SEARCH · PubMed Health

Results for “Sleep Apnea, Obstructive”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources

PubMed2001

Cardiovascular variability characteristics in obstructive sleep apnea.

Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Altered cardiovascular variability is a prognostic indicator for cardiovascular events. This review examines the evidence that OSA is accompanied by alterations in cardiovascular variability. This alteration is evident even in the absence of hypertension, heart failure or other disease states, and may be linked to the severity of OSA. The presence of clear-cut abnormalities in time and frequency-domain measures of blood-pressure and heart-rate variability in normotensive OSA patients provides intriguing evidence for the concept of an etiologic interaction between sleep apnea and cardiovascular disease. Mechanisms that could contribute to altered cardiovascular variability in patients with sleep apnea include abnormalities in chemoreflex, baroreflex and endothelial function.

Blood Pressure↗

PubMed1997

Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients.

Obstructive sleep apnea (OSA), is a common clinical condition affecting at least 2-4% of the adult population. Hypertension is found in about half of all OSA patients, and about one-third of all patients with essential hypertension have OSA. There is growing evidence that successful treatment of OSA can reduce systemic blood pressure (BP). Body position appears to have an important influence on the incidence and severity of these sleep-related breathing disturbances. We have investigated the effect of avoiding the supine position during sleep for a 1 month period on systemic BP in 13 OSA patients (six hypertensives and seven normotensives) who by polysomnography (PSG) were found to have their sleep-related breathing disturbances mainly in the supine position. BP monitoring was performed by 24-h ambulatory BP measurements before and after a 1 month intervention period. We used a simple, inexpensive method for avoiding the supine posture during sleep, namely the tennis ball technique. Of the 13 patients, all had a reduction in 24-h mean BP (MBP). The mean 24-h systolic/diastolic (SBP/DBP) fell by 6.4/2.9 mm Hg, the mean awake SBP/DBP fell by 6.6/3.3 mm Hg and the mean sleeping SBP/DBP fell by 6.5/2.7 mm Hg, respectively. All these reductions were significant (at least P < 0.05) except for the sleeping DBP. The magnitude of the fall in SBP was significantly greater in the hypertensive than in the normotensive group for the 24 h period and for the awake hours. In addition, a significant reduction in BP variability and load were found. Since the majority of OSA patients have supine-related breathing abnormalities, and since about a third of all hypertensive patients have OSA, avoiding the supine position during sleep, if confirmed by future studies, could become a new non-pharmacological form of treatment for many hypertensive patients.

Adult↗

PubMed1999

Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea syndrome patients.

Obstructive sleep apnea syndrome (OSAS) patients may have symptoms for years prior to recognition of their disorder, or they may be treated for the associated comorbidities. We hypothesized that such patients would be heavy consumers of health care resources for several years prior to diagnosis. We therefore compared health service utilization for a 10-year interval prior to diagnosis of 181 OSA patients to those of randomly selected age-, gender-, and geographically matched controls from the general population. OSAS patients used approximately twice as many health care services (as defined by physician claims and overnight stays in hospital) in the 10 years prior to their initial diagnostic evaluation for apnea. Physician claims for the OSA patients totaled $686,365 ($3972 per patient), compared to $356,376 ($1969 per patient) for the controls for the 10-year period examined in this study. Use of health services was significantly higher in 7 of 10 years prior to diagnosis. The OSAS patients also had more overnight hospitalizations: they spent 1118 nights (6.2 per patient) in hospital vs 676 nights (3.7 per patient) for controls in the decade prior to diagnosis. We conclude that by the time patients are finally diagnosed for sleep apnea, they have already been heavy users of health services for several years. It is possible that our findings reflect not OSAS per se, but the presence of some of the risk factors that predispose to OSAS, such as obesity, alcohol usage and perhaps tobacco consumption.

Canada↗

PubMed1998

Pathophysiologically correlated deficits of information processing in obstructive sleep apnea patients.

