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Biomedical subjects

K Rasche

Publications and source records attributed to K Rasche.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Incidence of cutaneous sensitization to environmental allergens in obstructive sleep apnea syndrome].

A skin prick test was performed in 75 patients with an obstructive sleep apnea syndrome (OSAS) to test allergic skin reactivity to 18 common inhalant allergens. Additionally, anterior rhinomanometry was performed. Results were compared with a group of 21 patients with chronic obstructive pulmonary disease and with 198 workers of the chemical industry. A positive (> or = 4 mm wheal diameter) skin test to at least one allergene was present in 49 per cent of the OSAS patients, compared to 14 per cent in COPD patients and 28 per cent in industrial workers (p < 0.05; chi 2-test)-33 per cent (n = 25) of the OSAS patients with a sleep apnea syndrome showed skin reactivity to house dust mite (D. ph., D. f.) compared to 9.5 per cent in COPD patients and 12.6 per cent in industrial workers (p < 0.05 chi 2-test). No difference was found between anthropometric, polysomnographic, or rhinomanometric data comparing OSAS patients with positive skin reactions against house dust mites (n = 25) and those without any allergic skin reactivity (n = 38).

Adult↗
PubMed1996

[Complications of nasal CPAP therapy. Consequences for general practice].

BACKGROUND: The prevalence of the obstructive sleep apnea syndrome is about 5% in the entire population. The amount of treatment-indications grows for this particular sleep-related breathing disorder due to the increasing usage of diagnostic screening tests. In most cases, the positive-pressure ventilation, PPV (nCPAP, nBiPAP) is considered as a highly effective form of treatment, in comparison to other treating methods. The residential polysomnographic supervised adjustment of the treatment is optimally applied to most of the patients. Due to the increasing number of the treated patients, the reports about the appearance of short-termed side effects during the adjustment of the PPV become more frequent. PATIENTS AND RESULTS: We report on 9 patients who showed complications during the initial stage of treatment. The most common one, during the nCPAP-therapy, was the increase of central apneas. Because of this complication, a rapid optimization of the respiratory pressure or a change to a nBiPAP-therapy was necessary in 5 of the patients. 2 of the patients showed cardiac arrhythmias, some of which were severe. One patient produced a remarkable central hypoventilation during the initial phase of a nCPAP-therapy. The nBiPAP-titration combined with right-heart-catheter monitoring could demonstrate in another patient a possible cardiac decompensation through an increased ventilatory pressure. CONCLUSION: The risk of a positive-pressure ventilation is higher in patients with accompanying cardiac, pulmonary, neuropsychiatric and/or otorhinolaryngologic disorders. Considering the various predisposing factors of the patients we suggest an intensive apparative monitoring as well as stuff-supervision during the introduction to a respiratory treatment. If complications appear, a rapid improvement of the ventilatory pressure or a change to another respiratory treatment is indicated.

Aged↗
PubMed1996

[Reproducibility of computer-assisted mouth occlusion pressure measurements].

BACKGROUND: The measurement of mouth occlusion pressure is an easy method to assess respiratory drive and muscle function. Lately there is a variety of computer assisted programmes, but their precision is discussed controversially. In this study we analysed the repeatability of measurements of mouth occlusion pressures performed by a computer assisted measurement unit. PATIENTS AND METHODS: We examined maximal inspiratory mouth occlusion pressure (PI(max)), mouth occlusion pressure 100 ms after onset of inspiration (PO.1) and PI(max) after 100 ms (PO.1(max)) of 32 patients with COPD. Subjects were divided into group A (normal blood gas pressures) and group B (hypercapnia due to alveolar hypoventilation). Controls (K) consisted of 22 healthy men. Criteria for repeatability were analysis of variance, intraindividual standard deviation of the mean and the variation coefficient of 5 consecutive measurements. RESULTS: Controls produced the highest values for PI(max) and the lowest ones for PO, 1. Intraindividual standard deviation was small as well as the variation coefficient; we found no statistically significant differences. Compared with controls in group A PI(max) values were markedly reduced with elevated PO.1 values. Intraindividual standard deviation and variation coefficient were low, differences not significant. We observed similar results for group B, variance analysis showed no significant differences, deviation around the mean was small. CONCLUSION: Our data suggest a high repeatability of measurements of mouth occlusion pressures. Especially patients with severe COPD and alveolar hyperventilation are able to produce valid and reliable test results.

