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

Several well controlled epidemiologic and hemodynamic studies suggest that about 20% of sleep apnea syndrome (SAS) patients will have chronic obstructive pulmonary disease (COPD), and the majority of these patients (with combined diseases) will have pulmonary hypertension. Indeed it has been suggested that only patients with underlying hypoxemia, such as that from COPD, will develop right heart failure in the OSA setting. Experience shows that apnea/COPD patients will have severe hypersomnolence associated with the OSA, cough and dyspnea with the airways disease, and edema and plethora related to chronic hypoxemia. Many patients present with respiratory failure and are diagnosed at the time of initial intubation and mechanical ventilation. Episodic nocturnal hypoxemia may be worsened by a steeper rate of desaturation due to lower alveolar and blood oxygen stores, and longer apneas perhaps contributed to by depressed chemosensitivity. Daytime hypoxemia may also add to the severe hemodynamic disturbances. Since COPD cannot be cured, aggressive treatment of SAS is critical. Past studies have shown that tracheostomy or nasal CPAP in this setting not only leads to resolution of episodic nocturnal desaturation but may lead to rapid improvement in daytime oxygenation in many patients. Pulmonary hypertension and other measures of cardiopulmonary function improve when apnea is cured. Elimination of the SAS may disclose nonapneic REM related desaturation that could require supplemental oxygen therapy in addition to tracheostomy or nasal CPAP. Pulmonary function testing in SAS patients with smoking histories, followed by aggressive treatment of SAS, is recommended.
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PMID:Chronic lung disease in the sleep apnea syndrome. 211 88

Six European treatment centers contributed to a controlled trial to study nocturnal hypoxemia in COPD patients having daytime PaO2 of 60-70 mmHg. The trial is composed of two parts: first, patients inclusion, taking men aged under 70 years, excluding sleep apnea syndrome and all other concomitant pathologies leading to nocturnal desaturation. We described this population and determined the frequency and degree of nocturnal desaturation. Correlations between different daytime and sleep parameters have also been established. The second part concerns the study of the two sub-populations of nocturnal desaturators and nondesaturators. This is followed by random allocation of the desaturators to oxygen or no oxygen treatment. We defined significant nocturnal desaturation as cumulated unsaturation period, exceeding 30% of total time, in bed spent under SaO2 lower than 90%. Twenty out of 46 patients were desaturators (43%). Only the first part is dealt with in this article.
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PMID:Nocturnal hypoxemia and long-term oxygen therapy in COPD patients with daytime PaO2 60-70 mmHg. 211 90

The diagnostic value of flow-volume curves for sleep apnea was studied in 32 patients with obstructive sleep apnea, 40 simple snorers, and 30 healthy nonsnorers. A sawtooth appearance of the flow-volume curve was seen in 22 of the sleep apnea patients (69%), 14 of the simple snorers (35%), and 10 of the nonsnorers (33%). The ratio of midexpiratory flow (FEF 50) to midinspiratory flow (FIF 50) was greater than 1 in 6 of the sleep apnea patients (19%), 3 of the simple snorers (8%), and 2 of the nonsnorers (7%). Thus, only the sawtooth sign was more frequently found in sleep apnea patients than in controls (p less than 0.01). Sleep apnea patients with a sawtooth appearance of the flow-volume curve had a higher apnea index (38.7 +/- 22 vs. 21.5 +/- 12.1; p less than 0.01) and lower nocturnal minimum oxygen saturation (68.1% +/- 16.8 vs. 81.3% +/- 9.97; p less than 0.01) than those without. In symptomatic snorers, sensitivity of the sawtooth sign for sleep apnea was 72% and specificity 61%, for a FEF50/FIF50 ratio above 1 sensitivity was 17% and specificity 83%. In asymptomatic patients, sensitivity of either sign was extremely poor (33%) and specificity was 67% for the sawtooth sign and 85% for FEF50/FIF50 greater than 1. We conclude that abnormal flow-volume curves are of limited value for predicting sleep apnea.
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PMID:Flow-volume curves in obstructive sleep apnea and snoring. 212 37