In obstructive sleep apnea patients, who intermittently stop breathing at night for some seconds, functions of vigilance and attention seem to be impaired. The aim of our study was to investigate if nocturnal hypoxia as one possible detrimental factor is associated with the degree of modality shift effect expressing attention function at a very basic level of information processing. For the first time an experimental approach was applied to examine attention deficits in sleep apnea patients. Correlation analyses between pathophysiological parameters and attention function revealed a stronger association for the modality shift effect than for simple reaction times.

Cognition Disorders↗

PubMed1995

Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea.

Snoring and obstructive sleep apnea (OSA) are related to narrowing of the upper airway. A mandibular advancement splint (MAS) could improve both conditions by increasing oropharyngeal and hypopharyngeal dimensions. The effects of a MAS on snoring and OSA was evaluated 3.5 +/- 2.1 (mean +/- SD) mo after issue in 57 subjects with habitual loud snoring, 39 of whom had an apnea-hypopnea index (AHI) > or = 10. Assessment was by questionnaire (all subjects) and polysomnography (51 subjects, 47 male) including measurement of sound intensity. Use of the MAS was randomized to first or second half of study. Snores were scored where inspiratory noise was greater than 5 dB above background. Total sleep time, sleep efficiency, % REM sleep, and % sleep spent supine were similar (p > 0.05) with and without the MAS. Snores per sleep minute, corrected for time in apnea, and sound intensity of snores (% snores > or = 50 dB) decreased with the MAS from 11.0 +/- 5.8 and 42.0 +/- 25.0% to 9.0 +/- 6.0 (p < 0.01) and 26.2 +/- 25.2% (p < 0.01), respectively. Using the MAS significantly improved OSA: AHI decreased from 32.2 +/- 28.5 to 17.5 +/- 22.7 (p < 0.01) and arousal index decreased from 31.4 +/- 20.6 to 19.0 +/- 14.6 (p < 0.01). AHI decreased to < 20 with the MAS in 12 of 17 subjects where untreated AHI was between 20 and 60, and in 2 of 9 subjects where untreated AHI was > 60. Forty-five patients continued to use the MAS regularly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Why don't all heavy snorers have obstructive sleep apnea?

Patients with obstructive sleep apnea (OSA) and heavy snorers without apnea both show intrathoracic suction pressures during sleep that exceed their static upper airway closing pressures. Complete airway occlusion, however, occurs only in the former patient group. We hypothesized that the kinetic properties of the airflow would be different in these two types of patients because of differences in upper airway morphology. The pharyngeal computed tomography (CT) was used to measure the cross-sectional areas of the upper airways in 15 patients with OSA, 25 nonapneic heavy snorers, and 14 control subjects while they were awake. Nocturnal breathing was monitored with the static charge-sensitive bed (SCSB). The patients with OSA had a narrower airspace at the velopharyngeal (VP) level than the controls (p less than 0.01); the nonapneic snorers did not differ from the other groups. At the tongue base (TB) and the hyoid bone (HB) levels there was no difference between the OSA and the control groups, but the nonapneic snorers had narrower airways at both of these levels compared with control subjects (p less than 0.01) and at the hyoid bone level compared with the OSA group (p less than 0.05). The VP/HB ratio was the parameter that best distinguished the patients with OSA from the nonapneic snorers (lower in the OSA group, p less than 0.001). We suggest that airway collapse during sleep is favored by a narrow velopharynx associated with large hypopharynx. Some heavy snorers may not have an oropharyngeal collapse because the peak inspiratory suction pressure could already be damped down at the level of the relatively narrow hypopharyngeal airways.

Airway Resistance↗

PubMed1999

Relationship of arousals from sleep to sympathetic nervous system activity and BP in obstructive sleep apnea.

