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 1,099 records · Page 61Linked to original sources

PubMed1994

Cephalometric evaluation of pharynx, soft palate, adenoid tissue, tongue, and hyoid bone following the use of a mandibular repositioning appliance in obstructive sleep apnea patients.

The aim of this study was to evaluate the pharynx, soft palate, adenoid tissue, tongue, and hyoid bone when a mandibular repositioning appliance was used for managing patients with obstructive sleep apnea. Lateral cephalograms of 45 adult obstructive sleep apnea patients from the Lancaster Cleft Palate Clinic were taken without the appliance and some days later with the device in the mouth. This device was used during sleep for improving patients' respiration. Twenty-four cephalometric variables were evaluated. When the appliance was in the mouth, significant alterations (P < .001) were observed in the distances: (a) between anterior and posterior pharyngeal walls at the level of the second and third cervical vertebrae, respectively; (b) between the most superior point of the tongue and the maxillary plane; and (c) between the hyoid bone and the mandibular plane, ramus plane, cervical vertebrae tangent, mandibular symphysis, gonion, and third and fourth cervical vertebrae. The results of this study indicate that significant changes in pharyngeal space, hyoid bone, and tongue positions take place in obstructive sleep apnea patients when a mandibular repositioning device is used.

Adenoids↗

PubMed1998

Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome.

Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening blood pressure in sleep apnea syndrome patients. Data (polysomnography, blood pressure [BP], and urine catecholamines) of 38 consecutive OSA patients (age, 46+/-14.5 years) were analyzed. Stepwise logistic regression analysis revealed that minimal oxygen saturation level (SaO2min) was a significant predictor of both morning and evening norepinephrine levels, and that 37% of morning systolic BP variance could be accounted for by a combination of age and norepinephrine, while 20% of the diastolic BP variance was accounted for by SaO2min alone. In contrast, RDI entered the prediction equation only when minimal oxygen saturation was rejected first. Our results indicate that the degree of nocturnal hypoxia is more closely associated with the level of sympathetic activation and with daytime level of blood pressure than with sleep fragmentation.

Adult↗

PubMed1988

Obstructive sleep apnea--an orthodontic concern.

A description of the obstructive sleep apnea syndrome and its many ramifications, with a case report on the diagnosis and treatment of a patient whose condition was relieved by orthodontics and orthognathic surgery.

Activator Appliances↗

PubMed2002

Endoscopic classification of pharyngeal stenosis pattern in obstructive sleep apnea hypopnea syndrome.

Twenty-one patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) were classified into three categories according to their pharyngeal stenosis patterns during sleep, as determined from endoscopic findings: (i) a falling type (n = 6); (ii) an all-round type (n = 11); and (iii) a bilateral type (n = 4). In all patients with the bilateral type, the palatine tonsils were hypertrophied, and the apnea-hypopnea indexes (AHI) were improved markedly by surgery. Conversely, the AHI of patients with the falling and all-round types were reduced by a smaller percentage. Surgical therapy is only to be recommended to patients with OSAHS whose pharynx is bilaterally stenotic.

Constriction, Pathologic↗

PubMed1997

Population and occupational screening for obstructive sleep apnea: are we there yet?

Several features of obstructive sleep apnea (OSA) suggest that it may be an appropriate disease for screening programs for general populations and more specific high-risk groups. Preliminary data suggest that OSA represents an important health problem in terms of high prevalence, increased levels of morbidity and mortality, and increased public safety risk. Furthermore, the chronicity of the disease and the relatively low levels of recognition of the disorder in the medical community suggest a potential for lead-time gains for screening programs. Specific groups that might be considered for screening programs include commercial vehicle operators, hazardous duty personnel, and certain groups of medical patients. The purpose of this clinical commentary is to consider the issues of population and specific group screening for OSA by reviewing the general principles of screening for chronic disease and then applying these principles specifically in the case of OSA. More extensive outcomes data relating levels of severity of the disorder to its potential adverse outcomes are needed and will assist in tailoring appropriate screening programs and determining the cost-effectiveness of screening various populations.

