Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0037315 (sleep apnea)
 8,000 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1991-2000 2052 patients (81% men and 19% women) were referred to our Sleep Laboratory because of OSA suspision. In 1194 (58%) subjects (88% men and 12% women) diagnosis of obstructive sleep apnoea (OSA, AHI > 10) was confirmed. In 430 of them (36%) mild OSA (AHI 11-25), in 243 (20%) moderate OSA (AHI 26-40), and in 521 (44%) severe OSA (AHI > 40) was diagnosed. Epworth sleepiness scale score in those groups was 10.4, 10.5 and 13.0 points respectively. 908 (76%) of patients with OSA were submitted to nCPAP treatment. Effective CPAP pressure ranged from 5 to 20 milibars, mean 8.4 mbars. In 21 patients upper airway resistance syndrome (UARS) was diagnosed. Central sleep apnoea, most frequently of Cheyne-Stokes respiration type was diagnosed in 13 patients. The most common diseases accompanying OSA were: systemic hypertension (46%), coronary heart disease (29%), diabetes (12%), and COPD (9%). Majority of OSA patients (61%) were obese (BMI > 30 kg/m2), 32% were over weight (BMI 25-30 kg/m2). Only 7% had normal body weight (BMI 20-25 kg/m2). Long-term (more than one year) compliance to treatment was found in 70% of patients prescribed CPAP.
 ...
PMID:[Ten years experience of the sleep laboratory at the Institute of Tuberculosis and Lung Disease in Warsaw]. 1192 60

Many pulmonary function tests require forced expiration, and the precision of the tests depends on the effort of the subjects. In elderly people, the reproducibility of test results may be inadequate because of insufficiency of the subjects' effort, and the diagnosis of COPD, which is frequently observed in elderly people, is often difficult. To improve the accuracy of the diagnosis, pulmonary function tests that do not require effort are needed. In this study, effortless pulmonary function tests (examinations of the cardiogenic oscillation, negative expiratory pressure, exhaled temperature, and exhaled breath condensate), the application of which to various respiratory disorders (i.e., sleep apnea syndrome, COPD, bronchial asthma) is attempted, are presented.
 ...
PMID:[Effort-independent pulmonary function tests]. 1367 39

Sleep is characterized by a profound change of load and capacity of the respiratory system. Load increases due to a rise in upper and lower airway resistance. Capacity decreases due to reduced chemosensitivity, a decrease in muscle activity and minute ventilation. Whereas these changes do not lead to relevant blood gas changes and do not disturb sleep in healthy subjects, patients with respiratory diseases frequently show the first symptoms of their disease during sleep. Pulmonary diseases in which sleep plays an important role are asthma, COPD, hypercapnic respiratory failure, sleep disordered breathing, the overlap-syndrome and cystic fibrosis. Medical history should include sleep and complaints during the night. In asthmatics peak-flow measurements during the night may provide valuable information. In all other disorders mentioned, nocturnal ambulatory recording of respiration and arterial oxygen saturation often allow the detection of relevant disorders of breathing during sleep. If ambulatory monitoring reveals relevant pathology, then further evaluation and treatment in the sleep laboratory are warranted.
 ...
PMID:[Relevance of sleep for patients with lung diseases]. 1534 Jun 96

Extensive evidence links cardiovascular disease and sleep disordered breathing. OSA has adverse effects on blood pressure, cardiovascular status,and mortality. Effective CPAP therapy can improve blood pressure and cardiac function in patients who have OSA. Patients who have congestive heart failure have a high prevalence of sleep-disordered breathing, with OSA occurring in 30% of such patients and Cheyne-Stokes respiration in 40%.CPAP is the preferred mode of therapy for both types of sleep-disordered breathing in patients who have coexistent congestive heart failure. Nocturnal worsening of asthma is a common manifestation of this disease that indicates increased disease severity. Therapy focuses on judicious use of long-acting bronchodilators, and the presence of OSA should also be considered. COPD is frequently associated with impaired sleep, likely because of chronic dyspnea and sleep-associated hypoxemia. Appropriate therapy again includes long-acting bronchodilators and possibly nocturnal supplemental oxygen. Gastroesophageal reflux during sleep may lead to prolonged episodes of esophageal acid exposure and may be a common sequela of OSA, perhaps triggering nocturnal worsening of asthma. Endstage renal disease and chronic dialysis are commonly associated with a host of troublesome sleep problems,including OSA, RLS, PLMD, and daytime sleepiness.
 ...
PMID:Sleep and medical disorders. 1593 98

