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Biomedical subjects

F Yasuma

Publications and source records attributed to F Yasuma.

At least 19 recordsLinked to original sources

Augmentation of respiratory sinus arrhythmia in response to progressive hypercapnia in conscious dogs.

Respiratory sinus arrhythmia (RSA) may serve to enhance pulmonary gas exchange efficiency by matching pulmonary blood flow with lung volume within each respiratory cycle. We examined the hypothesis that RSA is augmented as an active physiological response to hypercapnia. We measured electrocardiograms and arterial blood pressure during progressive hypercapnia in conscious dogs that were prepared with a permanent tracheostomy and an implanted blood pressure telemetry unit. The intensity of RSA was assessed continuously as the amplitude of respiratory fluctuation of heart rate using complex demodulation. In a total of 39 runs of hypercapnia in 3 dogs, RSA increased by 38 and 43% of the control level when minute ventilation reached 10 and 15 l/min, respectively (P < 0.0001 for both), and heart rate and mean arterial pressure showed no significant change. The increases in RSA were significant even after adjustment for the effects of increased tidal volume, respiratory rate, and respiratory fluctuation of arterial blood pressure (P < 0.001). These observations indicate that increased RSA during hypercapnia is not the consequence of altered autonomic balance or respiratory patterns and support the hypothesis that RSA is augmented as an active physiological response to hypercapnia.

Animals↗

Differential effects of hypoxia and hypercapnia on respiratory sinus arrhythmia in conscious dogs.

To test the hypothesis that hypoxia and hypercapnia have different effects on the genesis of respiratory sinus arrhythmia (RSA), the magnitude of RSA to these stimuli was compared in 3 unanesthetized dogs. Respiration was continuously monitored through a permanent tracheostomy, and the electrocardiogram and blood pressure were also monitored. The magnitude of RSA was assessed as an instantaneous amplitude of the R-R interval oscillation in the high-frequency band of 0.15-0.80Hz by means of complex demodulation. In a total of 47 runs with hypoxia, heart rate, mean arterial pressure, respiratory rate and tidal volume increased, but RSA magnitude decreased even after adjusting for the effects of respiratory rate and tidal volume. In a total of 39 runs with hypercapnia, heart rate and mean arterial pressure did not change, despite the increased respiratory rate and tidal volume. In contrast to hypoxia, RSA magnitude increased even after adjusting for the effects of respiratory rate and tidal volume. The different effects of the two respiratory stimuli on RSA magnitude were noted at any level of ventilation and support the original hypothesis.

Animals↗

Row-a-boat phenomenon: respiratory compensation in advanced Duchenne muscular dystrophy.

BACKGROUND: "Row-a-boat" phenomenon (RBP) is a spontaneous upper-body movement in patients with advanced Duchenne muscular dystrophy (DMD), when sitting upright supported by a belt around the body in a wheelchair. However, the role of RBP has not been clarified. OBJECTIVES: To support the hypothesis that RBP is an abnormal pattern of respiration to compensate for the atrophied respiratory muscles in advanced DMD. PATIENTS AND METHODS: Age, degree of ventilator dependency, and blood gas and spirometry values of 12 patients with spontaneous RBP were compared to those of 8 patients without RBP. All patients were men, and all exhibited a comparable level of motor function (unable to ambulate). Spirometry was undertaken with an ambulatory pneumotachograph in six patients with RBP in two conditions: sitting with RBP and sitting without RBP. In the latter condition, because a patient's shoulders, neck, and head were manually restricted, RBP was prevented. RESULTS: We found that the patients with RBP were older (mean, 25.98 years vs 19.84 years), more dependent on mechanical ventilation (13.96 h/d vs 4.31 h/d), and had lower FVC and percentage of FVC (511.3 mL vs 762.5 mL and 13.37% vs 20.11%, respectively) than those without RBP. We also found that the frequency of RBP was identical with tidal breathing, and FVC was increased by 50.8% by simply allowing RBP. CONCLUSION: We conclude that RBP is a respiratory movement to compensate for the atrophied respiratory muscles in advanced DMD.