Chronic Disease↗

PubMed1999

Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung disease.

It is controversial whether obstructive sleep apnea (OSA) causes pulmonary hypertension (PH) in the absence of hypoxemic lung disease. To investigate this further we measured awake pulmonary hemodynamics, pulmonary gas exchange, and small airways function in 32 patients with OSA (apnea- hypopnea index, mean +/- SE, 46.2 +/- 3. 9/h) who had normal screening lung function. Pulmonary artery pressure (Ppa) and cardiac output were measured by Doppler echocardiography at three levels of inspired oxygen (FIO2 0.50, 0.21, and 0.11) and during incremental increases in pulmonary blood flow (10, 20, and 30 microgram/kg/min dobutamine infusions) while breathing 50% oxygen. Eleven patients had PH (mean Ppa >/= 20 mm Hg, Group I). They did not differ from patients without PH (Group II) in lung function, severity of sleep-disordered breathing, age, or body mass. Compared with Group II, Group I patients had increased small airways closure during tidal breathing (FRC-closing capacity: Group I, -0.16 +/- 0.11; Group II, 0.27 +/- 0.09 L; p < 0.05), more ventilation-perfusion inequality (AaPO2: 23.8 +/- 2.8; 19.8 +/- 1.4 mm Hg; p = 0.08), a greater pulmonary artery pressor response to hypoxia (DeltaPpa FIO2, 0.50 to 0.11: 16.4 +/- 1.93; 6.4 +/- 0.77 mm Hg; p < 0.05) and a marked rise in Ppa during increased pulmonary blood flow. We conclude that PH may develop in some patients with OSA without lung disease and that it is associated with small airways closure during tidal breathing and heightened pulmonary pressor responses to hypoxia and during increased pulmonary blood flow. Such changes are consistent with remodeling of the pulmonary vascular bed in affected patients with OSA, seemingly unrelated to severity of sleep-disordered breathing.

Blood Pressure↗

PubMed1993

Mandible enclosure of upper airway and weight in obstructive sleep apnea.

Although anatomic lesions and obesity can produce obstructive sleep apnea (OSA), most subjects with OSA have no recognizable anatomic lesion. We hypothesized that the occurrence of OSA is related to the size of the region enclosed by the mandible and the degree of obesity. We studied 30 subjects with a range of OSA and obesity with magnetic resonance imaging (MRI). MRI was performed with T-1 weighted sequences. Nocturnal polysomnography was performed in all subjects. Univariate regression analysis indicated there was a significant correlation between the number of apneas and hypopneas per hour of sleep (AH/h) and (1) the area enclosed by the mandible ramus (AMR1) (r = 0.48, p < 0.01) and (2) the distance from the teeth to the posterior mandible ramus (r = 0.39, p < 0.05). Stepwise multiple regression analysis indicated that weight, AMR1, and height explained 69% of the variance of AH/h (r2 = 0.69). We conclude that the occurrence of OSA in these subjects is related to the size of the region enclosed by the mandible as well as to their weight.

Adult↗

PubMed1994

Uvulopalatopharyngoplasty and inferior sagittal mandibular osteotomy with genioglossus advancement for treatment of obstructive sleep apnea.

We prospectively studied nine patients with the obstructive sleep apnea (OSA) syndrome with polysomnography before and after combined (seven simultaneous and two sequential) uvulopalatopharyngoplasty and inferior sagittal mandibular osteotomy with genioglossus advancement as treatment for OSA. All patients had failed to tolerate nasal continuous positive airway pressure and had a respiratory disturbance index (RDI) > or = 20. All patients were found to have disproportionate pharyngeal anatomy with airway narrowing by cephalometrograms and/or fiberoptic nasopharyngoscopy. Following surgery there were significant reductions in the average numbers of respiratory events and significant improvements in average oxygen saturation measurements. When RDIs < or = 5 and < or = 10 are chosen as objective success benchmarks, the success rates are 67 percent (6/9) and 78 percent (7/9), respectively.

