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

In recent years, there has been rapid progress in the pathophysiology, diagnostic methods and therapeutics of sleep apnea syndrome (SAS). In this article, we present our findings in these fields for the past several years. Recently, we have been able to use ultralow-field magnetic resonance (MR) fluoroscopy to visualize the upper airway for extended periods of time. The severity of SAS should be evaluated by precise history taking, physical and laboratory examination and polysomnography together with SpO2 and esophageal pressure monitoring. Treatment strategy includes multidisciplinary approaches, life style modification and suitable treatment choice, such as CPAP, dental appliance, upper airway surgery, pharmacological agents.
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PMID:[Sleep apnea syndrome (SAS)]. 950 39

A 29-year-old woman of the bronchial asthma was admitted to our hospital. Her asthmatic symptoms were refractory in spite of the administration of 30 mg of daily-oral prednisolone. During the asthma-attack, marked arterial oxygen desaturation was noted. So we doubted that she had obstructive sleep apnea complicated with obesity. Sleep Apnea Monitor revealed her nocturnal desaturation and frequent sleep apnea. To avoid the desaturation, we recommended her to keep prone position during the sleep. And both desaturation and asthmatic symptoms were dramatically improved. Nasal-CPAP also had been effective for them. These findings suggest that sleep apnea mediated oxygen desaturation may be one of the promotor of asthmatic symptoms.
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PMID:[A case of refractory bronchial asthma improving with treatments of sleep apnea syndrome]. 952 63

Although a number of devices have been developed to monitor sleep and breathing in the home, there are few publications on methodologies by which CPAP can be titrated in the home setting. This study was conducted to determine the outcome of CPAP titration in the home using the Healthdyne NightWatch (NW) system. This home sleep-evaluation system was used to diagnose sleep apnea in 30 patients using a previously described methodology. These patients subsequently underwent CPAP titration in the home using the NW system, with modem technology allowing the transfer of data from the home to the laboratory. This group was compared with 30 patients who were diagnosed with sleep apnea using standard in-lab polysomnography and had CPAP titrated on a full night in the laboratory. Both groups were subsequently placed on CPAP at the appropriate pressure for 6-8 weeks, after which a full in-lab study was completed to assess CPAP efficacy at the prescribed pressure. Compliance was also determined using a pressure-activated monitor. No differences in any variable assessed could be found between the two groups. Mean compliance was 4.6 + 0.5 (SEM) and 4.3 + 0.5 hours of CPAP use per night for the home and in-lab groups respectively. Mean AHIs on the follow-up study were 7.4 + 1.2 and 7.6 + 1.6 events per hour for the home versus in-lab groups. Sleep stage distribution was also quite comparable between groups. As a result, this study suggests that sleep apnea can be diagnosed and CPAP titrated in the home with a similar outcome, at least at 6 to 8 weeks, to standard in-laboratory testing.
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PMID:Evaluation of the Healthdyne NightWatch system to titrate CPAP in the home. 954 3

The study was undertaken to investigate whether a long-term CPAP therapy improves the symptoms of daytime sleepiness in patients with the obstructive sleep apnoea syndrome. Seventy six patients (72 men and 4 women) with AHI = 53(+/- SE = 3), BMI 35 (+/- SE = 0.8), mean age 46.3 (+/- SE = 11.4) have undergone CPAP therapy for at least one year (mean: 2.48 +/- SE = 0.33). The aggravation of alterations of the daytime sleepiness was estimated using the questionnaire from Sleep Laboratory at the Marburg University and the Epworth Sleepiness Scale (ESS). After the CPAP therapy, we have observed the decrease of the symptoms of the excessive daytime sleepiness (p < 0.001). Negative correlation between CPAP compliance and ESS outcome was observed (r = 0.4; p < 0.001). There was not correlation between the term of using CPAP and the degree of the complaints decrease.
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PMID:[The effect of long-term therapy of obstructive sleep apnea syndrome with CPAP for symptoms of daytime sleepiness]. 955 15

