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)

Upregulation of brain adenosine receptors in DBA/2J mice as affected by theophylline and caffeine, adenosine antagonists, was examined following subcutaneous drug implantation to ensure chronic exposure. Scatchard analysis of binding to membranes of cerebral cortex and cerebellum from individual mice showed a differential upregulation of (-)-N6-R-[G-3H]phenylisopropyladenosine ([3H]-L-PIA) binding density by theophylline. After 14 days of exposure to theophylline (serum concentration of 1.2 +/- 0.01 micrograms/ml measured by HPLC analysis), the Bmax for L-PIA binding to cerebellar membranes increased 22% over the control mice (statistically significant at P less than 0.01 level). Theophylline had no effect on the Bmax for L-PIA binding to cerebral cortical membranes. The observed increases in Bmax values of cerebellar (13.2%) and cerebral cortical membrane binding (14.2%) on chronic exposure to caffeine (7.1 +/- 0.5 micrograms/ml) were not statistically significant at the P less than or equal to 0.05 level. Neither methylxanthine affected the dissociation constant, KD, for L-PIA. The increased potential for adenosine receptor upregulation by theophylline compared to caffeine following chronic, low level exposure suggests that caffeine treatment for sleep apnea may be preferred to the standard theophylline therapy.
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PMID:Chronic exposure to subcutaneously implanted methylxanthines. Differential elevation of A1-adenosine receptors in mouse cerebellar and cerebral cortical membranes. 360 53

One hundred subjects without any complaint of sleep disturbance were evaluated in the sleep laboratory for the presence of sleep apnea and sleep apneic activity (SAA). This sample, which had a representative proportion of women and men and a wide age distribution, included only subjects who were physically and mentally healthy and were not using any medication. None of the subjects had the clinical condition of sleep apnea, and only 12 percent of the subjects met the more liberal criterion for SAA. The prevalence of SAA was slightly higher in men than in women. SAA was positively and significantly correlated with increasing age. However, relative severity, as judged by the mean number of events and the duration of events, showed no consistent pattern in relation to age. Further, it was demonstrated that those subjects with SAA were significantly heavier than those without the activity. Neither smoking nor caffeine consumption was related to the presence of SAA. When the amount of each sleep stage was controlled for, SAA occurred significantly more often during REM sleep. A relatively small number of EEG arousals were related to SAA, with only about one-fifth of the events resulting in brief arousals.
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PMID:Sleep apneic activity in a normal population. 707 80

Sleep disturbance among uremic patients is reported to be high, but data on the actual prevalence, clinical significance, and causative factors is limited. A sleep questionnaire was distributed to an entire hemodialysis unit of 64 patients. Of the 54 patients who completed the survey, 83.3% had sleep-wake complaints. Disturbed sleep was reported by 28 patients (51.8%), and causes were secondary to delayed sleep onset in 25 patients (46.3%), frequent awakening in 19 patients (35.2%), restless legs syndrome (RLS) in 18 patients (33.3%), and generalized restlessness in six patients (11.1%). Daytime sleepiness was the most frequent complaint, reported by 36 patients (66.7%), and RLS was the second most frequent specific complaint, reported by 31 patients (57.4%). Symptoms of sleep apnea were described by seven patients (13.0%). Male gender, age more than 60 years, RLS, and caffeine intake were associated with more sleep-wake complaints (P = 0.009, P = 0.002, P = 0.028, and P = 0.008, respectively). Urea and creatinine levels were higher in patients with RLS (P = 0.04 and P = 0.08, respectively); otherwise, no other metabolic or demographic variable was associated with specific sleep disorders or disturbance. Sleep problems are very common in dialysis patients and likely contribute to the impaired quality of life experienced by many of these patients.
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PMID:Sleep complaints are common in a dialysis unit. 748 27

Sleep complaints, habits, and medical history were surveyed in 81 patients chronically receiving continuous ambulatory peritoneal dialysis. Seventy-three percent of the sample reported insomnia, and 52% reported unintentional napping during the day. Behavioral factors (such as caffeine or alcohol use) or the severity of concurrent medical disease did not account for the sleep problems. Eighteen of these patients subsequently underwent polysomnography and objective measurement of daytime sleepiness. Clinically significant sleep apnea syndrome was present in 11. The presence of sleep apnea was associated with increased levels of psychological distress and daytime sleepiness. Periodic leg movements during sleep were also frequently observed but had minimal effect on sleep quality. Implications of these findings for clinical practice are discussed.
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PMID:Sleep disorders in patients on continuous ambulatory peritoneal dialysis. 757 84

