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Biomedical subjects

U Brandenburg

Publications and source records attributed to U Brandenburg.

At least 37 records · Page 2Linked to original sources
PubMed1996

[nCPAP therapy and maxillary and mandibular osteotomy compared: attention during the day in obstructive sleep apnea].

11 patients with obstructive sleep apnea (OSA) and maxillary and mandibular characteristics participated. All patients received nCPAP therapy for at least 3 months. The surgical treatment principle consists of 10 mm maxillary and mandibulary advancement. Cardiorespiratory polysomnography (cPSG) control was assessed 3 months after surgical treatment. The daytime vigilance was investigated using a 90-min 4-choice reaction-time test. Patients reports of excessive daytime sleepiness (EDS) were confirmed by pre-treatment vigilance testing. Accordingly, daytime vigilance, respiratory and polysomnography patterns were improved with nCPAP and surgical treatment in a likewise manner. The tolerance to monotonous situations increased distinctly with nCPAP as well as after osteotomy. Surgical treatment of OSA in carefully selected cases has positive effects on sleep and daytime vigilance. There were no significant differences in the cPSG nor in vigilance tests with regard to nCPAP therapy.

Adult↗
PubMed1995

[Outpatient or inpatient treatment? Analysis of indications in psychosomatic medicine].

This is an empirical study of the criteria which indicate inpatient or outpatient treatment. The two essential elements to the process of indication are, firstly, the recommendation of the outpatient clinic conference and, secondly, the preference of the patient. A specially developed test inventory was used for the statistical evaluation of one hundred case decisions of our outpatient clinic conference. As expected, the indication is not reduced to a one-dimensional schema but is the result of a complex process. Nonetheless, several characteristics can be identified, such as the length of the illness, any psychosomatic pretreatment, the recommendations of the first diagnostician and the patient's own wish for a particular type of treatment. In sum, this study is an example of a descriptive analytical approach for the differential research on indication. Such an approach could be of importance when discussing how to control quality of psychosomatic and psychotherapeutic treatments.

Ambulatory Care↗
PubMed1995

Reversal of sinus arrest and atrioventricular conduction block in patients with sleep apnea during nasal continuous positive airway pressure.

Sinus arrest and atrioventricular (AV) block have been demonstrated in as much as 30% of patients with sleep apnea (SA). The reversal of heart block after tracheostomy has been shown. Nasal continuous positive airway pressure (nCPAP) now is widely used as the treatment of SA, but little data are available on the effect of nCPAP on heart block in patients with SA. During a 17-mo period 239 patients were found to have SA in an ambulatory study. Heart block was identified in 17 (16 male, one female) of these patients. Standard polysomnography and two-channel long-term ECG before and during nCPAP therapy were performed in order to assess the effect of nCPAP on SA and heart block. Mean age of the 17 patients was 50.7 yr (range, 27 to 78 yr), mean respiratory disturbance index (RDI) was 90/h (SD +/- 36.1) before nCPAP and 6/h (SD +/- 6.2) on the second treatment night. The number of episodes of heart block during sleep decreased significantly (p < 0.001) from 1,575 before therapy to 165 during nCPAP. In 12 patients (70.6%) heart block was totally prevented by nCPAP. In another three patients, there was a 71 to 97% reduction in the number of episodes of heart block on the second treatment night, and in two of them a complete reversal occurred thereafter. Two patients exhibited an increase in block frequency during nCPAP, which was reversed after 4 wk of nCPAP in one but persisted in the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Interactive computer program for the analysis of cardiovascular polysomnographic recordings.

A computer program for the analysis of blood pressure, heart rate, oxygen saturation and some other polysomnographic signals is presented. The program analyzes the signals, digitized by using a 100 Hz sampling frequency, in one second resolution. The analysis and calibration periods can be entered to the program by pointing at the appropriate positions of the displayed signal with a mouse. As analysis results the program can produce statistical tables or graphical representations of the measured variables as a function of time. The program can be used in routine polysomnographic cardiovascular analysis and due to its flexibility also in experimental studies.

