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 505 records · Page 28Linked to original sources

PubMed1994

Obstructive sleep apnea attack in complex craniosynostosis.

For treatment of patients with complex craniosynostosis, increased intracranial pressure, severe exophthalmos, and apnea attacks are important indications for operative intervention. Little has been reported on obstructive sleep apnea in complex craniosynostosis. Obstructive sleep apnea attacks in complex craniosynostosis are evaluated in relation to the upper and middle pharyngeal space and to the dimensions of the maxilla and mandible measured on cephalograms. The value of the pharyngeal air space in craniosynostosis had no relationship with either the frequency of sleep apnea attack or with severity of snoring. The dimensions had a close relationship with obstructive sleep apnea attack.

Adolescent↗

PubMed1994

Epidemiology of obstructive sleep apnea.

Sleep-disturbed breathing, which includes apneas, hypopneas, and oxygen desaturations, occurs in asymptomatic individuals and increases with age. Obstructive apnea is the most frequent type of respiratory disturbance documented by polysomonography, the gold standard test for assessing sleep-disturbed breathing. Many of the prevalence studies done to date have had one or more methodological weaknesses, including selection biases, varying definitions of obstructive sleep apnea, failure to distinguish types of apneas, failure to control for confounding variables, and small sample size. Although there is consensus on the definitions of sleep-disturbed breathing, the appropriate number of apneas and hypopneas for diagnosing clinically significant obstructive sleep apnea is uncertain. While the cutoff of five or more apneas and hypopneas per hour is historically considered abnormal, the origins of this number are vague, and the longevity of those who have this value on polysomnography is not necessarily reduced. This is particularly true among those without symptoms of obstructive sleep apnea syndrome, which include excessive daytime sleepiness, snoring, nocturnal awakenings, and morning headaches. Investigators should be careful to distinguish symptomatic study subjects from asymptomatic subjects, and to exclude central apneas in calculating their estimates. In addition, various studies have used different definitions of sleep apnea syndrome, making comparisons of point estimates difficult. It would be more appropriate for researchers to estimate morbidity and mortality indices with confidence intervals, using several different cutoff points. Subject selection in all studies should follow a two-stage sampling procedure. All subjects with symptoms compatible with obstructive sleep apnea syndrome and a subsample of asymptomatic individuals should be studied with all-night polysomnography. If portable monitoring is used, the validity and reproducibility of this diagnostic method should be assessed. Subjects with significant comorbidity should be excluded from prevalence studies. Factors that clearly increase the risk of sleep-disturbed breathing and obstructive sleep apnea and its related symptoms include age, structural abnormalities of the upper airway, sedatives and alcohol, and probably family history. Although endocrine changes such as growth hormone, thyroid hormone, and progesterone deficiency also have been suggested as risk factors for exacerbating obstructive sleep apnea syndrome, there is minimal epidemiologic evidence to support this. Case-control studies are recommended to assess the relation of endocrine factors to obstructive sleep apnea syndrome in a rigorous fashion. A limited number of mortality studies have suggested decreased survival in persons with the obstructive sleep apnea syndrome, possibly primarily due to vascular-related disease.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2002

Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea.

BACKGROUND: Reduction of nocturnal obstructive events during lateral position in patients with obstructive sleep apnea was previously reported. However, little information is available regarding mechanisms of the improvement and the precise pharyngeal site influenced by the lateral position. The authors tested the hypothesis that structural properties of the passive pharynx change by changing the body position from supine to lateral. METHOD: Total muscle paralysis was induced with general anesthesia in eight patients with obstructive sleep apnea, eliminating neuromuscular factors contributing to pharyngeal patency. The cross-sectional area of the pharynx was measured endoscopically at different static airway pressures. Comparison of static pressure-area plot between the positions allowed assessment of the influence of the position change on the mechanical properties of the pharynx. RESULTS: The static pressure-area curves of the lateral position were above those of the supine position, with increasing maximum cross-sectional area and decreasing the closing pressure at both retropalatal and retroglossal airways. CONCLUSIONS: Lateral position structurally improves maintenance of the passive pharyngeal airway in patients with obstructive sleep apnea.

Adult↗

PubMed2003

The role of oral appliances in treating obstructive sleep apnea.