Sleep is disturbed in 90% of patients with major depression. Disordered sleep physiology may persist after clinical remission of depression, suggesting either that sleep disruption is a trait characteristic of recurrent depression or that depressed patients acquire new habits that perpetuate sleep-related problems. This article reviews the data suggesting a common pathophysiology between sleep and depression. It then focuses on a strategy for evaluating and treating sleep disruption in depressed patients. Treatment must have a conservative goal of restoring sleep quality to the pre-episode level. The treatment of sleep disruption relies primarily on optimal treatment of the depression itself. This includes evaluation and treatment of comorbid medical disorders, substance use (e.g., caffeine, alcohol), and sleep disorders (e.g., nocturnal myoclonus, sleep apnea). The effects of the different classes of antidepressant medications on sleep architecture are presented. Nonpharmacologic strategies for improving sleep, such as behavior modification, relaxation, and phototherapy, are discussed. Finally, the risks and benefits of hypnotic use in the depressed patient and a treatment algorithm for the acute and chronic use of hypnotics are considered.
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PMID:Treatment of sleep disturbances in depressed patients. 784 8

Refreshing sleep requires both sufficient total sleep time as well as sleep that is in synchrony with the individual's circadian rhythm. Problems with sleep organization in elderly patients typically include difficulty falling asleep, less time spent in the deeper stages of sleep, early-morning awakening and less total sleep time. Poor sleep habits such as irregular sleep-wake times and daytime napping may contribute to insomnia. Caffeine, alcohol and some medications can also interfere with sleep. Primary sleep disorders are more common in the elderly than in younger persons. Restless legs syndrome and periodic limb movement disorder can disrupt sleep and may respond to low doses of antiparkinsonian agents as well as other drugs. Sleep apnea can lead to excessive daytime sleepiness. Evaluation of sleep problems in the elderly includes careful screening for poor sleep habits and other factors that may be contributing to the sleep problem. Formal sleep studies may be needed when a primary sleep disorder is suspected or marked daytime dysfunction is noted. Therapy with a benzodiazepine receptor agonist may be indicated after careful evaluation.
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PMID:Sleep problems in the elderly. 1032 61

The purpose of this study was to determine whether caffeine consumption confounds the relationship among adrenergic tone, as measured by urinary norepinephrine (NE), blood pressure (BP) and obstructive sleep apnoea (OSA). Data were analysed using correlation and regression analysis, analysis of covariance and t-tests. Subjects included normotensives and hypertensives with and without OSA: 38 men, 23 women, aged 30-60 y; 100-150% of ideal body weight; without other major illness. Patients were studied using polysomnography, caffeine consumption was assessed, 24-h urinary NE levels were examined and ambulatory BP was recorded. Patients with OSA (N=27) reported significantly greater caffeine consumption than those without OSA (N=34) (295 vs. 103 mg, P=0.010), but caffeine was not significantly correlated with their ambulatory BP. In contrast, NE excretion correlated with caffeine consumption (r=0.24, P=0.041), apnoea severity (r=0.65, P < 0.001) and BP (r=0.34, P < 0.005). Significant OSA-NE and BP-NE relationships remained even after controlling for caffeine consumption. Patients with OSA consumed nearly three times the amount of caffeine as patients without OSA. While caffeine partially explains the increased adrenergic tone in patients with OSA and the relationship between BP and NE, it does not appear to contribute significantly to the relationship between OSA and elevated BP.
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PMID:Does caffeine confound relationships among adrenergic tone, blood pressure and sleep apnoea? 1101 66

Recently there has been a sizeable increase in research on fatigue and accidents in transportation. Therefore a meeting was convened last year to discuss prevalence, mechanisms and countermeasures, with the intention to produce an international consensus document. It was concluded that official statistics strongly underestimate prevalence, and that a reasonable estimate, based on research, lies between 10 and 20% for accidents on the road, in the air and at sea. The main causes are disturbed sleep and work at the circadian low, caused by night work, morning work, sleep/wake disorders (including sleep apnea) or social obstacles to sleep. Suggested countermeasures include information/education of the public and of transportation companies, as well as enforcement of existing work hour regulation. Additional countermeasures include strategic use of napping and caffeine, as well as implementation of rumble strips and--possibly--electronic devices for drowsiness detection.
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PMID:[International consensus meeting on fatigue and the risk of traffic accidents. The significance of fatigue for transportation safety is underestimated]. 1146 74