Adult↗

PubMed1996

Posture-dependent change of tracheal sounds at standardized flows in patients with obstructive sleep apnea.

BACKGROUND: The ability of awake subjects with obstructive sleep apnea (OSA) to dilate their pharynx during inspiration may be defective. Airflow through a relatively more narrow pharyngeal passage should lead to increased flow turbulence and hence to louder respiratory sounds. We therefore studied the increase of tracheal sound intensity (TSI) in the supine position as an indicator of abnormal pharyngeal dynamics in patients with documented OSA. SUBJECTS AND METHODS: Sound was recorded with a contact sensor at the suprasternal notch in 7 patients with OSA (age, 52 +/- 8 years; body mass index, 29.0 +/- 3; apnea-hypopnea index, 58 +/- 17; means +/- SD), and in 8 control subjects, including obese subjects and snorers (age, 39 +/- 8 years; body mass index, 28.6 +/- 4). Subjects breathed through a pneumotachograph and aimed at target flows of 1.5 to 2 L/s, first sitting, then supine. Flow and sound signals were digitized at a 10-KHz rate. Fourier analysis was applied to sounds within the target flow range and average power spectra were obtained. Spectral power was calculated for frequency bands 0.2 to 1, 1 to 2, and 2 to 3 KHz. RESULTS: In the supine position, OSA patients had a significantly greater increase of inspiratory TSI than control subjects: 7.5 +/- 1.2 dB vs 1.7 +/- 3.4 dB (p < 0.001); 6.6 +/- 1.7 dB vs 1.3 +/- 3.9 dB (p < 0.005); and 12.2 +/- 3.2 dB vs 5.6 +/- 3.1 dB (p < 0.001) at low, medium, and high frequencies, respectively. Expiratory TSI also increased in supine subjects, but the change was significantly greater in OSA subjects only at high frequencies. These findings confirm our earlier observations that did not include obese subjects or snorers among control subjects. SUMMARY: Measuring posture effects on tracheal sounds is noninvasive and requires little time and effort. The greater increase of inspiratory TSI in supine OSA patients compared to subjects without OSA suggests a potential value for daytime acoustic screening.

Adult↗

PubMed1988

Determinants of daytime sleepiness in obstructive sleep apnea.

To investigate determinants of daytime sleepiness in obstructive sleep apnea syndrome (OSAS), we studied 100 unselected OSAS patients by nocturnal polygraphic recording and the Multiple Sleep Latency Test (MSLT). Data obtained were submitted to three types of analysis. Respiratory disturbance index, oxygen saturation indices, body mass index, and total nocturnal sleep time did not significantly correlate with daytime sleepiness, as measured by the MSLT. Analysis of subgroups based on weight and degree of alertness also showed a nonsignificant correlation with daytime sleepiness. The best predictor of the excessive daytime sleepiness (EDS) frequently found in OSAS patients was the nocturnal polygraphic recording of the sleep disturbances and sleep structure anomalies that reflect the brain's overall dysfunction in OSAS. Understanding why an electroencephalogram arousal response occurs during sleep in association with abnormal breathing and how this response can become blunted may help us to better predict the development of EDS.

Body Weight↗

PubMed1999

[Efficacy of demand of positive airway pressure therapy for treating obstructive sleep apnea syndrome].

UNLABELLED: The treatment of choice for obstructive sleep apnea syndrome (OSAS) is nasal continuous positive airway pressure (nCPAP). The precise level of pressure is adjusted by polysomnography. Devices to deliver pressure on demand have recently been designed to adapt the level of pressure to each respiratory cycle according to flow modification. OBJECTIVE: To compare the manual titering nCPAP system with that of demand continuous positive airway pressure (nDPAP) in patients diagnosed of OSAS. PATIENTS AND METHODS: Eighteen consecutive patients whose OSAS was diagnosed by conventional polysomnography were enrolled with apnea-hypopnea indexes over 10/hour (AHI > 10) and clinical symptoms of daytime drowsiness and/or cardiovascular risk factors. Titering polysomnographs were performed for all patients with nCPAP and with nDPAP and analyzed blindly. RESULTS: No significant differences between nCPAP and nDPAP were found in neurophysiological variables analyzed (sleep architecture, arousals, sleep efficiency) or in respiratory variables (AHI, oxygen saturation) with the exception of minimum SatO2 during REM sleep, which was significantly better with nCPAP (p < 0.03). Mean end pressure with nCPAP and mean pressure with nDPAP were similar; it is also worth noting that mean pressure was lower with nDPAP than with titered nCPAP pressure a mean 65.7 +/- 22% of the time. CONCLUSION: Automatic nDPAP is as effective as titered nCPAP for treating patients with OSAS.

