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Results for “Sleep Apnea, Obstructive”

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PubMed1999

Acute effects of paroxetine on genioglossus activity in obstructive sleep apnea.

STUDY OBJECTIVE: To determine the acute effects of paroxetine on genioglossus activity during NREM sleep. DESIGN: A single dose of Paroxetine (40 mg) or placebo was administered four hours before bedtime on nights separated by one week in a double blind randomized crossover manner. The moving time average of genioglossus muscle activity (EMGgg) expressed as a percentage of maximum was measured using a mouthpiece electrode customized for each subject. The peak inspiratory and tonic values of EMGgg and the corresponding esophageal pressure deflections (DP) during the last three occluded breaths of obstructive apneas during NREM sleep were analyzed. SETTING: NA. PARTICIPANTS: 8 adult men with severe obstructive sleep apnea (OSA). INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Paroxetine increased the peak inspiratory EMGgg (29.8+/-2.4 (SE) versus 24.4+/-2.7 % max, p<0.05) and peak EMGgg/DP ratio (0.78+/-0.12 versus 0.65+/-0.11 % max/cm H2O, p<0.01) but not the tonic EMGgg (11.6+/-0.9 versus 9.8+/-0.7 % max) nor the DP (39.4+/-2.2 versus 38.2+/-2.8 cm H2O). Linear regression analysis of the peak inspiratory EMGgg versus DP relationship showed that paroxetine increased the slope (0.62+/-0.11 versus 0.49+/-0.09 % max/cm H2O, p<0.01). However, the apnea + hypopnea index (paroxetine: 75.2+/-5.5 versus placebo: 73.7+/-6.9 events/hour) did not differ. CONCLUSIONS: Paroxetine augmented peak inspiratory genioglossus activity during NREM sleep but this effect was not sufficient to decrease the frequency of obstructive apnea in this group with severe OSA.

Adult↗

PubMed1996

Obstructive sleep apnea in pregnancy.

Obstructive sleep apnea is a common medical condition characterized by periodic apneas during sleep that produce hypoxia and sleep disruption. Several cases of obstructive sleep apnea in pregnancy have been reported. In the case reported the woman admitted for evaluation and management of preeclampsia was observed experiencing apneic episodes and oxygen desaturation during sleep. Subsequent evaluation confirmed the diagnosis of obstructive sleep apnea. Pregnancy may be complicated by obstructive sleep apnea with potential adverse effects on the mother and fetus. Prompt diagnosis would allow early treatment and may prevent low birth weight and the development of preeclampsia.

Female↗

PubMed1998

[Obstructive sleep apnea and obstructing nasal polyps].

BACKGROUND: Nasal obstruction may be a causative factor in the etiology of obstructive sleep apnea. No studies were found that dealt with the role of nasal polyps in sleep apnea. METHOD: Two male patients, 69 and 44 years old, were examined in our clinic because of nasal polyps occluding the nasal cavity. Their main complaint was nasal breathing obstruction with hyposmia. The clinical history revealed snoring but neither apnea nor daytime sleepiness was reported. Both patients underwent full nocturnal 12-channel polysomnography (PSG) prior to endonasal sinus surgery. PSG and nasal endoscopy were performed 3 months postoperatively. RESULT: The patients showed an increased apnea hypopnea index (AHI) from 21.1 to 76.6 and 7 to 38.8 respectively. Excessive daytime sleepiness (EDS) appeared and relative duration of REM sleep decreased. Nasal CPAP therapy was recommended. CONCLUSION: Although patients felt relieved after surgery since their nasal breathing problem was solved, the results with respect to AHI, EDS, and sleep pattern were unexpected. Perhaps these findings can be explained by surgical alteration of nasal receptors or by a postoperative switch from oral to nasal nocturnal breathing.

Adult↗

PubMed1989

[Polysomnographic diagnosis of obstructive sleep apnea syndrome].

