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PubMed2006

[Perioperative management of severe obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To investigate the perioperative management of severe obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS: Fifty-three patients with severe OSAHS received uvulopalatopharyngoplasty with uvula preservation and radiofrequency tongue base reduction. All the patients were treated with automated continuous positive airway pressure (CPAP) for 3-7 days before operation and automated antibiotic therapy administered in the oropharynx, with 24 h ECG monitoring postoperatively. Polysomnography were carried out before and 6 months after surgery. RESULTS: The preoperative apnea hypopnea index (AHI) and lowest SaO(2) (LSaO(2)) were 58.4-/+5.1/h and 0.650-/+0.059, respectively, which were 15.5-/+3.2/h and 0.864-/+0.064 at 6 months after surgery, respectively, showing significant changes after surgery (P<0.01). Dyspnea occurred in 2 cases after operation, intraoperative bleeding in 1 case, primary bleeding in 2 cases and hypertension crisis in 1 case. CONCLUSION: Severe OSAHS patients are subject to great surgical risk. Application of auto-CPAP before operation can significantly improve the patients' tolerance of surgery and anesthesia, and reduce the surgical risks and preoperative complications.

Adult↗

PubMed2003

Heart rate variability in obstructive sleep apnea: a prospective study and frequency domain analysis.

BACKGROUND: Cyclic variation of the heart rate is observed during apneic spells in obstructive sleep apnea (OSA). We hypothesized that autonomic changes would affect frequency-domain measures of heart rate variability (HRV). METHODS: We studied 20 patients (15 men, 5 women, mean age 47.2 +/- 12.2 years) with suspected OSA undergoing overnight polysomnography, and five patients (4 men, 1 woman, mean age 49.2 +/- 8.6 years) with recently diagnosed sleep apnea undergoing polysomnography while wearing continuous positive airway pressure (CPAP). Holter monitors were applied during sleep studies and data were analyzed in 5-minute blocks over the course of the night. Using spectral analysis, low frequency (LF) and high frequency (HF) powers were calculated for each interval. Overall mean and standard deviation (SD) for LF power, HF power, and the LF:HF ratio were recorded for each patient. Comparisons were made between patients with severe OSA (apnea hypopnea index (AHI) > 30, n = 8), moderate OSA (AHI 1-30, n = 5), without OSA (AHI < 10, n = 7), and patients wearing CPAP (n = 5). RESULTS: Assessment of overnight LF or HF power revealed no significant difference between the four groups. The LF:HF ratio, which represents sympathovagal balance, was higher among those with moderate disease compared to normals and those with severe OSA (both P = 0.037). The standard deviation of the LF:HF ratio was higher among those with moderate disease compared to normals (P = 0.0064) and those with severe OSA (P = 0.0006). OSA patients receiving CPAP behaved like patients with moderate OSA, with increased SD of the LF:HF ratio. CONCLUSIONS: The observed changes in the LF:HF ratio and its SD suggest an increased sympathetic tone and discordance in sympathovagal activity in moderate OSA, which is blunted in severe OSA. CPAP may restore autonomic defects, characteristic of severe OSA, to moderate levels.

Adult↗

PubMedDate not supplied

[Causes of excessive daytime sleepiness in hypercapnic and normocapnic obstructive sleep apnea patients].

