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Results for “Sleep Apnea, Obstructive”

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PubMed1994

Obstructive sleep apnea manifesting as suspected angina: report of three cases.

OBJECTIVE: To describe three cases of obstructive sleep apnea that resembled coronary artery disease and to suggest features that might distinguish these two syndromes. DESIGN: We present three detailed case reports of patients with severe obstructive sleep apnea and discuss similar cases from the literature. MATERIAL AND METHODS: Two obese women and one obese man with previously undiagnosed obstructive sleep apnea had chest discomfort, episodic dyspnea, and palpitations, most prominent at night. All three patients had multiple cardiac risk factors and had previously undergone cardiac evaluations, including at least two prior cardiac catheterizations each. Repeated cardiac catheterization revealed less coronary occlusive disease than expected on the basis of the symptoms in all three patients and a small atrial septal defect in one patient. When reassessed, the medical histories suggested obstructive sleep apnea. RESULTS: Overnight polysomnography documented the presence of severe sleep apnea; the three patients had mean values of 56 disordered breathing events per hour and 44% minimal oxygen saturation. Although bi-level or continuous positive airway pressure yielded initial improvement, all patients had difficulty with routine use of this therapy after 1 1/2 years of follow-up. CONCLUSION: The initial manifestations of severe obstructive sleep apnea may simulate angina, suggest arrhythmia, or mimic heart failure. Failure to inquire about snoring and daytime somnolence in patients with chest pain may prevent the identification of clinically significant disordered breathing during sleep.

Aged↗

PubMed2004

Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial.

STUDY OBJECTIVE: To investigate the short-term effect (4 weeks) of oral appliance therapy for obstructive sleep apnea on blood pressure. DESIGN: Randomized, controlled, crossover trial. SETTING: Multidisciplinary sleep disorders clinic in a university teaching hospital. PATIENTS: Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography (apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms--daytime sleepiness, snoring, witnessed apneas, fragmented sleep; age > 20 years; and minimum mandibular protrusion of 3 mm). INTERVENTION: A mandibular advancement splint (MAS) and control oral appliance for 4 weeks each. MEASUREMENTS AND RESULTS: Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period. Patients showed a 50% reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index. There was a significant reduction with the MAS in mean (+/- SEM) 24-hour diastolic blood pressure (1.8 +/- 0.5 mmHg) compared with the control (P = .001) but not in 24-hour systolic blood pressure. Awake blood-pressure variables were reduced with the MAS by an estimated mean (+/- SEM) of 3.3 +/- 1.1 mmHg for systolic blood pressure (P = .003) and 3.4 +/- 0.9 mmHg for diastolic blood pressure (P < .0001). There was no significant difference in blood pressure measured asleep. CONCLUSION: Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure, similar to that reported with continuous positive airway pressure therapy.

Adult↗

PubMed1983

Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea.

Because it has been suggested that patients with obstructive sleep apnea have a narrower pharyngeal airway than normal persons, we performed lateral fluoroscopy and computed tomographic (CT) scans of the pharynx in patients with this syndrome. Fluoroscopy in 6 sleeping patients showed that the obstruction always began during inspiration when the soft palate touched the tongue and posterior pharyngeal wall. The CT scans in 9 awake subjects demonstrated that the narrowest section of the airway in patients and in control subjects was the region posterior to the soft palate. The cross-sectional area of this region was significantly narrower in patients than it was in control subjects (p less than 0.001). Because a narrow airway would be more likely to collapse during inspiration than a normal one would (Bernoulli's Principle), we conclude that the narrow airways we observed in awake patients may be an important contributing factor in the pathogenesis of obstructive sleep apnea.

Adult↗

PubMed1984

A surgical treatment for snoring and obstructive sleep apnea.

Snoring caused by oropharyngeal obstruction and some cases of obstructive sleep apnea syndrome can be cured or considerably lessened by resecting redundant tissue from patients' oropharynx and soft palate. Preoperative, and in some instances postoperative, sleep monitoring is a necessary part of evaluating these conditions.

Humans↗

PubMed2005

Physiologic pacing in patients with obstructive sleep apnea: a prospective, randomized crossover trial.