Adult↗
PubMed1996

[Incidence of chronic obstructive respiratory tract disease in patients with obstructive sleep apnea].

Data concerning the occurrence of chronic-obstructive pulmonary disease (COPD) in patients with obstructive sleep apnea syndrome (OSAS) vary between 11 and 20% due to the underlying definition of COPD. We investigated the frequency of COPD in 202 patients with OSAS. The obstructive pattern was defined by bodyplethysmography (Rt > 0.35 kPa x 1(-1) x s(-1)), flow-volume-curve (MEF50 < 50% pred.), Tiffeneau-index (FEV1/IVC < 70% pred.) and anamnesis (cough and/or sputum). Prevalence of COPD in our 202 patients with OSAS was 16.3%. Patients with OSAS and COPD had a higher body-mass-index (BMI), lower PaO2 and spent more time in an oxygen saturation < or = 90% in relation to total recording time (t90). Polysomnographically there was no difference between the two groups with regard to the ventilatory parameters apnea-index (AI) and apnea-hypopnea-index (AHI). As there is a high risk of developing hypercapnia, pulmonary arterial hypertension and cor pulmonale in patients with OSAS and COPD there is need for early diagnosis of the combination of both diseases.

Adult↗
PubMed1996

[Anamnestic and polygraphic parameters in obstructive sleep apnea syndrome patients with reduced nasal respiration during the day in comparison with obstructive sleep apnea patients with normal nasal respiration].

Nasal obstruction is a predictive factor for snoring and may contribute to the development of an obstructive sleep apnea syndrome (OSAS). The aim of this study was to further evaluate the impact of nasal obstruction in OSAS. Therefore, we investigated 2 groups of OSAS-patients, matched pairs concerning gender, age, and BMI: OSAS-patients with nasal obstruction (N, n = 28), total nasal airflow < 500 ccm/s (referred to 150 pa pressure of difference or unilateral nasal resistance > 1 pa/ccm/s), and 28 OSAS-patients without nasal obstruction (control-group K, total nasal airflow > 700 ccm/s [referred to 150 pa pressure of difference or unilateral nasal resistance > 1 pa/ccm/s]). We performed anterior rhinomanometry, lung-function testing, cardio-respiratory polygraphy, and patients answered a standardized questionnaire. We found the following significant differences: 1) N complained more often (n = 17) about dyspnea at night than K (n = 7, p < 0.05, Chi2-test). 2) N had a higher apnea index (20.4 +/- 19.0/h) than K (9.6 +/- 10.0/h, p < 0.05, Student's t-test). There were, however, no significant differences concerning lung function, number of nocturnal hypopneas, nocturnal SaO2 and heart rate. Our results underline the importance of nasal ventilation in the pathogenesis of OSAS. At least in moderate cases of OSAS a therapy of nasal obstruction might be of success in order to abolish nCPAP-therapy or might reduce nasal problems during nCPAP-therapy and thus ameliorate patient's therapy compliance.

Airway Resistance↗
PubMed1996

[Signs of right heart stress in diurnal normoxemic patients with chronic obstructive lung disease and nocturnal hypoxemia].

Nocturnal hypoxemia in daytime normoxemic patients with COPD may lead to an increased right ventricular afterload due to pulmonary hypertension. We investigated the frequency of clinical, electrocardiographical, and radiological signs of right cardiac insufficiency (SRCI) in 178 consecutive COPD-patients [71 bronchitis, 25 emphysema, 82 bronchitis plus emphysema; PaO2 = 60 mm Hg]. Patients with asthma, left ventricular impairment, obstructive sleep apnea syndrome, primary pulmonary hypertension, and neuromuscular diseases were excluded. Polysomnography was performed in all patients. They were divided into 3 groups concerning SRCI: missing, doubtful, and secure SRCI. Parameters of nocturnal pulse oximetry were analyzed within the three groups (Student's t-Test. Chi2-Test. p < 0.05). 25.8% of the patients had secure SRCI without a significant frequency difference between patients with bronchitis and/or emphysema. Patients with secure SRCI had a significant lower mean nocturnal SaO2 than those with missing SRCI (92.7 +/- 2.5 vs. 90.3 +/- 3.5%). With regard to the high prevalence of SRCI in association with nocturnal hypoxemia routine control of nocturnal oxygenation is recommended in daytime normoxemic COPD-patients for the early decision for nocturnal oxygen therapy.

