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

Massive obesity may lead to serious, and sometimes fatal, respiratory complications. Alterations of ventilatory mechanics and function are well known; they include a decrease in respiratory compliance, an increase in ventilatory work and a restrictive pulmonary disease. Hypoxemia is rather due to an impaired ventilation/perfusion ratio than to alveolar hypoventilation. Sleep Apnea Syndrome (SAS) is very frequent in excessively obese patients. These subjects with daytime hypersomnolence should be systematically screened for SAS before the occurrence of life-threatening complications. Continuous positive airway pressure ventilation through a nasal mask is the treatment of choice of SAS especially since the results of body weight reduction and ENT surgery are inconstant and variable in these patients.
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PMID:[Respiratory complications of massive obesity]. 160 68

Acoustic pulse reflectometry is a relatively recent technique which allows the non-invasive measurement of human airways. The technique consists of guiding an acoustic impulse through the subject's mouth and into the airway. Suitable analysis of the resulting reflection (the 'echo') allows a reconstruction of the area-distance function. The non-invasive nature of the technique offers significant advantages over the established methods of x-ray cephalometry and CT scanning, and makes it very attractive for the investigation of ENT problems and sleep apnoea, and in the anaesthetic management of patients. This paper describes the theory and limitations of acoustic reflectometry, discusses previous work, and suggests some modifications: it is currently being implemented clinically.
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PMID:Acoustic reflectometry for airway measurement. Principles, limitations and previous work. 185 59

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal. The isolation rate of H. influenzae was much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p less than 0.05), as was that of group A streptococci, 5.4 per cent versus 16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies of B. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups. The high tonsillar core recovery rates of H. influenzae and group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.
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PMID:High recovery of Haemophilus influenzae and group A streptococci in recurrent tonsillar infection or hypertrophy as compared with normal tonsils. 207 11

The diagnosis of obstructive sleep apnea is frequently made by taking a meticulous history coupled with a high index of suspicion. Snoring and hypersomnolence are clinical features common to individuals with sleep apnea. Since snoring is said to be a "disease of listeners," it is not uncommon that bed partners reported an increased incidence of depression and marital displeasure. It is for this reason that the spouse or bed partner should be interviewed, since the patient may not be aware of any sleeping problems. Physicians should also be alert to complaints of excessive daytime somnolence, because studies have shown that patients with obstructive sleep apnea are at increased risk for automobile crashes. It has been estimated that approx 58,000 motor vehicle accidents involving people with sleep apnea will occur in the US each yr. By proper diagnosis and treatment, the physician is in a unique position to prevent at least some of the automobile accidents that result from falling asleep while driving. Polysomnography is the only definitive way to obtain a diagnosis of sleep apnea. This allows the physician not only to diagnosis the disorder, but also helps in the evaluation of the severity of the syndrome and selection of therapy. An ENT evaluation is also important in ruling out anatomic disorders that can cause upper airway obstruction. Certain factors, such as alcohol and sedative ingestion, may aggravate the condition in a person predisposed to sleep apnea, and subtle changes, such as unexplained hypertension, polycythemia, and cor pulmonale, should lead one to investigate the possibility of sleep apnea as the etiology.
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PMID:Diagnosis of obstructive sleep apnea. 229 95

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

Several studies have been reported suggesting a relationship between pharyngeal obstruction due to ENT pathology and the sleep apnea syndrome (SAS). To determine the incidence of pathological ENT findings that may present symptoms similar to SAS, we performed ENT examination, fiberoptic nasopharyngoscopy, rhinomanometry and partial audiometry and electronystagmography in 431 patients who had undergone polysomnography for clinically suspected SAS. 336 patients were referred for ENT examination; 95 patients had some kind of ENT disease and therapy before polysomnography. In the first group 31% showed one or more pathological ENT finding (ears 9%, nasopharynx 2%, nose 19%, oropharynx 5%, larynx 5%, neck 1%); 10.5% had pathology in two regions and 0.7% in three regions. An ENT operation was indicated in 23%, usually for nasal obstruction. ENT findings included chronic otitis media, adenoids, enlargement of lingual tonsil and vocal cord pathology, but no patient had a malignant tumor or severe pharyngeal obstruction. We conclude that severe anatomical abnormalities or dysplastic syndromes are rare; only 2 SAS patients had acromegaly due to hypophyseal adenoma and 1 patient without SAS had craniofacial dysplasia. However, ENT examination frequently revealed severe nasal obstruction due to septal deviation, polyposis or adenoids. These findings emphasize the need for ENT examination and therapy before application of CPAP (continuous positive air pressure) therapy.
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PMID:[How frequent are pathologic ENT findings in patients with obstructive sleep apnea syndrome?]. 260 43

