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)

The year 2002 was marked by the publication of several studies for which the results have above all brought confirmation but also disappointment. One of them has even revealed a new therapeutic approach. In patients affected by sinus dysfunction the MOST study has shown the absence of superiority of DDD stimulation over VVI stimulation in respect of death and cerebral vascular accidents. However, double chamber stimulation reduces the risk of atrial fibrillation, the signs of cardiac insufficiency and slightly improves the quality of life. In the field of multisite stimulation, the MIRACLE study has in patients with moderate to severe cardiac insufficiency confirmed the results of the MUSTIC study with a significant improvement relating to the 6 minute walking test, the NYHA class, the quality of life, and the ejection fraction. The 12 and 24 month follow up of patients included in the MUSTIC study has shown the persistence of the observed short term benefit. Hopes for prevention of atrial fibrillation by atrial stimulation piloted by special algorithms have not been confirmed by the results of the PIPAF study except for patients with predominantly spontaneous AV conduction. The significance of stimulation in disabling vaso-vagal syncope has been questioned by the publication of the results of the VPS 2 study. Cardiac stimulation could in the future constitute a new treatment for sleep apnoea syndrome because it has been reported that atrial overdrive significantly reduces the amount of central or obstructive apnoea.
 ...
PMID:[The best of cardiac pacing in 2002]. 1261 61

The relationship between pacing mode and sleep is not yet known, and therefore polysomnography was used to evaluate the effect. A total of 16 patients (8 men and 8 women; mean age, 72 +/- 9 years) with DDD pacemakers made up the study population. Of these 16 patients, 8 patients had complete AV block and 8 patients had sick sinus syndrome. The recording was done twice in VVI and DDD modes. Between VVI mode and DDD mode, sleep latency time (VVI mode: 38 +/- 25, DDD mode 23 +/- 27 min), frequency of temporary waking (8.3 +/- 6.7, 3.7 +/- 2.9 times), the number of episodes of apnea (59 +/- 84, 36 +/- 55 times, the apnea-hypopnea index (AHI) (15 +/- 18, 10 +/- 13), and efficacy of sleep (72% +/- 10%, 81% +/- 11%) were significantly different. Also, the apnea index improved significantly in DDD mode. There was no significant difference in total sleep time and in total duration of temporary waking between the two groups. From the study results, a reduction in sleep disturbance was achieved when DDD pacing mode was chosen, rather than VVI mode. Furthermore, efficacy of sleep also improved significantly compared with VVI mode. Interestingly, sleep apnea syndrome in four patients with AHI > or = 15 notably ameliorated when DDD mode was chosen; however, the mechanism involved in amelioration is still ambiguous and needs further assessment.
 ...
PMID:Effect of pacing mode on sleep disturbance. 1459 11

We report on an 83-year-old male with traumatic brain injury after syncope with a fall in the morning. He had a history of seizures, coronary artery disease and paroxysmal atrial fibrillation (AF). No medical cause for seizures and syncope was determined. During rehabilitation, the patient still complained of seizures, and also reported sleepiness and snoring. Sleep apnea diagnostics revealed obstructive sleep apnea (SA) with an apnea-hypopnoea index of 35/h, and sudden onset of tachycardia with variations of heart rate based on paroxysmal atrial fibrillation. Additional tests showed nocturnal AF which spontaneously converted to sinus rhythm mid-morning with an arrest of 5 s (sick sinus syndrome) and seizures. A DDD-pacer was implanted and no further seizures occurred. SA therapy with nasal continuous positive airway pressure was refused by the patient. Our findings suggests that screening for SA may offer the possibility to reveal causes of syncope and may introduce additional therapeutic options as arrhythmia and SA often occur together which in turn might be responsible for trauma due to syncope episodes.
...
PMID:Trauma and syncope-evidence for further sleep study? A case report. 2581 Aug 17

The direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban are increasingly prescribed in atrial fibrillation (AF) patients, although dosage in elderly patients, safety in chronic kidney disease, food- and drug-interactions, laboratory tests for monitoring, and antidote are not clarified. In a 78-year-old man with an acute stroke, paroxysmal AF and sick-sinus-syndrome were detected as he received a DDD-pacemaker and 5 mg apixaban/bid. He had a history of hypertension, hypothyroidism, diabetes mellitus, hyperlipidemia, sleep apnea, lumbar discopathy, and nephropathy. Renal function deteriorated after 2 months, and apixaban was changed to phenprocoumon. Three months later, he suffered from abdominal pain and hemorrhagic shock due to rupture of an infrarenal aortic aneurysm. After reversal of the anticoagulation with prothrombin-complex concentrate, a stent-graft with exclusion of the aneurysm was implanted. Switching from apixaban to phenprocoumon was probably life-saving. Vitamin-K-antagonists should be preferred to DOAC in patients with AF and vascular disease.
...
PMID:A Probable Life-Saving Switch from Apixaban to Phenprocoumon. 2650 41