An estimated 14 million Americans are afflicted with COPD and are at risk for significant abnormalities in gas exchange and ventilation that are exacerbated by sleep. In addition 10-15% of COPD patients concomitantly suffer from sleep apnea. The term "Overlap Syndrome" was originally coined by Flenley to describe the relationship between COPD and sleep apnea. Patients with overlap syndrome are characterized by having lower PaO2 during wakefulness, higher PaCO2, elevated pulmonary artery pressure and more significant episodes of nocturnal hypoxemia than sleep apnea patients without COPD. COPD and sleep apnea have long been individually recognized for having significantly detrimental affects on the respiratory physiology of patients. The mechanisms of both diseases compromise the gas exchange, oxygenation, and overall mortality and morbidity in the affected patients. While both of these diseases individually represent significant detriment to affected patients, the combination of these two diseases has been shown to have an even more profound affect on patients' oxygenation, gas exchange, and breathing patterns. As our understanding of the physiological processes of sleep develops, the relationship between obstructive sleep apnea and obstructive lung disease has become progressively more apparent. Identification and appropriate management of these patients is particularly important because the 5 year survival of patients with overlap syndrome is lower than that of patients with sleep apnea alone as shown in prospective trials.
COPD 2005 Sep
PMID:Sleep in COPD patients. 1714

Actimetry is a widely accepted technology for the diagnosis and monitoring of sleep disorders such as insomnia, circadian sleep/wake disturbance, and periodic leg movement. In this study we investigate a very sensitive non-contact biomotion sensor to measure actimetry and compare its performance to wrist-actimetry. A data corpus consisting of twenty subjects (ten normals, ten with sleep disorders) was collected in the unconstrained home environment with simultaneous non-contact sensor and ActiWatch actimetry recordings. The aggregated length of the data is 151 hours. The non-contact sensor signal was mapped to actimetry using 30 second epochs and the level of agreement with the ActiWatch actimetry determined. Across all twenty subjects, the sensitivity and specificity was 79% and 75% respectively. In addition, it was shown that the non-contact sensor can also measure breathing and breathing modulations. The results of this study indicate that the non-contact sensor may be a highly convenient alternative to wrist-actimetry as a diagnosis and screening tool for sleep studies. Furthermore, as the non-contact sensor measures breathing modulations, it can additionally be used to screen for respiratory disturbances in sleep caused by sleep apnea and COPD.
 ...
PMID:An evaluation of a non-contact biomotion sensor with actimetry. 1800 43

Pulmonary artery hypertension secondary to chronic lung diseases is a clinical entity with no specific symptoms that can develop as a result of parenchymal lung disorders (COPD-emphysema, sleep apnea syndrome, diffuse parenchymal lung diseases, etc.) and pulmonary vascular disorders (vasculitis, sarcoidosis, etc.). In the clinical history of these chronic and invalidating diseases, pulmonary vasculature goes through various degenerative and/or proliferative changes, responsible of the pulmonary arterial hypertension appearance. The rise in pulmonary artery pressure can be subtle and the progression from an asymptomatic disease to a more severe syndrome is often common in all forms of secondary pulmonary arterial hypertension. Etiopathology of pulmonary artery hypertension secondary to chronic lung diseases is based on one or more of the following mechanisms: hypoxic vasoconstriction, decreased area of pulmonary vascular bed, volume/pressure overload. In these forms, the above three mechanisms show common mediators, all responsible of disease progression but singularly potential reversible. Therapies for secondary pulmonary artery hypertension consist primarily on the treatment of the underlying disease. Therapy is most effective when initiated prior to the onset of irreversible pulmonary vascular damage. In the last two decades, new medical treatments (prostacyclins, endothelin receptor antagonists, phosphodiesterase inhibitors) for pulmonary arterial hypertension have been available for the sporadic and the secondary to systemic sclerosis forms. The role of these drugs in the other forms of pulmonary arterial hypertension has not been well studied yet. This review will go through the pathogenesis and the several therapeutic approaches for pulmonary artery hypertension secondary to chronic pulmonary diseases or pulmonary vasculature disorders.
 ...
PMID:Pulmonary arterial hypertension secondary to chronic lung diseases: pathogenesis and medical treatment. 1803 16

Patients with COPD may show slow, progressive deteriorations in arterial blood gases during the night, particularly during rapid eye movement (REM) sleep. This is mainly due to hypoventilation, while a deterioration of ventilation/perfusion mismatch plays a minor role. The severity of gas exchanges alterations is proportional to the degree of impairment of diurnal pulmonary function tests, particularly of partial pressure of oxygen (PaO2) and of carbon dioxide (PaCO2) in arterial blood, but correlations between diurnal and nocturnal blood gas levels are rather loose. Subjects with diurnal PaO2 of 60-70 mmHg are distinguished in "desaturators" and "nondesaturators" according to nocturnal oxyhemoglobin saturation behavior. The role of nocturnal hypoxemia as a determinant of alterations in sleep structure observed in COPD is dubious. Effects of the "desaturator" condition on pulmonary hemodynamics, evolution of diurnal blood gases, and life expectancy are also controversial. Conversely, it is generally accepted that occurrence of sleep apneas in COPD is associated with a worse evolution of the disease. Nocturnal polysomnographic monitoring in COPD is usually performed when coexistence of sleep apnea ("overlap syndrome") is suspected, while in most other cases nocturnal oximetry may be enough. Nocturnal oxygen attenuates sleep desaturations among stable patients, without increases in PaCO2 of clinical concern. Nocturnal treatment with positive pressure ventilators may give benefit to some stable hypercapnic subjects and patients with the overlap syndrome.
 ...
PMID:Respiratory disorders during sleep in chronic obstructive pulmonary disease. 1804 93

