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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prescribing tricyclic antidepressants presents potential hazards to patients with heart disease, glaucoma, prostatic hypertrophy and epilepsy for their symptoms may be aggravated. Mianserin, on the other hand, has little effect on the heart and the parasympathetic nervous system and this drug may be used safely in these circumstances. Tricyclic antidepressants and mianserin also differ in their toxicity when taken in overdose. Poisoning with mianserin rarely causes more than drowsiness except when other drugs have been taken. In contrast overdose with tricyclic antidepressants frequently causes epileptic convulsions, arhythmias, hypotension, and anticholinergic signs. Death occurs in 2-3% of overdoses, usually due to cardiovascular collapse, respiratory depression or status epileptic's either alone or in combination.
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PMID:[Depressed patients and their treatment. Therapeutic mistakes and toxicity (author's transl)]. 731 62

We describe five patients with severe nocturnal cough and daytime somnolence in whom the coughing attacks are triggered by assuming the supine body position. Quantity and quality of the nocturnal cough were evaluated in the sleep laboratory with and without nasal continuous positive airway pressure (N-CPAP). Air flow characteristics were assessed using flow volume and airway resistance loops. Airway anatomy was evaluated bronchoscopically. In all five patients, the cough had a barking quality. Flow-volume loops showed an expiratory collapse phenomenon in two of the patients. Endoscopically, all five patients had signs of airway collapse. All patients had difficulty falling asleep because of coughing and were awakened by it frequently. Sleep times ranged from 2.5 to 4.5 h per night. With N-CPAP pressures ranging from 5 to 13 cm H2O, all five patients had clinically significant improvement in their symptoms. Their sleep times increased to a range of 5 to 7.5 h per night and the daytime somnolence markedly improved or resolved. All five patients requested a N-CPAP unit for home use. We conclude that a cough that is predominantly associated with or exacerbated by the supine body position may be treated effectively with N-CPAP.
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PMID:Intractable cough associated with the supine body position. Effective therapy with nasal CPAP. 763 7

In an investigation of 2 closely related Miniature Horses with a history of excessive sleepiness, depression and episodes of collapse, a diagnosis of narcolepsy was made on the basis of neurological examination and pharmacological testing. Further investigations included electroencephalographic examination (EEG), and analysis of protein content, cell count and monoamine metabolite concentrations of lumbosacral cerebrospinal fluid (CSF). There were no abnormalities noted in the EEGs, and no consistent changes in CSF neurotransmitter metabolites in the narcoleptic horses when compared with 3 normal, unrelated Miniature Horses and 2 related, clinically unaffected animals. The breeding background of the 2 affected horses was investigated and a limited survey of Miniature Horse breeders in North America was conducted. These investigations have shown that narcolepsy is a rare but distinct syndrome in the Miniature Horse, and that the cases described here appear to represent a familial occurrence of the disease.
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PMID:Familial occurrence of narcolepsy in miniature horses. 827 92

Obstructive sleep apnea syndrome results from a loss of muscular activity of pharyngeal dilators and airway collapse at the hypopharynx-base of tongue or the oropharynx-soft palate. The hyoid arch and its muscle attachments strongly affect hypopharyngeal airway patency and resistance. On the basis of these concepts and previous experience, a modified hyoid suspension procedure is presented. Fifteen consecutively treated surgical patients underwent an isolated modified hyoid suspension procedure to correct hypopharyngeal obstruction. Oropharyngeal-palatal obstruction had previously been corrected or was thought not to be a component of the obstruction. Treatment outcomes were based on objective polysomnographic data and subjective clinical correction of excessive daytime sleepiness. The polysomnographic data included analysis of the respiratory disturbance index and lowest oxyhemoglobin desaturation. On the basis of these criteria, 12 of 15 patients (75%) had correction of their excessive daytime sleepiness and marked improvement in their sleep disorder breathing. The mean preoperative respiratory disturbance index was 44.7 +/- 22.6, and the lowest oxyhemoglobin desaturation was 82% +/- 6%. The postoperative respiratory disturbance index and lowest oxyhemoglobin desaturation were 12.8 +/- 6.9 and 86% +/- 5%, respectively. The modified hyoid suspension procedure appears to offer significant adjunctive treatment for hypopharyngeal obstruction in obstructive sleep apnea syndrome.
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PMID:Obstructive sleep apnea and the hyoid: a revised surgical procedure. 799 Dec 49

