[Sleep disorders and heart and vascular diseases].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M Partinen
Publications and source records attributed to M Partinen.
Cephalometric analysis of the obstructive sleep apnea syndrome.
The cephalometric measurements of 33 Finnish OSAS patients showed a fairly normal relationship between the base of the skull and the maxilla (SNA 82.3), whereas the mandible was slightly smaller than average (SNB 78.0). In 58% of the patients the mandible was significantly retrognathic and/or small in relation to the maxilla, even if dental occlusion was satisfactory. The sagittal lengths of the anterior cranial base and the maxilla were fairly normal. The hyoid bone was constantly situated more inferiorly and posteriorly than on average (MP-H 32.6). UPPP, genioplasty and advancement of the floor of the mouth and hyoid suspension were found to be effective in severe OSAS. The changes caused by the operation could best be verified cephalometrically by a more anterior position of the hyoid bone (average change of 11.1 mm).
Adult↗
Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients.
To evaluate the morbidity associated with obstructve sleep apnea syndrome (OSAS), we undertook a seven-year follow-up study of 198 OSAS patients seen between 1972 and 1980. The patients had been submitted to tracheostomy (71 patients) or had received a weight-loss recommendation (127 patients). Despite a lower mean apnea index (AI) (43 vs 69) and a lower mean body mass index (BMI) (31 vs 34 kg/m2) at entry, excessive daytime sleepiness (EDS) and vascular morbidity were significantly higher in the conservatively treated group. The relative risk (odds ratio) of finding EDS in the conservatively treated group, after adjustment for BMI at seven-year follow-up, was 3.7 (95 percent confidence interval [CI] = 2.6-5.3). The relative risk of developing new vascular problems in the same population, estimated by Cox models, was 2.3 (95 percent CI = 1.5-3.6). The effect of tracheostomy, independent of age, BMI, and AI at entry, was highly significant. At entry, 56 percent of the population already had a vascular problem, particularly hypertension, thus emphasizing the need for earlier treatment of the sleep-related abnormal breathing.
Adolescent↗
Flight attendants' desynchronosis after rapid time zone changes.
The aim of the present study was to measure perceived effects of rapid time zone changes on flight attendants' sleep length, quality, adaptation, and recovery time, and to clarify the individual factors related to perceived desynchronosis after time zone changes. The mean age of 285 female subjects was 35.0 years and that of 57 men was 34.1 years. The data were gathered by means of a questionnaire filled out by all Finnish flight attendants who worked on transmeridian routes. The quality of sleep, perceived adjustment, and recovery times were dependent on the flight direction and on the number of time zones crossed. The effects of age, neuroticism, and sex partly explained the variation of perceived desynchronosis, which increased linearly with increasing age and neuroticism.
Adult↗
Morphometric facial changes and obstructive sleep apnea in adolescents.
Explore the source record for details and available documents.
Adenoidectomy↗
Prevalence of every night snoring and obstructive sleep apnoeas among 30-69-year-old men in Bologna, Italy.
An epidemiological survey of the prevalence of snoring and sleep apnoeas was performed on 3479 30-69-year-old men living in Bologna, north-east Italy. First a postal questionnaire was sent. It was returned with appropriate answers by 1170. A 20% random sample of those who did not answer were invited by telephone to return the questionnaire. Among these groups 119 (10%) and 19 (5.6%) respectively answered that they always snored. A random sample of 40 every-night snorers were studied by polysomnography. Based on the frequency of every-night snoring and the results of polysomnography we estimated that the minimal prevalence of sleep apnoea among 30-69-year-old men was 2.7% considering an apnoea + hypopnoea index of 10 or more pathological. According to the Lugaresi classification we had a 2.5% prevalence of heavy snorers' disease (HSD) Stage 1 or higher. These figures indicate that obstructive sleep apnoea during sleep is a major public health problem.
Adult↗
Snoring as a risk factor for sleep-related brain infarction.
We studied 177 consecutive male patients aged 16-60 years with brain infarction verified by neuroradiology and analyzed the time of onset of stroke symptoms related to sleep and the role of possible or known risk factors for brain infarction. Brain infarction occurred relatively more often during the first 30 minutes after awakening than at any other time. In multiple stepwise logistic regression analyses, snoring was the only independent risk factor differentiating stroke occurring during sleep and stroke occurring either during sleep or during the first 30 minutes after awakening from stroke occurring at other times of the day. The risk ratios were 2.65 (95% confidence interval 1.32-5.29, p less than 0.005) and 3.16 (95% confidence interval 1.61-6.22, p less than 0.001), respectively. Other factors tested were age, arterial hypertension, diabetes mellitus, smoking, alcohol consumption, and body mass index. Arterial hypertension seemed to have an additive effect on the independent risk caused by snoring.
Adolescent↗
Evaluation of automatic analysis of SCSB, airflow and oxygen saturation signals in patients with sleep related apneas.
