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 883 records · Page 49Linked to original sources

PubMedDate not supplied

Pediatric obstructive sleep apnea syndrome and anesthetic management.

Sleep-related breathing disorders require special attention in children who spend a considerable time sleeping. Obstructive sleep apnea syndrome is characterized by episodes of upper airway obstruction during sleep. Symptoms include hyperactivity, enuresis, headache, failure to thrive, and increased respiratory effort and total sleep time. The most common cause is adenotonsillar hypertrophy. Coexisting diseases are obesity, neuromuscular and craniofacial anomalies, and Down's syndrome. Early diagnosis is important to minimize neurocognitive, cardiac and developmental complications. Polysomnography is the gold standard for diagnosis. Although the features of pediatric obstructive sleep apnea syndrome are distinctly different from that in adults, it may predispose to the adult type of the syndrome. As therapy concerns several surgical approaches as well as conservative techniques, anesthetic management calls for particular attention. Pre- and postoperative sedation must be performed cautiously and patients must be watched closely with respect to airway obstruction and hypoventilation. Difficult intubation must always be considered.

Anesthesia↗

PubMed2004

Obstructive sleep apnea syndrome in children: a state-of-the-art review.

Snoring and obstructive sleep apnea are a frequent problem not only in adults, but also in children and adolescents, as can be seen from current epidemiological data. The epidemiology, etiology, diagnosis, and management of obstructive sleep apnea syndrome (OSAS) in adults have been adequately established on the basis of evidential data. As a result of this, both physicians and the public are increasingly aware of OSAS in adults. Although there are numerous parallels between pediatric and adult OSAS, the situation in children differs that in adults. There is a greater variety of symptoms in children with OSAS, diagnosis is often more difficult with serious consequences for growth and development of children. Treatment of OSAS in children is also different from that of the adult patient. There are many possible causes for the development of obstructive sleep apnea in children. These include hypertrophy of the tonsils and syndromes such as Down syndrome, Pickwickian syndrome, Prader-Willi syndrome or Marfan syndrome. OSAS can, however, also be the result of obesity, midfacial dysplasia, retro- or micrognathia, allergic rhinitis or muscular dystrophy. Epidemiological data presented in the literature concerning the incidence of OSAS in children is extremely varied. This wide range is probably due to the fact that snoring may be misdiagnosed as OSAS. The diagnosis of OSAS in children may only be made by considering clinical history (such as rate of growth, tendency to fall asleep during the day, sleep disturbances, susceptibility to infection, etc.), polysomnography (if possible during several nights) and accompanying instrumental diagnosis including cephalometry or laryngoscopy. One of the problems of polysomnography in childhood is that performance and interpretation of the results have not yet been standardized or evaluated for different age groups. Treatment depends on the cause of OSAS and require multidisciplinary management involving the pediatrician, pediatric or adolescent psychiatrist, ear, nose, and throat specialist, maxillofacial surgeons, and neurosurgeons. Adenotonsillectomy (ATE) is the therapy generally chosen if the child has adenoidal vegetations and/or tonsillar hypertrophy. Corrective surgery is possible for rare malformation syndromes. Nocturnal masks for continuous positive airway nasal pressure or procedures for mask respiration are effective in children, but are only used in exceptional cases, such as when ATE is contraindicated or when symptoms of OSAS remain after surgery. The success of pharmacological treatment of OSAS in children has not been evaluated in controlled clinical trials.

Adenoids↗

PubMed1985

Obstructive sleep apnea.

This chapter provides an account of obstructive sleep apnea that is designed for clinicians. Current ideas about the mechanism of upper airway obstruction are reviewed, and the clinical features are discussed in a manner intended to facilitate the clinical assessment of such patients. Various forms of treatment are reviewed, with major emphasis given to the use of nasal positive airway pressure, a form of therapy developed by the authors.

Airway Obstruction↗

PubMed2002

Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion.