UNLABELLED: Daytime sleepiness assessed using the Epworth sleepiness scale (ESS) and polysomnography results were compared in 43 patients with obstructive sleep apnea (OSA) with concomitant chronic hypercapnia (PaCO2 53 +/- 6 mmHg), and in 58 patients with the OSA syndrome accompanied by normocapnia (PaCO2 < or = 45 mmHg, mean 39 +/- 3 mmHg). The OSA patients with hypercapnia were more sleepy than those with normocapnia (ESS 18 +/- 7 vs 15 +/- 7, p < 0.05), but apnea index values were similar in both groups (54 +/- 20 and 49 +/- 17). The following parameters of electrophysiological sleep structure were obtained in the hypercapnic OSA patients: sleep stage 1: 66 +/- 28%, stage 2: 28 +/- 27%, stage 3 + 4: 1 +/- 1%, REM sleep 5 + 6% of the total sleep time, while in the OSA patients with normocapnia: stage 1: 39 +/- 19%, stage 2: 28 +/- 27%, stage 3 + 4: 2 +/- 2%, and REM sleep 6 +/- 7% of the total sleep time. Stage 1 NREM sleep was found to be longer, and stage 2 NREM--shorter in hypercapnic than in normocapnic OSA patients (p < 0.01). CONCLUSION: Increased daytime sleepiness in both groups patients with the OSA syndrome is due to sleep fragmentation as well as to deficiency of deep and paradoxical sleep (almost absent deep sleep and extremely shortened REM sleep). Hypercapnic OSA patients' more marked sleepiness may result from a more pronounced disturbance of their sleep macrostructure, with a considerable predomination of stage I NREM sleep.

Blood Gas Monitoring, Transcutaneous↗

PubMed2006

Angiotensin-converting enzyme inhibitors and obstructive sleep apnea.

Angiotensin-converting enzyme (ACE) inhibitors may induce cough and rhinopharyngeal inflammation. Obstructive sleep apnea (OSA) is characterized by upper airway inflammation. We describe a patient who, during enalapril treatment, developed cough, upper airway symptoms, and diurnal sleepiness, with an increased number of obstructive apnea-hypopnea episodes (apnea-hypopnea index [AHI], 25) during sleep. Her symptoms and AHI improved 1 month after enalapril was discontinued and diuretic therapy (hydrochlorothiazide-spironolactone) was initiated. Similar findings were observed in 4 other patients with OSA who had ACE inhibitor-induced cough. The mean +/- SD AHI was 33.8+/-21.0 during enalapril treatment and 20.0+/-17.0 after withdrawal of this drug (P = .04). Exhaled nitric oxide, a marker of airway inflammation, was increased during enalapril treatment (15.0 +/- 4.3 parts per billion) and decreased after discontinuation of this drug (9.0 +/- 2.6; P = .03). No significant difference in the AHI and exhaled nitric oxide was observed in 4 patients with OSA who did not experience cough, before or after withdrawal of ACE inhibitor treatment. These findings suggest that ACE inhibitor treatment may contribute to OSA by inducing upper airway inflammation.

Aged↗

PubMed1995

The cranial base in obstructive sleep apnea.

PURPOSE: The purpose of this investigation was to determine if there are cranial base differences in adults with obstructive sleep apnea (without identifiable craniofacial abnormalities) when compared with those of adults without airway problems. METHODS: Cephalometric analysis of the cranial base of 52 patients with documented sleep apnea were compared with 96 normal adult patients. Each of the groups was subdivided based on skeletal profiles (Class I, II, III). Cephalometric measurements included cranial base flexure angle and anterior and posterior cranial base lengths. Standard analysis of variance and Students' t test were used to determine level of significance. RESULTS: The cranial base flexure angle in patients with documented sleep apnea was significantly more acute than that found in the nonapnea group. Patients with a skeletal Class III profile had the most acute cranial base flexure whereas those with Class II profiles had the most obtuse angles. This pattern was true for apnea and nonapnea groups. No cranial base length differences could be found in either group. CONCLUSION: The results of this study demonstrate that there were abnormalities of the cranial base in patients with obstructive sleep apnea. Abnormalities of the cranial base seen in "nonsyndrome" obstructive sleep apnea patients are similar to those seen in patients with certain identifiable syndromes. This may suggest that sleep apnea is a reflection of a form of craniofacial syndrome.

Adult↗

PubMed2004

Obstructive sleep apnea and ageing Myotonometry demonstrates changes in the soft palate and tongue while awake.

