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

A programme for the differential diagnosis of rhonchopathy is reported, based upon the MESAM system developed at the University of Marburg. With this biparametric long-term monitor the snoring noise and the heart beat frequency (a beat-by-beat analysis) were recorded in 94 patients with a history of snoring. Other investigations included tape recordings of the snoring noise, nasoendoscopy, pulsed cineradiography of the pharynx and the recording of the character of the snoring. This programme is much cheaper than a sleep laboratory, but it can distinguish between obstructive sleep apnoea syndrome, habitual rhonchopathy and non-snorers, mainly by means of the characteristic patterns of MESAM recordings. A sleep apnoea syndrome was diagnosed in 19 patients and habitual rhonchopathy in 38 patients, whereas 33 patients were regarded as non-snorers. Ten of our 19 patients with sleep apnoea were re-examined by a sleep laboratory and the diagnosis was proved in all of these cases. In the 38 patients with habitual rhonchopathy auditory analysis of the snoring noise classified 23 patients as velar and 10 as pharyngeal snorers; 5 patients showed a mixed type of rhonchopathy. The questionnaire accompanying the MESAM system, nasal endoscopy and cine films support the individual diagnosis by revealing typical complaints and characteristic organic findings and thus contribute to the differential diagnostic screening. However, the three groups do overlap quite markedly with respect to symptoms und organic findings. In summary, the MESAM system provides an economically viable examination programme that can be used routinely by the otorhinolaryngologist for the differential diagnosis of rhonchopathy.
HNO 1991 Dec
PMID:[Differential diagnosis of rhonchopathy using the MESAM system]. 179 59

We report a 2-year-old infant with severe obstructive sleep apnoea. The symptoms had deteriorated for several months, and indicated complete obstruction shortly after the child fell asleep, with reduction of the oxygen saturation to under 30%. Since the obstruction could only be interrupted by waking the child, a tracheostomy was proposed. Endoscopy under general anaesthesia revealed no pathological findings. The stenosis could only be seen using transnasal fibre-optic endoscopy when the obstruction occurred during sleep: the oropharyngeal wall collapsed at the level of the velopharyngeal sphincter. A tube passed through the nose and through the collapsing section of the pharynx to the entrance of the larynx prevented the apnoea. The parents were taught to introduce and fix the tube. After an observation period of 1 year the larynx had stabilized spontaneously, and the tube has to be introduced only rarely.
HNO 1991 May
PMID:[Functional nasopharyngeal fiberoptic endoscopy for pre-therapeutic diagnosis of sleep apnea syndrome in infants. A case report]. 187 38

Knowledge of the connection between habitual snoring diseases and obstructive sleep apnoea has stimulated research into sleep disturbance in patients at high risk of cardiovascular disease. Any disturbance of nasal ventilation leads to a higher resistance to breathing and may cause cardiovascular complications in the long run. Anatomical and functional conditions that lead to intermittent incomplete blockage or complete occlusion of the upper respiratory tract must be detected and surgically eliminated, if possible. Surgical procedures for treating snoring and obstructive sleep apnoea may be successful and fill the gap between conservative treatment and continuous nasal positive airway pressure therapy. Our experience in 24 patients in presented.
HNO 1991 Apr
PMID:[Experience with surgical therapy in snoring and sleep apnea]. 206 69

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.
HNO 1989 Dec
PMID:[How frequent are pathologic ENT findings in patients with obstructive sleep apnea syndrome?]. 260 43

Correlations between the manifestation of obstructive sleep apnoea syndrome (OSAS) and anatomical or functional changes in the upper respiratory tract remain controversial. The correlation between obstruction of the upper respiratory tract and the degree of sleep apnoea syndrome was investigated in 60 patients with obstructive sleep apnoea (diagnosed by polysomnography) and in 55 healthy controls. After clinical examination, rhinomanometry and determination of the size of the lower jaw and oropharynx, the motility of the pharyngeal walls during Mueller's manoeuvre was evaluated by flexible endoscopy. No significant anatomical or functional differences were observed between OSAS patients and healthy controls. There was no correlation between the degree of OSAS (expressed by the apnoea index) and pharyngeal size. Although no specific statement concerning diagnosis or degree of OSAS can be made on the basis of an otolaryngological examination, OSAS patients should always undergo otolaryngological examination to exclude pharyngeal disease.
HNO 1988 Apr
PMID:[ENT medical findings in obstructive sleep apnea syndromes]. 304 55

Laryngo-tracheo-bronchoscopy on a 2 year old boy with the sleep apnea syndrome showed no anatomic abnormalities and no signs of upper airway obstruction. After tonsillectomy the infant revealed an improvement in sleep pattern, and 1 1/2 years later, the syndrome has been relieved completely. In our opinion, the sleep apnea syndrome is an indication for tonsillectomy.
HNO 1985 Feb
PMID:[Sleep apnea syndrome in children: indications for tonsillectomy]. 398 Feb 51