Adult↗
PubMed1996

[Sex-specific sleep anamnesis in obstructive sleep apnea syndrome?].

Although the prevalence of obstructive sleep apnea syndrome (OSAS) is about 4% in men and 2% in women, women are underrepresented in clinical routine. The aim of this study was to determine whether differences in clinical features of OSAS may in part explain the bias observed. 224 men and 24 women with polysomnographically confirmed OSAS filled in a symptom-focussed multiple-choice questionnaire. Polysomnographical results were comparable in both groups. With regard to snoring, daytime sleepiness and tendency of falling asleep there were no differences between both groups. Women more frequently complained about difficulties of initiating and maintaining sleep and about apneas. Further investigations have to concentrate on the pathomechanisms of OSAS in women which may in part explain the gender differences in sleep apnea associated symptoms.

Adult↗
PubMed1996

[Acoustic evoked potentials (AEP) in obstructive sleep apnea syndrome].

Patients with obstructive sleep apnea syndrome (OSAS) present upper airway obstruction during sleep which can be documented by electromyography. The cause of weakness in oropharyngeal muscles is still unknown. Lesions of pons and medulla oblongata have to be expected. Brainstem auditory evoked potentials (BAEP) may indicate pathological changes in these regions. Several studies described normal BAEP in OSAS-patients. Moderate forms of OSAS as well as central sleep apnea syndromes were investigated, however. In our study 20 patients (17 men, 3 women, mean age 53.9 +/- 2.1 ys) with severe OSAS (apnea/hypopnea-index: 34.2 +/- 14.1/h, part of O2-saturation < or = 90% during sleep (SaO2 < or = 90%): 13.5 +/- 4.2%, minimal nocturnal O2-saturation: 78.0 +/- 2.5%) before starting nCPAP-therapy were investigated. BAEP were elicited after applying clicks 70 dB above threshold to each ear. Means of single wave latencies as well as interpeak latencies (I-V, I-III, III-V) were delayed significantly compared to normal controls. Main prolongations were seen regarding wave latency I (p < or = 0.001) and-interpeak latency I-V (p < or = 0.001). Prolongation of interpeak latencies (mean +/- 2.5 SD) of one or two sides could be demonstrated in 12 out of 20 patients. Pontomesencephal lesions (9 patients) dominated. There was no connection with respiratory parameters. As against pathological BAEP changes correlated with the duration of the disease. In conclusion pathological BAEP indicating brainstem lesions were seen in 60% of the examined OSAS-patients. Mesencephal lesions dominated, number of lesions increased with duration of disease. Therefore pathological findings have not to be considered as cause but as a result of hypoxemia in OSAS. Pathological BAEP may reveal a higher risk for cerebrovascular stroke. Therefore these patients should be leaded to further cerebrovascular investigation.

Electromyography↗
PubMed1995

[Sensitivity and specificity of pulse oximetry in diagnosis of sleep-related respiratory disorders].

As there is a great demand for polysomnography, screening tests had to be established in the diagnosis of sleep-related disordered breathing. Oxygen saturation is often used as a main diagnostic criterion of these screening tests. In 207 patients (42 women, 165 men) suspected to suffer from a sleep apnea-syndrome we compared oxygen saturation (pulse oxymetry) with apnea-hypopnea-index (AHI, polysomnography). An AHI > or = 5/h and a minimal oxygen saturation < 90% and/or more than 5 oxygen desaturations/h > or = 4% were regarded as pathological. We found a good correlation of significant oxygen desaturations measured with pulse oxymetry and AHI (r = 0.85). Compared to AHI, pulse oxymetry was seen as a sensitive method (sensitivity 0.97) to recognize sleep apnea-patients. Coincidence of COPD decreased specificity of pulse oxymetry from 0.48 to 0.23 but had no influence on its sensitivity. 13 percent of the patients without further cardiorespiratory disease had a normal AHI (< 5/h) but a pathological pulse oxymetry. We conclude, that pulse oxymetry in combination with a positive case history is a sensitive method to recognize sleep apnea-patients. Not all sleep apnea-patients' can be diagnosed only by regarding AHI without taking oxygen saturation into account.

