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

Resistant hypertension is defined as failure to achieve goal blood pressure (BP) when a patient adheres to the maximum tolerated doses of 3 antihypertensive drugs including a diuretic. Although the exact prevalence of resistant hypertension is currently unknown, indirect evidence from population studies and clinical trials suggests that it is a relatively common clinical problem. The prevalence of resistant hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. Management of resistant hypertension must begin with a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with "pseudo-resistance," such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Education and reinforcement of life-style issues that affect BP, such as sodium restriction, reduction of alcohol intake, and weight loss if obese, are critical in treating resistant hypertension. Exclusion of preparations that contribute to true BP treatment resistance, such as nonsteroidal anti-inflammatory agents, cold preparations, and certain herbs, is also important. Lastly, BP control can only be achieved if an antihypertensive treatment regimen is used that focuses on the genesis of the hypertension. An example is volume overload, a common but unappreciated cause of treatment resistance. Use of the appropriate dose and type of diuretic provides a solution to overcome treatment resistance in this instance.
J Am Coll Cardiol 2008 Nov 25
PMID:Resistant hypertension: an overview of evaluation and treatment. 1932 67

Adaptive servo-ventilation as well as continuous and bi-level positive airway pressure seems to effectively treat sleep apnea syndrome (SAS) in patients with chronic heart failure (CHF), and to improve left ventricular function. However, no randomized data show a significant impact of ventilation on survival in patients with CHF. By contrast, there is overwhelming evidence that cardiac resynchronization therapy (CRT) improves outcomes in patients with CHF. CRT also provides a clinically significant decrease in SAS severity in patients with CHF. Consequently, CRT eligibility criteria should always be searched for in patients with severe CHF having SAS.
Int J Cardiol 2010 Apr 01
PMID:Sleep apnea in patients with heart failure: could cardiac resynchronization therapy be the first line treatment? 1880 98

Global risk assessment is the standard of care for coronary artery disease management. In this setting, sleep apnea syndrome, which includes obstructive sleep apnea and central sleep apnea, is being increasingly recognized as a potentially modifiable risk factor for coronary artery disease. Emerging evidence points toward a cause and effect relationship between sleep apnea syndrome and medical conditions like insulin resistance, hypertension, heart failure, and myocardial ischemia. The effects of sleep apnea on coronary artery disease can be independent of many traditional risk factors. Continuous positive airway pressure has been shown to decrease inflammatory markers that are elevated in sleep apnea syndrome. Well-designed randomized controlled clinical trials are needed to better establish the role of sleep apnea in the genesis and progression of coronary artery disease.
Crit Pathw Cardiol 2008 Dec
PMID:Sleep apnea syndrome: implications on cardiovascular diseases. 1905 Apr 22

Sleep-disordered breathing (SDB) and cardiovascular disease (CVD) are closely related; however, the effect of SDB on the long-term prognosis of patients with CVD is unknown. Our aim in this study was to assess the association between SDB and fatal cardiovascular events in patients with CVD. We performed a long-term follow-up study of 135 patients with CVD. The average observation period was 610 +/- 268 days. The patients were classified into 2 groups based on their apnea index: patients with apnea index >or=5/h (Group H) were diagnosed with SDB (n = 43), and those with apnea index <5/h (Group L) were diagnosed without SDB (n = 92). In Group H, obstructive sleep apnea (OSA) was diagnosed if obstructive apnea index was >or=5/h, and central sleep apnea was diagnosed if central apnea index was >or=5/h. Group H had a significantly lower survival rate than Group L (p <0.005), particularly those with OSA in Group H (p <0.0005). In a Cox proportional hazards model with presence of OSA, age, brain natriuretic peptide, left ventricular ejection fraction, and cardiovascular risk factors, the odds ratio of fatal cardiovascular events was 2.45 (95% confidence interval 1.26 to 5.08) for OSA (p <0.01), which was associated with an increased risk of mortality. In conclusion, our results suggest that SDB is associated with a poorer long-term prognosis and that the presence of OSA is a strong predictor of fatal cardiovascular events in patients with CVD.
Am J Cardiol 2009 Mar 01
PMID:Influence of untreated sleep-disordered breathing on the long-term prognosis of patients with cardiovascular disease. 1923 43

