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Biomedical subjects

J K Walsh

Publications and source records attributed to J K Walsh.

At least 55 records · Page 3Linked to original sources
PubMed1987

Nasopharyngeal complications following uvulopalatopharyngoplasty.

This report presents our experience with nasopharyngeal complications of UPPP in 85 patients undergoing the procedure from May, 1982 to January, 1985. Three patients developed nasopharyngeal stenosis and one patient developed permanent velopharyngeal insufficiency. Surgical management in two patients with nasopharyngeal stenosis resulted in adequate nasopharyngeal airway, while one patient still has a moderate stenosis following two surgical procedures. The patient with velopharyngeal insufficiency underwent Teflon paste injection in the posterior pharyngeal wall. This resulted in complete alleviation of his nasal regurgitation.

Constriction, Pathologic↗
PubMed1986

Somnofluoroscopy: its role in the selection of candidates for uvulopalatopharyngoplasty.

The purpose of this study was to evaluate the efficacy of somnofluoroscopy in the selection of candidates for uvulopalatopharyngoplasty (UPPP). Somnofluoroscopy is a lateral fluoroscopic examination of the upper airway with synchronous polysomnography that provides information about the dynamic function of the airway and the level of stenosis or occlusion during sleep. Somnofluoroscopies were performed preoperatively in 26 consecutive patients undergoing UPPP. Preoperative and postoperative polysomnographic data were obtained on each patient. On review of the somnofluoroscopic recordings, two levels of the airway were considered: level 1, above the horizontal plane through the midportion of body of the second cervical disk, and level 2, below this plane. The examinations were then scored for the following: (A) most narrow level of airway during wakefulness, (B) first level(s) of airway to collapse during apnea, and (C) all levels of the airway to collapse during apnea. It was shown that patients whose narrowest part of the upper airway is at level 1 and whose first point of airway collapse during apnea episodes is at level 1 are good candidtates for the UPPP. Only three of 15 patients in this group did not respond to the operation. Patients with other patterns are uniformly poor candidates for this procedure. Results are encouraging but preliminary because of the small number of patients. It appears that somnofluoroscopy is a reliable selection criterion for UPPP in patients with obstructive sleep apnea.

Adult↗
PubMed1986

Evaluation of insomnia.

The effective treatment of patients with a complaint of insomnia requires an appreciation of the range of etiologic factors underlying the symptom of insomnia, as well as sound clinical judgment and appropriate application of available therapeutics. Systematic inquiry regarding nocturnal and daytime aspects of a patient's life is helpful in narrowing the range of diagnostic possibilities. Specialized evaluation at a sleep disorders center may be useful in cases of chronic insomnia that remain refractory to initial interventions.

Adolescent↗
PubMed1985

Daytime alertness in subjective and objective insomnia: some preliminary findings.

Daytime performance and alertness were examined in two groups of patients with disorders of initiating and maintaining sleep (DIMS) and a control group of self-described good sleepers. Individuals complaining of disturbed sleep that was verified by polysomnographic indices (objective DIMS) and a group with complaints of disturbed sleep in the absence of objective findings (subjective DIMS) were compared with normal sleepers. Nocturnal polysomnographic recordings documented increased sleep latencies and decreased sleep efficiencies for the objective DIMS group and essentially normal sleep for the subjective DIMS group. However, the subjective DIMS group showed impaired daytime vigilance compared with both the objective DIMS and control groups. Additionally, the subjective DIMS group demonstrated an atypical daytime alertness and a tendency toward lowered arousal during vigilance task performance. Insomniacs without clear objective findings of disturbed sleep, therefore, showed decrements commonly seen following sleep loss or sleep disturbance, whereas insomniacs with evidence of disturbed nocturnal sleep did not differ from the control group in terms of waking function.

Adult↗
PubMed1985

Somnofluoroscopy: cineradiographic observation of obstructive sleep apnea.

Systematic cineradiographic observation of the upper airway with simultaneous polysomnography, termed somnofluoroscopy, was performed for a relatively large sample of obstructive sleep apnea patients. These observations suggest that (a) the site of upper airway occlusion may be oropharyngeal, hypopharyngeal, or both; (b) upper airway dynamics appear to be consistent within a given patient and variable among patients; and (c) a passive mechanism results in occlusion rather than active muscular contraction. Somnofluoroscopy is a relatively simple procedure that may be helpful in the selection of treatment for individual sleep apnea patients.