We have developed a computerized analysis of respiratory and body movements (static charge sensitive bed [SCSB]), oxygen saturation (pulse oximeter), and airflow (thermistor) for the evaluation of sleep related apneas. The cumulative distribution of oxygen saturation, the number and distribution of desaturation events, and the duration and type of apneas are assessed. Analysis is performed separately during the total recording time and during the time when the patient sleeps on his back. We have compared the automatic analysis with the results obtained on simultaneous daytime polysomnograph naps in 55 subjects (snorers or obstructive sleep apnea syndrome [OSAS] patients). The compressed graphs obtained automatically demonstrated a periodic breathing pattern in all 22 patients who presented sleep-related apneas at polygraphic recording. The cumulative distribution of oxygen saturation was not as steep in the apnea patients as in patients not showing apneas; in 19 of the 22 OSAS patients, the value was outside our normal limits (80 percent of the recording time inside 3.6 percent SaO2 variation band). The apnea index (AI) was 26.4 in manual and 23.3 in automatic analysis. Using the automatic method there were three false negative cases in the analysis of desaturations; in these patients periodic breathing was present in output graphs indicating need for further polygraphic assessment. The duration of apneas in the automatic analysis was shorter than in manual analysis, but the agreement was sufficient for screening purposes (mean error less than 3 s, mean duration of apneas 20.1 s). The automatic method is presently used in clinical routine for screening purposes, for assessment of the severity of the disorder and the type of treatment that a subject may need, in epidemiologic investigation and follow-up of the treatment.
Adult↗
The diurnal variability of ventricular premature depolarizations: influence of heart rate, sleep, and wakefulness.
The relationships between ventricular premature depolarizations (VPDs) and heart rate (HR) were determined in 14 patients with ventricular arrhythmias and the influence of these relationships on the diurnal variability of ventricular arrhythmias was evaluated. The influence of sleep state, wakefulness, and level of activity on the frequency of VPDs was also studied. Subjects completed 48-72 h of ambulatory electrocardiographic monitoring and nocturnal sleep recordings. Plots of VPD frequency vs. HR were examined and subjects were categorized as HR-dependent if they manifested log-linear increase in VPDs with increasing HR and as HR-independent if no relation between VPD frequency and HR was detected. Sleep suppression of VPDs was observed in the HR-dependent group (p less than 0.05). The reduction in VPD frequency correlated with the reduction in HR and was independent of sleep state or wakefulness. No change in VPD frequency was observed during wakefulness, rapid eye movement sleep, or non-rapid-eye-movement sleep in the HR-independent group. The influence of level of activity on ventricular arrhythmia frequency was also assessed in seven subjects. Any decreases in VPD frequency observed during inactivity were associated with a decrease in HR. These observations suggest that HR is a major determinant of the diurnal variation of VPD frequency in a subset of patients with frequent VPDs.
Arousal↗
Prazosin contraindicated in patients with narcolepsy.
Explore the source record for details and available documents.
Aged↗
Self-evaluations of factors promoting and disturbing sleep: an epidemiological survey in Finland.
The purpose of this epidemiological survey (N = 1600) was to describe the factors which middle-aged urban people in Finland perceived as promoting or disturbing sleep. The response rate was 75%. The results suggested that quality of sleep is determined by numerous factors; social and psychological factors, health status, external sleeping conditions, life style and living habits. Every third respondent felt that exercise had a positive impact on sleep. Second in importance were reading and listening to music. Furthermore, sauna, shower and bath, stability in life, psychological factors, positive experience in work, satisfactory sexual life and good and quiet sleeping environment were reported to have positive effects on sleep. Men considered work-related pressure and fatigue (20%) as the most important factor disturbing falling asleep or quality of sleep. In women's ranking work problems appeared no sooner than in the third place. Women reported worries, interpersonal problems, and marital and family discord as the most disturbing factors to sleep (37%). Coffee in the evening had a negative effect on falling asleep. Although a 'nightcap' was considered to improve relaxation on falling sleep, men ranked alcohol as the fourth disturbing factor. Other disturbing factors were stress, irregularities in everyday life because of social events, travelling or atypical catnaps. Eating and exercising too heavily or too late in the evening were found to disturb sleep. On the other hand, temporary lack of exercise seemed to impair the quality of sleep. As external factors disturbing sleep the subjects considered noise light, too high room temperature, tight clothing, unfamiliar sleeping environment and restless children.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Women and the obstructive sleep apnea syndrome.
Twenty-seven women referred to a sleep disorders clinic for symptoms of obstructive sleep apnea syndrome (OSAS) during one year were systematically analyzed after polygraphic monitoring of sleep and cephalometric x-ray examination. Our subjects, one-third of whom were premenopausal, comprised approximately 12 percent of the total OSAS population seen. Women with OSAS were compared with 110 OSAS men and with a group of 16 women without OSAS but referred to orthodontists for mild dental malocclusion. Women with OSAS were massively obese, much more so than their male counterparts. There was no significant difference between pre- and postmenopausal women, with the exception of the respiratory disturbance index (RDI), which was lower in the postmenopausal group despite similar morbid obesity (seemingly better tolerated by women with OSAS than by men with the same syndrome) and long mandibular plane-hyoid bone distance. The significantly higher RDI noted in premenopausal women, despite equally massive obesity and upper airway abnormalities, is thought to be related to hormonal status and better arousal response. Chronic obstructive lung disease (COLD) seen in a subgroup of women with OSAS did not differentiate this subgroup from the other OSAS patients when oxygen saturation during sleep, frequency of abnormal respiratory events and sleep variables were considered. Massive obesity is the dominant factor for the appearance of OSAS in women.