Adult↗

Long-term treatment of ischemic dilated cardiomyopathy with continuous positive airway pressure.

An 81-year-old man with ischemic dilated cardiomyopathy complained of frequently awakening from sleep due to choking; subsequent polysomnography revealed Cheyne-Stokes respiration (CSR) with sleep apnea. With continuous positive airway pressure (CPAP) through a nasal mask, both the CSR and symptoms disappeared. After 6-12 months, chest X-ray and echocardiographic findings continued to improve without any change in pharmacological treatment. For three years, CPAP had been effective to eliminate CSR during sleep. Long-term CPAP treatment, which is rarely applied for congestive heart failure in Japan, is useful in alleviating the adverse effects of CSR and, thereby, maintaining a good quality of life in these patients.

Aged↗

Influence of movement arousal on circadian rhythm of blood pressure in obstructive sleep apnea syndrome.

OBJECTIVE: To investigate the hypothesis that repeated arousals at the termination of apnea/hypopnea in obstructive sleep apnea syndrome (OSAS) are related to abnormal circadian rhythm of blood pressure (BP). DESIGN AND METHODS: We performed polysomnography (PSG) with pulse oximetry in 26 middle-aged patients with OSAS aged 42-58 years (mean age 51.8 years). The intensity of arousal on PSG was graded into two levels: grade 1 (EEG arousal, EA), an abrupt shift in EEG frequency, and grade 2 (movement arousal, MA), EEG arousal with an increase in electromyogram activity lasting at least 3 s. The number of apnea/hypopneas per hour (apnea/hypopnea index, AHI), and length of time during which nocturnal oxygen saturation decreased below 90% (oxygen desaturation time, ODT) were also evaluated. Percentage EA and %MA were assessed by the ratio of the number of apneas and hypopneas with EA or MA to the number of apneas and hypopneas in total. The 24 h systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured noninvasively. Multiple regression analysis was performed among AHI, ODT, %EA and %MA or among age, body mass index and %MA. RESULTS: The %MA was the most significant factor contributing to the elevated 24 h SBP (r= 0.46, P< 0.05); oxygen desaturation (r= 0.44, P< 0.05) was the next most important contributing factor. The level and pattern of 24 h BP differed significantly between the patients with %MA 85% and %MA < 85% (mean 24 h SBP: 147 +/- 16.8 versus 125 +/- 19.6 mmHg, P< 0.01; mean 24 h DBP: 97.5 +/- 14.3 versus 85.6 +/- 14.6 mmHg, P< 0.01), and also differed between those with severe OSAS, i.e. ODT > or = 130 min, and mild to moderate OSAS, i.e. ODT < 130 min, (mean 24 h SBP: 149 +/- 15.8 versus 132 +/- 20.6 mmHg, P < 0.01; mean 24 h DBP: 100 +/- 14.1 versus 87.4 +/- 14.0 mmHg, P < 0.01). CONCLUSION: Our findings suggest that MA and oxygen desaturation in OSAS make an important contribution to abnormal circadian rhythm of BP. We conclude that repeated end-apneic arousal and/or hypoxic asphyxia and the subsequent sleep fragmentation may contibute to nocturnal and diurnal elevation of BP.

Adult↗

Impact of acute hypoxia on heart rate and blood pressure variability in conscious dogs.