To evaluate cardiac structure and function as well as blood pressure in the obstructive sleep apnoea syndrome (OSAS), we investigated 61 male patients and 61 male controls with M-mode and two-dimensional echocardiography. All patients had a history of habitual snoring and a diagnosed light to severe OSAS by previous investigations of nocturnal oxygen saturation status. No subject in the control group had a history of OSAS or hypertension. Body weight was higher in the OSAS patients than in the controls (P less than 0.001). Fifty per cent (31 out of 61) of the OSAS patients had systemic hypertension; 17 of these 31 were on pharmacological antihypertensive treatment. Neither the systolic nor the diastolic blood pressures were found to correlate to the severity of the OSAS (desaturation index). The heart rate was higher at rest in the OSAS patients with or without systemic hypertension compared to the controls with or without a blood pressure level above 165/95 mmHg (P less than 0.05 and P less than 0.01, respectively). Left ventricular (LV) internal dimensions as assessed by echocardiography did not differ between the two groups, while the interventricular septum and the LV posterior wall were thicker in the OSAS group. Thus, the LV mass and the LV mass index were significantly higher among the OSAS patients (P less than 0.001 and P less than 0.001). The LV mass index was approximately 15% higher among the 30 normotensive OSAS patients with no history of cardiac disease compared with the normotensive controls (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. 217 47

Previously we reported that abstaining chronic alcoholic men demonstrated significantly more nighttime hypoxemia than a control group. Here, we report a replication employing a larger sample of abstaining chronic alcoholics and a more appropriate control group than that used in the previous study. Forty-seven males, 48.4 +/- 1.7 years of age (mean +/- SEM), reporting 24.8 +/- 1.5 years of heavy alcohol use, comprised the abstaining alcohol group. Thirty-five age- and weight-matched males, 50.3 +/- 1.7 years were the control group. The alcohol group had significantly more nighttime oxygen desaturations below 90% than did the control group (16.9 +/- 3.3 vs. 6.2 +/- 1.4, F = 7.8, p less than 0.01), with significantly higher percentages of individuals in the alcohol group manifesting more than 10 or 20 oxygen desaturations below 90%. Regression analyses within the alcohol group revealed that severity of alcohol abuse, but not age, body mass index, days abstinent, or smoking significantly predicted levels of nighttime hypoxemia. These results confirm our original observation of increased nighttime hypoxemia in abstaining chronic alcoholic men and suggest that long-term alcohol abuse may be a risk factor for development of sleep apnea.
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PMID:Nighttime hypoxemia is increased in abstaining chronic alcoholic men. 217 70

A 23-year-man with morbid obesity and obstructive sleep apnea syndrome (OSAS) was admitted. He was 170 cm in height and 170 kg in weight. He underwent dietary treatment several times, but his weight returned to its original level, or even higher, within a short period. A diagnosis of OSAS was made by nocturnal polysomnography. In this morbidly obese patient with OSAS a nocturnal sleep apnea study was performed before and after weight reduction surgery (gastric restriction). The postoperative findings revealed a dramatic body weight reduction. At the same time, the results of apnea and oxygen desaturation were remarkably improved too. These results indicate that weight reduction surgery is a definitely effective treatment for morbid obesity associated with OSAS.
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PMID:[A case of obstructive sleep apnea syndrome remarkably improved by gastric restriction surgery]. 221 20

A simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography. These two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome (OSAS). A static charge sensitive bed (SCSB) was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements. Periods of obstructive apneas gave a diamond-shaped periodic respiration movement pattern in the SCSB, usually accompanied by repetitive oxygen desaturations. The average number of desaturations greater than or equal to 4 percent per sleeping hour was termed the oxygen desaturation index (ODI) and compared with the apnea index (AI). In the whole population they were well correlated (p less than 0.0001, R2 = 0.41), but in individual cases there were considerable discrepancies. Patients with periodic respiration movements less than 18 percent of total sleeping time and ODI less than 2 never had AI greater than or equal to 5, whereas patients with periodic respiration greater than 45 percent and ODI greater than 6 always had AI greater than or equal to 5. Fifty-one of the 77 patients fulfilled these criteria. A bradycardia response to apneas was absent in 29 percent of patients with AI greater than or equal to 5. A combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of OSAS in a majority of patients with clinical symptoms. In borderline patients, further investigations should be performed.
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PMID:A limited diagnostic investigation for obstructive sleep apnea syndrome. Oximetry and static charge sensitive bed. 224 72

