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

Although the use of a standard nasal continuous positive airway pressure device to combat obstructive sleep apnea is often effective, it is neither curative nor universally well tolerated. Thus, surgical intervention is often inevitable. We describe a simple, conservative surgical procedure performed on a patient with profound mandibular retrognathia (dolichofacial type), accompanied by sleep apnea. The procedure resulted in a significant pharyngeal airway enlargement of 53 and 87% at the mandible angle and hyoid bone levels, respectively, increased oxygen saturation, reduction in the respiratory disturbance index by 50%, and improved sleep quality. We present a procedure for patients whose sleep apnea is due to extensive mandibular retrognathism with concomitant retrolingual narrowing and collapse.
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PMID:Genioglossal advancement--a simple surgical procedure for sleep apnea. Case report and literature review. 1236 22

Knowledge of the fatigability of the genioglossus muscle is of interest because this muscle prevents pharyngeal collapse, especially during sleep. In the present investigation, signs of fatigue in the genioglossus muscle were studied by measuring the tongue endurance using a force transducer and electromyographic (EMG) activity of the genioglossus muscle in eight nonapnoeic men. Mean absolute EMG values and spectrum analysis were calculated at three levels of submaximal effort. Median frequency and the force:mean absolute EMG value ratio were independent of force level (F = 0.37, P = 0.93; F = 0.35, P = 0.94, respectively) but dependent on effort duration (F = 52, P < 0.0001; F = 16, P < 0.0001). Force:mean absolute EMG value and logarithmic median frequency decreased linearly with respect to time and were similar at the three force levels when time was expressed as a percentage of total test time (F = 0.37, P = 0.93). The decrease in median frequency was ascribable to a larger increase in low- than in high-frequency components, as shown by the significant decrease in the high-frequency:low-frequency ratio (F = 27, P < 0.0001) with time. The method of investigation used in this study allowed detection of the behaviour of the tongue during fatigue and, therefore, should be useful in disorders where mechanical failure of the tongue is suspected, such as the sleep apnoea syndrome or in neuromuscular disorders.
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PMID:Genioglossal electromyogram during maintained contraction in normal humans. 1243 87

Moderate to severe obstructive sleep apnoea is usually associated with multiple levels of pharyngeal airway collapse, including tongue base obstruction. A new technique has recently been introduced that improves the nocturnal retro-lingual airway. This study was a prospective, non-randomized single-institution evaluation of a recently introduced surgical technique. Nineteen consecutive patients with previously untreated moderate to severe obstructive sleep apnoea underwent tongue suspension using the Respose system and concomitant palatopharyngoplasty (multilevel pharyngeal surgery). The patient demographics and treatment outcomes were prospectively collected and retrospectively analysed. There were 16 men and three women, with a mean (+/-SD) age of 44.9 years (+/- 14.2) and a mean pre-operative apnoea-hypopnoea index (AHI) of 42.8 +/- 24.8. Twelve of the 19 patients (63.2 per cent) have had post-operative polysomnography; eight of these 12 (67 per cent) met the standard criteria for surgical response. Among these eight patients, the AHI improved from 32.4 to 14.4 (p<0.01); the individual scores fell by a mean of 51.7 per cent. The apnoea index improved from 7.4 to 0.9 (p<0.01), with the individual scores falling by a mean of 81.4 per cent. There was anatomic and radiographic evidence of multilevel upper airway enlargement. Notably, the body mass index remained essentially unchanged (31.5 +/- 7.2 to 31.2 +/- 7.6, p>0.5). Subjectively, the mean Epworth sleepiness scale score fell from 11.0 +/- 5.4 to 5.4 +/- 3.8 (p<0.005). Four patients suffered transient velopharyngeal insufficiency, and two patients complained of limited anterior excursion of the tongue. There were no serious, long-term complications. The tongue suspension procedure represents a minimally invasive technique for improving the nocturnal retro-lingual airway in patients with obstructive sleep apnoea. It is easily performed by otolaryngologists, distinguishing it from other established techniques designed to address tongue base obstruction.
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PMID:Minimally invasive tongue base surgery for obstructive sleep apnoea. 1243 8

