Biomedical subjects

H Engleman

Publications and source records attributed to H Engleman.

4 recordsLinked to original sources

PubMed1999

Neuropsychological function in obstructive sleep apnoea.

Patients with obstructive sleep apnoea (OSA) experience neuropsychological deficits falling broadly into the four areas of daytime sleepiness, cognitive deficits, reduced driving competence and impaired psychosocial well-being. Case-control studies of daytime function in OSA patients generally indicate moderate to severe daytime sleepiness using polysomnographic or self-rating assessments. Cognitive performance on tests of attention and concentration ability, visuomotor and constructional skills, verbal fluency, planning and problem-solving, memory and executive function may be mildly to moderately impaired. These two symptoms may contribute to a road traffic accident rate in OSA between two and seven times higher than that of normals, and to the high prevalence of minor psychiatric morbidity, and reductions in functional and health status, among patients. The daytime impairments associated with OSA are improved by continuous positive airway pressure (CPAP) therapy, although a lack of complete normalization has been suggested for objective sleepiness and some areas of cognitive function. The severity of sleepiness and cognitive impairments show weak and moderate correlations with frequency of sleep-disordered breathing in clinical and epidemiological studies. Experimental and clinical evidence supports a role for nocturnal physiological events of OSA, arousals and hypoxaemia, in directly or indirectly producing neuropsychological deficits, particularly those of sleepiness and cognitive deterioration.

Journal Article↗

PubMed1992

Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome.

Patients with sleep apnea/hypopnea syndrome commonly demonstrate impaired daytime performance. In a prospective study, 29 patients with sleep apnea/hypopnea syndrome were assessed polysomnographically to determine the relationship of cognitive performance and daytime sleepiness with sleep disruption, hypoxemia, and mood. Deterioration of cognitive performance correlated significantly with increasing severity of nocturnal breathing irregularity, magnitude of nocturnal hypoxemia, and extent of sleep disruption. Multiple regression analysis identified frequency of apneas plus hypopneas and of arousal and the extent of nocturnal hypoxemia as the variables most strongly associated with cognitive deficits. Anxiety and depression also contributed to this impairment. Objective daytime sleepiness was not significantly associated with nocturnal variables. This study showed that the frequency of breathing irregularities and the extent of both sleep disruption and nocturnal hypoxemia are important in determining daytime function in patients with sleep apnea/hypopnea syndrome. All of these factors should be considered when deciding which patients require treatment.

Adult↗

PubMed1991

Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance.

Most patients with asthma waken with nocturnal asthma from time to time. To assess morbidity in patients with nocturnal asthma nocturnal sleep quality, daytime sleepiness, and daytime cognitive performance were measured prospectively in 12 patients with nocturnal asthma (median age 43 years) and 12 age and intellect matched normal subjects. The median (range) percentage overnight fall in peak expiratory flow rate (PEF) was 22 (15 to 50) in the patients with nocturnal asthma and 4 (-4 to 7) in the normal subjects. The patients with asthma had poorer average scores for subjective sleep quality than the normal subjects (median paired difference 1.1 (95% confidence limits 0.1, 2.3)). Objective overnight sleep quality was also worse in the asthmatic patients, who spent more time awake at night (median difference 51 (95% CL 8.1, 74) minutes), had a longer sleep onset latency (12 (10, 30) minutes), and tended to have less stage 4 (deep) sleep (-33 (-58, 4) minutes). Daytime cognitive performance was worse in the patients with nocturnal asthma, who took a longer time to complete the trail making tests (median difference 62 (22, 75) seconds) and achieved a lower score on the paced serial addition tests (-10 (-24, -3)). Mean daytime sleep latency did not differ significantly between the two groups (2 (-3, 7) minutes). It is concluded that hospital outpatients with stable nocturnal asthma have impaired sleep quality and daytime cognitive performance even when having their usual maintenance asthma treatment.

Adult↗

PubMed1989

Symptoms and signs of progressive hydrocephalus.

The clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure.

Cerebrospinal Fluid Shunts↗