To examine whether the impacts of hypoxia on autonomic regulations involve the phasic modulations as well as tonic controls of cardiovascular variables, heart rate, blood pressure, and their variability during isocapnic progressive hypoxia were analyzed in trained conscious dogs prepared with a permanent tracheostomy and an implanted blood pressure telemetry unit. Data were obtained at baseline and when minute ventilation (VI) first reached 10 (VI10), 15 (VI15), and 20 (VI20) l/min during hypoxia. Time-dependent changes in the amplitudes of the high-frequency component of the R-R interval (RRIHF) and the low-frequency component of mean arterial pressure (MAPLF) were analyzed by complex demodulation. In a total of 47 progressive hypoxic runs in three dogs, RRIHF decreased at VI15 and VI20 and MAPLF increased at VI10 and VI15 but not at VI20, whereas heart rate and arterial pressure increased progressively with advancing hypoxia. We conclude that the autonomic responses to isocapnic progressive hypoxia involve tonic controls and phasic modulations of cardiovascular variables; the latter may be characterized by a progressive reduction in respiratory vagal modulation of heart rate and a transient augmentation in low-frequency sympathetic modulation of blood pressure.

Acute Disease↗

Age related differences in electroencephalographic and cardiac arousal at the termination of sleep apnea/hypopnea.

OBJECTIVE: The purpose of the present study was to determine whether electroencephalographic (EEG) and cardiac arousal, i.e. heart rate elevation at the termination of apnea/hypopnea are related to aging. METHODS: The subjects were 13 middle-aged (40-60 years of age, 47.8+/-5.35 years) and 10 elderly (>60 years of age, 69.8+/-5.31 years) male patients with obstructive sleep apnea syndrome. We evaluated the number of apneas per an hour of sleep (apnea index: AI), the number of hypopneas per an hour of sleep (hypopnea index: HI), the summation of HI and AI (apnea/hypopnea index: AHI), sleep stage, the amount of time during which nocturnal oxygen saturation was decreased below 90% (oxygen desaturation time: ODT), and EEG and cardiac arousal at the termination of apnea/hypopnea using polysomnography with pulse oximetry. RESULTS: There was no significant difference in AHI, duration of apnea/hypopnea, and sleep stage distribution between the two groups. However, the ratio of apnea/hypopnea with EEG and cardiac arousal was significantly higher in middle-aged than in elderly patients. The ratio of HI to AHI was significantly lower in middle-aged than in elderly patients. In middle-aged patients, EEG and cardiac arousal were significantly correlated with AI, AHI, and ODT, whereas, in elderly patients, these parameters were not similarly correlated. CONCLUSION: Our findings suggest that the differences in EEG and cardiac arousal, and the pattern of sleep-disordered breathing (SDB) between middle-aged and elderly patients with SDB might be a physiological phenomenon of aging.

Adult↗

[Evaluation of cranial CT findings of patients with muscular dystrophy: with a reference to cerebral vascular disease and cardiac complications].

We evaluated cranial CT findings of 160 patients with various type of progressive muscular dystrophy (PMD). Significant brain atrophy was observed in 21 out of 63 cases of Duchenne muscular dystrophy (DMD), 7 out of 15 Becker muscular dystrophy (BMD), no case of 2 female dystrophinopathy (F-dyst), 11 out of 21 limb-girdle muscular dystrophy (LG), all cases of 10 Fukuyama type congenital muscular dystrophy (FCMD), 2 out of 5 fascioscapulohumeral muscular dystrophy (FSH), and 32 out of 44 myotonic dystrophy (MyD). Genetical degenerative process and vascular insufficiency seemed to cause brain atrophy in these disease. The intracranial calcification was observed in one DMD, one LG and seven MyD. One LG patient showed focal atrophy in left temporal lobe, and one MyD demonstrated right temporal meningioma. The trace of cerebral vascular accident was disclosed in eleven patients with PMD (1 DMD, 2 BMD, 1 F-dyst, 2 LG, 5 MyD). In these cases, 2 patients had dilated cardiomyopathy, 6 patients with decreased left ventricular ejection fraction, 3 with atrial fibrillation, 1 with cardiac arrest followed by pacemaker instillation, 1 with Adam-Stokes attack, and 3 with 1 degree AV-block. Diffuse low density in the white matter was seen in a patient with F-dyst, a FCMD patient, and 8 MyD patients. Cardiac emobolism, severe arrythmia, cardiogenic shock and hemodynamic disorder were seemed to cause cerebral vascular disease in PMD.