STUDY OBJECTIVE: Obstructive sleep apnea (OSA) patients have a high frequency of arousals. We hypothesized that arousals significantly influence tonic sympathetic nervous system function. DESIGN: We examined the association of 11 variables measuring sympathetic activity, including plasma norepinephrine (NE), urinary NE, and BP measurements, with movement and cortical arousals. PATIENTS: Sixty-seven subjects with various degrees of hypertension and OSA were evaluated. All patients were free from antihypertensive medications. RESULTS: The age (range, 35 to 60 years), weight (range, 100 to 150% of ideal body weight), and diet of the subjects were similar. The movement arousal index was correlated with daytime baseline plasma NE (BNE), daytime urine NE, mean daytime diastolic BP, and systolic BP during rapid eye movement sleep (r = 0.39 to 0.53; p < or = 0.002). Cortical arousals did not correlate with any of the variables. A multiple regression procedure was performed to examine how well movement arousals predicted those variables with significant correlations. The respiratory disturbance index (RDI) and nighttime pulse oxyhemoglobin saturation were included in the regression equation due to their close association with movement arousals. Movement arousals independently predicted BNE (t [48] = 2.06; p < 0.05). No other variable independently predicted any of the measurements of sympathetic activity. CONCLUSIONS: These findings suggest that movement arousals may influence daytime sympathetic tone independently of RDI and nighttime saturation.

Adult↗

PubMed1998

Compensatory excretion of prostacyclin and thromboxane metabolites in obstructive sleep apnea syndrome.

Since obstructive sleep apnea syndrome (OSAS) is often linked with systemic hypertension, we sought to clarify the characteristics of prostanoid metabolism in OSAS. In 7 OSAS patients (apnea-hypopnea index, 51.0 +/- 23.4) and 7 non-snorers as control, nocturnal urine was sampled and analyzed for stable metabolites of prostacyclin (PGI2) and thromboxane A2 (TxA2), [6-keto-PGF1alpha and thromboxane B2 (TxB2)]. The ratio of 6-keto-PGF1alpha to TxB2 was significantly higher in OSAS (2.97 +/- 1.52) than in control (1.38 +/- 0.38). Successful treatment with nasal continuous positive airway pressure (8.3 +/- 1.5 cmH2O) for 3 days caused a significant decrease in mean blood pressure in OSAS. Moreover, the 6-keto-PGF1alpha to TxB2 ratio also significantly decreased to 1.74 +/- 0.58, a level which may not significantly different from control. These results suggest that the production ratio of PGI2 to TxA2 is shifted toward vasodilatation in untreated OSAS. We conclude that the production of prostanoids plays a role in compensating for the systemic hypertension in OSAS.

6-Ketoprostaglandin F1 alpha↗

PubMed1989

Neuropsychiatric manifestations of obstructive sleep apnea: a review.

Obstructive sleep apnea (OSA) may result in neuropsychiatric complications. Psychiatrists need to be alert to the possibility that patients who present to them with cognitive and/or affective disorders, who also have sleep related complaints such as snoring and significant daytime hypersomnolence, may have OSA. Clinical suspicion needs to be reinforced by obtaining a history from the bed partner. A polysomnogram will establish the diagnosis. Once the diagnosis is made, several treatment options are available. Treatment of sleep apnea usually leads to a resolution, or at least improved control, of the complicating neuropsychiatric disorder. Physicians must be aware that sedating neuroleptic or antipsychotic agents may worsen sleep apnea and, thereby, aggravate the neuropsychiatric disturbance.

Humans↗

PubMedDate not supplied

Cervical headgear therapy as a factor in obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) has been a subject of increasing interest from the orthodontic point of view, but less attention has been paid to the possible influence of orthodontic treatment on its occurrence. The aim here was to study possible associations between the use of cervical headgear and nocturnal cessations of airflow and the severity of the latter. METHODS: The subjects were 30 children (12 boys, 18 girls, mean age 8.2, sd 1.61 years), divided into three groups: a group of 10 children undergoing headgear therapy, selected for this examination because of symptoms of OSAS while using headgear, an age-matched control group of 10 healthy children and a group of 10 with OSAS. Standard cephalograms of the headgear group prior to the orthodontic therapy and the corresponding cephalograms of healthy controls were analysed. A polygraphic (PG) sleep evaluation was used to assess the tendency for OSAS. Apnea and hypopnea periods were summated as apnea index (AI) and number of desaturations as desaturation index (ODI). All the subjects spent one night sleeping under laboratory conditions, those with orthodontic treatment spending the first half of the night with the headgear and the latter half without. RESULTS: The position of the mandible was found to be slightly more posterior in the headgear group than in the control group. The children in the headgear group were found to have significantly more apnea/hypopnea periods during the hours when the appliance was used, and the ODI-index showed increased values in this group. CONCLUSIONS: We suggest that headgear therapy may contribute to the occurrence of sleep apnea, when a strong predisposition, such as mandibular retrognathia to the development of upper airway occlusion already exists.