BACKGROUND: Sleep-related breathing disorders are common and often are associated with vascular complications such as arterial hypertension, coronary heart disease and stroke. The most widely studied form of these disorders is obstructive sleep apnea. Patients usually are diagnosed with obstructive sleep apnea years after the onset of symptoms, which generally are nonspecific and include excessive daytime sleepiness, chronic fatigue and habitual snoring. The risk factors for sleep apnea are obesity, advancing age, male sex and maxillofacial abnormalities. This review focuses on the diagnosis and treatment of obstructive sleep apnea and, specifically, on the utility of oral appliances in the management of this disorder. METHODS: The review is based on a MEDLINE search for articles in English on this topic. The article discusses results of randomized studies and prospective case series. CLINICAL IMPLICATIONS: Several treatment options are quite effective. Nasal continuous positive airway pressure, with an overall acceptance rate of 70 percent, is the most widely used treatment modality. Maxillofacial surgery, although effective, is reserved for patients who have not responded to the more conventional therapies. Newer methods include application of oral appliances. Oral appliances have been shown to alleviate the severity of respiratory disturbances during sleep by about 60 percent, with an overall acceptance rate of 75 percent. The long-term complications generally are minor and are related to occlusal changes and temporomandibular joint discomfort. CONCLUSIONS: With the advent of oral appliances, dentists are increasingly involved in managing the care of patients with sleep-related breathing disorders. Further studies are needed to determine the long-term complications of this type of intervention for the treatment of sleep-related breathing disorders.

Adult↗

PubMed2006

[Case of obstructive sleep apnea syndrome exacerbated due to cervical spinal cord injury].

A 70-year-old man injured his spinal cord at the fourth cervical vertebra due to a fall and became quadriplegic. Following emergency treatment, the patient was admitted to our hospital for rehabilitation. On admission, respiratory function tests indicated a percent vital capacity value (%VC) of 58.6%, revealing restrictive ventilatory impairment. After admission, we observed difficulty breathing at night and extreme snoring and thus performed a simple full-night polysomnography. Results showed an apnea-hypopnea index (AHI) of 46.5/hr and serious obstructive sleep apnea syndrome (OSAS). Based on these results, we conjectured that a preexisting OSAS condition was exacerbated by the cervical spinal cord injury, and thus administered nasal continuous positive airway pressure (NCPAP) in addition to respiratory rehabilitation. A speedy disappearance of clinical symptoms was found with the application of NCPAP. Compared to a 3% oxygen desaturation index (ODI 3%) of 31.0 dips/hr prior to treatment, the ODI 3% dropped to 3.5 dips/hr after 14 days, and 0 dips/hr after 60 days, indicating an obvious improvement in nocturnal oxygen desaturation.

Aged↗

PubMed2026

Effects of CPAP on endothelial activation and fibrinolytic balance in coronary artery disease with obstructive sleep apnea: The RICCADSA randomized controlled trial.

BACKGROUND: Obstructive sleep apnea (OSA) promotes endothelial activation and a prothrombotic milieu through intermittent hypoxia, oxidative stress, and systemic inflammation, mechanisms closely linked to atherosclerosis progression. The vascular effects of continuous positive airway pressure (CPAP) therapy in patients with established coronary artery disease (CAD) remain incompletely understood. OBJECTIVE: To evaluate the longitudinal effects of CPAP treatment on endothelial adhesion molecules and fibrinolytic balance in patients with CAD and OSA. METHODS: In this randomized controlled analysis from the RICCADSA trial, 210 revascularized CAD patients with moderate-to-severe OSA were assigned to CPAP (n = 104) or no-CPAP (n = 106) and had available biomarker measurements at baseline and 12 months. Circulating intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and plasminogen activator inhibitor-1 (PAI-1) were assessed. Linear mixed-effects models were used to examine longitudinal changes and time-by-treatment interactions adjusted for cardiometabolic covariates. RESULTS: For ICAM-1, no significant time-by-treatment interaction was observed. For PAI-1, a borderline time-by-treatment interaction suggested a numerically smaller increase in the CPAP group compared with no-CPAP (p = 0.09). CPAP treatment was associated with a significantly greater reduction in VCAM-1 over time compared with no-CPAP (time-by-treatment interaction p = 0.045 in adjusted models). CONCLUSIONS: CPAP treatment was associated with selective modulation of vascular biomarkers in patients with CAD and OSA, characterized by attenuation of endothelial activation reflected by reduced VCAM-1 levels, while fibrinolytic imbalance appeared largely resistant to intervention. These findings support pathway-specific vascular responses to CPAP and provide mechanistic insight into residual atherosclerotic risk in this high-risk population.