All night polysomnographic studies performed in 149 patients with OSA syndrome revealed marked disturbances of the sleep structure and the disorders of breathing during sleep: obstructive apneas in all patients, hypopneas in 25% and central apneas in 12%. The mean apnea index was 68 +/- 29, the mean percent of sleep time spent in apnea 50 +/- 21%. The typical obstructive apnea duration was 25 +/- 7s in NON REM sleep and 40 +/- 34s in REM sleep. The longest obstructive apnea duration was 48 +/- 24s in NON REM sleep and 71 +/- 42s in REM sleep. During obstructive apneas the typical arterial oxygen saturation was 82 +/- 9% in NON REM sleep and 71 +/- 17% in REM sleep; the lowest arterial oxygen saturation was 73 +/- 14% in NON REM sleep and 62 +/- 21% in REM sleep. Forty six percent of patients had apnea-related cardiac arrhythmias or conduction disturbances.

Adolescent↗

PubMed2006

[New approaches to treatment of bradyarrhythmia in patients with obstructive sleep apnea syndrome].

AIM: To confirm or reject effects of CPAP on sleep asystole and to elucidate possible dependence on correction of respiratory disorders. MATERIAL AND METHODS: Thirteen patients (11 males and 2 females aged 19 to 66 years) with bradyarrhythmia (BA) arising in sleep participated in the study. BA was caused by transient atrioventricular block of the degree II-III in 9 cases (69%), episodes of sinus node arrest and/or synoatrial block in 6 (46%) cases. Two (15%) patients had combination of BA forms. To diagnose sleep respiratory disorders, polysomnography (PSG) was made. Diagnostic criteria of sleep obstructive apnea syndrome (SOAS) were apnea/hypopnea index (AHI) more than 5 episodes for 1 hour sleep. The patients were divided into two groups. Individual selection of therapeutic pressure under PSG control was performed in SOAS patients (the study group). CPAP-therapy was effective in AHI < 5. In the control group (AHI < 5) such selection was made too. CPAP-therapy was effective in the controls if episodes of apnea/hypopnea were not registered through the night of monitoring. RESULTS: In the study group CPAP-therapy was effective. The AHI decreased from 73.2 to 4.4, oxygen saturation of arterial blood increased from 74 to 85%, mean duration of asystoles fell from 5.2 to 1.3 s, pauses with duration more than 2 s disappeared. In the control group sleep apnea/hypopnea episodes disappeared but in asystole CPAP was uneffective. CONCLUSION: CPAP-therapy is effective and pathogenetically sound method of treating patients with nocturnal bradyarrhythmia associated with sleep respiratory disorders.

Adult↗

PubMed2006

Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine.

A significant number of patients with obstructive sleep apnea neither tolerate positive airway pressure (PAP) therapy nor achieve successful outcomes from either upper airway surgeries or use of an oral appliance. The purpose of this paper, therefore, was to systematically evaluate available peer-reviewed data on the effectiveness of adjunctive medical therapies and summarize findings from these studies. A review from 1985 to 2005 of the English literature reveals several practical findings. Weight loss has additional health benefits and should be routinely recommended to most overweight patients. Presently, there are no widely effective pharmacotherapies for individuals with sleep apnea, with the important exceptions of individuals with hypothyroidism or with acromegaly. Treating the underlying medical condition can have pronounced effects on the apnea/hypopnea index. Stimulant therapy leads to a small but statistically significant improvement in objective sleepiness. Nonetheless, residual sleepiness remains a significant health concern. Supplemental oxygen and positional therapy may benefit subsets of patients, but whether these therapies reduce morbidities as PAP therapy does will require rigorous randomized trials. PAP therapy has set the bar high for successful treatment of sleep apnea and its associated morbidities. Nonetheless, we should strive towards the development of universally effective pharmacotherapies for sleep apnea. To accomplish this, we require a greater knowledge of the neurochemical mechanisms underlying sleep apnea, and we must use this infrastructure of knowledge to design well-controlled, adequately powered studies that examine, not only effects on the apnea/hypopnea index, but also the effects of pharmacotherapies on all health related outcomes shown beneficial with PAP therapy.