Blood Pressure↗
PubMed1995

[Detecting blood pressure variation using spectral analysis in obstructive sleep apnea syndrome with and without nCPAP therapy].

The variation of blood pressure was investigated by power spectrum analysis in 12 patients with severe sleep apnea with and without nCPAP-therapy. In the baseline findings systolic and diastolic variation consisted of mainly two types of pressure oscillations: Swings of slow frequency (0-0.06 Hz) in tight association with the periodicity of breathing disorder and arousal and extensive respiratory pressure waves (0.2-0.5 Hz) due to the increased intrathoracic pressure changes during breathing efforts with partial or complete obstruction of the upper airway. In general systolic was higher than diastolic variation and the contribution of slow pressure oscillations was considerably bigger than that of respiratory waves. Sufficient nCPAP-therapy resulted in a decrease of the mean pressure and in a clear reduction of systolic and diastolic variation in which both types of pressure waves were diminished in a similar manner. At last there was a higher proportion of pressure waves in the frequency range of the Mayer-waves (0.06-0.2 Hz) with nCPAP-therapy.

Adult↗
PubMed1995

[Surgical treatment of obstructive sleep apnea by osteotomy of the facial bones (results of 1 year)].

Surgical treatment of obstructive sleep apnea with abolition of obstructive apneas and hypopneas is possible by maxillomandibular advancement as our own results in 24 patients show. Maxilla and mandible must be advanced at least about 10 mm to secure success. Indication for maxillomandibular advancement should be restricted to patients with certain craniofacial disorders, which are of retrognathic dolichofacial type combined with pharyngeal narrowing. Before considering surgical treatment other possible contributing factors as for instance obesity should be eliminated, the more as nCPAP-therapy constitutes an effective conservative method. Despite our unchanged success rate after 1 year further polysomnographic follow-up control is essential to see what happens 5, 10 or 20 years after maxillomandibular advancement.

Adult↗
PubMed1994

[Does velopharyngoplasty as a speech-improving measure in cleft palates lead to obstructive sleep apnea?].

Velopharyngoplasty performed to correct velopharyngeal insufficiency in cleft palate patients may cause obstructive sleep apnea in individual cases. The aim of this study was to answer the question, following velopharyngoplasty to what extent and with what frequency can signs of breathing disturbances during sleep be observed. Following the recommendations of the German Sleep Society, a step-by-step procedure was adopted. In 25 patients, in some cases before the operation and in all cases following surgery, nightly oxygen saturation, heart rate, and snoring were recorded. When observable pathological signs surfaced, a cardiorespiratory polygraph was taken. Up to this point only quickly passing signs of sleep related breathing disturbances have been observed. In not a single case could lasting sleep related breathing disturbances as a result of velopharyngoplasty be proven. Nevertheless, the call for pulse oximetric monitoring in the immediate postoperative phase together with corresponding pre-operative observation is legitimate. Even if at this point the danger of sleep related breathing disturbances following velopharyngoplasty appears to be minimal, these preliminary results should be polysomnographically studied within the framework of a much larger test study in order to reach still more reliable conclusions and in order to intercede if necessary with counter measures in the rare individual case of breathing disturbance during sleep following velopharyngoplasty.

Adolescent↗
PubMed1994

Morphology of the viscerocranium in obstructive sleep apnoea syndrome--cephalometric evaluation of 400 patients.

The aim of this study was the cephalometric evaluation of patients with obstructive sleep apnoea in order to see whether certain craniofacial characteristics exist. Additional to known skeletal facial parameters cephalometric analysis has been used to establish pharyngeal dimensions. Surprisingly, many patients with obstructive sleep apnoea (nearly 40%) showed certain craniofacial characteristics which apparently predispose to pharyngeal obstruction and to obstructive sleep apnoea. More than one third of 400 patients prove to have pharyngeal narrowing combined with more or less distinct maxillary and mandibular deficiency. Cephalometric evaluation helps to identify sleep apnoea patients, in whom maxillomandibular advancement surgery might be effective in the treatment of obstructive sleep apnoea. According to our results, an indication for surgical treatment by maxillomandibular advancement exists in patients with maxillary and especially mandibular deficiency combined with pharyngeal narrowing.