The high prevalence of obstructive sleep apnea (OSA) has only recently been appreciated, in part because the symptoms and signs of chronic sleep disruption are often overlooked in spite of their debilitating consequences. They typically develop insidiously during a period of years. We now know that the lives of millions of people each year are significantly impaired by the sequelae of OSA. Many of these patients go unrecognized, with tremendous medical and economic consequences for individual patients and for society. Evidence indicates that chronic, heavy snoring may be associated with increased long-term cardiovascular and neurophysiologic morbidity. Therefore considerable interest lies in the study of the epidemiology and the natural history of these related disorders. The fundamental problem in OSA is the periodic collapse of the pharyngeal airway during sleep. The pathophysiology of this phenomenon is reviewed in some detail. During apneas caused by obstruction, airflow is impeded by the collapsed pharynx in spite of continued effort to breathe. This causes progressive asphyxia, which increasingly stimulates breathing efforts against the collapsed airway, typically until the person is awakened. Hypopneas predominate in some patients and are caused by partial pharyngeal collapse. The clinical sequelae of OSA relate to the cumulative effects of exposure to periodic asphyxia and to sleep fragmentation caused by apneas and hypopneas. Some patients with frequent, brief apneas and hypopneas and normal underlying cardiopulmonary function may have considerable sleep disruption without much exposure to nocturnal hypoxia. Patients with sleep apnea often have excessive daytime sleepiness. As the disorder progresses, sleepiness becomes increasingly irresistible and dangerous, and patients develop cognitive dysfunction, inability to concentrate, memory and judgment impairment, irritability, and depression. These problems may lead to family and social problems and job loss. Cardiac and vascular morbidity in OSA may include systemic hypertension, cardiac arrhythmias, pulmonary hypertension, cor pulmonale, left ventricular dysfunction, stroke, and sudden death. The challenge for the clinician is to routinely consider the diagnosis and to incorporate several basic questions in the historical review of systems regarding daytime or inappropriate sleepiness. The diagnosis of OSA is made with polysomnography, and the decision to treat is based on an overall assessment of the severity of sleep-disordered breathing, sleep fragmentation, and associated clinical sequelae. The therapeutic options for the management of OSA are reviewed. Recognition and appropriate treatment of OSA and related disorders will often significantly enhance the patient's quality of life, overall health, productivity, and safety on the highways.
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PMID:Obstructive sleep apnea. 814 53

Obstructive sleep apnea affects millions of individuals. It usually is due to pharyngeal collapse during sleep, resulting in daytime somnolence. This can have grave consequences on everyday life and in the long term can lead to pulmonary and systemic hypertension, myocardial disease, and stroke. Non-structural obstructive sleep apnea can be relieved by tracheostomy and continuous positive airway pressure, two methods that bypass the overly compliant pharyngeal musculature during inspiration. It may well be desirable to exchange a dynamic and more physiologic approach to obstructive sleep apnea for these purely static solutions. This approach should restore disturbed cyclical stiffening of the upper airway by electronically stimulating the appropriate muscles, timed by information originating during the inspiratory effort. The open-loop systems proposed here are based upon principles pioneered by us for the rehabilitation of the paralyzed larynx that are now well within practical reach of current technologies.
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PMID:The potential for neurostimulation in obstructive sleep apnea. 818 85

In summary, there is much evidence in the literature that nasal obstruction causes obstructive sleep apnea, usually of mild to moderate degree, in many individuals. In addition, it is a contributory factor in individuals with severe obstructive sleep apnea. This appears to occur because of its contribution to upper airway resistance which directly or indirectly results in a reduction in intraluminal pressure during inspiration and collapse. Nasal obstruction via its influence on the so-called nasal-pulmonary reflex, may also result in alveolar hypoventilation. In patients who have symptoms consistent with obstructive sleep apnea syndrome and/or other disorders of excessive somnolence, a careful history eliciting findings of possible nasal obstruction as well as a thorough nasal examination is appropriate. If nasal obstruction is present, intervention should be considered as part of the routine therapy for obstructive sleep apnea syndrome.
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PMID:The role of nasal obstruction in obstructive sleep apnea syndrome. 844 35