Benzhydryl Compounds↗

PubMed2005

Pathophysiology of obstructive sleep apnea.

This article explores the physiologic basis and symptoms of obstructive sleep apnea--a general term encompassing central sleep apnea and obstructive sleep apnea. The former is relatively uncommon while the latter is much more common. Episodic collapse and blockage of the upper airway occur during sleep despite continuous respiratory effort. Three types of sleep obstructive breathing--apnea, hypopnea, and airway resistance--are associated with respiratory-related arousals from sleep.

Humans↗

PubMed2004

Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring.

UNLABELLED: The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome. The SONA Pillow is a triangular pillow with space to place your arm under the head while sleeping on the side. Twenty-two patients with nocturnal polysomnogram (NPSG)-proven obstructive sleep apnea syndrome were included in this study; the group included 11 mild, 8 moderate, and 3 severe sleep apnea patients. All patients had a second attended NPSG performed while utilizing this specific inclined pillow. The pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring. In this group, RDI ranged from 5.1 to 35.2 and decreased on the average from 17 events per hour to fewer than 5 events per hour while utilizing the inclined pillow (<0.0001). Also, a statistically significant difference was noted in rapid eye movement (REM) RDI decrement in all patients with mild to moderate sleep apnea (p=0.001) and the increase in SaO2 was also significant (p=0.004). Overall, snoring was decreased or eliminated (p=0.017). CONCLUSION: A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea. Using this pillow also reduces snoring.

Adult↗

PubMed2002

Arterial stiffness increases during obstructive sleep apneas.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) appears to be an independent risk factor for diurnal systemic hypertension, but the specific biologic markers for this association have not been well established. Increased arterial stiffness is an important measure of increased left ventricular load and a predictor of cardiovascular morbidity and may precede the onset of systemic hypertension in humans. However, arterial stiffness has not been measured in association with obstructive apneas in patients with OSA, nor related to systemic blood pressure (BP) activity in this setting. Our objective was to test the hypothesis that arterial stiffness may be utilized as a sensitive measure of arterial vasomotor perturbation during obstructive events in patients with OSA, by demonstrating that (1) arterial stiffness increases acutely in association with obstructive apnea and hypopnea, and that (2) such increased stiffness may occur in the absence of acute BP increase. DESIGN: Prospective, cross-sectional. SETTING: A tertiary-care university-based sleep and ventilatory disorders center. PATIENTS: Forty-four normo- and hypertensive adult patients (11 women, 33 men) with polysomnographically diagnosed moderate to severe OSA. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Beat-to-beat BP was recorded from the radial artery by applanation tonometry during nocturnal polysomnography. Arterial augmentation index (AAI), a measure of arterial stiffness, was calculated as the ratio of augmented systolic BP (SBP) to pulse pressure and expressed as a percentage for the following conditions: awake, the first 10 ("early apnea") and last 10 ("late apnea") cardiac cycles of obstructive events, and the first 15 cardiac cycles following apnea termination ("post apnea"). Mean AAI (+/-SD) for the group was significantly increased during NREM sleep from early apnea to late apnea (12.02 +/- 2.70% vs 13.35 +/- 3.54%, p<0.05, ANOVA). During REM (analyzed in 20 patients), MI again significantly increased from early apnea to late apnea (11.75 +/- 2.81% vs 13.43 +/- 4.97%). Conversely, neither mean SBP nor mean arterial BP was significantly changed from early apnea to late apnea in NREM (SBP 130 +/- 14 mmHg vs 129 +/- 14 mmHg) or REM (SBP 128 +/- 22 mmHg vs 127 +/- 21 mmHg). CONCLUSIONS: Arterial stiffness increases acutely during obstructive apneas in both NREM and REM sleep, in the absence of measurable BP change. These data suggest that arterial stiffness may be a sensitive measure of acute arterial vasomotor perturbation in this setting and may have implications concerning cardiovascular sequelae in patients with OSA.

Adult↗

PubMed1998

Obstructive sleep apnea in women.