Adolescent↗
PubMed1985

Further evaluation of uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea syndrome.

Since its introduction in 1981 uvulopalatopharyngoplasty (UPPP) has become an alternative surgical approach to permanent tracheostomy in treating obstructive sleep apnea (OSA). However, the criteria for selecting candidates for this procedure are unclear and the prediction of a positive response remains an enigma. This article presents the experience with UPPPs performed on 35 patients who had moderate to severe OSA. Criteria for patient selection included apnea severity, cardiopulmonary sequelae, and clinical symptomatology. All but two patients demonstrated clinical improvement, although there was considerable variability in the degree of response. Patients were classified as good or poor responders on the basis of the severity index (SI), which represents the number of apneas and hypopneas per hour of sleep resulting in oxygen saturation below 85%. A greater than 50% improvement in the SI was considered a good response. Twenty-three patients (65.7%) were good responders and the remaining 12 (34.3%) were poor responders. The need for permanent tracheostomy was obviated in 16 of 32 patients presenting with disabling daytime sleepiness or severe cardiopulmonary sequelae. Therefore it appears that UPPP is useful for treating most OSA patients.

Adult↗
PubMed1984

Acute administration of triazolam for the daytime sleep of rotating shift workers.

Ten rotating shift workers, who changed shifts every 1 to 4 weeks, slept in the laboratory during the first four daytime sleep periods of two consecutive tours of night shift. Prior to the first two sleep periods of one tour, the subjects were given 0.5 mg triazolam. Placebo was administered prior to sleep periods one and two of the other night shift tour. Neither drug nor placebo was given before the third and fourth sleep period of either tour of night shift. Conditions were counterbalanced among subjects. Polysomnography demonstrated that triazolam significantly increased total sleep time and sleep efficiency relative to placebo, primarily by promoting sleep maintenance. No adaptation to daytime sleep was seen during the four consecutive sleep periods without triazolam (placebo, then no drug). Triazolam did not appear to promote adaptation to daytime sleep on the 2 days following triazolam administration.

Adaptation, Physiological↗
PubMed1983

Effects of lorazepam and its withdrawal on sleep, performance, and subjective state.

The effects of 3 mg lorazepam on polysomnographic recordings, performance, anxiety, and perceived sleep were examined. Six insomniac subjects slept in the sleep laboratory for 18 consecutive nights after having taken placebo or lorazepam. Polysomnographic data and subjective reports indicated hypnotic efficacy in terms of sleep initiation and maintenance. There was some evidence of rebound insomnia after drug withdrawal, although it was not evident from all measures. Clear performance decrements occurred during lorazepam use.

Adult↗
PubMed1981

Periodic breathing in infants with histories of prolonged apnea.

Periodic breathing (PB) during sleep was investigated in two groups of full-term infants with histories of apnea that were terminated by resuscitation. One group of infants had been reported to be asleep whereas the other group had been reported to be awake when apnea was noted. Electrophysiologic sleep recordings were made after the apneic incident. The infants with histories of prolonged apnea while asleep exhibited more PB during recorded sleep than infants with histories of apnea while awake. Increased PB during sleep in full-term infants, therefore, may not be associated with all prolonged apneic episodes in infants but may be specifically associated with those episodes that occur during sleep.

Apnea↗
PubMed1981

Gastroesophageal reflux in infants: relation to apnea.

The temporal relationship between apnea and gastroesophageal reflux was examined in 14 infants with abnormal GER scores and histories of prolonged apnea. Simultaneous polysomnographic and intraesophageal pH recordings were performed for each infant. GER episodes were compared to control segments of the recording (without GER) for frequency and type of apnea. Apnea was equally likely to occur during the control segments as during the GER episodes. Brief obstructive apneic episodes were more common during the onset of GER episodes than the onset of control segments. GER duration appeared prolonged during sleep. GER and apnea were not temporally related in the majority of instances, and may be two manifestations of a more general developmental delay.

Apnea↗