Recent reports have suggested that flow volume curve abnormalities may be of interest in the diagnosis of obstructive sleep apnea syndromes by showing either extrathoracic airway obstruction (ratio of expiratory flow to inspiratory flow at 50 percent of forced vital capacity [FEF50/FIF50] exceeding 1) or upper airway fluttering (indicated by a sawtooth aspect on the mid-half of the inspiratory part of the curve) or both. In our study, 57 patients referred for a suspected sleep apnea syndrome (SAS) underwent conventional spirometry, assessment of flow-volume curves, ENT examination, and polysomnography. Thirty patients had an obstructive SAS, four patients a central SAS, and 23 patients no SAS. Signs of upper airway fluttering (the sawtooth sign) were present in 61 percent of the patients with obstructive SAS and in 46 percent of the patients without obstructive SAS (central SAS or no SAS). Signs of extrathoracic upper airway obstruction (FEF50/FIF50 greater than 1) were present in 67 percent of the patients with obstructive SAS and in 71 percent of the patients without obstructive SAS. These results suggest that upper airway abnormalities, as reflected by abnormal flow volume curves, are not always associated with obstructive SAS; they favor the hypothesis of a central component in the mechanism of upper airway occlusion during sleep.
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PMID:Flow-volume curve abnormalities and obstructive sleep apnea syndrome. 396 23

Twenty-three adults with moderate to severe sleep apnea syndrome (SAS) and positive ENT obstructive findings were treated by either tonsillectomy or by submucosal resection (SMR). Fourteen of the 23 patients (60.8%), 5 of the 7 who underwent tonsillectomy and 9 of the 16 treated by SMR, reported on a clinical improvement in the quality of their nocturnal sleep and diurnal hypersomnolence. Post-treatment polyhypnographic recordings in all responding patients disclosed significantly less apneas and waking within sleep.
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PMID:Effects of nasal surgery and tonsillectomy on sleep apnea. 665 69

Seventy-eight workers, drawn from a population of 1502 presumably healthy working men who were interviewed about sleep habits and sleep disorders, underwent polygraphic recordings for at least 1 night. A significant association was found between the complaint of excessive daytime sleepiness and the incidence of sleep apnea. Workers with more than 10 apneas per hour of sleep complained significantly more about loud snoring, hypermotility in sleep, and frequent headaches. They had significantly more ENT findings and hypertension.
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PMID:Incidence of sleep apnea in a presumably healthy working population: a significant relationship with excessive daytime sleepiness. 666 93

Obstructive sleep apnoea may present with a wide range of symptoms resulting in a variety of referral pathways. A multidisciplinary approach to examination and diagnosis helps to determine the most appropriate treatment plan for each individual. The subject is seen by each member of the team, appropriate investigations undertaken and a further meeting arranged at which all opinions are discussed. A reasoned treatment regime is produced, taking into consideration the patient's wishes and overall medical condition. This paper describes the team approach currently employed in the Department of Thoracic Medicine at The Prince Charles Hospital, Brisbane, Australia. The thoracic physician and ENT surgeon work in close collaboration with their dental colleagues: an orthodontist, prosthodontist and a maxillofacial surgeon. An outline of the examination and investigations made by each is described and the multidisciplinary approach is illustrated by a description of the management of five subjects with suspected obstructive sleep apnoea.
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PMID:The importance of a multidisciplinary approach to the assessment of patients with obstructive sleep apnoea. 885 Jan 65


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