OBJECTIVES: This study was designed to assess the impact of prevention of bradycardia with physiologic pacing on the severity of obstructive sleep apnea. BACKGROUND: Apneic episodes during sleep are associated with slowing of the heart rate during apnea and tachycardia with subsequent arousal. Patients with permanent pacemakers may have reduced episodes of sleep apnea when their pacemaker rate is set faster than their spontaneous nocturnal heart rate. METHODS: We conducted a prospective, randomized, single-blind crossover trial of temporary atrial pacing in obstructive sleep apnea to reduce the apnea hypopnea index (AHI). Fifteen patients (age 60 +/- 13 years, 12 men) with moderate to severe obstructive sleep apnea (AHI 34 +/- 14) underwent insertion of an externalized atrial permanent pacing system via the left subclavian vein. Patients underwent overnight respiratory sleep studies in hospital, during atrial pacing at 75 beats/min, and with pacing turned off. The order of pacing mode was randomized, with crossover the subsequent night to the other mode. Patients were blinded to pacing mode, and the analysis of sleep recordings was blind to pacing mode. RESULTS: Pacing was tolerated without complications in all patients. Overnight physiologic pacing did not affect the AHI (pacing 39 +/- 21/h vs. control 42 +/- 21/h, p = 0.23, 95% confidence interval -9.3 to 2.5 for difference), desaturation time (pacing 3.8 +/- 6.0% vs. control 3.5 +/- 4.3%, p = 0.70), or the minimum SaO(2) (pacing 75 +/- 10% vs. control 77 +/- 11%, p = 0.38). There was a borderline significant reduction in circulatory time with pacing (pacing 23.4 +/- 3.2 s vs. control 25.5 +/- 4.4 s, p = 0.09). CONCLUSIONS: Temporary atrial pacing does not appear to improve respiratory manifestations of obstructive sleep apnea. Permanent atrial pacing in this patient population does not appear to be justified.

Aged↗

PubMed1992

Studies in the genetics of obstructive sleep apnea. Familial aggregation of symptoms associated with sleep-related breathing disturbances.

Previous studies of single families have suggested that familial factors may be important in the pathogenesis of obstructive sleep apnea. In this report, the role of inheritance in obstructive sleep apnea was assessed by quantitating the degree of familial clustering of symptoms associated with sleep-related breathing disorders. In total, 272 subjects from 29 families identified through an index case with obstructive sleep apnea and 21 control families with no relative known to have sleep apnea were studied with questionnaires that ascertained health status and symptoms. The unadjusted odds ratios of habitual or disruptive snoring, breathing pauses, and excessive day-time sleepiness in subjects with a single relative with the same symptom were 1.40 to 1.53 (p less than 0.05). Odds ratios increased progressively for subjects with increasing numbers of symptomatic relatives). Adjustment for body mass index, age, and gender modestly reduced these odds ratios to 1.33 to 1.42. These data suggest a significant familial aggregation of symptoms associated with sleep-disordered breathing that appears independent of familial similarities in weight.

Adult↗

PubMed2001

[Vascular disorders and obstructive sleep apnea syndrome].

The relationships between obstructive sleep apnoea syndrome (OSAS) and vascular diseases are still under discussion, but increasing evidence demonstrates that the OSAS is an independent risk factor for stroke, coronary artery diseases and hypertension. Many recent studies have found a 70 to 95 percent frequency of OSAS in patients with acute stroke. Furthermore the presence of OSAS in stroke patients could lead to a poor outcome. The potential mechanisms linking OSAS and stroke and probably multiple (arterial hypertension, cardiac arrhythmia, increased atherogenesis, coagulation disorders, and modifications of cerebral metabolism and hemodynamic). Despite numerous incertainties, OSAS should be systematically screened when it is clinically suspected in patients with acute vascular event (stroke, coronary artery diseases). However, the best time for treatment with continuous positive airway pressure remains to be determined.

Coronary Disease↗

PubMed1990

Use of modified silicone tracheal cannula for obstructive sleep apnea.

Experience with the original Montgomery silicone tracheal cannulas in 47 patients with obstructive sleep apnea has been reported. Further experience with 10 obstructive sleep apnea patients who used modified silicone tracheal cannulas that permit periodic self-removal, cleaning, and reinsertion was analyzed. Two patients used the tube briefly and without complications. The remaining eight patients used the modified cannula for 18 to 24 months. The average number of office visits following insertion was three. Compared to the original cannulas, there were markedly fewer difficulties with granulations, infection, and tube malposition with the modified cannulas. The improvements make this modified device a useful tool worth further study in obstructive sleep apnea patients requiring tracheostomy.

Adult↗

PubMed1993

Role of chemical drive in recruiting upper airway and inspiratory intercostal muscles in patients with obstructive sleep apnea.