Upper airway dilator muscles are important in the pathogenesis of obstructive sleep apnea syndrome (OSAS). The present study compares changes of tissue properties between the soft palate and tongue in different age groups of apnea patients and healthy subjects. Materials and methods: OSAS patients diagnosed by polysomnography (15 patients - aged 30-70 years; 10 patients - aged 18-29 years) and healthy volunteers (10 subjects - aged 30-70 years; 10 patients - aged 18-29 years) participated in the study. Computerized endopharyngeal myotonometry was used to measure the biomechanical properties - stiffness and elasticity of the soft palate [M. Veldi, V. Vasar, A. Vain, T. Hion, M. Kull, Computerized endopharyngeal myotonometry (CEM): a new method to evaluate the tissue tone of the soft palate in patients with obstructive sleep apnea syndrome, J. Sleep Res. 9 (2000) 279-284; M. Veldi, V. Vasar, T. Hion, M. Kull, A. Vain, Ageing, soft-palate tone and sleep-related breathing disorders, Clin. Physiol. 21 (2001) 358-364] and lingual tissues [M. Veldi, V. Vasar, T. Hion, A. Vain, M. Kull, Myotonometry demonstrates changes of lingual musculature in obstructive sleep apnea, Eur. Arch. Otorhinolaryngol. 259 (2002) 108-112; M. Veldi, V. Vasar, T. Hion, A. Vain, M. Kull, Myotonometry demonstrates changes of soft palate and genioglossal muscle in obstructive sleep apnea, Sleep Med. 4 (Suppl. 1) (2003) S49] during wakefulness. Results: We did not find any statistical differences in tissue properties between the soft palate and the tongue tissues, either stiffness or elasticity, in young non-snorers and young patients of apnea (P > 0.05). The stiffness of the soft palate of middle-aged apnea patients was increased compared with the tongue (P < 0.001). The elasticity of tongue of middle-aged patients of apnea was decreased compared with the soft palate (P < 0.001). Conclusions: The biomechanical properties of the soft palate and the tongue undergo different changes in the case of snoring and upper airway obstruction and ageing.

Journal Article↗

PubMed1992

Cardiovascular changes associated with obstructive sleep apnea syndrome.

Five men free of lung or cardiovascular diseases and with severe obstructive sleep apnea participated in a study on the impact of sleep states on cardiovascular variables during sleep apneas. A total of 128 obstructive apneas [72 from stage 2 non-rapid-eye-movement (NREM) sleep and 56 from rapid-eye-movement (REM) sleep] were analyzed. Each apnea was comprised of an obstructive period (OP) followed by a hyperventilation period, which was normally associated with an arousal. Heart rate (HR), stroke volume (SV), cardiac output (CO) (determined with an electrical impedance system), radial artery blood pressures (BP), esophageal pressure nadir, and arterial O2 saturation during each OP and hyperventilation period were calculated for NREM and REM sleep. During stage 2 NREM sleep, the lowest HR always occurred during the first third of the OP, and the highest was always seen during the last third. In contrast, during REM sleep the lowest HR was always noted during the last third of the OP. There was an inverse correlation when the percentage of change in HR over the percentage of change in SV during an OP was considered. The HR and SV changes during NREM sleep allowed maintenance of a near-stable CO during OPs. During REM sleep, absence of a compensatory change in SV led to a significant drop in CO. Systolic, diastolic, and mean BP always increased during the studied OPs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Treatment of obstructive sleep apnea syndrome].

The results of the treatment of the obstructive sleep apnea syndrome with tracheostomy (68 patients), continuous positive airway pressure (67 patients) or uvulopalatopharyngoplasty (14 patients) have been presented. The best results were after tracheostomy or during continuous positive airway pressure application, worse results gave uvulopalatopharyngoplasty.

Adult↗

PubMed1981

Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience.

Obstructive sleep apnea syndrome (OSAS), a disabling disorder that leads to life-threatening cardiorespiratory events during sleep, has been treated by tracheostomy. This article reports long-term follow-up data of 50 patients who have undergone this procedure, and the indications for surgery are summarized. Surgery may result in secondary local and general acute and subacute complications, but, on a long-term basis, patients were completely relieved of clinical symptoms, returned to full activity, and adapted normally to social and familial life. Temporary closure of the tracheostomy during sleep led to recurrence of obstructive sleep apnea.

Adolescent↗

PubMed1999

Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure.