Obstructive sleep apnea is a complex disorder characterized by periodic cessation of breathing during sleep. Classically, men exclusively have been evaluated for mode of presentation or associated morbidity that accompanies obstructive sleep apnea; minimal investigation has been undertaken with regard to the female population. Recent literature indicates that obstructive sleep apnea is much more prevalent in women than previously recognized and is increasingly underdiagnosed. We present a review of a large cohort of women with obstructive sleep apnea, with specific attention to presenting symptoms, coexisting medical problems, and surgical efficacy. The study group comprised 58 women with the diagnosis of obstructive sleep apnea; we analyzed the group for presentation, polysomnographic findings, and therapeutic management. We reviewed cases for medical management or surgical intervention. In the surgery group, each patient was evaluated with polysomnography before and after surgery. Significant coexisting medical problems were identified in both groups. We address the success of surgical intervention.

Adult↗

PubMedDate not supplied

Screening for obstructive sleep apnea: an evidence-based analysis.

Sleep disordered breathing is a spectrum of diseases that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA). Obstructive sleep apnea is a common sleep disorder and is estimated to have an incidence of 24% in men and 9% in women. However, many authors believe that up to 93% of women and 82% of men with moderate to severe OSA remain undiagnosed. There is a strong link between sleep disordered breathing and hypertension, believed to be due to sleep fragmentation, intermittent hypoxemia, and increased sympathetic tone, which results in a higher mortality and morbidity rate among these patients. It is therefore desirable to attempt to diagnose all patients with OSA, to institute early treatment intervention, and to prevent development of cardiovascular complications. The gold standard for diagnosing OSA remains the attended overnight level I polysomnogram. However, in view of the limited resources, including limited number of recording beds, high cost, long waiting lists, and labor requirements, many authors have explored the use of clinical predictors or questionnaires that may help to identify higher-risk patients. Screening devices in the form of single or multiple channel monitoring systems have also been introduced and may represent an alternative method to diagnose OSA. The ideal screening device should be cheap, readily accessible, easily used with minimal instructions, have no risk or side effects to the patient, and be safe and accurate. We review a variety of clinical predictive formulae and several screening devices available for the diagnosis of OSA.

Cardiovascular Diseases↗

PubMedDate not supplied

[Changes in the upper airway in patients with sleep obstructive apnea and/or chronic snoring treated with mandibular appliances].

We have analysed the possible modifications in the upper airways (UA) of the lateral cranial teleradiography in 25 adult males with Obstructive Sleep Apnea (OSAS) and/or chronic snoring, with dental and squeletal Class I, treated with advance mandibular appliances (MAD). Results of our study showed a clear increase of the UA in the oropharynx in all the subjects studied. The study of the changes in the UA using the lateral cranial teleradiography in order to evaluate the effectiveness of the MAD can contribute to consider its effectiveness in the cases with OSAS when they are indicated. However it will be needed to contrast these results with polisomnography.

Adult↗

PubMed2006

Hypertension research in sleep apnea.

Obstructive sleep apnea (OSA) is characterized by repetitive partial and total collapse of the upper airway that induces stressful arousals throughout sleep to reestablish breathing. Although estimates vary, prevalence has been reported as high as 20% in the adult population. OSA is common in several chronic diseases, the most common of which is obesity. Evidence is strong that OSA increases the risk of hypertension and both fatal and nonfatal cardiovascular events. Several mechanisms linking OSA to hypertension have been proposed, with increased sympathetic activation implicated as the prime mediator. This review summarizes recent data on the influence of OSA on blood pressure, the effect of standard OSA therapy on improving blood pressure, and the potential of lifestyle modification for further decreasing hypertension risk. Challenges confronting the investigation of blood pressure outcomes in response to treatment in OSA patients are discussed.

Blood Pressure↗

PubMed2005

Lymphocyte activation as a possible measure of atherosclerotic risk in patients with sleep apnea.