Patent foramen ovale (PFO) is a remnant of the foetal circulation, found in about a quarter of the population. PFO is an asymptomatic condition and the high prevalence infers that it is in most cases of no or only limited clinical significance. However, recent research has found an increased prevalence of PFO in cryptogenic stroke, decompression illness and migraine. The presence of a PFO has also been associated with oxygen desaturation in conditions such as obstructive pulmonary disease and obstructive sleep apnoea. The rapid evolution and widespread availability of catheter-based closing techniques have further stimulated interest. The seemingly growing significance of PFO will be discussed in this review.
Int J Cardiol 2009 May 01
PMID:The significance of patent foramen ovale: a current review of associated conditions and treatment. 1923 60

128 congestive heart failure (CHF) patients with a median age of 55 years and median left ventricular ejection fraction of 35.4% were followed up for a median period of 35 months. 23 (18%) had no sleep apnea (CHF-N), 55 (43%) had obstructive sleep apnea (CHF-OSA), and 50 (39%) had central sleep apnea (CHF-CSA). At the end of follow-up, mortality was greater in the CHF-CSA group than in the CHF-N group (18.2 vs 6.7/100 person-years, p=0.017). However, after adjusting age and the New York Heart Association functional class central sleep apnea, obstructive sleep apnea, or the severity of sleep apnea are not predictors for survival in CHF. In addition, the percentages of combined events were not significantly different among three groups. Untreated sleep apnea has no independent impact on the prognosis of patients with CHF.
Int J Cardiol 2010 Oct 29
PMID:Impact of untreated sleep apnea on prognosis of patients with congestive heart failure. 1934 64

Disturbances in cardiovascular neural regulation, influencing both disease course and survival, progress as heart failure worsens. Heart failure due to left ventricular systolic dysfunction has long been considered a state of generalized sympathetic activation, itself a reflex response to alterations in cardiac and peripheral hemodynamics that is initially appropriate, but ultimately pathological. Because arterial baroreceptor reflex vagal control of heart rate is impaired early in heart failure, a parallel reduction in its reflex buffering of sympathetic outflow has been assumed. However, it is now recognized that: 1) the time course and magnitude of sympathetic activation are target organ-specific, not generalized, and independent of ventricular systolic function; and 2) human heart failure is characterized by rapidly responsive arterial baroreflex regulation of muscle sympathetic nerve activity (MSNA), attenuated cardiopulmonary reflex modulation of MSNA, a cardiac sympathoexcitatory reflex related to increased cardiopulmonary filling pressure, and by individual variation in nonbaroreflex-mediated sympathoexcitatory mechanisms, including coexisting sleep apnea, myocardial ischemia, obesity, and reflexes from exercising muscle. Thus, sympathetic activation in the setting of impaired systolic function reflects the net balance and interaction between appropriate reflex compensatory responses to impaired systolic function and excitatory stimuli that elicit adrenergic responses in excess of homeostatic requirements. Recent observations have been incorporated into an updated model of cardiovascular neural regulation in chronic heart failure due to ventricular systolic dysfunction, with implications for the clinical evaluation of patients, application of current treatment, and development of new therapies.
J Am Coll Cardiol 2009 Jul 28
PMID:Sympathetic nervous system activation in human heart failure: clinical implications of an updated model. 1962 11