Adult↗

Circadian rhythm of autonomic activity in patients with obstructive sleep apnea syndrome.

BACKGROUND AND HYPOTHESIS: Although the immediate effects of sleep apnea on hemodynamics and the neurological system have been studied, little is known about the circadian rhythm of heart rate variability in patients with obstructive sleep apnea syndrome (OSAS). The purpose of the present study was to investigate the effects of sleep apnea on the autonomic activity during daytime, which may play some role in the pathogenesis of cardiovascular complications in OSAS. METHODS: We studied 18 middle-aged male patients with OSAS and 10 age-matched control subjects. Patients with OSAS were classified according to the severity of OSAS: patients with an apnea index (AI) < 20 were considered to have mild OSAS (Group 1, n = 8) and patients with an AI > or = 20 were considered to have severe OSAS (Group 2, n = 10). Heart rate variability was calculated from the 24-h ambulatory electrocardiograms by the Fourier transformation. Power spectra were quantified at 0.04-0.15 Hz [low frequency power (LF)ln(ms2)] and 0.15-0.40 Hz [high frequency power (HF)ln(ms2)]. The HF component and the ratio of LF to HF were used as indices of the parasympathetic and sympathetic activity, respectively. RESULTS: The circadian rhythms of the LF, HF, and LF/HF ratio differed significantly in Group 2 compared with Group 1 and control subjects (p < 0.05). Hypertension (> 160/95 mm Hg) was found in 7 (70.0%) of 10 patients in Group 2, and in 1 (12.5%) of 8 patients in Group 1. Echocardiographic evidence of left ventricular hypertrophy (LVH) (an interventricular septal thickness or a left ventricular posterior wall thickness > or = 12 mm) was found in 3 (30.0%) of 10 patients in Group 2, and in 1 (12.5%) of 8 patients in Group 1. The mean HF from 4 A.M. to 12 noon was significantly lower in Group 2 than in Group 1 and the control group, and it correlated significantly with the lowest nocturnal SaO2 (r = 0.58, p < 0.05). The mean LF/HF ratio during the same period was significantly higher in Group 2 than in Group 1 and the control group, and it correlated significantly with total time of the nocturnal oxygen saturation < 90% (r = 0.64, p < 0.005) and the lowest nocturnal SaO2 (r = 0.56, p < 0.05). Ventricular tachycardia was found in the early morning in one patient, ST-T depression in two patients, and sinus arrest in two patients in Group 2. CONCLUSION: These findings suggest that sleep-disordered breathing associated with severe oxygen desaturation might influence heart rate variability not only during sleep but also during daytime. OSAS per se might contribute to altered circadian rhythm in autonomic activity leading to the development of cardiovascular diseases.

Adult↗

Twenty-four-hour ambulatory oxygen desaturation and electrocardiographic recording in obstructive sleep apnea syndrome.

