep apnea are associated with an increased risk of stroke, myocardial ischemia, and infarction. Finally, there are now two papers showing a significantly decreased probability of 5-year survival in patients with symptomatic sleep apnea. The good news is that treatment with tracheostomy or NCPAP improves mortality rates to normal. Approximately 90 per cent of patients can tolerate a night's initial trial with CPAP. Long-term acceptance of CPAP has now been reviewed in a number of studies, and it appears to be about 65 to 70 per cent.
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PMID:Sleep disorders and upper airway obstruction in adults. 219 4


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