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

From 1958 to 1986, 27 crewmembers with suspected sleep disorders were referred to the USAF School of Aerospace Medicine. The presenting complaint in most cases was excessive daytime sleepiness (EDS). Prior to 1984, evaluations included neurologic and psychiatric testing, screening laboratory studies, and awake and asleep electroencephalography. Polysomnography and sleep latency studies were included after 1984. In the majority of cases, the etiology of the complaint could not be determined. The prevalence of EDS is estimated to be between 0.3% and 4.0% of the adult population. Major causes cited in the world literature include the sleep apnea syndromes, narcolepsy, parasomnias interrupting sleep, hypersomnia secondary to systemic or affective disorders, and essential hypersomnia. Current sleep lab techniques and human leukocyte antigen (HLA) typing are reported to make the diagnosis in up to 90% of sleep disorders. Evaluation of EDS should begin with a history emphasizing sleep habits, work schedules, daytime naps, and presence of vegetative signs. A sleep diary will allow a more accurate estimate of the quantity of nocturnal sleep. This diary may reveal poor sleep hygiene or insomnia. Polysomnography and/or multiple sleep latency determination can then be used to diagnose sleep apnea, parasomnias, and narcolepsy.
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PMID:Evaluation of the sleepy crewmember: USAFSAM experience and a suggested clinical approach. 265 2

Sleep apnea and obstructive snoring are sleep related breathing disorders (SRBD). Nevertheless, there is only a quantitative difference between snoring and the obstructive form of sleep apnea. Snoring occurs in at least 20% of the population; 50% of the 50 year old male snore. Although in most of the cases only harmless snoring is concerned. It becomes serious if it leads as the independent SRBD "obstructive snoring" to a continuous oxygen desaturation and a sleep disturbance or, if in cases of sleep apnea a postapnoic snoring is concerned. The snoring pattern "loud and irregular" is always a sign for a serious SRBD. Still, no exact statement can be given concerning the frequency of obstructive snoring. However, the prevalence of sleep apnea in men of the mean age group has been determined to 10%. By the so-called sleep apnea syndrome are summarized clinical pictures with symptoms and findings caused by sleep apnea, respectively with those which can be reduced by sufficiently early introduced therapy. Most frequent symptoms and findings are: hypertension, loud and irregular snoring, daytime sleepiness and nocturnal cardiac arrhythmias. Especially hypersomnia has always to be taken seriously. In relation with other symptoms and findings associated with apnea it is always an indication for the examination for sleep apnea and obstructive snoring.
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PMID:[Snoring and sleep apnea syndrome]. 266 55

Sleep apnea has been overlooked for many years. However new studies show, that sleep apnea is very prevalent. Approximately 2-5 per cent of the adult population suffer from obstructive sleep apnea. Sleep apnea is related to several symptoms including hypersomnia, headache and cognitive dysfunctions. Sleep apnea is probably a risk factor for cardio- and cerebrovascular complications. Treatment reduce symptoms and the cardio- and cerebrovascular risk. The most effective treatment is Nasal Continuous Positive Airway Pressure (NCPAP), but surgical treatment is effective in selected cases, and includes UvuloPalatoPharyngoPlasty (UPPP), mandibular advancement, nasal surgery and partial tongue resections. No medical treatment is actually know to reduce obstructive sleep apnea.
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PMID:[Sleep apnea]. 279 82