BACKGROUND: Although nocturnal pulseoximetry is routinely performed in obstructive sleep apnea syndrome (OSAS), pulseoximetry over a 24-h period has not been studied. HYPOTHESIS: The purpose of the study was to determine whether simultaneous 24-h oxygen desaturation and electrocardiographic (ECG) recording might be used to screen for daytime sleep sequelae in patients with OSAS. METHODS: Simultaneous recording of arterial oxygen saturation (SpO2) and ECG was conducted over a 24-h period in 18 male patients with OSAS (mean age 51.3 years) who were diagnosed by standard polysomnography (PSG), and in 15 age-matched healthy subjects (mean age 52.7 years) as controls to evaluate circadian variation of these parameters. The measures of heart rate variability (HRV) were calculated from 24-h ambulatory ECGs. Seventeen patients with OSAS showed excessive daytime sleepiness (EDS). We calculated the duration in which SpO2 decreased to < 90% (duration of SpO2 < 90%). The number of apnea/hypopneas per hour (AHI) during sleep was investigated with Apnomonitors (Chest MI, Co., Tokyo) on the same day as the SpO2 recordings. RESULTS: Controls showed no episodes of oxygen desaturation. In patients with OSAS, driving (33.3% of patients with OSAS) was the most common activity in which SpO2 decreased to < 90%, followed by daytime napping (27.8%) and resting after meals (22.2%). The duration of SpO2 < 90% over a 24-h period correlated significantly with the duration levels recorded during sleep (r = 0.99, p < 0.05) and in the afternoon (r = 0.62, p < 0.05), and with the AHI (r = 0.55, p < 0.05), but not with the duration of SpO2 < 90% in the morning. The number of ventricular premature beats correlated significantly with the duration of SpO2 < 90% for a 24-h period, but not with measures of HRV. Ventricular tachycardia was found in two (11.1%) and ST-T depression in three patients (16.6%) with underlying cardiac diseases. CONCLUSION: Our results suggest that daytime sleep attacks accompanied by oxygen desaturation in patients with moderate to severe OSAS may contribute to the occurrence of traffic or cardiovascular accidents. We conclude that 24-h ambulatory recordings of SpO2 and ECG are useful for screening for daytime sleep sequelae associated with the potential risk of this pathology in OSAS during social activities.

Adult↗

Prognosis of the middle-aged and aged patients with obstructive sleep apnea syndrome.

The long-term natural course of obstructive sleep apnea syndrome (OSAS) is studied in order to determine whether severity of nocturnal oxygen desaturation associated with apnea/hypopnea, body mass index (BMI), and hypertension influence survival in young (<40 years), middle-aged (40-64 years), and aged (> or = 65 years) using a questionnaire survey. One hundred and forty-eight patients with OSAS aged 17-78 years (136 men, 12 women, mean 52.0+/-12.3 years), who were diagnosed by standard polysomnography (PSG) between 1983 and 1993, participated in the study. The survey revealed 15 deaths and 101 survivors; 32 subjects could not be located. The survival rate was 71.4% (95% confidence interval: 55.6-87.2%). The survival rate in patients with OSAS was significantly lower than that in the age and sex-adjusted control Japanese population (87.6%). In the young group, only one death (a 19-year-old woman) occurred unexpectedly during sleep. The patient showed an apnea/hypopnea index (AHI) of 33 per h and the length of time that the nocturnal oxygen saturation (SaO2) fell below 90% (time of SaO2 <90%) of 205 min. The survival rate in middle-aged patients with OSAS was significantly lower than that in the age and sex-adjusted control Japanese population (79.2 vs 91.0%), but this pattern was not seen among the aged. Time of SaO2 <90% was significantly longer in the middle-aged patients than in the aged patients, but AHI did not differ between the two groups. Moreover, it was significantly correlated with AHI in middle-aged patients, but not in the aged patients. The survival rate was significantly lower in patients with hypertension than in the patients without such complications in the middle-aged group (57.9 vs 90.4%). Cox proportional-hazard regression model including age, hypertension, BMI, AHI, lowest SaO2, and time of SaO2 <90% showed that hypertension was only significantly associated with lower survival rate in total group and middle-aged patients, but not in the young or aged patients. The prognosis in patients with OSAS may differ among the generations. The prognosis in the middle-aged population may depend on the role of OSAS on the complications of hypertension or severity of oxygen desaturation, but not on AHI only.

Adolescent↗

Eight-year follow-up study of a patient with central alveolar hypoventilation treated with diaphragm pacing.