In previous analyses of the occurrence of central (CSA) and obstructive sleep apnea (OSA) in patients with congestive heart failure (CHF), only men were studied and risk factors for these disorders were not well characterized. We therefore analyzed risk factors for CSA and OSA in 450 consecutive patients with CHF (382 male, 68 female) referred to our sleep laboratory. Risk factors for CSA were male gender (odds ratio [OR] 3.50; 95% confidence interval [CI], 1.39 to 8.84), atrial fibrillation (OR 4.13; 95% CI 1.53 to 11. 14), age > 60 yr (OR 2.37; 95% CI 1.35 to 4.15), and hypocapnia (PCO(2 )< 38 mm Hg during wakefulness) (OR 4.33; 95% CI 2.50 to 7. 52). Risk factors for OSA differed by gender: in men, only body mass index (BMI) was significantly associated with OSA (OR for a BMI > 35 kg/m(2), 6.10; 95% CI 2.86 to 13.00); whereas, in women, age was the only important risk factor (OR for age > 60 yr, 6.04; 95% CI 1.75 to 20.0). We conclude that historical information, supplemented by a few simple laboratory tests may enable physicians to risk stratify CHF patients for the presence of CSA or OSA, and the need for diagnostic polysomnography for such patients. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure.

Atrial Fibrillation↗

PubMed1998

Four-year-old girl with Goldenhar-sequence and severe obstructive sleep apnea, symptoms, diagnosis and therapy.

Recently sleep related breathing disorders in children have received considerable attention. Unfortunately, cardiorespiratory polygraphy is expensive and time-consuming, and up until now today only a few pediatric hospitals have complete facilities for all-night cardiorespiratory polygraphy. Nevertheless, the prevalence of sleep related breathing disorders in children is higher than has previously been thought. To show the importance of proper diagnosis of sleep related breathing disorders, we report a case of a 4-year-old girl with severe obstructive sleep apnea caused by Goldenhar-sequence (facio-auriculo-vertebral dysplasia). Despite some treatment efforts to correct the aplastic right mandible, the symptoms of obstructive sleep apnea were not immediately recognized and remained untreated. Untreated obstructive sleep apnea led to growth and mental retardation. After polygraphic confirmation of obstructive sleep apnea and appropriate interdisciplinary treatment, the 4-year-old girl made rapid advances in growth and mental development.

Child, Preschool↗

PubMed2005

[Serum leptin concentration and sympathetic activation estimated on the adrenaline and noradrenaline serum concentration in patients with obstructive sleep apnea].

UNLABELLED: Hypertension, coronary heart diseases, obesity, diabetes mellitus are often present in patients with obstructive sleep apnea (OSA). The aim of the study was to estimate the serum leptin concentration and sympathetic activity in patients with obstructive sleep apnea and in control group. INVESTIGATED GROUP: 51 persons (F6, M45) were included into the study. The control group (GK) consisted of 15 snoring person (15 M) in the age x = 44.19 +/- 14.60, study group (GB) consisted of 36 patients with OSA (6F, 30M) in the age 5 1.47 +/- 8.95 years. METHODS: Leptin was measured by RIA methods using the HUMAN LEPTIN RIA KIT (LINCO Research, Inc).: adrenaline and noradrenaline were measured in the serum by HPLC methods (BIO-RAD). RESULTS: The serum concentrations of leptin (ng/mL), adrenaline and noradrenaline (pg/mL) in patients with OSA compared with control group were respectively 15.55 +/- 11.26 : 61.2 +/- 27.4: 523.2 +/- 165.1 vs 10.34+/- 6.86 : 47.7 +/- 27.3: 447.9 +/- 102.6. There was positive significant correlation between leptin concentration and BMI (r = 0,34) and serum leptin and adrenalin concentration (r = 0,34). The serum leptin concentration was significantly higher in the female group. In the male group there was tendency to increase leptin concentration together with degree of OSA grade estimated by AHI and AHI <50 leptin concentration 12.23+/- 6.96 ng/mL vs AHI>50 and leptin concentration 13.35 +/- 3.54ng/ml. CONCLUSIONS: 1. In the group of patients with OSA the serum concentrations of leptin, adrenaline and noradrenaline were higher then in control group. 2. There are positive statistical significant correlation between serum leptin levels and BMI and serum adrenaline concentration in the study group. 3. The serum leptin concentration was higher in the female group. 4. There was tendency to increased leptin concentration in the study group together with degree of OSA grade estimated by AHI. 5. Our results confirm correlation between leptin and sympathetic activity and their influences on obesity and degree of OSA grade in studied group.

