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

It seems well known that sleep apnea syndrome (SAS) is associated with cardiovascular complications, inclusive myocardial infarctions. Our study aimed to test the hypothesis that patients suffering from cerebral SAS have more cerebrovascular findings resp. brain infarctions than a matched control group. We analysed prospectively MRI studies of 14 patients with SAS and controls without SAS in respect of specific and nonspecific vascular cerebral lesions including atrophic changes of the brain. In contrast to our expectations, the rate of SAS-associated ischemic brain lesions is unimportant and not significantly different from age-associated brain lesions in controls. The rate of brain infarctions is distinctly different from that of myocardial infarctions. The outcomes are discussed with regard to new results of "ischemia-induced" ischemic tolerance on different tissues.
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PMID:[Sleep apnea syndrome and cerebral lesions--a prospective MRI study]. 941 26

Sleep apnea syndrome is a recognized manifestation of Arnold-Chiari malformation that almost invariably has been described in association with other neurological findings. We report a 39-year-old man who presented with severe daytime hypersomnolence. A detailed neurological examination was completely normal. Polysomnography revealed moderately severe mixed central and obstructive sleep apnea and hypopnea with persistence of central apnea and hypersomnolence despite nasal continuous positive airway pressure therapy. A history of severe headaches precipitated by sustained laughter prompted the consideration of an Arnold-Chiari malformation (ACM). A type I ACM with no evidence of syringomyelia or hydrocephalus was confirmed by MRI and successfully decompressed by suboccipital craniotomy and upper cervical laminectomies. Post-operatively the patient's headaches and hypersomnolence disappeared and a repeat polysomnography showed marked improvement in the sleep-disordered breathing. Physicians should be aware that severe sleep- disordered breathing may be the initial and sole presenting feature of Arnold-Chiari malformation.
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PMID:Arnold-Chiari malformation presenting as sleep apnea syndrome. 1076 56

A case of rhabdomyoma in the base of the tongue that caused dysphagia and sleep apnea is presented. Diagnosis was accomplished by means of fine needle aspiration biopsy and MRI. The tumor was completely removed by a tongue midline split.
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PMID:Rhabdomyoma of the base of the tongue. A case report. 1083 52

The purpose of this study was to apply dynamic MRI for the positional diagnosis of airway obstruction during snoring and sleep apnea and to compare the apnea hypopnea index (AHI) and the square measure of the pharynx obtained before and after laser-assisted uvula-palate-pharyngoplasty (LAUP). From December 1997 to October 1998, dynamic MRI and overnight monitoring were performed at the hospital of Tokyo Medical University on 42 patients who complained of snoring and symptoms related to sleep apnea syndrome (SAS). Of the 42 patients, four exhibited collapse at the position of the soft palate (soft palate type) as diagnosed by dynamic MRI, and four exhibited collapse at the position of the soft palate as well as the tongue (complex type). LAUP was performed on these eight patients with obstructive SAS (OSAS). After LAUP, the AHI of these eight patients with OSAS decreased significantly (p < 0.05). The square measure of the pharynx of these eight patients was increased (p < 0.01). The AHI of all four patients with soft-palate obstruction decreased, and the square measure of the pharynx of three of these four patients increased. The AHI of three of four patients with the complex type decreased, while the square measure of the pharynx of two of these four patients increased.
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PMID:[Measurement of the square measure of the pharynx and the positional diagnosis of airway obstruction during obstructive sleep apnea syndrome by dynamic MRI]. 1114 Mar 24

A 49-year-old woman with 6 months history of body weight loss, muscle weakness, and dysarthria, was found with respiratory arrest and resuscitated in the morning of January 1999. An MRI brain scan revealed diffuse swelling and T2/FLAIR high signal intensity with mild Gadolinium enhancement in the lower pons and medulla oblongata. Although the histological diagnosis could not be obtained, glioma (astrocytoma) was suspected. In the morning of July 3rd she presented sweating and cyanosis. Her arterial oxygen saturation was 18%. When we asked her to breathe more, she kept breathing and oxygen saturation was normalized. However, she could not breathe at all when she fell asleep without stimulation. She was kept under respiratory support for 2 months. Her symptoms improved with fluctuating course after 70 Gy of radiation therapy. Ondine curse is one type of sleep apnea syndrome, defined as the selective disturbance of autonomous breathing. Surgical operation and stroke are the reported causes of this syndrome. Brainstem tumor is relatively common cause for children's Ondine curse. On the other hand, it rarely causes adult's Ondine curse as a main symptom.
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PMID:[A case of Ondine curse associated with a medullary tumor]. 1121 2

In patients with obstructive sleep apnoea (OSA) anatomic and functional upper airway abnormalities are frequent and severe. Invasive methods are used to identify and quantitate the obstruction, to precisely locate its site, etc. as part of pre-treatment or of preoperative evaluations.These methods (lateral skull radiographs, computerized tomography, MRI, fibroscopies, etc) are too expensive and too invasive to be utilized in field surveys. To the classical sleep questionnaires and anthropometric measurements, some simple nose-throat examinations, easily accepted by the volunteers in a population study, could add useful information for the identification of the subjects at risk for sleep-disordered breathing. The present paper is a review of these examinations and of their utility.
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PMID:Breathing pauses during sleep: can a non-invasive ENT examination help identify subjects at risk in epidemiological settings? 1139 15