We had treated a 17-year-old girl with central alveolar hypoventilation with diaphragm pacing at home for the past 8 years. Nocturnal diaphragm pacing with an open tracheostomy was effective in maintaining an adequate ventilation after 4 months of undergoing training of the diaphragm on the pacemaker implantation. However, the diaphragm pacemaker failed to maintain it mostly in the presence of respiratory tract infection, when she was treated with intermittent positive-pressure ventilation. Pulse oximetry was used at home for monitoring the adequacy of respiratory support. We conclude that the respiratory assistance by the diaphragm pacemaker or the use of a mechanical ventilator as a backup was highly useful for the home care of a patient with central alveolar hypoventilation.

Adolescent↗

Suppressed cardiac and electroencephalographic arousal on apnea/hypopnea termination in elderly patients with cerebral infarction.

The goal of the present investigation is to show the clinical significance of arousal response at termination of apnea/hypopnea in patients with sleep apnea syndrome (SAS) after cerebral infarction. We polygraphically assessed "cardiac arousal," which is defined as an abrupt increase in heart rate at a termination of sleep apnea/hypopnea, and electroencephalographic (EEG) arousal. There were six elderly subjects, bedridden after cerebral infarction, with SAS aged 71-87 years (mean 72.3 years) and 11 age-matched patients with SAS aged 61-78 years (mean 62.3 years) as controls. The following sleep parameters were measured: number of apneas per hour (apnea index [AI]), number of hypopneas per hour (hypopnea index [HI]), summation of the two (apnea/hypopnea index [AHI]), and duration in which nocturnal oxygen saturation was decreased below 90% (duration of SaO2 < 90%). We calculated the ratio of apnea/hypopnea per hour with cardiac arousal to total apnea/hypopneas (XI) (% cardiac arousal [XI/AHI x 100]) and the ratio of that with EEG arousal (YI) (% EEG arousal [YI/AHI x 100]). Between the two groups, we found no significant difference in body mass index, the ratio of central apnea to total apnea/hypopnea, AHI, duration of apnea/hypopnea, lowest SaO2, and duration of SaO2 < 90%. Compared with controls, % cardiac and % EEG arousals were significantly lower in patients with cerebral infarction. In contrast, the ratio of HI to AHI was significantly higher in patients with cerebral infarction than in control subjects. Our findings indicate that cardiac and EEG arousals at termination of apnea/hypopnea are significantly suppressed in elderly patients with SAS after cerebral infarction, which may provide useful information on the pathophysiology of SAS in patients with cerebrovascular disease.

Aged↗

Recording of electroencephalograms and electrocardiograms during daytime sleep in trained canines: preparation of the sleeping dogs.

Although respiration in trained canines is well investigated, the process of preparing dogs has not been described in any great detail. Moreover, their daytime patterns of sleep and wakefulness during 1 or 2 h of electroencephalogram (EEG) and electrocardiogram (ECG) recordings are not clear. Therefore, we describe the process of selecting and training dogs, in which we recorded EEG and ECG in the laboratory. First, 14 of 1242 dogs dealt with over a 1 year period were chosen. They were trained for 2 h to lie quietly and to sleep in the laboratory; this training procedure was repeated 152 times. Three dogs were then selected and a permanent tracheostomy was performed in one. Finally, EEG and ECG were recorded with the bipolar fine needle electrodes; respiration was recorded simultaneously through a tube inserted to a tracheostomy in one dog. Wakefulness, slow wave sleep (SWS) and rapid eye movement (REM) sleep (REMS) were identified according to the EEG pattern and on the basis of the behavioral criteria. Recordings were performed 12 or 13 times in each dog. Complete sleep cycles, including wakefulness, SWS and REMS in this sequence, were observed 3.9-4.1 times. The mean duration of SWS was 2.2-4.4 min and that of REMS was 3.5-4.6 min. The REMS latency was 33.9-41.8 min. Fluctuation of heart rate with respiration, termed respiratory sinus arrhythmia, was noted in the ECG. Heart beat increased with inspiration and decreased with expiration. The present study demonstrates how to select and train sleeping dogs and shows their undisturbed daytime sleep and wakefulness patterns.

Animals↗