Upper airway dilating muscle activity increases during apneic episodes in patients with obstructive sleep apnea (OSA). To elucidate the relative contribution of chemical and nonchemical stimuli to augmentation of the upper airway dilating muscle, we measured the response of genioglossus muscle (GG) and inspiratory intercostal muscle (IIM) activities to obstructive apnea during non-REM sleep and compared them with the response to progressive hypoxia and hypercapnia during awake periods in seven male patients with OSA. GG EMG was measured with a wire electrode inserted percutaneously, and IIM EMG was measured with surface electrodes placed in the second intercostal space parasternally. Responses to hypoxia and to hypercapnia were assessed by rebreathing methods in the supine position while awake. Following these measurements, a sleep study was conducted with the EMG electrodes placed in the same locations. The relationship between GG and IIM activities during the cycle of apnea and postapneic ventilation in non-REM sleep was quasi-linear, and the slope of the regression line was significantly greater than those during progressive hypoxia and progressive hypercapnia. The amplitude of GG activity at 70% of maximum IIM activities in the hypoxic test was 140 +/- 20% (mean +/- SEM) during non-REM sleep, which was also significantly greater than that during hypoxia (51 +/- 10%) and that during hypercapnia (59 +/- 15%). These results suggest that nonchemical factors contribute considerably to augmentation of GG activity during obstructive apneic episodes. The nonchemical stimuli may arise from mechanoreceptors activated by upper airway obstruction and behavioral factors associated with change in sleep states.

Adult↗

PubMed2006

Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension.

OBJECTIVES: Obstructive sleep apnoea (OSA) might cause right ventricular dysfunction and pulmonary hypertension. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on right ventricular myocardial performance index (MPI) in OSA patients without hypertension. METHODS: 49 subjects without hypertension, diabetes mellitus, any cardiac and pulmonary disease had overnight polysomnography and echocardiography. In 18 moderate-severe OSA (apnea-hypopnea index > or = 15) patients, right ventricular free wall diameter (RVFWD) was measured by M-mode, and right ventricular MPI was calculated as (isovolumic contraction time+ isovolumic relaxation time) / pulmonary ejection time using Doppler at baseline and after 6 months CPAP therapy. RESULTS: Mean age was 46.5 +/- 4.9 year. Patients had high body mass index (BMI: 30.6 +/- 4,0 kg/m2), but there was no change in either BMI or blood pressures after 6 months. Right ventricular end-diastolic and end-systolic diameters were in normal limits at baseline, and did not change after CPAP usage. Baseline RVFWD (7.1 +/- 2.1 mm) significantly decreased after CPAP therapy (6.2 +/- 1.7 mm, p < 0.001). 15 of patients (83%) had right ventricular diastolic dysfunction at baseline, and it was completely improved in 11 of them (73%) by CPAP usage. Right ventricular global dysfunction was shown in 11 patients (61%) with a high MPI (62.2 +/- 9.3%) at baseline; and MPI was significantly decreased after CPAP therapy (47.3 +/- 8.4%, p < 0.0001), and it was completely corrected in 4 of them (36%). CONCLUSION: CPAP therapy significantly decreases RVFWD and improves right ventricular diastolic and global functions (MPI) in OSA patients without hypertension.

Adult↗

PubMed1993

Obstructive sleep apnea and the kidney.

Recent studies of obstructive sleep apnea and its comorbidity with other systemic diseases have stimulated interest in the relationship of apnea to renal disease and hypertension. Polysomnographic sleep studies in patients on dialysis who complain of day-time fatigue or sleepiness reveal significant apnea in up to 73% of those studied. Abnormalities in respiratory controller mechanisms from chronic hypocarbia, metabolic acidosis, and uremic toxins have been blamed for the occurrence of apnea in this setting. Proteinuria and sometimes nephrotic syndrome have been recognized in morbidly obese patients with sleep apnea syndrome. Renal biopsies of such patients have shown glomerulomegaly and focal segmental sclerosis. It is postulated that these lesions may result from increased glomerular filtration and blood flow. Elevated urine output, sodium and chloride excretion, and atrial natriuretic peptide have been well demonstrated in obstructive apnea patients and correct to control levels with treatment of the apnea. Both acute (with each apnea) and chronic daytime blood pressure elevation are frequently observed in sleep apnea patients, and occult sleep apnea is postulated as one possible cause of "primary" hypertension in middle-aged men. In younger patients, such hypertension seems to be more reversible with the elimination of apnea. In older patients, however, the cure of systemic hypertension cannot be guaranteed with the elimination of the apnea, and asymptomatic apnea patients tend not to tolerate the bother and discomfort of apnea treatment with nasal continuous positive airway pressure. Therefore, aside from a careful history regarding sleep symptomatology, polysomnographic studies of clinic populations with primary hypertension to search for apnea as a cause cannot be recommended.

Aged↗

PubMed2002

Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome.