Adult↗

PubMed1991

Three-dimensional upper airway computed tomography in obstructive sleep apnea. A prospective study in patients treated by uvulopalatopharyngoplasty.

The success of uvulopalatopharyngoplasty in treating obstructive sleep apnea varies considerably. Some of this variability may be accounted for by differences in the site of upper airway narrowing. To determine whether preoperative awake upper airway and soft tissue volumes predict the response to uvulopalatopharyngoplasty, preoperative awake computed tomograms (CT) of the upper airway were performed on 60 consecutive patients with symptomatic obstructive sleep apnea. Tracings were made from the CT scans of upper airway, tongue, and soft palate. Computer software was used to determine the cross-sectional area and volume of the upper airway, tongue, and soft palate. Patients underwent overnight polysomnograms before and 3 months after uvulopalatopharyngoplasty. Tongue volume was larger (p less than 0.02) and both upper airway to tongue volume (p less than 0.0005) and oropharynx to soft palate volume ratios (p less than 0.01) were smaller in obese patients. A good response to uvulopalatopharyngoplasty as defined by a postoperative apnea index of less than 5 apneas/h or a reduction in apnea index greater than or equal to 50% was seen in 50 patients (83%). Patients who had a good response had a smaller oropharyngeal cross-sectional area (p less than 0.01), a smaller upper airway volume (p less than 0.05), a smaller upper airway to tongue volume ratio (p less than 0.01), and a smaller oropharynx to soft palate volume ratio (p less than 0.05). Obese patients with obstructive sleep apnea have larger tongues and smaller upper airways relative to tongue and soft palate size. Patients with smaller upper airways, particularly relative to tongue and soft palate size, have a good response to uvulopalatopharyngoplasty.

Computer Graphics↗

PubMed1998

Obstructive sleep apnea: oral appliance therapy and severity of condition.

OBJECTIVE: The purpose of this study was to determine whether an oral appliance can effectively treat severe obstructive sleep apnea. DESIGN: The study was conducted at a tertiary care military facility with an accredited sleep laboratory. Results of the treatment of the first 25 patients with obstructive sleep apnea referred for oral appliance therapy were retrospectively analyzed. Each patient received a mandibular advancement appliance and underwent polysomnography 2 weeks after delivery of the appliance. Patients were divided into two groups: those with slight-to-mild obstructive sleep apnea who had a respiratory disturbance index less than 21, and those with more severe disease. Treatment was considered to be successful if the posttreatment respiratory disturbance index was less than 5. RESULTS: Nine (90%) of the 10 patients with slight-to-moderate disease were successfully managed with the oral appliance. Of the 15 patients in the moderate-to-severe group, 9 (60%) were successfully managed. CONCLUSION: Oral appliances have commonly been recommended only for mild obstructive sleep apnea. This study indicates that they may also have a role to play in selected cases in which the condition is more severe. There is a paucity of information about long-term success. This short-term (2-week) study should be followed by others evaluating the effect over longer periods.

Adult↗

PubMed2006

[Noninvasive ventilation for obstructive sleep apnea hypopnea syndrome in children].