Adult↗

PubMed1992

Autonomic stress tests in obstructive sleep apnea syndrome and snoring.

Apneic events in the obstructive sleep apnea syndrome (OSAS) are associated with cardiovascular responses mediated through the autonomic nervous system. We examined autonomic cardiovascular responses in 33 patients (median age = 50 years, range = 20-72 years) undergoing polysomnography for suspected OSAS. We examined these responses in the evening and at arousal in the morning. Tests consisted of heart rate responses to Valsalva maneuver, deep breathing and change from lying down to standing. In addition, systolic blood pressure (BP) response to standing and diastolic BP response to handgrip were studied. Each abnormal test scored +1 and each marginal result +0.5. Autonomic nervous system (ANS) test results were scored as abnormal if a subject had a score > 1 which included at least one abnormal test. The total scores for evening and morning tests combined showed 11/24 sets of scores > 1 in 12 severe OSAS patients [median RDI (apnea+hypopnea per hour slept) = 44 (range = 31-74)] compared to 3/22 in non-OSAS (p = 0.04). The response to deep breathing, expressed as an expiratory to inspiratory ratio (E/I), was the test most often found abnormal. A significant difference between normal abnormal autonomic stress test (AST) groups was observed in the evening and the morning as regards cumulative time spent under 90% SaO2 and minimal SaO2. We conclude that abnormal autonomic stress responses are common in OSAS and are probably a secondary defect.

Adult↗

PubMedDate not supplied

Need for multi-diagnostic approaches before considering treatment in obstructive sleep apnea.

To choose an appropriate therapeutic treatment for obstructive sleep apnea syndrome (OSAS) depends on accurately diagnosing the underlying problems that lead to the disease. Evaluating local anatomical problems is critical. New techniques, such as imaging, permit us to do this more effectively. Appreciating the involvement of the central nervous system (CNS) in a fully developed syndrome is also important. Abnormal stimulation of the autonomic nervous system can be evaluated easily with a Holter ECG. Recognizing that OSAS is a multi-faceted problem whose various symptoms interact and aggravate one another helps to explain why treatments may not be immediately effective.

Airway Resistance↗

PubMedDate not supplied

Palatopharyngoplasty and obstructive sleep apnea syndrome.

Thirty-five patients diagnosed with obstructive sleep apnea syndrome (OSAS) underwent palatopharyngoplasty (PPP) after an objective evaluation. They were all monitored polygraphically after surgery. The group's postsurgical results were positive, with significant improvement in the apnea-hypopnea index (A + H index) and oxygen desaturation. However, patients with hypopharyngeal or mandibular problems or massive obesity had poor postsurgical results. As no subject has been followed for longer than two years, the long-term prognosis for this surgical approach is unknown.

Follow-Up Studies↗

PubMed1993

[Continuous noninvasive blood pressure measurement in obstructive sleep apnea syndrome without and with CPAP therapy].

The obstructive sleep apnea syndrome is accompanied with episodic increases of systemic blood pressure (B.P.) and possibly with persistent hypertension. to find out the influence of nCPAP therapy on systemic blood pressure in sleep apnea patients, 10 patients (apnea index 9-51/h) were monitored by means of continuous noninvasive blood pressure measurement during polygraphy, circulation was examined before and 2-7 days after CPAP therapy. Every 30 minutes a 2-minute period of the systolic and diastolic B.P. was visually averaged and from these data the mean pressure of 7 hours nocturnal sleep was calculated. The mean systolic pressure before therapy was 139 +/- 32 mmHg and decreased to 122 +/- 14 mmHg under nCPAP (significant), the mean diastolic pressure before therapy was 74 +/- 17 mmHg and decreased to 64 +/- 8 mmHg under nCPAP. The maximal B.P. during the 7-hour measurement decreased from 155 +/- 27 mmHg to 137 +/- 20 mmHg under nCPAP.