Adult↗
PubMed1994

Surgical treatment of obstructive sleep apnea by maxillomandibular advancement.

In recent years obstructive sleep apnea syndrome has gained increasing interest. Treatment of choice is nasal continuous positive airway pressure ventilation during sleep for upper airway patency, which does not cure sleep apnea and has to be applied throughout a patient's lifetime. In respect to various underlying pathomechanisms, in certain cases with craniofacial disorders, causal therapy by craniofacial osteotomies seems possible. A series of 21 consecutive patients with maxillary and mandibular deficiency were treated primarily with a 10-mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort-I osteotomy, respectively. Obstructive sleep apnea syndrome was considerably improved in all patients. In 20 of 21 patients, the postoperative respiratory disturbance index (RDI) was reduced clearly to under 10, oxygen saturation rose and sleep quality improved. This was achieved by a maxillomandibular advancement of 10 mm without secondary refinements. In one patient the RDI could only be reduced to 20, probably due to insufficient maxillary advancement; oxygen desaturations still existed despite secondary corrections. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space.

Adult↗
PubMed1993

[Influence of nCPAP therapy on bradycardic arrhythmias in sleep apnea].

In 5-10% of patients with sleep apnoea, AV conduction block or sinus arrest up to several seconds can be demonstrated. We studied the effect of nCPAP treatment on apnoea-associated heart blocks. 10 consecutive patients (9 m, 1 f) between 28-56 years of age (mean value 43.4 y) were studied. The diagnosis of sleep apnoea and nocturnal heart blocks during the first visit at the outpatient department were the only selection criteria. A standard polysomnography before and during nCPAP was performed. Mean pretreatment RDI was 91/h. Repetitive II degrees and III degrees AV conduction blocks were diagnosed in 2 patients (pts) and sinus arrest of 2 to 11 s in 8 pts at the study without therapy. 89.2% of heart blocks occurred during REM-sleep. In 8 pts a complete reversal of heart blocks could be demonstrated during nCPAP. In 2 pts heart blocks persisted at a reduced number during REM-sleep, mainly during ineffective nCPAP. In 80% of our pts nCPAP leads to a complete reversal of heart blocks. The indication for pacemaker implantation must be established on an individual basis.

Adult↗
PubMed1993

[Spectral analysis of long-term blood pressure measurements in patients with sleep-related respiratory disorders].

Spectral analysis of long-term recordings of blood pressure is a convenient method to recognise and reveal the amplitude and periodicity of changes in blood pressure during sleep. The increased variability of nocturnal blood pressure in patients with sleep apnoea is mainly determined by two types of oscillating variations in blood pressure: 1. Oscillations in a low frequency range of 0.0-0.06 Hz associated with breathing disorders and consecutive arousals. 2. Oscillations in a higher frequency range of 0.2-0.5 Hz associated with three different patterns of breathing. Normal undisturbed breathing, regular snoring and ineffective breathing efforts during obstruction of the upper airways. Furthermore, the interaction between breathing or breathing disorder and arterial blood pressure is determined by the influence of the sleep stages.

Adult↗
PubMed1993

[Non-invasive, continuous, portable blood pressure recording in the sleep laboratory].

The importance of cardiovascular consequences of sleep related breathing disorders implies the need for continuous recording of blood pressure in any cardiorespiratory polysomnography. Invasive techniques, which are the gold standard, are limited to special indications and studies. Non-invasive, continuous methods opened new possibilities for sleep laboratory investigations. The existing Finapres system proved to be a valuable method if parallel video recording was applied. The size of the system restricts its application to stationary settings only. Therefore the methodology was improved and integrated in a portable recorder. A prototype of this recorder, the Portapres, was validated against invasive pressure in 9 one-hour tests during the day and 12 polysomnographic recordings of 8 hours duration. The Portapres has now two finger cuffs and an automatic hydrostatic height compensation to overcome limitations of the Finapres. The technical implementation of the recorder needs more improvements. The correlation of mean blood pressure was 0.81 and mean pressure of the Portapres was 6.8 mmHg lower than invasive values.