Detailed analysis of the upper airway has not been performed in children with obstructive sleep apnea. We used magnetic resonance imaging and automatic segmentation to delineate the upper airway in 20 children with obstructive sleep apnea and in 20 control subjects (age, 3.7 +/- 1.4 versus 3.9 +/- 1.7 years, respectively). We measured mean and minimal cross-sectional area, length, and volume of: (1) the total airway; (2) regions along the adenoid, tonsils, and where adenoid and tonsils overlap; and (3) 10 segments at 10% increments along the airway. The mean cross-sectional area of the total airway of the obstructive sleep apnea group was significantly smaller in comparison with the control group, 28.1 +/- 12.6 versus 47.1 +/- 18.2 mm2, respectively (p < 0.0005). Minimal cross-sectional area and airway volume were smaller in this group, 4.6 +/- 3.3 versus 15.7 +/- 12.7 mm2 (p < 0.0005), and 1,129 +/- 515 versus 1,794 +/- 846 mm3 (p < 0.005), respectively. Regional analysis suggested that the upper airway in children with obstructive sleep apnea is most restricted where adenoid and tonsils overlap. Segmental analysis demonstrated that the upper airway is restricted throughout the initial two-thirds of its length and that the narrowing is not in a discrete region adjacent to either the adenoid or tonsils, but rather in a continuous fashion along both.

Child↗

PubMedDate not supplied

Abnormal SPECT myocardial perfusion imaging during periods of obstructive sleep apnea in morbid obese patients without known heart disease.

OBJECTIVE: Determine the myocardial perfusion characteristics in obstructive sleep apnea and its possible role in cardiovascular damage. METHODS AND PROCEDURES: Fourteen patients from the Obesity Clinic weighing less than 130 kg underwent myocardial perfusion studies using single photon emission computed tomography with technetium 99m-labeled sestamibi during nighttime polysomnographic recordings. Coronary angiograms were performed on patients with suspect of severe coronary obstruction according nighttime myocardial perfusion studies or pharmacological stress carried out during waking hours. RESULTS: All 14 patients manifested myocardial perfusion defects during sleep, affecting an average of 5.5 segments/patient, although only 8 presented ischemic ST segment changes and none demonstrated rhythm or conduction disturbances. Angiographic examination of the 10 patients with the most severe perfusion defects did not reveal significant coronary obstruction, and fewer perfusion defects were documented during daytime scintigraphy. DISCUSSION: In obese patients with obstructive sleep apnea, myocardial perfusion defects appear to occur with highest frequency and severity during nighttime sleep, justifying further investigation in a larger number of patients with obstructive sleep apnea and more significant obesity.

Coronary Circulation↗

PubMed2003

[Diagnosis of pediatric obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To discuss the clinical feature and diagnosis of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) and analyze characteristics of polysomnography. METHODS: Cephalometric analysis, fibrous endoscopic examination and sleep breathing studies were performed in 49 cases with suspected complaints and signs. RESULTS: Most of them had marked history about snore, sleep apnea and signs of upper airway obstruction caused by enlargement of tonsil and/or adenoid. Polysomnography (PSG) was given to 41 cases who was proved 1 case with primary snore, 5 cases with upper airway resistance syndrome, 35 cases with OSAHS. Another 8 cases with OSAHS were diagnosed by Autoset I studies. CONCLUSION: Many features of pediatric OSAHS are different from adult OSAHS. The common symptom of pediatric OSAHS include snore, restless sleep, struggling to breathe, abnormal paradoxical chest/abdomen motion, mouth breathing, failure-to-thrive. Obesity and excessive daytime sleepiness are little present. Severe cases may be associated with cor pulmonale. PSG play an important role in exact diagnosis of pediatric sleep related breathing disorder. The results demonstrate that pediatric OSAHS are characterized by partial upper airway obstruction, more or less apnea and associated with staged desaturation. They have little sleep structure disorder and difficulty breathing are not associated with arousal. Apnea hypopnea index (AHI), lowest oxygen saturation (LSaO2) and desaturation index below 90% (SIT90%) are very important factors to measure about serious degree of pediatric OSAHS.

Child↗

PubMed1998

Prevalence of patent foramen ovale and its contribution to hypoxemia in patients with obstructive sleep apnea.