Aged↗

PubMed2004

[Obstructive sleep apnea syndrome as a risk factor of glaucomatous neuropathy].

The consequences of sleep apneas in patients with obstructive sleep apnea (OSA) syndrome may influence the function of visual system. In 21 patients with OSA syndrome (apnea/hypopnea index--AHI 50+/-20) the detailed ophthalmologic studies, including tonometry, biomicroscopic evaluation of the anterior segment of the eye, automatic perimetry and stereoscopic examination of the eye fundus have been performed. In 4 patients (19%) the signs of lesions in the optic tract have been found. These were: defects in visual field caused by glaucoma (primary open-angle glaucoma and normal-tension glaucoma) in 2 patients and defects in visual field (concentric and quadrantic homonymous) caused by diffuse lesions in the cortico-nuclear tract in 2 patients. In patients with the lesions in the optic tract there were severe disorders of breathing during sleep: AHI >60, mean SaO2 at the end of the apneas <86% and minimal SaO2 at the end of the apneas <70%. The authors conclude that in OSA patients there is a high risk of the lesions of the optic tract as a consequence of severe and repetitive hypoxemia during sleep.

Adult↗

PubMed1998

Pharyngeal airway obstruction in obstructive sleep apnea: pathophysiology and clinical implications.

In obstructive sleep apnea, airflow obstruction is caused by pharyngeal collapse. Current evidence suggests that anatomic alterations predispose to pharyngeal collapse. This article examines the role of structures that elongate and dilate the pharynx in maintaining pharyngeal patency. Their influence on pharyngeal collapsibility is considered. Insights gained are then presented within a conceptual framework that can be used for treating patients.

Airway Obstruction↗

PubMed2006

Obstructive sleep apnea and insulin resistance: a role for microcirculation?

Obstructive sleep apnea is an increasingly recognized medical problem. The recent attention to its frequency in the general population and its important role in metabolic, vascular, and behavioral aspects have sharply increased the number and nature of investigations, thereby revealing new aspects that open new approaches in research. Whereas obstructive sleep apnea is a well-known phenomenon accompanying obesity and diabetes, new findings strongly suggest that this close relationship may also operate in the opposite direction. Indeed obstructive sleep apnea may be a primary feature inducing or aggravating a series of vascular and metabolic disturbances closely resembling the metabolic syndrome. This review will discuss established and potential mechanisms responsible for these changes. Obstructive sleep apnea indeed appears to gather all the elements necessary to induce insulin resistance, hypertension, and possibly heart failure. After careful analysis of these modifications and considering how they are intertwined, we propose that microcirculation could represent the common denominator mediating the progression of this pathology, as it is eventually the case in the metabolic syndrome and diabetes domain. This plausible hypothesis is discussed in detail and should be verified by appropriate preclinical and clinical protocols, which are now achievable by using noninvasive techniques in humans.

Cardiovascular Diseases↗

PubMed2001

[Obstructive sleep apnea syndrome. Which therapy for which patients].

Obstructive sleep apnea syndrome is defined by the American Academy of Sleep Medicine as a combination of at least five obstructive events per hour of sleep and such other symptoms as daytime sleepiness, ischemic heart disease and stroke. In addition to weight reduction, the use of oral appliances, and continuous positive airway pressure (CPAP), a number of surgical interventions such as uvulopalatopharyngoplasty and maxillomandibular advancement are also available for the treatment of sleep apnea. Since no prolongation of life has yet been shown for most of the therapeutic options, treatment needs to be individualized on the basis of symptoms, clinical findings and compliance.

Humans↗

PubMed1988

Reversible proteinuria in obstructive sleep apnea syndrome.