Adult↗
PubMed1995

[Long-term acceptance of n-CPAP therapy by patients with sleep related respiratory disorders].

The therapeutic effect in application of n-CPAP therapy (nasal continuous positive airway pressure) is dependent on both the acute effect of this therapy and the long-term acceptance and consequent palliation respectively avoidance of sequelae. We present 50 patients (47 male, 3 female) treated with n-CPAP therapy because of severe sleep-related disorders of breathing. All patients had polysomnography, and in addition questionnaires were mailed to all 50 patients in order to get information concerning the symptoms of sleep-related disorders of breathing before and under n-CPAP therapy, mode of therapy and side-effects in application of n-CPAP therapy. Patients were treated for at least three to a maximum of 25 months with n-CPAP (average 10.5 months). Long-term acceptance with n-CPAP was defined as persistent use of n-CPAP during every night for at least five hours. On average continuous positive airway pressure of 8.6 mbar (range 4-18) was effective in normalizing formerly severe pathological respiratory parameters. Apnea-index decreased from 22.8 to 2.17/h on average. Regarding the symptoms of sleep-related disorders of breathing before and under n-CPAP therapy, we saw that almost 100% of our patients complained of the main symptoms of sleep-related disorders of breathing. By regular n-CPAP application a complete reduction of these symptoms could be achieved in nearly 80% of patients. Long-term acceptance of n-CPAP therapy was reported by 78% of our patients who used their n-CPAP device every night for at least five hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Seasonal occupational asthma in an agricultural products merchant--a case report.

A 52-year-old agricultural products merchant reported mild occupational asthma and rhinitis throughout the year, with severe asthma from February to May. He had been exposed to various substances, particularly grain, insecticides, fungicides, and fertilizers over 35 years. We identified a castor-bean-containing fertilizer as the cause of the disease by skin prick test and bronchial provocation test. Specific IgE against castor bean was detected by enzyme allergosorbent test, and proteins with mol. mass of less than 14.4 kDa and masses of 15.5, 29.5, and 30.5 kDa were identified as allergens by Western blot analysis. The seasonal character of symptoms could be explained by a more frequent use of the fertilizer during spring. Six months after avoidance of the allergen, the patient reported chronic bronchitis without asthma. Occupational allergy to castor bean should be considered in subjects with seasonal asthma and exposure to "natural" fertilizers.

Asthma↗
PubMed1994

A rare manifestation of von Recklinghausen neurofibromatosis: advanced neurofibromatous infiltration in lung of a HIV-positive patient.

This is a report of a 28-year-old HIV+ man with extensive involvement of lungs, spinal roots and peripheral nerves by neurofibromatosis von Recklinghausen. Huge masses (neurofibromas) ventral of the spine, which already infiltrated into the foramina intervertebralia, could be located by magnetic resonance imaging and high resolution computer tomography. Strikingly, most biopsies taken by bronchoscopy of the bronchial wall from various parts of the airways revealed extended infiltration by neurofibromas in submucosal areas, but no malignant tissue components. In addition, HIV infection with low CD4/CD8 ratio (0.1) and low CD4+ cells (160/microliters) was found.

Adult↗
PubMed1993

[Unexplained confusion in the aged as a sequela of central sleep apnea syndrome--a case report].

Central sleep apnoea syndromes (cSAS) represent a heterogeneous group of sleep-related disorders of breathing during sleep. cSAS may develop in the course of neurological syndromes or congestive heart failure. Frequency increases with age. A case of a 89-year old man is reported who was sent to hospital because of a state of confusion. He fell asleep all day with periods of restlessness during night. Sleep-related apnoeas could already be observed during daytime. Cardiopulmonary daytime diagnostics did not reveal any abnormal findings. Polysomnographic measurements, however, showed an apnoea-hypopnoea index of 37.8 apnoeas/hypopnoeas per hour with predominantly central apnoeas. Pernasal application of 1 litre of oxygen per minute during sleep normalised breathing patterns, daytime sleepiness, and the nighttime states of confusion stopped. Consequently, sleep-related disorders of breathing have to be considered in the differential diagnostics of unclear states of confusion in old age. In these cases polysomnography is indicated even in geriatric patients.

Aged↗