To evaluate the clinical usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children, we studied 32 patients (mean age, 7.1 +/- 2.6 yr; 20 males) with symptoms of obstructive sleep apnea, malocclusion, and a baseline apnea index > 1 event/h. A group of 19 subjects was randomly assigned to a 6-mo trial of an oral appliance; the remainder acted as control subjects. At baseline and after the trial all patients underwent physical examination, a standard polysomnography, and orthodontic assessment. A modified version of the Brouillette questionnaire related to obstructive sleep apnea symptoms was administered to parents before and after the trial and a clinical score was calculated. Of the 32 subjects enrolled, 4 treated subjects and 5 control subjects were lost to follow-up. Polysomnography after the trial showed that treated subjects all had significantly lower apnea index (p < 0.001) and hypopnea index values (p < 0.001) than before the trial, whereas in untreated control subjects these values remained almost unchanged. Clinical assessment before and after treatment showed that in 7 of the 14 subjects (50%) the oral appliance had reduced (a fall of at least 2 points in the respiratory score) and in 7 had resolved the main respiratory symptoms, whereas untreated patients continued to have symptoms. In conclusion, treatment of obstructive sleep apnea syndrome with an oral appliance in children with malocclusion is effective and well tolerated.

Anthropometry↗

PubMed1998

[The occurrence of hypertension in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To determine the changes in blood pressure (BP) and its correlated factors in patients with obstructive sleep apnea syndrome(OSAS). METHOD: Retaining manometric tube in radial artery and polysomnography(PSG) were done synchronously in 13 patients with OSAS in whom was diagnosed by whole-night PSG. Oxygen therapy was given to two of the patients and NCPAP treatment was given to four of the patients on the following night. RESULT: (1) Six of the patients (46 percent) had daytime hypertension (SBP > 18.7 kPa and/or DBP > 12 kPa), the incidence of transient hypertension during apnea in 7 patients who do not have daytime hypertension was 86% (6/7). (2) Lowest oxygen saturation during sleep was significantly correlated with the level of SBP(r = -0.659, P < 0.05) and DBP(r = -0.677, P < 0.01) in awake, the baseline of SBP(r = -0.777, P < 0.01) and DBP (r = -0.590, P < 0.05) in NREM sleep and that of SBP(r = -0.585, P < 0.05) in REM sleep. In REM sleep, the changes in MBP showed significantly correlation with the changes in oxygen saturation during apnea (r = 0.598, P < 0.05). In NREM sleep, the changes in SBP were significantly correlated with apnea length(r = 0.580, P < 0.05). The changes in BP showed no correlation with apnea index in different sleep stages (P > 0.05). (3) Nocturnal elevation in BP disappeared in four patients who received NCPAP treatment, but not in two patients who received oxygen therapy. CONCLUSION: The transient hypertension during apnea might be recurrent episodes in patients with OSAS who have normal daytime BP. Nocturnal hypoxemia and apnea length might play a role in nocturnal elevation in BP in patients with OSAS. Hypoxemia was not the major factor in BP elevation after obstructive apneas. Simple oxygen administration could not normalize the elevation in BP during apnea in patients with OSAS and NCPAP might be an appropriate therapy.

Adult↗

PubMed1990

[Treatment of obstructive sleep apnea with a mandibular repositioning appliance].

A patient with obstructive sleep apnea has been treated by means of a mandibular repositioning appliance made of silicone rubber. The patient is a male and 54 years old with a slim body and complained a excessive daytime sleepiness and unsatisfied sleep. A lateral head plate revealed retruded mandible and narrow A-P diameter in the lower part of oropharynx. Moderate frequency of apnea was found in the initial all-night polysomnographic recording. The mandible has been brought forward by 5 mm and downward by 11 mm, which enlarges the diameter of oropharynx anterio-posteriorly by 2-3 mm. Since the appliance has been inserted during bed-time, the daytime sleepiness and unsatisfied sleep has been eliminated. The second polysomnographic recording revealed significant increment of deep NREM sleep and REM sleep and decrement of arousal during sleep after insertion of the appliance. It is indicated, therefore, that the application of the mandibular repositioning appliance is one of the effective methods for the treatment of obstructive sleep apnea.