Snoring usually is trivial and unimportant, but it can turn into a social or medical problem. Obesity, hypertension and heart disease are more frequent among snorers than among nonsnorers, and especially snorers with hypersomnia during the day are at risk. Hypersomnia in association with snoring usually signifies obstructive sleep apnea. Increased resistance in the upper airways, together with negative inspiratory pharyngeal pressure and muscular hypotonia during deep non-REM and REM sleep, lead to collapse of the pharynx, hypoxia and hypercapnia. Only after arousal from sleep does muscle tone return, pharyngeal obstruction reopen and airflow resume. Since this process can occur 300 or 400 times a night, repetitive alveolar hypoventilation leads to pulmonary-arterial hypertension and cor pulmonale, and the repetitive sympathetic activations can cause systemic hypertension or serious cardiac arrhythmias. The countless arousals deprive the sufferer of deep non-REM and REM sleep and their consequence is sleep fragmentation. The symptoms are excessive daytime sleepiness, intellectual deterioration and personality and behavioral changes. Oronasomaxillofacial, endocrine and neuromuscular anomalies and diseases predispose to sleep apnea, and alcohol or CNS-depressant drugs can favour its occurrence. Diagnosis is made by nighttime oxymetry, and if this is abnormal, by polysomnography. After polysomnography it is possible to distinguish between obstructive and nonobstructive sleep apnea, and the decisions for an adequate treatment can be made.
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PMID:[Dangerous snoring. Sleep-apnea syndrome]. 331 92

Besides sleep apnea, the main disorders of excessive daytime sleepiness include narcolepsy and hypersomnia. Narcolepsy is characterized by periods of irresistible sleepiness and sleep attacks of brief duration and, most often, by one or more of the auxiliary symptoms: cataplexy, sleep paralysis, and hypnogogic hallucinations. Generally, sleepiness and sleep attacks in hypersomnia are of longer duration and are more resistible than in narcolepsy; also, the auxiliary symptoms are absent. There are three types of hypersomnia: idiopathic, secondary, and periodic. Nocturnal sleep is typically disrupted in narcolepsy, whereas in idiopathic hypersomnia it is prolonged and in secondary hypersomnia it is variable. The exact causes of narcolepsy and idiopathic hypersomnia are unknown; however, there is evidence for genetic predisposition for either disorder. In secondary hypersomnia causative factors include: neurologic, such as head injuries, cerebrovascular insufficiency, and brain tumors; general medical, such as metabolic disorders, various intoxications, and conditions leading to brain hypoxia; and psychiatric, most notably depression. Although the cause of periodic hypersomnia is unclear, most research supports the notion of underlying organic disease. Often, the evaluation of patients with excessive daytime sleepiness can be completed in the office setting, based on the sleep history and a thorough neurologic, general medical, and psychiatric assessment. Whenever indicated, ancillary laboratory studies, such as computed tomography and magnetic resonance scans, should be performed. Sleep laboratory recordings generally are not necessary unless there is suspicion of sleep apnea or narcolepsy in the absence of auxiliary symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Disorders of excessive sleepiness: narcolepsy and hypersomnia. 333 60

Sleep-induced narrowing of the upper airways underlies the widespread and supposedly trivial complaint of snoring, which may not only constitute a risk factor for the cardiocirculatory system, but in predisposed individuals may lead to the OSAS. The latter is a life-threatening condition characterized by repeated episodes of cessation of respiration at night with an associated drop in SaO2. Patients frequently present with hypersomnia, systemic and pulmonary hypertension, and even heart failure. HSD is the term we use to describe the evolutive stages from snoring to OSAS. ICAH, or Ondine's curse, is the clinical syndrome of sleep-related respiratory insufficiency in the absence of airway stenosis. We do not consider central sleep apnea to be an independent disorder. For the treatment of HSD, weight reduction should be attempted first. Also, if there are malformations in the upper airway, they should be surgically corrected. The use of various medications has been rather discouraging, and CPAP and other devices that are intended to overcome the obstruction are poorly tolerated by patients. The most effective surgical treatment for OSAS, even in progressed stages of the disease, is tracheostomy.
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PMID:Sleep-related respiratory disorders. 333 61