To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using a questionnaire was conducted on parents of 233 CP children (1-5 years old, mean age: 2.7) and on those of 343 control children during a routine medical check-up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.4% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter (Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea-hypopnea index (AHI) of greater than 5 and a low level of SaO2 (LSaO2) of less than 85%, respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in 1 child, tracheostomy in 2 children, and nasal CPAP in 1 child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.
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PMID:[Obstructive sleep apnea in children with cerebral palsy]. 958 65

A survey performed in 100 CPAP users indicated that irritation of the face, a painful nose and nasal obstruction were among the most frequently mentioned complaints in chronic CPAP users. In 132 normocapnic SAS patients a significant improvement of PaO2 was shown, with a decrease of the alveolo-arterial oxygen difference. This improved gas exchange was parallelled by a significant increase in the FRC and TLC. Maybe a modulation in force of the respiratory muscles may be involved. These data were more pronounced in obstructive sleep apnea than in central sleep apnea. In 50 chronic CPAP users we could show a lower AHI immediately after CPAP withdrawal after a previous prolonged treatment. These findings may support the insufflation theory as a mechanism of action of CPAP. Traditionally, mechanical splinting of the upper airway has been considered as the dominant mechanism of action. Other mechanisms like changes in regulation of breathing and decrease of the pharyngeal edema may be involved as well.
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PMID:[Nasal CPAP in sleep-related respiration disorders: patient profile, therapy compliance and influence of gas exchange and lung function pattern]. 963 49

We investigated the effects of posture and nasal ventilation with continuous airway pressure (CPAP) on nasal resistance in snorers with or without obstructive sleep apnea (OSA). Posterior rhinomanometry was performed in 70 snorers referred for polysomnography and in 11 nonsnoring volunteers, (1) in the seated posture; (2) and (3) after 10 minutes in the supine position, before and after inhalation of oxymetazoline; and (4) 10 minutes after return to the seated position. The effect of CPAP on posterior rhinomanometry was also examined in the nonsnorers and in 12 of the snorers. Changing from the seated to the supine position resulted in an increase in resistance in snorers and nonsnorers (resistance supine 182 +/- 10.9% and 128 +/- 6.7% respectively of seated value, p < 0.05). After oxymetazoline instillation, resistance in the supine position decreased but remained higher in snorers than baseline value in the seated position. Effects of posture and oxymetazoline were similar in snorers with or without sleep apnea. During nasal ventilation with CPAP, resistance was 30 +/- 3.8 and 45 +/- 4.4% of value before CPAP in snorers and nonsnorers, respectively (p < 0.05). These effects of posture and CPAP were also observed when resistance was measured with anterior rhinomanometry. In conclusion, nasal resistance measured with posterior rhinomanometry in the supine position is not predictive for OSA. Nasal ventilation with CPAP resulted in an acute and marked decrease in nasal resistance.
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PMID:Nasal resistance in snorers with or without sleep apnea: effect of posture and nasal ventilation with continuous positive airway pressure. 977 22