Adult↗

PubMed1995

[Subjective well-being in obstructive sleep apnea syndrome before and after nCPAP therapy].

18 obstructive sleep apnea patients (mean time of nCPAP-treatment: 412 nights) were asked about their subjective well-being before therapy and under treatment with nCPAP. Also their wifes were asked to give an outer appraisal. Both groups reported a clear reduction of general well-being before therapy and significant improvements in excessive daytime sleepiness, depression, physical and psychical complaints and the rate of patients accidents under nCPAP. In context with a good compliance of therapy these results indicate that the nCPAP-treatment was subjectively experienced as effective.

Adult↗

PubMed1995

Palatal muscle electromyogram activity in obstructive sleep apnea.

Eight subjects (5 men, 3 women, ages 27 to 55) with obstructive sleep apnea syndrome (OSAS) were studied to quantify and compare electromyographic (EMG) activity of levator veli palatini (LVP) and palatoglossus (PG), two velopharyngeal muscles, and genioglossus (GG) during obstructive apnea cycles in non-rapid eye movement (NREM) sleep. EMG activity of three successive preapneic breaths, first and last apneic efforts, and three successive postapneic breaths was quantified for each muscle as peak phasic inspiratory EMG normalized as percent activity of the last preapneic breath. In all subjects, apnea onset coincided with simultaneous inspiratory EMG nadir of all three muscles (LVP = 63 +/- 40%, PG = 74 +/- 53%. GG = 83 +/- 48%. mean +/- SD activity of last preapneic breath). Apnea resolution did not occur until inspiratory EMG of all three muscles simultaneously reached maximal activity, at levels significantly greater than preapneic activity as well as activity of the last preapneic effort (LVP = 215 +/- 205%, PG = 227 +/- 240+, GG = 235 +/- 202%, mean +/- SD activity of last preapneic breath, p < 0.05, Fisher's partial least-squares difference [PLSD] test for each muscle). The presence or absence of electroencephalographic arousal at apnea resolution did not influence these patterns of EMG activity. Inspiratory recruitment of velopharyngeal as well as oropharyngeal muscles appears to be associated with upper airway patency during sleep in patients with OSAS.

Adult↗

PubMed2005

An association between oxygen desaturation and D-dimer in patients with obstructive sleep apnea syndrome.

D-dimer, a degradation product of fibrin, is being increasingly used as a marker and prognostic factor in various thrombotic diseases. Previous reports have shown that obstructive sleep apnea is associated with platelet activation and hypercoagulability. The aim of the study was to assess the potential role of the plasma D-dimer test in patients with obstructive sleep apnea. We designed a prospective group comparison study in a tertiary-care, university-affiliated medical center. One hundred and three patients of mean age 57 years (range 50-76 years) with symptoms suggestive of obstructive sleep apnea were included. Polysomnography was performed in all cases, and blood was collected for plasma D-dimer measurement by MiniQuant turbidmetric assay. The demographic and polysomnograph data were compared between patients with normal and high (> 250 ng/ml) D-dimer levels. The group with higher D-dimer values had lower mean minimal oxygen saturation (72.1 +/- 16.4 vs. 81.7 +/- 11.6%, p = 0.008) and a longer mean period of oxygen saturation below 90% (84.1 +/- 86.2 vs. 38.5 +/- 70.8 minutes, p = 0.032). There was no correlation of respiratory disturbance index and sleep architecture with D-dimer values. We concluded that sleep apnea syndrome is associated with fibrinolytic activity. Oxygen desaturation seems to be one of the mediatory factors in the putative connection between obstructive sleep apnea and hypercoagulability state.

Aged↗