Cephalometry↗

PubMed1991

[ST segmental changes and arrhythmias in obstructive sleep apnea].

Patients with obstructive sleep apnea show a fall in arterial oxygen saturation during apneas. Whether this is causing myocardial ischemia and consecutively ST segment depressions in the electrocardiogram is not known. Therefore 15 consecutive patients (53 +/- 8 years, apnea index 45 +/- 28, minimal oxygen saturation 71 +/- 14%) with OSA were studied by Holter electrocardiogram and polysomnography. History and exercise testing gave no evidence of coronary heart disease. Three patients had ventricular arrhythmias Lown IVA and 10 had Lown I or III. Three patients showed unspecific negative T waves or ST segment elevations. In no patient significant ST segment depression was found. It is concluded that OSA does not lead to ischemic ST segment depression in the absence of coronary heart disease. The cause of ventricular arrhythmias in OSA seems not be related to myocardial ischemia.

Adult↗

PubMedDate not supplied

[Hypercapnic stimulation and ventilation response in the syndrome of sleep obstructive apnea. Comparison of reinhalation and steady state].

The objective of this study was to assess ventilatory response to stimulation with CO2 in patients suffering obstructive sleep apnea syndrome (OSAS) but without chronic obstructive pulmonary disease (COPD), by examining differences between hyper- and normocapnic patients and comparing the results obtained with the usual techniques used to stimulate hypercapnia (rebreathing and stable-state). To this end, we studied 15 obese patients, all with an apnea-hypopnea index greater than 10 from a polysomnograph lasting a full night. The following lung function tests were performed: spirometry, air way resistance measures and static lung volumes by plethysmograph and arterial gasometry. We later analyzed ventilatory response by the stable-state method, with increasing CO2 concentrations (from 1 to 9%) and by the rebreathing method. Results from the two methods were similar for all patients: delta VE/delta PCO2 (0.64 +/- 0.35 vs 0.67 +/- 0.48 l/min/mmHg; p = 0.59), delta Vt/delta PCO2 (28.33 +/- 16.23 vs 26.42 +/- 16.94 ml/mmHg; p = 0.9), delta Vt/Ti/delta PCO2 (28.82 +/- 20.9 vs 29.41 +/- 23.78 ml/s/mmHg; p = 0.89) y delta P0.1/delta PCO2 (0.11 +/- 0.07 vs 0.117 +/- 0.05 cmH2O/mmHg; p = 0.58). We compared the results obtained by the two techniques by dividing the sample into two groups of 7 and 8 patients, respectively, depending on whether PaCO2 level before stimulation was higher or lower than 45 mmHg. The hypercapnic patients (group I) were older (61 +/- 3.5 vs 50 +/- 9 years; p = 0.04) but were not different with respect to body mass from the normocapnic patients (group II) (37.59 +/- 6.4 vs 34.56 +/- 4.75 kg/m2; p = 0.33). The results from the two techniques for stimulating hypercapnia were similar within each group, with a statistically significant decrease (p < 0.03) in patients with daytime hypercapnia in delta VE/delta PCO2 delta Vt/delta PCO2, delta Vt/Ti/delta PCO2 and delta P0.1/delta PCO2. We conclude that there are no differences in the results obtained with the rebreathing and stable state techniques. Likewise, ventilatory response to stimulation with CO2 in individuals with OSAS and daytime hypoventilation is less than of normocapnic patients.

Carbon Dioxide↗

PubMed2000

Obstructive sleep apnea in infants: relation to family history of sudden infant death syndrome, apparent life-threatening events, and obstructive sleep apnea.