Stimulating cardiac beta 1-adrenoceptors with oxyfedrine causes dilatation of coronary vessels and positive inotropic effects on the myocardium. beta 1-adrenergic agonists increase coronary blood flow in nonstenotic and stenotic vessels. The main indication for the use of the phosphodiesterase inhibitors pamrinone, mirinone, enoximone and piroximone is acute treatment of severe congestive heart failure. Theophylline is indicated for the treatment of asthma, chronic obstructive pulmonary disease, apnea in preterm infants ans sleep apnea syndrome. Severe arterial occlusive disease associated with atherosclerosis can be beneficially affected by elcosanoids. These drugs must be administered parenterally and have a half-life of only a few minutes. Sublingual or buccal preparations of nitrates are the only prompt method (within 1 or 2 min) of terminating anginal pain, except for biting nifedipine capsules. The short half-life (about 2.5 min) of nitroglycerin (glyceryl trinitrate) makes long term therapy impossible. Tolerance is a problem encountered with longer-acting nitric oxide donors. Knowledge of the pharmacokinetic properties of vasodilating drugs can prevent a too sudden and severe blood pressure decrease in patients with chronic hypertension. In considering the administration of a second dose, or another drug, the time necessary for the initially administered drug to reach maximal efficacy should be taken into account. In hypertensive emergencies urapidil, sodium nitroprusside, nitroglycerin, hydralazine and phentolamine are the drugs of choice, with the addition of beta-blockers during catecholamine crisis or dissecting aortic aneurysm. Childhood hypertension is most often treated with angiotensin-converting enzyme (ACE) inhibitors or calcium antagonists, primarily nifedipine. Because of the teratogenic risk involved with ACE inhibitors, extreme caution must be exercised when prescribing for adolescent females. The propagation of health benefits to breast-fed infants, combined with more women delaying pregnancy until their fourth decade, has entailed an increase in the need for hypertension management during lactation. Low dose hydrochlorothiazide, propranolol, nifedipine and enalapril or captopril do not pose enough of a risk of preclude breastfeeding in this group. The most frequently used antihypertensive agents during pregnancy are methyldopa, labetalol and calcium channel antagonists. Methyldopa and beta-blockers are the drugs of choice for treating mild to moderate hypertension. Prazosin and hydralazine are used to treat moderate to severe hypertension and hydralazine, urapidil or labetalol are used to treat hypertensive emergencies. The use of overly aggressive antihypertensive therapy during pregnancy should be avoided so that adequate uteroplacental blood flow is maintained. Methyldopa is the only drug accepted for use during the first trimester of pregnancy.
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PMID:Clinical pharmacokinetics of vasodilators. Part II. 967 32

This paper deals with the potential role of two blood pressure regulatory systems in the development of hypertension in obstructive sleep apnoea (OSA). Beside the acute and long-term sympathoexcitation documented in this disease, there seems to be an impaired endothelium-dependent vascular relaxation. In particular, nitric oxide (NO)-mediated vasodilatation was impaired in patients with OSA. Both these changes act to increase blood pressure during physiological conditions. However, they may not be determinants for hypertension development in OSA as no differences between normo- and hypertensive patients with OSA were detected. Nevertheless, an altered balance between the vasoconstrictive influence of the sympathoadrenergic system and the vasodilatory action of NO-dependent vascular relaxation may be of importance in the development of sustained hypertension in OSA.
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PMID:Daytime waking autonomic function and vascular control in OSA. 1060 96

Oral appliances are used to treat snoring and sleep apnea. Yet, their success cannot be predicted without a therapeutical trial. This uncertainty and the high prices of the appliances are the reasons for their limited use. We tested a cheap, custom fit mandibular advancement device (SnorBan) for the treatment of sleep disordered breathing in order to assess its efficacy. 39 consecutive patients (51.1 +/- 9.2 years, BMI = 27.4 +/- 4.5 kg/m2) with different degrees of sleep disordered breathing (AHI = 16.6/h +/- 15.6/h) received the device after a thorough clinical examination. After getting used to the device a second polysomnography was performed. The AHI improved significantly from 16.6/h to 8.2/h (P < 0.01) in the whole group. The only patient who became worse could not get used to the device. Time with snoring dropped significantly from 16.3% to 6.6%, 59.1% of the sleep apnea patients were successfully treated as their RDI dropped below 10/h. The sleep efficiency remained unchanged. Slow wave sleep and REM-sleep increased significantly from 12% to 16% (P < 0.05). The overall compliance was 75%. The custom fit mandibular advancement device Snorban is a cheap and effective treatment for a number of patients with snoring and sleep apnea. The oral appliance is proven to be a useful and simple, non-surgical treatment option. Polysomnographic follow-up is mandatory as breathing may worsen with the device while asleep.
HNO 2000 Apr
PMID:[Use of an intraoral snoring therapy device of thermolabile plastic]. 1081 Jun 77

We introduce the standard method of measurement of nitric oxide recommended by American thoracic society in 1999 and report the results of exhaled NO and nasal NO in patients with obstructive sleep apnea syndrome(OSAS). Our data showed lower exhaled NO output in the patients with OSAS than that of normal volunteers(NV) and that of patients with simple obesity(SO). On the other hand, nasal NO in the OSAS patients is higher than that of NV and that of SO patients. Also, there were significant relationships between apnea index and exhaled NO and between desaturation during sleep and nasal NO. These findings suggested that NO from lower and upper airway will be a non-invasive maker of sleep disordered breathing in future.
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PMID:[Exhaled nitric oxide]. 1094 31


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