Humans↗

PubMed2005

Obstructive sleep apnea, morbid obesity, and adenotonsillar surgery: a review of the literature.

Obstructive sleep apnea syndrome is a common occurrence in the obese pediatric population. As this subgroup is rapidly expanding, these children will be increasingly encountered by the otolaryngologist in practice. The literature regarding the etiology, pathogenesis, diagnosis and surgical treatment of obstructive sleep apnea in morbidly obese children is reviewed and pertinent data presented.

Adenoidectomy↗

PubMed2005

[Obstructive sleep apneas and arteriosclerosis].

The clinical importance of the obstructive sleep apnea syndrome underlies in its association with a major morbimortality principally in relation with adverse vascular events. Different physiopathologic mechanisms boosted by the recurrence of obstructive apnea episodes including alterations in several inflammatory mediators, metabolic factors associated with a dysfunction of vascular endothelium and the development of arterial hypertension would lead to an acceleration of the atherosclerotic process responsible in causality degree of the increment of cardiovascular disease in these patients.

Arteriosclerosis↗

PubMed1989

Obstructive sleep apnea syndrome in patients with class II malocclusion.

This study was designed to analyze the effect of class II malocclusion as a factor in the development of obstructive sleep apnea syndrome. Although mandibular retrusion has been reported coincidentally with obstructive sleep apnea syndrome many times, no causal relationship has been established. No previous study has analyzed the occurrence of obstructive sleep apnea syndrome in patients with class II malocclusion without sleep complaints. In this study, we selected 12 patients with class II malocclusion who required surgical mandibular-lengthening or repositioning procedures. These patients were surveyed for sleep habits or sleep complaints and then studied with overnight polysomnography for sleeping or breathing abnormalities. None of these patients had obstructive sleep apnea syndrome. From this sample population, an incidence of obstructive sleep apnea syndrome of no more than 26.5% in the surgical population of patients with class II malocclusion can be extrapolated.

Adolescent↗

PubMed2000

Influence of longterm CPAP therapy on CO(2) drive in patients with obstructive sleep apnea.

According to recent publications, the values of the hypercapnic ventilatory responses (HCVR) in normocapnic obstructive sleep apnea (OSA) patients are highly variable, but they are usually within the normal range. In our study, CPAP therapy during 1 month did not seem to influence the HCVR [Verbraecken, J., De Backer, W., Willemen, M., De Cock, W., Wittesaele, W., Van de Heyning, P., 1995. Respir. Physiol. 101, 279-287]. It is, however, not well studied whether long term (1 year) CPAP therapy can influence HCVR in normocapnic patients. Therefore, we evaluated the effect of 1 year CPAP therapy on CO(2) drive in 20 OSA patients. The slope of HCVR (SHCVR) changed from 2.35+/-0.21 L min(-1) mmHg(-1) (control) to 1.66+/-0.16 L min(-1) mm Hg(-1) (P=0.04), but the mean within subject coefficient of variation in repeated measurements of SHCVR in treated and untreated OSA patients was not statistically different. Pa(O(2)) increased from 72+/-2 mm Hg to 80+/-2 (1 year) mm Hg. We conclude that CPAP therapy improves daytime gas exchange in normocapnic OSA and may possibly decrease CO(2) drive (slope) after a treatment period of 1 year.

Blood Gas Analysis↗

PubMed2000

Exercise training effect on obstructive sleep apnea syndrome.