OBJECTIVES: Familial aggregation of obstructive sleep apnea (OSA) has been shown to be associated with sudden infant death syndrome (SIDS) and apparent life-threatening events (ALTE) in infants. We wanted to determine the incidence of OSA in infants with siblings with ALTE and SIDS referred to our sleep clinic and to ascertain whether OSA was more common in infants who have family histories of SIDS, ALTE, and OSA. STUDY DESIGN: We studied 125 infants (mean age, 11.5 +/- 0.6 weeks) who were separated into 2 groups on the basis of their family history; polysomnographic studies were performed on each infant. RESULTS: Twenty infants had a multiple family history of SIDS, ALTE, or OSA (group 1), whereas the other 105 infants (group 2) had only one case of SIDS or ALTE within the family and no known history of OSA. We found that 19 of 20 infants in group 1 had OSA, whereas only 31 of 105 infants in group 2 had OSA (chi-squared analysis, P <.05). The OSA recorded was more frequent in infants of group 1 than in those of group 2. Follow-up studies in some infants with OSA demonstrated a progressive decrease in OSA, which resolved between 6 and 12 months of age. CONCLUSION: We conclude that infants of families with multiple histories of SIDS, ALTE, and OSA are more likely to have OSA than infants of families with only one case of SIDS or ALTE.

Age Factors↗

PubMed1992

From apnea of infancy to obstructive sleep apnea syndrome in the young child.

Obstructive sleep apnea syndrome (OSAS) and heavy snoring during sleep, without sleep apnea, has been well described in children and adults. We report a case series of 25 full-term infants, prospectively obtained from a database of nearly 700 "apparent life-threatening event" (ALTE) cases, who presented between 3 weeks and 4 1/2 months of age an ALTE and who progressively developed more florid symptomatology and polygraphic findings. All of them were classified as OSAS patients by five years of age. These index cases are compared with two other ALTE infant groups followed in parallel during the first year of life but whose symptoms were short-lived. The index cases presented more frequently a positive family history of OSAS and an early report of snoring or noisy breathing during sleep. Usage of an esophageal balloon to monitor esophageal pressure (Pes) and usage of nasal continuous positive airway pressure (CPAP) as a test may help in the early recognition of these infants, who appear to make more effort to breathe during sleep, based on the indirect evidence of Pes measurements. It is suggested that anatomic features, including a small posterior airway space leading to an abnormal degree of upper airway resistance, may be the cause of the symptoms presented by these infants. Considering the parental anxiety generated by persistence of symptoms after the first year of life in ALTE infants, recognition of this subgroup is important.

Apnea↗

PubMed2001

Breath-to-breath variability correlates with apnea-hypopnea index in obstructive sleep apnea.

BACKGROUND: Breathing in patients with obstructive sleep apnea (OSA) is frequently interrupted by periods of hypopnea and apnea. There is limited information regarding a possible disturbance of breathing outside these periods. STUDY OBJECTIVE: To analyze the degree of breathing disturbance during nonocclusion. DESIGN: Prospective determination of breathing variability during full polysomnographic sleep studies. PATIENTS: Breath-to-breath variation was monitored in 34 patients with OSA and in 9 healthy subjects. MEASUREMENTS AND RESULTS: All breath-to-breath intervals were automatically analyzed from flow signal, displayed, and manually corrected for artifacts. Distribution of all nonapneic breath intervals was analyzed for the extent of difference from a normal distribution pattern by specifying kurtosis. In untreated OSA patients, kurtosis was significantly reduced (0.0 +/- 0.5, mean +/- SD) compared to control subjects (0.8 +/- 0.5), indicating increased variability of nonoccluded breathing. This effect was present in all sleep stages, and the extent depended significantly on the degree of disease. Continuous positive airway pressure breathing was able to normalize kurtosis (1.0 +/- 0.9) immediately. CONCLUSIONS: Breathing in OSA is not only characterized by interruptions of breathing during occlusion, but by a greater variation in the pattern of normal-length breaths.

Adult↗

PubMedDate not supplied

There is no relationship between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome: a population study.