Sleep apnea syndrome (SAS) is often associated with arrhythmias. The study was performed to clarify the characteristics and mechanisms of the heart rate (HR) changes during and after sleep induced apneas. Thirty-one patients with SAS without definitive heart disease, aged 17-78 years (mean 54.2 years), were examined by electroencephalograms, electrocardiograms, electrooculograms, nasal and oral breathing, thoracic and abdominal respiratory movements and arterial oxygen saturation (SaO2). [Results and Discussion] At the onset of sleep apnea, some showed progressive reductions in HR, followed by abrupt tachycardia on the resumption of breathing. Thirty-one patients with SAS were classified into three Groups (A, B, C). Group A demonstrated that HR changes occurred associated with apnea both in stage REM and in stage non-REM. Group B demonstrated that HR changes occurred associated with apnea only in stage REM. Group C demonstrated that HR changes did not occur associated with apnea. In Group A, apnea frequency and apnea index were higher than those of Group C. In Group A, the lowest SaO2 was lower than that of Group C, total time under 90% of arterial oxygen saturation (SaO2) was longer than that of Group C. There was a good negative correlation between oxygen saturation and HR changes. Further, HR changes were augmented by arousal response. This might be related to the arousal response as well as to the cardiostimulatory effects of hypoxia associated with increased ventilation. The arousability in response to apneas might be important in HR changes. In SAS, the degree of HR changes was related to apnea frequency, apnea index, apnea length and sleep stage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Heart rate changes in sleep apnea syndrome]. 226 69

The nighttime blood oxygen saturation of 35 abstaining chronic alcoholic men was studied. Regression analyses indicated that various measures of alcohol abuse history (r = -.61, p less than .001) account for significant variance in nighttime hypoxemia. Age (r = -.39, p less than .05) and smoking history (r = .45, p less than .01) were less powerful predictors and both obesity and days abstinent from alcohol failed to correlate with hypoxemia. Possible mechanisms to explain the relationship between alcohol abuse history and hypoxemia are discussed. This and previously reported findings indicate that chronic alcohol abuse may predispose an individual to nighttime hypoxemia and be a risk factor for sleep apnea.
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PMID:Relationship of alcohol abuse history to nighttime hypoxemia in abstaining chronic alcoholic men. 229 46

Despite its widespread use, the validity of the 5/h morbidity cut-off for the Respiratory Disturbance Index (RDI) or the Movement Index (MI) in determining presence of sleep apnea (SA) or sleep-related periodic leg movements (PLMs), respectively, has not been determined for any aged population. One hundred community resident seniors 60 years of age or older underwent three consecutive nights of polysomnography and also completed conventional measures of subjective sleep-wake complaints (written sleep questionnaire, sleep log, sleep interview) and mood disturbances (Zung Self-Rating Depression and Anxiety Scales, Profile of Mood States, Beck Depression Inventory). Based on the 5/h cut-off, 34% had SA and 58% had PLMs. Despite this, the frequency of subjective sleep-wake and mood disturbance was low across methods of assessment. Groups formed by the 5/h cut-off for RDI or MI failed to differ significantly in responses on all subjective sleep-wake and mood measures. Higher cut-offs also were examined and proved weak or ineffective in predicting subjective sleep-wake and mood disturbance. Preliminary investigations suggested that alternative measures of severity of SA (means oxygen desaturation and means duration of apneas or hypopneas) may be better predictors of subjective disturbance than RDI in this population. These findings both (a) demonstrate that the polygraphically identified SA and PLMs which are widespread in seniors tend not to be manifested in self-reported sleep-wake or mood disturbance, and (b) illustrate the need for validated morbidity cut-offs for SA and PLMs.
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PMID:Morbidity cut-offs for sleep apnea and periodic leg movements in predicting subjective complaints in seniors. 233 Apr 74


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