Obstructive sleep apnea is a breathing disorder characterized by repeated collapse of the upper airway during sleep, with cessation of breathing. Four percent of middle-aged men and 2 percent of middle-aged women meet minimal criteria for the sleep apnea syndrome. Risk factors include loud, chronic snoring, obesity (especially nuchal), hypertension, excessive daytime sleepiness, and an increased tendency for automobile and work-related accidents. Cardiovascular comorbidity and complications include systemic hypertension, arrhythmias and possibly myocardial ischemia and myocardial infarction in patients with coronary artery disease. Diagnosis is confirmed by a sleep study; currently, polysomnography is the optimum test. Treatment options range from behavioral therapy alone for mild cases to a combination of behavioral approaches and continuous positive airway pressure and/or surgery for moderate and severe cases. Continuous positive airway pressure is the most effective noninvasive treatment. Primary care physicians play a key role in the identification, management and follow-up of patients with sleep apnea.
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PMID:Sleep apnea: is your patient at risk? National Heart, Lung, and Blood Institute Working Group on Sleep Apnea. 854 58

Obstructive sleep apnea syndrome (OSAS) is characterized by multiple interruptions of airflow between periods of arousals. A key feature of OSAS is the 20- to 40-s cyclic pattern of electrophysiologic parameters. The periodicity of the OSAS-related phenomena is reminiscent of the natural electroencephalographic (EEG) arousal rhythm of non-rapid eye movement (NREM) sleep known as the cyclic alternating pattern (CAP). Morphologically, CAP consists of transient arousals (phase A) that periodically interrupt the tonic theta/delta activities of NREM sleep (phase B). Functionally, CAP translates a condition of sustained arousal instability oscillating between a greater arousal level (phase A) and a lesser arousal level (phase B). CAP is also related to the controls of the motor and autonomic mechanisms. On the basis of the information simultaneously derived from EEG activities, muscle tone, and neurovegetative responses, it is possible to distinguish three subtypes of A phases corresponding to different levels of arousal power: A1 (dominated by EEG synchronization and weak activation of polygraphic variables); A2 (mixture of EEG synchronization/desynchronization and intermediate activation of polygraphic variables); and A3 (dominated by EEG desynchronization and strong activation of polygraphic variables). Unlike standard criteria, CAP parameters offer a more suitable perspective for evaluating sleep pathologies in which brief and frequent arousals appear as a prominent feature. The present study aimed at (a) assessing CAP parameters in OSAS patients and (b) investigating the reciprocal interactions between CAP and the cyclic variations in respiratory rate. Twelve obese middle-aged OSAS subjects complaining of daytime sleepiness were polygraphically compared with age-matched and gender-matched volunteers in good health and with no complaints about sleep and wakefulness (controls). In OSAS patients, conventional parameters showed predictable decrements in total sleep time, slow wave sleep, and REM sleep and increases in stage 1 and nocturnal awakenings. Sleep fragmentation was associated with a significant enhancement of CAP and of the A phases with longer and more desynchronized EEG patterns (especially A3). The increase of A3 subtypes permitted scoring and detecting CAP also in REM sleep. The great majority of respiratory pauses (96% in NREM and 80% in REM sleep) were coupled with CAP. All CAP-related respiratory events rose in close temporal connection with a phase B, while effective breathing was always recovered during phase A (especially A2 and A3 subtypes). These data suggest that (a) phase B of CAP offers a vulnerable background for upper airway collapse and for attenuation of biochemical and neural mechanisms in the control of the ventilatory drive and (b) survival in OSAS patients is effected by the enhancement of the strongest components of the natural arousal rhythm at sleep quality's expense.
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PMID:Polysomnographic analysis of arousal responses in obstructive sleep apnea syndrome by means of the cyclic alternating pattern. 884 69

Symptoms of habitual snoring and excessive daytime sleepiness are extremely common in the general population, and have poor predictive value in identifying patients with "true" sleep-related disordered breathing. The upper airways are the main anatomical site responsible for snoring and sleep apnoea; therefore, their examination via different means has been quite extensively assessed. Clinical examination may point to severe micrognathia or retrognathia, grossly hypertrophied tonsils, obvious macroglossia, and oedema and inflammation of the uvula and soft palate. A recently proposed model is promising, but has not been validated independently yet. Endoscopic investigations have been performed in awake as well as in sleeping patients, with the pharynx in relaxed or active states; their predictive value remains poor, both for diagnostic purposes and for identifying patients that may benefit from surgery. Radiographic and magnetic resonance imaging techniques have permitted a detailed understanding of the process of narrowing and collapse of the upper airways. Unfortunately, these techniques do not perform any better than the ones previously cited as clinically efficient tools for diagnosis in the population of patients suspected of sleep-related breathing disorders. In conclusion, clinical examination of the upper airways remains part of the clinical evaluation of patients suspected of sleep-related disordered breathing. Other imaging techniques may be used for research purposes, but do not yet seem to be worth including in the routine assessment of this population.
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PMID:Upper airway imaging in sleep apnoea syndrome: clinical applications. 986 11


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