Obstructive sleep apnea (OSA), a breathing disorder in sleep characterized by intermittent hypoxia and sleep fragmentation, constitutes an independent risk factor for cardiovascular morbidity. Investigating how this breathing disorder modulates immune responses may facilitate understanding one of the risk factors for atherosclerosis. T cells play a significant role in atherogenesis and plaque development via cytokine production and by directly contributing to vascular injury. Using flow cytometry and chromium release assays, we found that CD4 and CD8 T cells of OSA patients undergo phenotypic and functional changes and acquire cytotoxic capabilities. Thus, a shift in CD4 and CD8 T cells toward type 2 cytokine dominance with increased IL-4 expression was noted. IL-10 expression in T cells was negatively correlated with the severity of OSA, as determined by the apnea-hypopnea index (AHI), whereas TNF-alpha was positively correlated. CD8 T cells of OSA patients expressed a fourfold increase in TNF-alpha and CD40 ligand (CD40L), and exhibited an increased OSA severity-dependent cytotoxicity against endothelial cells. The percentage of CD4(+)CD28(null) and cytotoxicity of CD4 T lymphocytes were also significantly higher in OSA patients than in controls. Nasal continuous positive airway pressure (nCPAP) treatment, which ameliorated the severity of OSA, significantly lowered TNF-alpha and CD40L expression, and decreased cytotoxicity in CD8 T cells. In conclusion, increased cytotoxicity and cytokine imbalance in CD4 and CD8 T cells may be involved in atherogenesis in OSA. Nasal CPAP treatment ameliorates some lymphocyte dysfunctions and thus may moderate some atherogenic pathways.

Adult↗

PubMed2004

Diagnosis of sleep apnea.

Obstructive sleep apnea syndrome (OSAS) is characterized by repeated oropharyngeal occlusions occurring during sleep. The prevalence of moderate OSAS (with an apnea-hypopnea index = or >15/h) is 9% and 4% in male and female, respectively. It is associated with an abnormally high frequency of cardiovascular disease (hypertension, stroke, coronary heart disease) and excessive daytime sleepiness responsible for an increased frequency of work and road accidents. Because the treatment of OSAS provides many benefits to patients and society, it is very important to obtain an early diagnosis. The diagnosis of OSAS is based on the combination of characteristic clinical features plus compatible findings on instrumental tests in which multiple physiologic signals are monitored simultaneously during a night of sleep. A full night polysomnography, conducted by a technologist in a sleep laboratory, is the gold standard for the diagnosis of suspected OSAS, but the capacity for performing polysomnography is limited. On the basis of the high incidence and prevalence of OSAS, of the limited number of sleep laboratories, long waiting times and high costs recommendations have been formulated for the use of unattended portable systems in the assessment of OSAS. The main clinical aspects of of OSAS, the diagnostic approach with full night polysomnography and unattended portable systems, the differential diagnosis and some examples of cardiorespiratory portable monitoring are presented in this paper.

Diagnosis, Differential↗

PubMed2003

[Obstructive sleep apnea: factors important for severe daytime sleepiness].

The aim of the study - to investigate which of the following clinical (age, gender and weight) and polysomnographic data (respiratory disturbance index, duration of slow sleep, mean and maximum desaturation percent, arousal index) the most important for the daytime sleepiness in patients with obstructive sleep apnea syndrome. Obstructive sleep apnea was confirmed by polisomnography (ALICE 4 system). Daytime sleepiness was investigated using Epworth sleepiness scale (ESS). One hundred eight consecutive patients with obstructive sleep apnea were included in the study: 77 men (age 52.4+/-12.84 years) and 31 women (age 59.5+/-9.58 years). Correlation of ESS value and patients' weight was 0.32, p=0.001, ESS and respiratory disturbance index was 0.493, p<0.001, ESS and slow sleep time was -0.39, p<0.001, ESS and arousal index was 0.509, p<0.001, ESS and mean desaturation value was -0.352, p=0.001, and ESS and maximal desaturation value was -0.398, p<0.001. Logistic regression model was used to determine the role of gender, age, obesity degree (according to the body-mass index) and polysomnographic data for severe daytime sleepiness (ESS more than 10). In the univariate analysis male had odds ratio 3.52 (95% CI 1.35-9.16, p=0.01). In case of respiratory disturbance index is more than 34 - odds ratio was 4.25 (95% CI 1.85-9.76, p=0.001), slow sleep less than 38 minutes - odds ratio 3.08 (95% CI 1.38-6.9, p=0.006), mean desaturation less than 90% - odds ratio 4.09 (95% CI 1.68-9.96, p=0.002), maximal desaturation less than 80% 3.06 (95% CI 1.29-7.22, p=0.011), arousal index more than 30 - odds ratio 6.12 (95% CI 2.57-14.78, p<0.001). Only arousal index was statistically significant for the high daytime sleepiness in the multivariate analysis: odds ratio - 6.16 (95% CI 2.6-14.8, p<0.001).