In healthy individuals, caffeine intake may improve performance on cognitive tests. Obstructive sleep apnea (OSA) is a disorder that has been associated with impaired cognitive function. In this study, we investigated whether increased caffeine intake in untreated patients with OSA is linked to better cognitive performance. Forty-five untreated OSA patients underwent baseline polysomnography after completing a survey of 24-h caffeine intake. Participants completed a battery of neuropsychological tests, then demographically corrected T scores and a global deficit score (GDS) were calculated on these tests. Partial correlation analysis was performed to compare daily caffeine intake with GDS, after controlling for body mass index (BMI) and sleep apnea severity. Analysis of covariance was done to examine differences in daily caffeine intake between cognitively impaired (GDS >or= 0.5) and non-impaired (GDS < 0.5) individuals. Seven out of the 45 subjects met the criteria (GDS >or= 0.5) for cognitive impairment. There was a significant inverse association between caffeine intake and the GDS, both when controlling for BMI (r =or -0.331, p = 0.04) and when controlling for BMI and apnea severity (r =or-0.500, p = 0.002); those with less impairment consumed more caffeine. Analysis of covariance demonstrated that cognitively impaired individuals consumed one-sixth as much caffeine as non-impaired individuals (p < 0.05). In patients with moderately severe OSA, higher average daily caffeine intake was associated with less cognitive impairment.
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PMID:Caffeine intake is independently associated with neuropsychological performance in patients with obstructive sleep apnea. 1799 51

Modafinil is a wake-promoting agent that is pharmacologically different from other stimulants. It has been investigated in healthy volunteers, and in individuals with clinical disorders associated with excessive sleepiness, fatigue, impaired cognition and other symptoms. This review examines the use of modafinil in clinical practice based on the results of randomized, double-blind, placebo-controlled clinical trials available in the English language in the MEDLINE database. In sleep-deprived individuals, modafinil improves mood, fatigue, sleepiness and cognition to a similar extent as caffeine but has a longer duration of action. Evidence for improved cognition in non-sleep-deprived healthy volunteers is controversial.Modafinil improves excessive sleepiness and illness severity in all three disorders for which it has been approved by the US FDA, i.e. narcolepsy, shift-work sleep disorder and obstructive sleep apnoea with residual excessive sleepiness despite optimal use of continuous positive airway pressure (CPAP). However, its effects on safety on the job and on morbidities associated with these disorders have not been ascertained. Continued use of CPAP in obstructive sleep apnoea is essential. Modafinil does not benefit cataplexy.In very small, short-term trials, modafinil improved excessive sleepiness in patients with myotonic dystrophy. It was efficacious in fairly large studies of attention deficit hyperactivity disorder (ADHD) in children and adolescents, and was as efficacious as methylphenidate in a small trial, but has not been approved by the FDA, in part because of its serious dermatological toxicity. In a trial of 21 non-concurrent subjects, with 2-week treatment periods, modafinil was as effective as dexamfetamine in adult ADHD. Modafinil was helpful for depressive symptoms in bipolar disorder in a trial that excluded patients with stimulant-induced mania. A single dose of modafinil may hasten recovery from general anaesthesia after day surgery. A single dose of modafinil improved the ability of emergency room physicians to attend didactic lectures after a night shift, but did not improve their ability to drive home and caused sleep disturbances subsequently.Modafinil had a substantial placebo effect on outcomes such as fatigue, excessive sleepiness and depression in patients with traumatic brain injury, major depressive disorder, schizophrenia, post-polio fatigue and multiple sclerosis; however, it did not provide any benefit greater than placebo.Trials of modafinil for excessive sleepiness in Parkinson's disease, cocaine addiction and cognition in chronic fatigue syndrome provided inconsistent results; all studies had extremely small sample sizes. Modafinil cannot be recommended for these conditions until definitive data become available.Modafinil induces and inhibits several cytochrome P450 isoenzymes and has the potential for interacting with drugs from all classes. The modafinil dose should be reduced in the elderly and in patients with hepatic disease. Caution is needed in patients with severe renal insufficiency because of substantial increases in levels of modafinil acid. Common adverse events with modafinil include insomnia, headache, nausea, nervousness and hypertension. Decreased appetite, weight loss and serious dermatological have been reported with greater frequency in children and adolescents, probably due to the higher doses (based on bodyweight) used. Modafinil may have some abuse/addictive potential although no cases have been reported to date.
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PMID:Approved and investigational uses of modafinil : an evidence-based review. 1872 34


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