Several cephalometric studies have been published to study sleep apnea and hypopnea. The purpose of this review is to provide a clear analysis of the different and apparently contradictory cephalometric results and to describe certain pitfalls of the method. In general, an excessive development of the tongue and soft palate are observed in these subjects, limiting the pharyngeal airway. Bony anomalies include mandibular retrognathism and an excessive anterior ventral development of the skull associated with insufficient anterior growth of the base of the skull. The head is held in extension. These different factors contribute to blocking the upper airway and favor pharyngeal collapse. Cephalometry can be used to identify patients at risk and to propose an apnea/hypopnea index for precise etiological diagnosis and therapeutic decision making.
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PMID:[Cephalometric assessment in obstructive sleep apnea and hypopnea syndrome]. 1248 89

The obstructive sleep apnoea syndrome (OSAS) is a diagnosis related to snoring and caused by a collapse in the upper airway. OSAS patients suffer from desaturated oxygen levels during sleep as well as daytime sleepiness. In this paper, we propose a system able to identify and detect respiratory disorders online based on monitoring the airflow amplitude from a sleeping OSAS patient. By the use of chi(2)-analysis and a Haar wavelet transform on signals performed offline, reference templates indicating the specific apnoea pattern for four different patients are constructed and used for similarity matching against online signals. Detection is performed in the early stages of an upcoming airway dysfunction, thus providing an opportunity to alert the patient at sleep. The system-testing results indicate robust performance and flexibility for the patient. Our proposed solution can in turn operate as an alternative to today's OSAS treatment of choice, the continuous positive airway pressure (CPAP).
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PMID:Early online detection of upper airway obstructions in obstructive sleep apnoea syndrome (OSAS) patients. 1249 32

Respiratory disorders are common and important complications in acromegaly. Patients suffering from acromegaly display a 1.6-3.3 fold increase in mortality rate, which is due to respiratory disorders in 25% of cases. In these patients, mortality for lung disease is 2-3 fold higher than in the general population. Every portion of the respiratory system may be involved. Deformities of facial bones, edema and hypertrophy of the mucosae and pharyngeal and laryngeal cartilages, enlargement of the tongue and inspiratory collapse of the hypopharinx, all may contribute to respiratory alterations. Nasal polyps, "hormonal rhinitis", changes of the voice and snoring are common occurrences. Though rarely, a laryngocele may ensue. Pneumomegaly is frequently observed and, as suggested by functional studies, might be due to an increased number rather than volume of the alveoli. An obstructive respiratory syndrome caused by mucosal thickening of the upper airways and bronchi is observed in 25% of female and 70% of male patients. The sleep apnea syndrome (SAS) affects 60-70% of acromegalic patients. SAS may be of obstructive, central or mixed type. Obstructive SAS is the prevailing form in acromegaly. It is due to intermittent obstruction of upper airways with preserved activity of the respiratory center, as testified by the remarkable thoracic and abdominal respiratory efforts. The pathogenesis of the central type of SAS is more complex. Narrowing of the upper airways may induce reflex inhibition of the respiratory center. Moreover, increased GH levels and, possibly, defects in the somatostatinergic pathways, may increase the ventilatory response of the respiratory center to carbon dioxide, thereby leading to respiratory arrest. In the mixed type of SAS, the phenomena underlying the other two forms coexist. Oxygen desaturation concomitant with the apneic episodes accounts for the frequent nocturnal wakening and diurnal drowsiness. Among the clinical correlates of SAS, arterial hypertension is of particular interest due to the close correlation existing between the two disorders. Sleep deprivation related to SAS seems per se to favor the appearance of hypertension. Moreover, short lasting hypoxemia may induce prolonged elevations of blood pressure, mediated by decreased endothelial generation of nitric oxide. Thus, since cardiovascular events are the main cause of mortality in patients with acromegaly, it is reasonable to hypothesize that SAS is involved in the reduced life span of these patients.
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PMID:Prevalence and pathogenesis of sleep apnea and lung disease in acromegaly. 1250 76