Adolescent↗
Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep.
In a six-month period, 157 obstructive sleep apnea syndrome (OSAS) patients seen consecutively in clinic had standardized cephalometric roentgenograms and underwent polygraphic monitoring during sleep. Different variables, including cephalometric landmarks, body mass index (BMI), and polygraphic results (particularly degree of O2 saturation and number of abnormal breathing events), were statistically analyzed. As a rule, OSAS patients had upper airway anatomic abnormalities and an elevated BMI: massive obesity was associated with less anatomic abnormality, less nocturnal sleep disruption, and longer total sleep time (TST). Patients having a high respiratory disturbance index (RDI) were more likely to have upper airway anatomic abnormalities; they slept for a shorter time and had increased stage 1 non-rapid eye movement (NREM) sleep but decreased stage 3 and 4 and REM sleep. Long mandibular plane to hyoid bone (MP-H) distance and width of the posterior airway space (PAS) (space behind the base of the tongue) were statistically significant predictors of elevated RDI. The cephalometric variables were much less useful for predicting frequency of O2 saturation drops below 80 percent. The patient population can be subdivided into (a) patients with clear anatomic abnormalities and low BMI, (b) patients with morbid obesity with few abnormal cephalometric measurements, and (c) patients who have variably increased BMI and abnormal cephalometric measurements. This is the largest group. We concluded that standardized cephalometric roentgenograms can be useful in determining the appropriate treatment for OSAS patients.
Adult↗
Determinants of daytime sleepiness in obstructive sleep apnea.
To investigate determinants of daytime sleepiness in obstructive sleep apnea syndrome (OSAS), we studied 100 unselected OSAS patients by nocturnal polygraphic recording and the Multiple Sleep Latency Test (MSLT). Data obtained were submitted to three types of analysis. Respiratory disturbance index, oxygen saturation indices, body mass index, and total nocturnal sleep time did not significantly correlate with daytime sleepiness, as measured by the MSLT. Analysis of subgroups based on weight and degree of alertness also showed a nonsignificant correlation with daytime sleepiness. The best predictor of the excessive daytime sleepiness (EDS) frequently found in OSAS patients was the nocturnal polygraphic recording of the sleep disturbances and sleep structure anomalies that reflect the brain's overall dysfunction in OSAS. Understanding why an electroencephalogram arousal response occurs during sleep in association with abnormal breathing and how this response can become blunted may help us to better predict the development of EDS.
Body Weight↗
Long-term outcome for obstructive sleep apnea syndrome patients. Mortality.
As the actual mortality and morbidity of obstructive sleep apnea syndrome (OSAS) have been unknown heretofore, we undertook a follow-up study of 198 OSAS patients seen at the Stanford Sleep Disorders Clinic between 1972 and 1980, for whom either tracheostomy (71 patients) or weight loss (127 patients) had been recommended. At five-year follow-up, all of the deaths (14) had occurred among those conservatively treated with weight-loss (a mortality rate of 11 per 100 patients per five years). These patents also had a higher five-year crude vascular mortality rate: 6.3 per 100 patients per five years, with an age-standardized vascular mortality rate of 5.9 per 100 patients per five years (95 percent confidence interval [CI] 2.5-11.6) vs 0 per 100 for the surgically treated population; this despite a lower mean apnea index (43 versus 69) and a lower mean body mass index (31 versus 34 kg/m2) in the conservatively treated group. With the fictional adjunction of one possible death at five-year follow-up in the surgically treated group, the age-adjusted odds of vascular mortality at five years for the conservatively treated group was 4.7. Our data therefore encourage "aggressive" treatment for patients with OSAS.
Adolescent↗
Sleep apnea and mortality in an aged cohort.
In the aged, sleep may be a vulnerable period for death from cardiovascular causes. Because of its high prevalence in the elderly, sleep apnea has been suggested to be one mechanism contributing to such sleep-related mortality. In this study, a cohort of 198 non-institutionalized elderly individuals (mean age at entry = 66) were followed for periods up to 12 years after initial polysomnography. The mortality ratio for sleep apnea (defined as a Respiratory Disturbance Index of over 10 events per sleep hour) was estimated to be 2.7 (95% CI = .95, 7.47). Multiple regression with the Cox proportional hazards model suggested that cardiovascular death was most clearly associated with age in this cohort. These results raise the possibility that "natural" death during sleep in the elderly may be associated with specific pathophysiological events during sleep.
Aged↗
[Diagnosis and treatment of sleep apnea].
Explore the source record for details and available documents.
Humans↗
Nocturnal asthma: snoring, small pharynx and nasal CPAP.
We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Müller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.
Adolescent↗