BACKGROUND: Both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) are common diseases. Some recent studies suggest an increased prevalence of COPD among subjects with OSAS. OBJECTIVES: The study objective was to evaluate whether there is an epidemiological relationship between COPD and OSAS in a random population sample. MATERIALS AND METHODS: The study population, 356 males (53%) and 320 females, mean age 56.6+/-8.2 years (range 41-72), was selected from a voting list for parliamentary election in Warsaw. The investigation included lung diseases and smoking history with polysomnography and spirometry. RESULTS: OSAS was diagnosed in 76 subjects (11.3%), 59 males (8.8%) and 17 females (2.5%), mean apnea/hypopnea index (AHI) was 25.3+/-16.1, mean overnight SaO2 92.1+/-3.3%, minimum SaO2 76.9+/-9.4%, and SaO2<90%=18.9+/-23.9% of total sleep time. COPD was diagnosed in 72 subjects (10.7%), 39 males and 33 females. Severity of airflow limitation was assessed according to European Respiratory Society (ERS) guidelines: mild in 70%, moderate in 22%, and severe in 8%. In 7 subjects (9.2% of OSAS population, 1% of total population) OSAS and COPD overlapped. Polysomnographic variables were compared between overlap (overlap syndrome, OS) and OSAS subjects. In the OS mean AHI was 19.0 versus 25.3 in OSAS (nonsignificant), mean SaO2 89.6 versus 92.3% in OSAS (p<0.005), and time spent in SaO2<90% was 25.4 versus 18.2% in OSAS (p=0.04). CONCLUSIONS: COPD in subjects with OSAS was as frequent as in the general population. In the OS group mean arterial blood saturation was lower and time spent in desaturation was longer than in OSAS. The presented data suggest a more severe course of sleep-disordered breathing in subjects with coexisting COPD.

Adult↗

PubMed1996

Obstructive sleep apnea presenting during infantry field exercises: does the Army Weight Control Program protect soldiers from obstructive sleep apnea?

We report two cases of obstructive sleep apnea (OSA) that presented during infantry field exercises as snoring so loud as to risk betraying the unit's position. Both patients exceeded the height-weight standards of the Army Weight Control Program (AWCP). Since high body mass is a strong risk factor for OSA, we asked whether the AWCP reduces the risk of OSA. We found that it should for women in all age groups and for men over 40, but it is less protective for younger men (who constitute a large portion of Army personnel). In light of this and of previous estimates that up to 1.5% of all Army personnel exceed the AWCP standards, we conclude that there may be a significant number of unrecognized cases of OSA in the Army. Additionally, tightening of the AWCP standards may be warranted for women under 30 and men under 50, who currently are permitted to significantly exceed ideal body weight.

Exercise↗

PubMed1988

Diaphragmatic and genioglossus electromyographic activity at the onset and at the end of obstructive apnea in children with obstructive sleep apnea syndrome.

We studied the activity of the diaphragm and of the genioglossus at the onset and at the end of obstructive sleep apnea in children. Seven children (mean age 46 months, range 15-87) with obstructive sleep apneas mainly due to enlarged tonsils were tested during natural sleep. We recorded sleep stages (neurophysiological criteria), nasal and buccal air flow (thermistors), thoracoabdominal motion (magnetometers), genioglossus and diaphragm electromyographic activity (EMG) (surface electrodes), and transcutaneous partial pressure of oxygen (Radiometer 44 degrees C). A total of 153 obstructive apneas for the whole group of patients was studied. Compared to the preceding unoccluded breaths, genioglossus and diaphragm EMG data showed that 1) at the onset of obstructive apnea there was no significant decrease in genioglossus and/or diaphragm EMG, contrasting with published data for obese adults, and 2) at the end of obstructive apnea, significant preferential increase in genioglossus EMG, not related to the decrease in transcutaneous partial pressure of oxygen, was found as in obese adults. This study showed that different mechanisms may control the onset of obstructive apnea in children as compared to adults, whereas children and obese adults share the same preferential increase in genioglossus EMG at the end of obstructive apnea.

Child↗