Within the context of the comprehensive treatment of sleep disorders, which includes medical, neurologic, psychiatric, and social interventions, use of medication is often indicated. Among the three benzodiazepine hypnotics that are available in the United States for the treatment of insomnia, flurazepam is effective for both sleep induction and maintenance, and it retains most of its efficacy over a 4-week period of nightly administration; temazepam is effective only for sleep maintenance, and triazolam improves both sleep induction and maintenance with initial but not with continued administration. Rebound phenomena are more frequent and intense with the more rapidly eliminated drug, triazolam, and to a lesser degree with temazepam. Also, with triazolam, certain behavioral side effects, such as amnesia and psychotic-like symptoms, have been reported. With flurazepam, which is a slowly eliminated benzodiazepine, daytime sedation is more frequent than with the other two drugs. When insomnia is secondary to major depression, antidepressant medication should be administered. Methylphenidate, amphetamines, or other stimulant medications are used for the symptomatic treatment of the sleepiness and sleep attacks of narcolepsy and hypersomnia. For cataplexy and the other two auxiliary symptoms of narcolepsy, imipramine or other tricyclics are the drugs of choice. Protriptyline and medroxyprogesterone have been used in treating mild cases of obstructive sleep apnea, but their efficacy is limited. Similarly, for the treatment of central sleep apnea, medroxyprogesterone and acetazolamide have shown only limited effects. Medication for patients with sleepwalking, night terrors, or nightmares should be prescribed judiciously, and primarily when treatment of an underlying psychiatric condition is desired. The neuropharmacology of sleep should also consider drugs that may cause sleep disorders. Medications with sleep disturbing effects include various antihypertensives, bronchodilators, and the energizing antidepressants. Withdrawal of REM-suppressant drugs, such as the barbiturates, may cause nightmares in association with a REM rebound. Occasionally, a drug or a combination of drugs may produce somnambulistic-like activity in some patients.
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PMID:Clinical neuropharmacology of sleep disorders. 333 64

Although idiopathic CNS hypersomnolence is the third most frequent hypersomnia diagnosis, the syndrome is still unfamiliar to physicians, especially in Japan. In the Sleep Disorders Clinic of Kurume University Hospital, seven patients were diagnosed as idiopathic CNS hypersomnolence. All the patients complained of persistent daytime sleepiness, difficulty in morning awakening and lengthening of nocturnal sleep. Their daytime sleepiness had not been reduced even when they have taken sufficient nocturnal sleep. Various autonomic symptoms were observed, but what has noticeably been absent were cataplexy, sleep paralysis, sleep attack, sleep apnea or any other identifiable neurological disorders. The onset of the syndrome in four of the seven patients occurred in their teens. No therapeutic effects had been found after undergoing medical treatments.
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PMID:Clinical study on idiopathic CNS hypersomnolence. 345 14

Patients with a primary diagnosis of narcolepsy or idiopathic CNS hypersomnia seen at Stanford University Sleep Disorders Clinic over a 5-year period were studied retrospectively. The two patient groups were compared with respect to blood pressure, Minnesota Multiphasic Personality Inventory (MMPI) psychological profile, nocturnal sleep structure, prevalence and severity of sleep apnea and periodic leg movements in sleep, and daytime sleep tendency. Narcoleptic patients tended to have higher blood pressure, higher prevalence of abnormally elevated MMPI scores, more abbreviated and more disrupted sleep at night, and greater daytime sleep tendency. Sleep apnea and periodic leg movements were more prevalent in narcoleptic patients, but only periodic leg movements in sleep were more prevalent in narcoleptic patients than in the general population. Periodic leg movements during REM sleep were observed in more than one-third of narcoleptic patients, which may be an important pathophysiologic feature of this disorder.
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PMID:Comparative polysomnographic study of narcolepsy and idiopathic central nervous system hypersomnia. 370 48

Polysomnography and blood gas measurements during sleep in a young man with craniofacial dysostosis, who presented with an extremely severe sleep apnea syndrome, are reported. Tracheostomy relieved all his complaints permanently, namely hypersomnia, deteriorated intellectual performance, automatic behaviour with hypnagogic hallucinations and snoring. Laboratory results also returned to normal. The polygraphic data of night sleep (and daytime naps) before and after surgery suggest that hypersomnia was primarily caused by severe nighttime oxygen desaturations and that the hypnagogic hallucinations were caused by apnea-induced chronic REM sleep deprivation. Furthermore, the periodic variation of central respiratory drive, which was also abolished after surgery, is interpreted as the cause of apnea-induced fluctuations between sleep stages in this case.
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PMID:Severe adult hypersomnia--sleep apnea syndrome in craniofacial dysostosis. 374 15


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