We studied five patients with clinical and radiological evidence of syringobulbia (SB) to determine whether the distribution of lesions in relationship to the cardiorespiratory control networks in the medullary intermediate reticular zone (IRt) correlates with the presence of abnormalities in autonomic cardiovascular and respiratory control in these patients. All patients underwent high resolution MRI to characterize the size, volume and distribution of the SB lesions, cardiovascular autonomic function testing and polysomnography. One patient with bilateral IRt involvement at both the rostral and caudal medulla had orthostatic hypotension (OH), absent HR(DB), abnormal Valsalva ratio, exaggerated fall of BP during phase II and absent phase IV during VM, and a dramatic fall of BP during head up tilt; this patient also had severe obstructive sleep apnea (OSA) and exhibited BP drops during each respiratory effort. A second patient, with bilateral IRt involvement restricted to the caudal medulla, had less severe cardiovascular autonomic dysfunction but also exhibited severe OSA. The other three patients had small SB cavities sparing the IRt and had sleep apnea but no autonomic dysfunction. Autonomic dysfunction could not be related to the size of the syrinx or the degree of atrophy in the cervical spinal cord in any of the five patients. Bilateral involvement of the IRt by SB produces cardiovascular autonomic failure and sleep apnea. In patients with more restricted lesions, autonomic and respiratory dysfunction may be dissociated. Clinico-radiological correlations using high resolution MRI assessment of medullary lesions can provide insight into the central organization of cardiovascular and respiratory control in humans.
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PMID:Cardiovascular and respiratory consequences of bilateral involvement of the medullary intermediate reticular formation in syringobulbia. 1260 20

Disruption of circadian rhythm of blood pressure (BP) is associated with advanced target organ damage and poor cardiovascular prognosis. We studied silent cerebrovascular disease and stroke events in older Japanese patients with different nocturnal BP dipping. There was a J-shaped relationship of nocturnal dipping status with silent cerebral infarcts detected by brain MRI at baseline, and with stroke incidence during the follow-up period. The extreme-dippers (with marked nocturnal BP dipping) and risers (with higher nocturnal BP than awake BP) had a higher prevalence of silent cerebral infarcts and poorer stroke prognosis than those with appropriate nocturnal BP dipping (dippers). Extreme-dippers tended to have predominant systolic hypertension and increased BP variability. Several factors are affecting the diurnal BP variation pattern. The non-dipping pattern is associated with autonomic nervous dysfunction and poor sleep quality due to nocturnal behavior and sleep apnea. Extreme-dippers might have increased arterial stiffness with reduced circulating blood volume in addition to an excessive morning surge due to alpha-adrenergic hyperactivity. Morning BP surge, which is partly associated with nocturnal BP dipping status, was a predictor of stroke event independently for ambulatory BP level and silent cerebral infarcts. Antihypertensive medication that normalize the disrupted circadian BP variation might improve cardiovascular prognosis in high-risk hypertensive patients.
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PMID:[Blood pressure variation and cardiovascular risk in hypertension]. 1555 1

Since sleep apnea (SA) and stroke have many shared risk factors an independent contribution of SA to the overall risk of stroke is not easily proven and has been questioned recently. To contribute to this controversy, we analysed the frequency of SA in groups of patients with first and recurring ischemic stroke. We prospectively studied 102 patients admitted to our stroke unit. The prevalence of vascular risk factors and a history of previous stroke were recorded. All patients received cardio-respiratory polygraphy during the first 72 hours after admission. CT and MRI scans were evaluated for the location of the acute stroke and the presence of older vascular lesions. Thirty-four women and 68 men with a mean age of 64.5 +/- 13.7 years were included in the study. Cerebral lesions attributable to a previous stroke were identified in 25 patients, of whom 19 reported to have suffered a stroke before. Patients with stroke recurrence had a higher mean apnea-hypopnea index (AHI) (26.6/h vs. 15.1/h, p<0.05) and more often presented with a sleep apnea syndrome (SA) defined by an AHI >or=10/h (80 vs. 52%, p < 0.05) than patients with first ever stroke. Logistic regression analysis including the variables "age", "gender", "cumulative risk factors", "AHI >or=10/h", and "diabetes" identified diabetes (Odd's ratio [OR]=4.5) and AHI >or=10/h (OR=3.5) as independent risk-factors for stroke recurrence. According to our results SA is an independent risk factor for stroke recurrence. We therefore advocate routine sleep-apnea screening in all patients having suffered an ischemic stroke.
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PMID:Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims. 1602 59

The patient was a 55-year-old man who had shown progressive dysarthria and unsteady gait since 48 years of age. Neurologically, pure cerebellar ataxia without either pyramidal or extrapyramidal signs was seen. He had been diagnosed as having cortical cerebellar atrophy (CCA) at age 53. Polysomnography was carried out at June 17th, 2003, because of snoring and sleep apnea had occurred since January 2003. The results showed central dominant sleep apnea with an apnea index (AI) of 16.6. Apnea occurred during shallow sleep, stages I and II, while the length of REM sleep was almost normal, occupying 17.7% of total sleep time. The rhythm of his sleep was well preserved. Brain MRI showed cerebellar atrophy without any brainstem abnormality. Except for the central type sleep apnea, no other autonomic symptoms were found. We considered that the diagnosis of CCA remained applicable to the patient because of the presence of pure cerebellar symptoms over a 7-year-course, and the absence of brainstem atrophy on MRI. Sleep apnea seen in the present patient was distinct from MSA in which central type sleep apnea dominated, and that the sleeping rhythm including REM was preserved.
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PMID:[Cortical cerebellar atrophy presenting with central type sleep apnea syndrome]. 1611 30


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