Nasal continuous positive airway pressure (nCPAP) is the current treatment of obstructive sleep apnoea syndrome (OSAS). The indications of bilevel pressure support ventilation (BIPAP PSV) in OSAS patients remain controversial. The purpose of this investigation was to verify the frequency of prescription of BIPAP PSV in a group of OSAS patients when CPAP was ineffective or not tolerated during titration. The study included 286 consecutive patients > or = 18 years of age referred to two Sleep laboratories for sleep related breathing disorders (SRBD) between December 1994 and November 1995. Of these, 130 patients were enrolled and 105 (88 males, 77 females) with moderate to severe OSAS completed the study and were finally analysed. After a full night diagnostic polysomnography (PSGD), patients had a second full night PSG under nCPAP (PSGT). If nCPAP was not tolerated, or failed to correct breathing abnormalities during sleep, a second PSGT was performed, using a BIPAP PSV. Our study shows that nCPAP (mean 8.5 +/- 2.0 cmH20) was considered a satisfactory therapy in 81 patients (77%). Twenty four (23%) required BIPAP PSV (mean IPAP 13.9 +/- 2.9 cmH20). We found the highest prevalence of BIPAP in patients with OSAS associated to obesity hypoventilation syndrome (OHS) (11 of 17) and in OSAS associated to chronic obstructive pulmonary disease (COPD) (nine of 16). Patients treated with BIPAP PSV were more obese and had a higher PaCO2 and sleep-related desaturations and a lower FEV1, FVC, FEV1/FVC and PaO2. In conclusion our study shows that CPAP therapy in the effective therapeutic option in the majority of patients with OSAS. There is a subset of patients with OSAS associated to COPD or to OHS in whom BIPAP PSV may be a better treatment modality.
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PMID:Prescription of nCPAP and nBIPAP in obstructive sleep apnoea syndrome: Italian experience in 105 subjects. A prospective two centre study. 985 Mar 65

Snoring and OSA syndrome are prevalent and important causes of sleep disturbance. Snoring, historically considered to be only a habitual annoyance, has significant physical and social consequences. OSA is now considered to be a major public health concern with significant morbidity and mortality. CPAP is considered the treatment of choice for OSA syndrome, but poor patient acceptance and compliance remain problematic. Surgical procedures have been developed to alter the offending anatomic abnormalities responsible for OSA. Identification of the offending anatomic site with application of the most appropriate surgical procedure is essential for effective surgical treatment of OSA. When the region of the retropalate is correctly identified as the site of obstruction, UPPP can effectively treat OSA in a majority of patients. Surgical correction of nasal obstruction is advocated in conjunction with sleep apnea surgery when nasal obstruction exists. In OSA patients with retrolingual airway obstruction, a number of surgical procedures have been performed, with or without UPPP, with some improvement over UPPP alone. MMO has been effective in the treatment of OSA in patients with significant retrolingual airway obstruction with contributing skeletal abnormalities and in patients who have failed multiple other surgical procedures. MMO, however, is a procedure of considerable magnitude, requiring extensive oromaxillofacial surgical expertise. MMO is likely appropriate only in a limited number of patients. Tracheostomy is completely effective in the treatment of OSA syndrome but is undesirable to patients and is associated with significant physical and emotional morbidity. Nonetheless, tracheostomy can be lifesaving and remains an option for patients with severe OSA with serious associated cardiovascular complications, who cannot tolerate CPAP, and for whom other interventions are ineffective or unacceptable. Effective surgical treatment of snoring has been accomplished with UPPP and LAUP. LAUP is less invasive, less morbid, more cost-effective, and better tolerated and is likely the most appropriate procedure for debilitating symptomatic snoring. Currently, LAUP is not recommended for the treatment of OSA, despite some efficacy in patients with mild OSA. Exclusion of OSA in patients undergoing LAUP for snoring is important.
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PMID:Snoring, obstructive sleep apnea, and surgery. 992 62

A three-dimensional numerical modeling of airflow in the human pharynx using an anatomically accurate model was conducted. The pharynx walls were assumed to be passive and rigid. The results showed that the pressure drop in the pharynx lies in the range 200-500 Pa. The onset of turbulence was found to increase the pressure drop by 40 percent. A wide range of pharynx geometries covering three sleep apnea treatment therapies (CPAP, mandibular repositioning devices, and surgery) were modeled and the resulting flow characteristics were investigated and compared. The results confirmed that the airflow in the pharynx lies in the laminar-to-turbulence transitional flow regime and thus, a subtle change in the morphology caused by these treatment therapies can significantly affect the airflow characteristics.
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PMID:Modeling of airflow in the pharynx with application to sleep apnea. 1041 10


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