Analysis of the Framingham data has shown that the risk of heart failure is increased substantially among diabetic patients, while persons with the metabolic syndrome have an increased risk of both atherosclerosis and diabetes mellitus. Sleep apnea may be related to the metabolic syndrome and systemic inflammation through hypoxia, which might also cause the cardiac remodeling by increased oxidative stress. On the other hand, the renin-angiotensin system is activated in diabetes, and local angiotensin II production may lead to oxidative damage via the angiotensin II type 1 receptor. Basic and clinical data indicate that angiotensin II receptor blockers have the potential to preserve left ventricular function and prevent cardiac remodeling that is exaggerated by oxidative stress in patients with diabetes. Thus, alleviation of oxidative stress might be one possible strategy in the treatment of diabetic patients associated with sleep apnea.
Curr Cardiol Rev 2008 Nov
PMID:Regulation of oxidative stress and cardioprotection in diabetes mellitus. 2006 32

The aim of this study was to investigate whether patients with hypertrophic cardiomyopathy (HC) and sleep disordered breathing (SDB) have a higher prevalence of atrial fibrillation (AF) compared to patients with HC without SDB. HC is associated with a high prevalence of AF that contributes to increased morbidity and mortality. SDB is strongly associated with a higher incidence, prevalence, and recurrence of AF in patients without HC. Whether this association also applies to patients with HC is not known. Overnight oximetry was prospectively performed on 91 consecutive patients with echocardiographically confirmed HC. The presence or absence of AF in this population was correlated with the oximetric findings. SDB was associated with a higher prevalence of AF (40% vs 11%, p = 0.005). In addition, SDB was accompanied by significantly increased left atrial volume index (58 +/- 19 vs 42 +/- 13 ml/m(2), p = 0.0002). Increasing severity of SDB was correlated with higher AF prevalence and with increase in left atrial volume index. These associations remained significant even after accounting for potential confounders in a multivariate analysis. In conclusion, these findings suggest that the presence and severity of SDB may influence left atrial volume index and the prevalence of AF in patients with HC. SDB may therefore be an important and potentially modifiable cause of morbidity and mortality in this population.
Am J Cardiol 2010 Jun 01
PMID:Interactions between sleep disordered breathing and atrial fibrillation in patients with hypertrophic cardiomyopathy. 2049 69

Obstructive and central sleep apneas are treatable disorders, which contribute to cardiovascular morbidity in older adults. Younger adults with Marfan syndrome may also be at risk for sleep apnea, but the relation between cardiovascular complications and sleep apnea is unknown. We used MiniScreen8 portable monitoring devices for polygraphy in 68 consecutive adults with Marfan syndrome (33 men, 35 women, 41 +/- 14 years old) to investigate frequency of sleep apnea and its relation to cardiovascular morbidity. The apnea-hypopnea index (AHI) was 6 to 15/hour in 14 subjects (mild sleep apnea, 21%), and AHI was >15/hour in 7 subjects (moderate or severe sleep apnea, 10%). Among established risk factors for sleep apnea, only older age (Spearman rho = 0.35, p = 0.004) and body mass index (rho = 0.26, p = 0.03) were associated with increased AHI. Of all cases of apnea, 12 +/- 27 were obstructive, 11 +/- 25 central, and 3 +/- 9 mixed. AHI was associated with decreased left ventricular ejection fraction (rho = -0.33, p = 0.01), increased N-terminal pro-brain natriuretic peptide levels (rho = 0.35, p = 0.004), enlarged descending aortic diameters (rho = 0.44, p = 0.001), atrial fibrillation (phi = 0.43, p = 0.002), and mitral valve surgery (phi = 0.34, p = 0.02). Of these, left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide levels, atrial fibrillation, and mitral valve surgery were associated with AHI independently of age and body mass index. We found similar associations with oxygen desaturation index. In conclusion, sleep apnea exhibits increased frequency in Marfan syndrome and is not predicted by classic risk factors. Obstructive and central sleep apneas may relate to cardiovascular disease variables.
Am J Cardiol 2010 Jun 15
PMID:Frequency of sleep apnea in adults with the Marfan syndrome. 2053 40


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