Two patients with severe obstructive sleep apnea syndrome and high-grade proteinuria (greater than 1 g/d [1000 mg/d]) were studied. Three remissions in proteinuria coincided with correction of obstructive sleep apnea syndrome and improvement of blood oxygen levels. These remissions could be dissociated from reductions both in dry body weight and in hematocrit levels. We propose that sleep apnea may cause a functional and reversible type of proteinuria.

Adult↗

PubMed1994

Regional metabolic dependency in obstructive sleep apnea.

Abnormalities of oxygen use occur in obstructive sleep apnea, as do impaired cerebral perfusion and alterations of cerebral function. In this case study, the authors quantitated the local cerebral glucose metabolic rate in two patients with obstructive sleep apnea (one with and one without oxygen supply dependency) and assessed cerebral glucose use by increasing oxygen delivery through passive leg elevation. Obstructive sleep apnea was confirmed by visual analysis of nocturnal pulse oximetry traces in two patients and its severity assessed from the respiratory disturbance index and minimum oxygen saturation. Awake local cerebral glucose metabolic rate (microM/min/100 g) was determined by positron-emission tomography using [18F]-2-Fluoro-2-Deoxy-D-Glucose at baseline and on the following day during passive leg elevation. Conditions otherwise were unchanged. The patient with global oxygen supply dependency exhibited a significant increase in the local cerebral glucose metabolic rate. In contrast, the patient without global supply dependency had no change in the local cerebral glucose metabolic rate. These case studies demonstrate the first evidence of improvement in regional metabolic consumption in response to increased oxygen delivery and in the presence of global oxygen supply dependency.

Adult↗

PubMed2005

Aortic elastic properties and left ventricular diastolic dysfunction in patients with obstructive sleep apnea.

Although the responsible mechanisms are not yet fully known, obstructive sleep apnea is associated with an increased risk for cardiovascular disease and events. The aorta is not only a conduit delivering blood to the tissues but is also an important modulator of the entire cardiovascular system, its elastic properties also affecting left ventricular function and coronary blood flow. The aim of this study was to determine left ventricular diastolic function and aortic elastic properties in patients with obstructive sleep apnea syndrome. Fourteen male patients with obstructive sleep apnea and 14 age- and body mass index-matched healthy male controls took part in the study as a control group. All subjects underwent echocardiographic examination; left ventricular cavity dimension, standard and tissue Doppler parameters, and aortic diameter (3 cm above aortic valve) at systole and diastole were measured. While the aortic stiffness index in patients with obstructive sleep apnea was significantly higher than that of the control group (4.5 +/- 0.3 vs 2.1 +/- 0.1, P = 0.001), the aortic distensibility index was found to be lower in this group compared with controls (2.4 +/- 1.2 vs 3.9 +/- 1.5 cm2 dynes(-1) 10(-6), P = 0.009). Furthermore, peak velocity of myocardial systolic wave and peak velocities of myocardial diastolic waves in sleep apnea patients were lower than in controls. There was an association between aortic stiffness and the apnea hypopnea index (coefficient = 0.49, P = 0.002). We also found an inverse correlation between peak velocity of myocardial diastolic wave and aortic stiffness (coefficient = -0.43, P = 0.003), using multiple linear regression. Increased aortic stiffness that is associated with the severity of disease in patients with obstructive sleep apnea may lead to diastolic dysfunction of the left ventricle.

Adult↗

PubMed2002

The characteristics of five patients with obstructive sleep apnea whose apnea-hypopnea index deteriorated after uvulopalatopharyngoplasty.

The objective of this retrospective, consecutive, case series design study was to determine the number of unselected patients with obstructive sleep apnea (OSA) who deteriorated after uvulopalatopharyngoplasty (UPPP). Sixteen of 27 patients at the Sleep Clinic at Veterans Affairs Medical Center who underwent UPPP for OSA and who completed both a pre- and postpolysomnogram were studied. After comparing the apnea-hypopnea index (AHI) before and after UPPP, three groups of patients were identified: deteriorators, unchanged, and improvers. In five patients (31%), the AHI increased by more than 10% after UPPP (deteriorators); in four (25%), the AHI showed a change in either direction of less than 10% (unchanged); and in the remaining seven (44%), the AHI decreased by more than 10% after UPPP (improvers). The AHI deteriorated in five of 16 (31%) unselected patients with OSA in our clinic population who underwent UPPP. The mean pre-UPPP AHI was lower in the patients who deteriorated relative to all other patients (P = 0.02). We suggest that patients who undergo UPPP should have a post-UPPP polysomnogram to determine whether they have improved or deteriorated after the procedure and that alternative forms of treatment may be needed in some patients.