The role, if any, of exercise training in the management of individuals with obstructive sleep apnea syndrome (OSAS) is unclear. Anecdotally, patients have reported improvement in symptoms with regular participation in an exercise regime. In this study, we evaluated the effects of an exercise training program and weight loss on physical and subjective measures associated with OSAS. Nine subjects with mild to moderate OSAS completed a six month supervised exercise program. Pre and post-training measures on polysomnographic testing, physical training, anthropometric measures, quality of life (QOL), daytime somnolence and mood states were assessed. A significant decrease in the AHI (p=0.002) was noted along with improvements (p<0.05) in total sleep time, sleep efficiency, number of awakenings/hour, arousals/hour, apnea index and mean exercise training workloads. Significant decreases (p<.001) in weight (-6.2 kg) and body mass index (-1.6) were observed. Evaluation of QOL measures by the Health Status Questionnaire, Profile of Mood States and Epworth Sleepiness Scale showed significant changes in health status, affective state, and a decrease in daytime somnolence. Regular exercise training had a positive impact on the AHI, aerobic capacity, body mass index and QOL. However, exercise training alone was not an adequate intervention strategy for most individuals with OSAS but may serve well as an adjunct treatment strategy in the conservative management of individuals with mild to moderate OSAS.

Adult↗

PubMed2002

[Nocturnal cardiac dysrhythmias associated with obstructive sleep apnea].

The occurrence of cardiac dysrhythmias have been analysed in 16 adult patients suffering from obstructive sleep apnea syndrome of various severity randomly selected from more than 300 persons examined in our sleep laboratory from 1996 with a complex polysomnography Alice 3 (Healthdyne). The number of apneic episodes emerging in the first, second and third part of sleep was practically the same although their duration prolonged during the night culminating with an average of 25 sec (p < 0.02). OSA episodes caused a decrease of oxyhaemoglobin saturation to lower values during REM compared to NREM sleep (76.1% versus 81.7%, p < 0.05). Cardiac dysrhythmias occurred more frequently during and immediately after, than before OSA episodes demonstrating their causal relations.

Adult↗

PubMed2006

Total airway obstruction after maxillomandibular advancement surgery for obstructive sleep apnea.

BACKGROUND: Maxillomandibular advancement surgery is a surgical option for treating obstructive sleep apnea, especially in patients intolerant to, or noncompliant with, continuous positive airway pressure. METHODS: We describe a patient who underwent maxillomandibular advancement surgery, met criteria for tracheal extubation, and subsequently developed total airway obstruction immediately upon extubation. RESULTS: Before extubation, an airway exchange catheter was used and reintubation occurred without difficulty. The patient was brought back to the operating room for evacuation of a hypopharyngeal hematoma, as well as revision and replacement of fractured hardware. CONCLUSIONS: Nasopharyngolaryngoscopy should be performed routinely before extubating these patients to evaluate for pharyngeal edema and hematoma formation. IMPLICATIONS: Maxillomandibular advancement (MMA) surgery is increasingly used as a surgical option in the treatment of obstructive sleep apnea. We report a case of life-threatening airway obstruction after MMA and discuss the etiology of airway compromise after these surgeries.

Airway Obstruction↗

PubMed2003

[Influence of nasal obstruction on obstructive sleep apnea syndrome].

OBJECTIVE: To explore the influence of nasal obstruction on obstructive sleep apnea syndrome (OSAS). METHOD: 18 patients with OSAS concomitant with nasal obstruction and palatopharyngeal obstruction were only operated on nasal cavity to improve ventilation, followed-up six months. RESULT: 12 cases were reported remission, 4 cases efficient, and 6 cases unchanged, apnea and hypopnea index (AHI) decreased from 29.9 +/- 2.1 to 22.8 +/- 2.7, and lowest SaO2 (LoSaO2) increased from (75 +/- 2.9)% to (83.4 +/- 2.3)%. There was no significant difference for body mass index (BMI), but there was significant difference for preoperative AHI between non-effective groups and effective groups. CONCLUSION: Nasal obstruction is an important pathogenic factor. It is a necessary method to prevent OSAS by relieving nasal obstruction earlier and operation on nasal cavity is an effective method for the management of OSAS concomitant with nasal obstruction.