These practice parameters are an update of the previously published recommendations regarding the use of autotitrating positive airway pressure (APAP) devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome. Continuous positive airway pressure (CPAP) at an effective setting verified by attended polysomnography is a standard treatment for obstructive sleep apnea (OSA). APAP devices change the treatment pressure based on feedback from various patient measures such as airflow, pressure fluctuations, or measures of airway resistance. These devices may aid in the pressure titration process, address possible changes in pressure requirements throughout a given night and from night to night, aid in treatment of OSA when attended CPAP titration has not or cannot be accomplished, or improve patient comfort. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine has reviewed the literature published since the 2002 practice parameter on the use of APAP. Current recommendations follow: (1) APAP devices are not recommended to diagnose OSA; (2) patients with congestive heart failure, patients with significant lung disease such as chronic obstructive pulmonary disease; patients expected to have nocturnal arterial oxyhemoglobin desaturation due to conditions other than OSA (e.g., obesity hypoventilation syndrome); patients who do not snore (either naturally or as a result of palate surgery); and patients who have central sleep apnea syndromes are not currently candidates for APAP titration or treatment; (3) APAP devices are not currently recommended for split-night titration; (4) certain APAP devices may be used during attended titration with polysomnography to identify a single pressure for use with standard CPAP for treatment of moderate to severe OSA; (5) certain APAP devices may be initiated and used in the self-adjusting mode for unattended treatment of patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes); (6) certain APAP devices may be used in an unattended way to determine a fixed CPAP treatment pressure for patients with moderate to severe OSA without significant comorbidities (CHF, COPD, central sleep apnea syndromes, or hypoventilation syndromes); (7) patients being treated with fixed CPAP on the basis of APAP titration or being treated with APAP must have close clinical follow-up to determine treatment effectiveness and safety; and (8) a reevaluation and, if necessary, a standard attended CPAP titration should be performed if symptoms do not resolve or the APAP treatment otherwise appears to lack efficacy.
 ...
PMID:Practice parameters for the use of autotitrating continuous positive airway pressure devices for titrating pressures and treating adult patients with obstructive sleep apnea syndrome: an update for 2007. An American Academy of Sleep Medicine report. 1822 88

Diagnosed obstructive sleep apnea affects 2-4% of middle aged Americans and represents a substantial health care burden. Despite its prevalence, little is known about the demographic characteristics or clinical management of sleep apnea patients hospitalized for other comorbidities and surgeries. The aim of this study was to provide a broad characterization of the epidemiology of sleep apnea in hospitalized patients in the United States and to describe the trends in the management of their sleep apnea during their hospitalizations. Using the 2004 National Hospital Discharge Survey (NHDS), a nationally representative sample of discharges from nonfederal acute care hospitals in the United States, cases of sleep apnea were obtained from hospital discharge records coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The specific objectives of this study were to: (1) describe the prevalence of hospitalized unspecified sleep apnea individuals according to age, gender, and comorbidities; (2) estimate prevalence of the use of continuous positive airway pressure (CPAP) therapy during hospitalization and describe those uses according to hospital ownership and size. A retrospective analysis of data of hospitalized patients with unspecified sleep apnea from the 2004 National Hospital Discharge Survey (NHDS) was completed. In 2004, the NHDS collected data for approximately 371,000 discharges from a sample of 439 nonfederal short-stay hospitals. An estimated 34.9 million inpatients were discharged from nonfederal short-stay hospitals in 2004. Patients diagnosed with unspecified sleep apnea were identified using the International Classification of Diseases (Ninth Revision), Clinical Modification (ICD-9-CM) code of 780.57, which, before 2005, was the sole diagnostic code under which obstructive sleep apnea was listed. A subset of these patients, those receiving CPAP therapy, was further identified using the ICD-9-CM procedural code 93.90. Review of weighted discharge data identified a total of 293,478 estimated cases of unspecified sleep apnea. Approximately 64% of these individuals were between the ages 40 and 69 years old with a gender distribution of 55.3% males. The most common diagnoses in hospitalized sleep apnea patients were morbid obesity, congestive heart failure, coronary artery disease, exacerbation of COPD, and pneumonia. Sleep apnea was managed through the standardized therapy, CPAP, in 5.8% of hospitalized patients and CPAP therapy was more likely to be utilized in sleep apnea patients hospitalized in a government hospital than in a for-profit hospital. In conclusion, only a small percentage (5.8%) of patients diagnosed with unspecified sleep apnea in the 2004 NHDS were provided with CPAP therapy during hospitalization. There appear to be institutional differences in the utilization of CPAP therapy in hospitals across the United States. These findings suggest that in the United States, the management of sleep apnea in hospitalized patients is deficient, and the use of CPAP therapy in the hospital warrants further investigation.
 ...
PMID:Prevalence of unspecified sleep apnea and the use of continuous positive airway pressure in hospitalized patients, 2004 National Hospital Discharge Survey. 1823 92


<< Previous 1 2 3 4 5 Next >>