Aged↗

PubMed2004

Neuropeptide Y and leptin in patients with obstructive sleep apnea syndrome: role of obesity.

Neuropeptide Y (NPY) and leptin are two peptides involved in the regulation of body weight, energy balance, and sympathetic tone. This study investigates the independent role of apneas and obesity on NPY and leptin plasma levels in patients with obstructive sleep apnea syndrome (OSAS). To this end we compared their values in 23 obese (body mass index > 30 kg/m2) and 24 nonobese (body mass index < 27 kg/m2) patients with OSAS, and in 19 obese and 18 nonobese control subjects without OSAS. Patients who used continuous positive airway pressure for more than 4 hours/night were reexamined 3 and 12 months later. We found that NPY levels were increased (p < 0.01) in patients with OSAS independently of obesity. Leptin levels were also increased in OSAS but this was mostly associated to obesity. Continuous positive airway pressure treatment reduced NPY levels in all patients and leptin levels only in nonobese patients (p < 0.01). We concluded that NPY and leptin plasma levels are increased in patients with OSAS. Yet, whereas the former appear independent of obesity, the latter are mostly associated with obesity.

Analysis of Variance↗

PubMed2001

Degree of arousal is most correlated with blood pressure reactivity during sleep in obstructive sleep apnea.

We investigated blood pressure (BP) reactivity of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. The influences on BP reactivity of degree of arousal, the lowest O2 saturation (SaO2), and respiratory disturbance (RD) duration were compared. Ten normotensive or borderline hypertensive patients with OSA were studied with one-night polysomnography including non-invasive beat-to-beat BP monitoring (Finapres). We compared baseline BP, pre-apneic BP, and post-apneic BP during both REM and NREM sleep. Also, relationships between delta BP (post-apneic BP minus pre-apneic BP) and degree of arousal, the lowest SaO2, and RD duration were examined. During both REM and NREM sleep, pre-apneic BP was elevated compared with baseline BP. Post-apneic BP elevation was noted compared with pre-apneic BP. The degree of arousal was more significantly correlated with delta BP than the lowest SaO2. RD duration was hardly correlated with delta BP. Pre-apneic BP elevation seems to result from cumulation of sympathetic activation and sympathetic nervous system resetting. The correlation between delta BP and degree of arousal suggests that sympathetic activation causing post-apneic BP elevation may result mainly from an arousal response regardless of hypoxia.

Adult↗

PubMed1989

Precipitation of obstructive sleep apnea during pregnancy.

A case of severe obstructive sleep apnea developing during pregnancy is reported. A 27-year-old primigravida was well until the sixth month of pregnancy, when she developed loud snoring and excessive daytime sleepiness. Polysomnography was performed at 36 weeks' gestation and revealed severe obstructive sleep apnea. The patient was treated successfully during pregnancy with nasal continuous positive airway pressure, but continued to suffer from moderate obstructive sleep apnea after delivery. This case suggests that sleep apnea may be either precipitated or exacerbated during pregnancy.

Adult↗

PubMed1989

[Obstructive sleep apnea--a risk factor for arterial hypertension].

Obstructive sleep apnea is frequently found in middle-aged men. Usually, these patients are obese and therefore predisposed to hypertension. This study aimed to elucidate the relationships between hypertension, obesity and obstructive sleep apnea in 48 men suffering from sleep apnea. Hypertension was found in 39 of them (= 81%), 27 patients (= 56%) were morbidly obese (Broca index above 125%), 17 patients (= 36%) were moderately obese (Broca index between 100 and 125%) and 4 patients (= 8%) showed normal weight (Broca index below 100%). Severity of sleep apnea did not correlate with obesity or hypertension. Patients with sleep apnea who were hypertensive were significantly (p less than 0.025) more obese than those with normal blood pressure. Compared with an unselected population showing a similar degree of obesity, patients with obstructive sleep apnea showed a higher prevalence of hypertension and this is independent of age. These findings establish sleep apnea as a risk factor for hypertension.

Adult↗