Blood Pressure↗
PubMed1993

[Obstructive sleep apnea syndrome caused by craniofacial abnormalities].

Patients with obstructive sleep apnoea syndrome frequently present distinct changes in the craniofacial skeleton that result in a structural narrowing of the pharynx and promote pharyngeal collapse during sleep. The evaluation of the clinical data of patients with and without craniofacial dysmorphia reveals that mean age, mean Broca index and the number of additional diseases is decreased in patients with craniofacial dysmorphia. Young patients or patients with normal weight and OSAS usually present such skeletal changes. The number of sleep-related breathing disorders and the extent of nocturnal desaturation are also decreased in the group of patients with dysmorphia. The structure of sleep is similarly disturbed in both groups. In most cases patients with severe obstructive sleep apnoea have normal cephalometric data.

Adult↗
PubMed1993

[Functional anatomy of the upper airway: cephalometric and reflective acoustic studies].

Cephalometric analysis is an effective tool for the evaluation of craniofacial and pharyngeal changes in obstructive sleep apnoea. Meanwhile even for pharyngeal changes a lot of average values exist, which show significant differences for many cephalometric parameters. Approximately 40% of patients with obstructive sleep apnoea proved to have a retrognathic, dolichofacial appearance, which seems to contribute to obstructive apnoeas by retropositioning of the skeletal fixation for the muscles of the floor of the mouth and the tongue. Acoustic rhinometry for transnasal cross-sectional measurements of the upper airways is still under clinical trial. Whether it is a valuable supplement to cephalometric evaluation in the future will be mainly a question of software development.

Airway Resistance↗
PubMed1993

[Hemodynamics and sleep structure in attempted weaning after nCPAP ventilation therapy of obstructive sleep apnea syndrome].

nCPAP (continuous positive airway pressure) treatment is presently the standard therapy in marked obstructive sleep apnoea syndrome. Fundamentally, this is a long-term treatment. Various authors have been making different recommendations in respect of the frequency of application, based partly only on the patient's individual pattern of complaints and symptoms. Our study aimed at examining the short-term nocturnal effects of discontinuing the treatment course in 12 patients, using polysomnography as a diagnostic tool. Results showed that directly after discontinuation of therapy the sleep structure, respiration during sleep and the nocturnal blood pressure pattern returned to baseline findings. It is concluded from this that nCPAP treatment should be strictly adhered to every night to minimise the risk of cardiovascular complications in the patients concerned.

Adult↗
PubMed1993

[Indications and application of BiPaP therapy].

BiPAP allows the independent adjustment of in- and expiratory pressure. BiPAP may thus be used as a "physiologic" CPAP if high expiratory pressure values are not tolerated or as a pressure limited ventilator in pts. suffering from central sleep related breathing disorders (SRBD). 12 pts with SRBD were treated with nBiPAP: 7 did not tolerate the expiration against the elevated pressure, 4 pts suffering from MSA who still presented relevant CSA or central Hypoventilation during nCPAP and 1 pt. with CSA who did not respond to nCPAP. Mean age was 52.3 y (range 33-70) and mean broca index was 149.6 (range 115-254). RDI before therapy ranged between 33-152/h (mean value 79/h); in the five pts. who tolerated nCPAP, the reduction of the RDI obtained was considered insufficient (RDI during nCPAP: 16-71/h). During BiPAP mean RDI was 6.8/h (range 1-17) at pressure levels of 10/7 to 16/13 cm H2O (inspiratory/expiratory pressure) in those pts. that had not tolerated CPAP and 7.9/h (range 2-16.5) in the pts. suffering from central SRBD: in one pt. BiPAP could successfully replace a combined treatment with CPAP and IPPV. 11 pts. are using BiPAP for 10 to 25 months (mean value 13.5) now at home. If CPAP proves ineffective (central SRBD, high expiratory pressure) BiPAP constitutes an effective alternative therapy.

Adult↗