Adult↗

PubMed2000

Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome is common in middle-aged men and may be associated with an increased risk of cardiovascular disease. We investigated the effect of nasal continuous positive airway pressure (CPAP) treatment on levels of soluble cell adhesion molecules-which have been shown to be associated with the development of atherosclerosis-in these patients. SUBJECTS AND METHODS: We studied 23 patients with obstructive sleep apnea syndrome diagnosed by polysomnography who were treated with nasal CPAP. Serum soluble intercellular adhesion molecule-1, E-selectin, and vascular cell adhesion molecule-1 levels were measured before nasal CPAP was started, and after 3 or 4 days (n = 19), 1 month (n = 23), or 6 months (n = 11) of treatment. RESULTS: After 3 to 4 days of nasal CPAP therapy, the mean (+/- SD) soluble E-selectin level had decreased from 89 +/- 44 ng/mL to 69 +/- 28 ng/mL (P = 0.002). After 1 month, the soluble intercellular adhesion molecule-1 level had decreased from 311 +/- 116 ng/mL to 249 +/- 74 ng/mL (P = 0.02). After 6 months, soluble vascular cell adhesion molecule-1 levels had not changed significantly, while the mean soluble intercellular adhesion molecule-1 level (212 +/- 59 ng/mL) had decreased further (P = 0.02). Before treatment, soluble intercellular adhesion molecule-1 levels and the apnea and hypopnea index were correlated (r = 0.43, P = 0.04). CONCLUSIONS: Obstructive sleep apnea and hypopnea have a significant adverse effect on serum soluble cell adhesion molecule-1 levels that may be reduced by nasal CPAP treatment.

Adult↗

PubMedDate not supplied

Long-term results of tracheostomy for severe obstructive sleep apnea syndrome.

Severe obstructive sleep apnea (OSAS) is most often accompanied by metabolic syndrome, obesity, diabetes and coronary disease. In its most severe form, it is a life-threatening condition, requiring active and immediate help. Nasal continuous positive airway pressure (CPAP) is the most efficient nonsurgical treatment for patients with OSAS. However, for anatomical, disease-related and subjective reasons, many patients cannot accept this treatment. A permanent tracheostomy may be one alternative in such patients who, in addition, often suffer from extreme obesity and severe heart disease. In this paper, we describe the long-term follow-up results of 7 patients suffering from OSAS and treated with permanent tracheostomy. All the patients (5 men, 2 women) were diagnosed using the static charge sensitive bed method and night-time oximetry for sleep analysis. The mean body mass index (BMI) of the patients ranged from 34 to 60 and the age from 41 to 64 years. All the patients had severe OSAS and long periods of low oxygen saturation (SaO2) levels. Six patients had a CPAP trial before tracheostomy. Only 2 patients tolerated the trial but, despite the continuous use of CPAP, they were nonresponders. Permanent tracheostomy was done according to normal routine in each patient. After primary healing of 2 days, they used silver cannulae, which also allowed them to speak. The patients were evaluated every year after the tracheostomy. After some practical difficulties including proper maintenance of the cannula, all the patients quickly learned the correct management. In postoperative sleep studies, nadir SaO2 levels had improved significantly, obstructive apneas had disappeared and the subjective quality of life had improved. No marked changes in BMI were found.

Adult↗