OBJECTIVE: To study the efficacy and safety of noninvasive ventilation (NV) for treating children with obstructive sleep apnea. METHODS: Twenty-one children confirmed obstructive sleep apnea hypopnea syndrome (OSAHS) with full-night polysomnography (PSG) or ambulatory screening device were enrolled in the study. The NV treatment was carried out successfully for all cases. Nasal continuous positive airway pressure (nCPAP) compliance data were gathered via clinical follow-up examination, telephone interview, or mailed questionnaire. The statistical analysis was performed with SPSS 11.0 statistical software. Pre- and on-nCPAP parameters were compared with paired t-test. Twenty-one OSAHS children (17 boys, 4 girls) were enrolled into the study. The mean age of the children was 4. 5 years; ranging from 40 days to 11 years. RESULTS: nCPAP pressure was increased from 4 cm H2O by (1 cm H2O = 0.098 kPa) 0.2 cm H2O each time to the treating pressure which was between 4.8 and 16 cm H2O. Before nCPAP treatment, apnea hypopnea index (AHI) was (80.8 +/- 45.1)/h, the lowest pulse oxygen saturation (SPO2) 0.557 +/- 0.135 and SPO2 <0.90 time during sleep (42.9 +/- 31.9) %, which were much worse compared to that with nCPAP treatment, the above parameters decreased to (6.7 +/- 12.4)/h, 0.862 +/- 0.082, (1.1 +/- 2.5) % respectively(P <0.01). CONCLUSIONS: Noninvasive ventilation is a safe and effective treatment for OSAHS children. It is possible to use nCPAP as a short-term treatment or as a long-term treatment at home.

Child↗

PubMed2006

Monitored anesthesia care with a combination of ketamine and dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea.

We present a series of three children with trisomy 21 and obstructive sleep apnea who required sedation during magnetic resonance imaging of the upper airway. In an effort to provide effective sedation with limited effects on cardiovascular and ventilatory function, sedation was provided by a combination of ketamine and dexmedetomidine. Sedation was initiated with a bolus dose of ketamine (1 mg x kg(-1)) and dexmedetomidine (1 microg x kg(-1)) and maintained by a continuous infusion of dexmedetomidine (1 microg x kg(-1) x h(-1)). One patient required a repeat of the bolus doses of ketamine and dexmedetomidine and an increase of the dexmedetomidine infusion to 2 microg x kg(-1) x h(-1). Effective sedation was provided for all three patients. We noted no clinically significant hemodynamic or respiratory effects. No central apnea was noted although there was a brief episode of upper airway obstruction in one patient which responded to repositioning of the airway. All three patients developed some degree of hypercarbia with maximum P(E)(CO2) values of 6.4, 6.9, and 6.8 kPa (49, 53, and 52 mmHg), respectively. To date, this is the first report regarding the use of this combination in pediatric patients. Given the preliminary success noted in our three patients, prospective trials evaluating the efficacy of a dexmedetomidine-ketamine combination appears warranted.

Airway Obstruction↗

PubMed1982

Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome.

In order to determine whether reversible alterations in ventilatory control are found in obstructive sleep apnea syndromes, 5 male patients 31 to 57 yr of age presenting with the syndrome were polygraphically monitored before and several times during the 6 months after tracheostomy. They also had a hypercapnic ventilatory response study before surgery and again 3 months after surgery during the daytime. A dramatic decrease in overall apnea index was seen immediately after surgery, but the number of central apneas and the central apnea index did not reach low values until several months after tracheostomy. Ventilatory response to CO2 improved in all cases after surgery.

Adult↗

PubMed1987

Treatment of obstructive sleep apnea by uvulopalatopharyngoplasty.

Although uvulopalatopharyngoplasty has been proposed as a treatment for obstructive sleep apnea, there is limited objective data concerning its efficacy. We have examined 40 patients with moderate to severe obstructive sleep apnea before and 3 months following uvulopalatopharyngoplasty. A standardized questionnaire and detailed overnight sleep study were performed before and after surgery. In addition, 15 patients were retested 1 year postoperatively. Uvulopalatopharyngoplasty resulted in a statistically significant reduction in symptoms, blood pressure, apnea index, and total apneic time. There was no significant change in patient weight or sleep gas exchange. Seventy-seven percent had a reduction in apnea index of greater than 50%, which is better than other reported series using a more conservative approach. Our more aggressive surgical method will be shown in detail. The 1-year follow-up studies revealed the results were maintained or slightly improved over time.

Humans↗