Adult↗

PubMed1990

Obstructive sleep apnea syndrome or abnormal upper airway resistance during sleep?

Obstructive sleep apnea syndrome is well known by now, but, at both extremes of age, increased upper airway resistance may lead to clinical symptoms without complete apnea. Abnormal craniofacial features appear to be responsible for the very early appearance during childhood of increased upper airway resistance. In adults, snoring, often related to partial upper airway obstruction located in the pharynx, may be associated with changes in respiratory timing and intermittent arousal. Many treatments are currently available to deal with obstructive sleep apnea syndrome. It is important to recognize the location(s) of the upper airway obstruction before considering treatment and to evaluate the associated risk factors. Early recognition of factors involved in increased upper airway resistance may allow prevention, a more efficacious approach than treatment of an already developed syndrome.

Airway Resistance↗

PubMed2004

Awareness level of obstructive sleep apnea syndrome during routine unstructured interviews of a standardized patient by primary care physicians.

OBJECTIVE: To assess the awareness level of primary care physicians of obstructive sleep apnea syndrome during patient-physician encounters. DESIGN: A prospective study using a standardized patient approach, conducted between December 2001 and March 2002. Ten sleep experts reviewed and approved the checklist questionnaire. SETTING: Primary care clinics of Clalit Health Care Services, in the central region of Israel. PARTICIPANTS: Thirty physicians (100% compliance) randomly selected (matched by age, sex, board certification) from the 261 primary care givers in the region. INTERVENTION: A standardized patient incorporated into the physicians' daily practices. RESULTS: From the original checklist questionnaire, we identified 2 related question areas that at least 90% of sleep experts would pursue in light of the presenting scenario, "Do the patients snore, choke, or stop breathing in sleep?" and "Does the patient have sleepiness, unrefreshed sleep/fall asleep at undesirable times?" During the unstructured interview, only 10% of the physicians asked 3 or more questions. More than 85% of primary care physicians identified the need for polysomnography evaluation (27 physicians) or continuous positive airway pressure (26 physicians) treatment for obstructive sleep apnea syndrome. However, only 16% and 50% discussed possible complications of obstructive sleep apnea syndrome such as motor vehicle and work accidents and cardiovascular events, respectively. CONCLUSIONS: Primary care physicians cannot identify a common disorder associated with cardiovascular and neurobehavioral disease and could not identify the sleepiness as a source of dangerous driving. While understanding the algorithms for the diagnosis of sleep apnea, physicians cannot identify the patients for whom the diagnostics are needed. Education programs need to be developed to increase the level of suspicion of obstructive sleep apnea syndrome among practicing primary care physicians. Activities can be monitored and evaluated over time in the daily practice by standardized patients. EDUCATIONAL OBJECTIVE: Increased awareness level of obstructive sleep apnea syndrome among primary care physicians, through publications and educational programs, monitored by standardized patients.

Attitude of Health Personnel↗

PubMed2005

Surgical therapy for adult obstructive sleep apnea.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review will present the current state of art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiograph, formulation of a surgical plan through a selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

Adult↗

PubMed1999

Oral and maxillofacial surgery for the management of obstructive sleep apnea syndrome.

The initial reports of treating obstructive sleep apnea using the uvulopalatopharyngoplasty were encouraging; however, as further trials of this procedure were reported, it began to show disappointing results. It was found that the retropalatal airway was not the only site of obstruction and procedures would need to be developed that would address obstruction in the other portions of the airway involved, notably in the retrolingual or hypopharyngeal portion of the airway. It was first reported by oral surgeons that mandibular surgery could also improve sleep apnea and through their work and the work of others, techniques have been developed using skeletal surgery to enhance the patency of the airway during sleep. This article describes some of these techniques and their indications, complications, and results.

Humans↗