Adult obese patients with suspected or sleep test confirmed OSA present a formidable challenge throughout the perioperative period. Life-threatening problems can arise with respect to tracheal intubation, tracheal extubation, and providing satisfactory postoperative analgesia. Tracheal intubation and extubation decisions in obese patients with either a presumptive and/or sleep study diagnosis of OSA must be made within the context that there may be excess pharyngeal tissue that cannot be visualized by routine examination, and the literature indicates an increased risk of intubation difficulty. Regional anesthesia for postoperative pain control is desirable (although such management is not necessary or possible for many of these patients). If opioids are used for the extubated postoperative patient, then one must keep in mind an increased risk of pharyngeal collapse and consider the need for continuous visual and electronic monitoring. The exact management of each sleep apnea patient with regard to intubation, extubation, and pain control requires judgment and is a function of many anesthesia, medical, and surgical considerations.
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PMID:Obstructive sleep apnea in the adult obese patient: implications for airway management. 1251 63

Pharyngeal dilator muscles are clearly important in the pathogenesis of obstructive sleep apnoea syndrome. Substantial data support the role of a local negative pressure reflex in modifying genioglossal activation across inspiration during wakefulness. Using a model of passive negative pressure ventilation, we have previously reported a tight relationship between varying intrapharyngeal negative pressures and genioglossal muscle activation (GGEMG) during wakefulness. In this study, we used this model to examine the slope of the relationship between epiglottic pressure (Pepi) and GGEMG, during stable NREM sleep and the transition from wakefulness to sleep. We found that there was a constant relationship between negative epiglottic pressure and GGEMG during both basal breathing (BB) and negative pressure ventilation (NPV) during wakefulness (slope GGEMG/Pepi 1.86+/-0.3 vs. 1.79+/-0.3 arbitrary units (a.u.) cmH2O(-1)). However, while this relationship remained stable during NREM sleep during BB, it was markedly reduced during NPV during sleep (2.27+/-0.4 vs. 0.58+/-0.1 a.u. cmH2O(-1)). This was associated with a markedly higher pharyngeal airflow resistance during sleep during NPV. At the transition from wakefulness to sleep there was also a greater reduction in peak GGEMG seen during NPV than during BB. These data suggest that while the negative pressure reflex is able to maintain GGEMG during passive NPV during wakefulness, this reflex is unable to do so during sleep. The loss of this protective mechanism during sleep suggests that an airway dependent upon such mechanisms (as in the patient with sleep apnoea) will be prone to collapse during sleep.
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PMID:Within-breath control of genioglossal muscle activation in humans: effect of sleep-wake state. 1280 95

Surgery for sleep apnoea is challenging, particularly in patients with macroglossia. This has led us to develop a new procedure for reduction of the tongue base with low morbidity. Two types of bipolar radiofrequency probe were used via a percutaneous approach under an aseptic technique and general anaesthesia on 15 consecutive patients with retropalatal and retrolingual collapse. The lingual neurovascular bundles and probe were simultaneously identified with intraoperative real-time ultrasound to prevent neurovascular damage, and five patients had additional tongue mucosal suture advancement. All patients had previous or concurrent palatal surgery. The increase in cephalometric (retrolingual) posterior airspace (PAS) was 4 mm with a Spinevac wand and mucosal suture advancement, which is comparable to current-staged monopolar radiofrequency protocols requiring treatment for up to 6 months. Overall, 40% polysomnographic success was achieved, but it was 80% when additional phase 1 procedures were used. Morbidity was minimal with careful adherence to the perioperative care protocol.
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PMID:Ultrasound-guided radiofrequency submucosal tongue-base excision for sleep apnoea: a preliminary report. 1287 Dec 49

Obstructive sleep apnea is characterized by the repetitive collapse of the upper airway during sleep. A variety of nonsurgical treatments for obstructive sleep apnea have been developed, including behavioral therapies, continuous positive airway pressure (CPAP) devices, oral appliances and medications. Presently, CPAP is considered the first-line treatment for moderate to severe sleep apnea and one of the first-line treatments for mild disease. However, the effectiveness of CPAP is compromised because a large proportion of patients cannot tolerate the devices. Oral appliances are one of the first-line therapies for mild sleep apnea and a treatment for more severe disease if CPAP cannot be tolerated. Medications have thus far been unsuccessful as a treatment option for sleep apnea. All patients should be counseled to avoid sleep deprivation and sedatives (including alcohol) and to lose weight if obese.
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PMID:Alternative therapies for sleep apnea. 1297 73


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