STUDY OBJECTIVES: The objectives of this study were (1) to assess the prevalence of patent foramen ovale (PFO) by means of contrast transesophageal echocardiography (TEE) in patients with obstructive sleep apnea, and (2) to determine the potential contribution of right to left interatrial shunting to systemic oxygen desaturation following the performance of Valsalva maneuver. DESIGN: Performance of contrast TEE during Valsalva maneuver with simultaneous measurement of systemic arterial oxygen saturation (SaO2) by means of pulse oximetry in patients with obstructive sleep apnea and a control group. SETTING: Government teaching hospital, university hospital affiliate. PATIENTS: Study group comprised 48 patients with documented obstructive sleep apnea and 24 control subjects. INTERVENTIONS: Sleep studies, contrast TEE, Valsalva maneuver, pulse oximetry. MEASUREMENTS AND RESULTS: Thirty-three of 48 patients with obstructive sleep apnea compared with 4 of 24 control patients had a detectable PFO (69% vs 17%; p < 0.0001). All sleep apnea patients had comparable baseline SaO2 regardless of the presence of a PFO (93.9+/-1.7% vs 95+/-1.2%; p=not significant). After performance of a Valsalva maneuver, however, a significantly greater fall in SaO2 was observed in patients with obstructive sleep apnea and PFO compared with patients with obstructive sleep apnea without PFO (-2.4 +/- 1.5% vs -1.3 +/- 0.6%; p=0.007). A statistically significant fall in SaO2 (defined as > 4 SD of recorded SaO2 values after Valsalva maneuver in patients without PFO) was found in one third of patients with sleep apnea and PFO. CONCLUSION: We conclude that there is an increased prevalence of PFO in patients with obstructive sleep apnea that could contribute to significant hypoxemia after a Valsalva maneuver in approximately one third of these patients.

Aged↗

PubMed1994

Weight loss for obstructive sleep apnea: the optimal therapy for obese patients.

Obstructive sleep apnea (OSA) is a common disorder in which upper-airway obstruction during sleep results in cessation of breathing. OSA is associated with increased morbidity and mortality and impaired daytime functioning. Upper-body obesity is a risk factor for OSA, and it is well documented that weight loss has a notable ameliorative impact on the occurrence of OSA. Nasal continuous positive airway pressure (nCPAP) during sleep is the primary treatment for OSA, and is usually effective in relieving upper-airway obstruction. However, compliance with prolonged nCPAP use has been proven problematic. Upper-airway surgeries may be efficacious for the treatment of OSA in carefully selected patients, but often are not successful for obese patients with OSA. The concomitant use of nCPAP and behavioral weight loss therapy in obese patients with OSA may result in enhanced weight loss. In moderately obese patients, modest weight reduction may alleviate the need for long-term nCPAP therapy or upper-airway surgery. Severely obese patients usually require more substantial weight loss and may be candidates for behavioral therapy in combination with gastric surgery. The role of the dietitian in the treatment of OSA cannot be overemphasized and warrants further development and study.

Behavior Therapy↗

PubMed1992

Negative polysomnogram in patients with obstructive sleep apnea syndrome.

We evaluated the possibility that in some patients with obstructive sleep apnea, the initial polysomnogram may be negative. We reviewed polysomnograms performed at the Medical College of Georgia from 1984 to 1990 and found nine patients whose initial polysomnogram was negative but whose repeat polysomnogram confirmed obstructive sleep apnea. All nine patients (five women and four men; average age, 44.2 years) had an apnea index of less than 5 (fewer than five apneic episodes per hour) and had a total of fewer than 20 apneic episodes during the initial overnight polysomnogram. The change in average weight was not significant. Three patients had received short-term oxygen therapy, and two of these three received nasal continuous positive airway pressure prior to the initial study. The time that patients spent supine increased from 101 min in the initial study to 180 min in the second, but this was not significant (p = 0.12). Comparison of the initial and diagnostic polysomnograms showed significantly reduced total sleep time (from 3.75 +/- 1.84 h to 5.32 +/- 1.11 h; p = 0.04) and reduced rapid eye movement (REM) sleep time (from 0.27 +/- 0.27 h to 0.75 +/- 0.58 h; p = 0.037) in the initial study. We conclude that in a small subset of patients with obstructive sleep apnea, the initial polysomnogram may be falsely negative, which could be due to previous therapy, a reduction in total sleep time and REM sleep, or other unidentified factors.

Adult↗

PubMed2002

Obstructive sleep apnea: a comparison of black and white subjects.

OBJECTIVE: To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group. STUDY DESIGN: Cross-sectional retrospective review. SETTING: University-based sleep disorders laboratory. METHODS: The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level. RESULTS: Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P =.005). Black males with OSA have significantly lower oxygen saturations than white males (P =.025). CONCLUSION: Black males who present to the otolaryngologist-head and neck surgeon for evaluation of sleep-disordered breathing may be at increased risk of severe OSA.

Black People↗