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At least 163 records · Page 9Linked to original sources
PubMed1997

Obstructive sleep apnoea syndrome (OSAS) as a complication of carcinoid syndrome treated successfully by hepatic artery embolization.

Obstructive sleep apnoea syndrome (OSAS) appears to be an extremely rare complication of carcinoid syndrome and has not yet been reported in the literature. We describe a 75-year-old patient with a history of bronchial carcinoid who besides typical carcinoid syndrome symptoms developed sleep disturbance and day lethargy caused by massive facial and nasal tissue oedema. Sleep apnoea was confirmed by sleep study. Abdominal ultrasound and computed tomography (CT) scan showed the presence of multiple liver metastases. Because the patient did not respond to octreotide therapy, embolization of the hepatic artery was performed. After this procedure we observed dramatic improvement of the patient's life quality, and rapid disappearance of facial swelling and sleep apnoea symptoms. We conclude that hepatic artery embolization appeared to be an effective method of abolishing obstructive sleep apnoea associated with carcinoid syndrome.

Aged↗
PubMed2005

An adaptive detector of genioglossus EMG reflex using Berkner transform for time latency measurement in OSA pathophysiological studies.

To investigate obstructive sleep apnea syndrome mechanisms, we developed a device to measure the surface electromyogram (EMG) time latency reflex of the genioglossus muscle stimulated by time and amplitude calibrated negative pharyngeal pressure drops. The reflex signals were found to be disturbed by transient signals that generate false alarms. Thus, to reduce false alarm occurrences we designed an adaptive multiscale method. Continuous wavelet transform (CWT) is widely used in biomedical signal event detection processes. The Berkner transform is an approximation of a CWT that is based on a hierarchical scheme similar to discrete wavelet transform. We used the Berkner transform to build a multiscale detector because it offers the possibility of maxima coefficients linkage that leads to good accuracy in reflex onset localization. As a contribution to this novel approach we used a reconstruction formula to develop an adaptive method for scale range determination in our surface EMG reflex detector. Finally, we characterized our detector in terms of accuracy and robustness, first on synthesized signals and second, on signals acquired on apneic patients and healthy subjects. Preliminary results showed a significant difference (p < 0.01) between the two populations regarding the genioglossus muscle mean latency time. These physiological findings may partly explain why the upper airway protective reflex occurring when a negative pressure is applied to the upper airway is ineffective in OSA patients, leading to pharyngeal collapse.

Algorithms↗
PubMed1990

Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA.

Nasal CPAP is presently accepted as first-line therapy for obstructive sleep apnea, but a significant minority of patients do not tolerate nasal CPAP. The purpose of this study was to compare the benefits of nasal CPAP, nasal oxygen (O2), and placebo (air) using patients as their own controls. We studied eight men, aged 33 to 72 (mean 57 years), who had mild obstructive sleep apnea. To be eligible for study, patients had to have an apnea plus hypopnea index greater than or equal to 5, plus one or more of the following: blood pressure greater than 150/95 mm Hg, multiple sleep latency test mean score less than or equal to 10 minutes, or significant nocturnal cardiac ectopy. After a baseline study, patients received a month each of nocturnal O2 at 4 LPM and air at 4 LPM, presented in random order. The third month of treatment consisted of nasal CPAP (range 2.5 to 12.5 cm H2O). Patients underwent evaluation at baseline and after each month of treatment. It was concluded that oxygen was more effective in improving oxygenation and hypopneas than is nasal CPAP. However, oxygen did not reduce apneas or improve daytime hypersomnolence as well as nasal CPAP in patients with mild OSA. Oxygen might be considered as an alternate form of treatment for patients who are not hypersomnolent, or as an adjunct to nasal CPAP.

Adult↗
PubMedDate not supplied

Mandibular-Lingual Repositioning Device--MLRD: preliminary results of 8 patients with obstructive sleep apnea syndrome--OSAS.

Dental devices have been employed in the treatment of snoring and obstructive sleep apnea syndrome (OSAS) of mild to moderate degrees. The authors disclose the preliminary results in 8 patients with clinically diagnosed obstructive sleep apnea polisomnographically confirmed and treated with a dental device (Mandibular-Lingual Repositioning Device--MLRD) developed by one of the authors (RCB). Cephalometrics was performed before usage of MLRD, Epworth Sleepiness Scale (ESS) tests were conducted before and after the MLRD and a questionnaire that subjectively qualified the Overall Subjective Improvement of the patient (OSI) was filled out. The tests were repeated 4 weeks after the application of the MLRD. The average subjective overall improvement was 73.75% and the Epworth Sleepiness Scale was 13.88 (pre-MLRD) and 6.63 (post-MLRD) representing a significant statistical variation (p = 0.05). The authors discuss probable factors involved in the improvement of the subjective measurements of excessive sleepiness.

Body Weight↗
PubMed2000

[Long-term result after UPPP for OSAS by evaluation of nocturnal oxygenation].

The nocturnal oxygenation of 45 patients with OSAS who had UPPP at our hospital were evaluated by pulse oximetry before and after surgery and at the time more than one year after UPPP. "Successful case" is defined as the case that showed more than 50% reduced oxygen desaturation index(ODI) after UPPP. Twenty seven cases including 15 severe cases(ODI > or = 40) have showed continuously successful ODI for more than one year. We could not get good result in 8 cases, which kept high ODI. Four of them are now using dental appliance. We have recognized the recurrence of sleep apnea in 10 cases that once got successful results just after UPPP. Our report strongly suggests the importance of long-term follow-up after surgery.

Circadian Rhythm↗
PubMed2002

[Forest and population at Península de Osa, Costa Rica].

The research is focused on the relationship between population growth and conservation of the forest on the Osa Peninsula. Data of the geo-referenced censuses and information on land-use, derived from satellite images and aerial photography, were integrated into a GIS. We undertook an historical inventory of the changes in the population and the forest coverage, and the key events in the land tenure and economy of the region. Deforestation, reforestation, and fragmentation of the forest during the period 1980-1995 were analyzed. Relationships with the population potential, derived from the 1984 Costa Rican censuses, were identified, and the effects of third variables were controlled such as distances to the roads, rain, distances to the forest frontier, level of protection, etc. Both strong and significant associations between 1984 population potential and the three processes were detected. The probability of deforestation is null in unpopulated areas, 35% in areas with 25-30 potential farmers and to 65% in areas with 50 farmers and over. The probability of reforestation decreases from 100% to 28% and to 18% in these three categories. This kind of relationship persists in the multivariable analysis. An increase of 0.63% in the number of household, results in an increment of 1% in the risk of deforestation (elasticity). The elasticity in the chances of reforestation is -0.37 and 1% in fragmentation of the forest. An evaluation in the risk of deforestation for the period 1995-2005 was done. The most recent population data were used and it identifies several geographic areas with high deforestation risk.

Conservation of Natural Resources↗
PubMed2002

[Our experience with geniopexy in the treatment of OSAS].

OBJECTIVE: We examine geniopexy efficacy in OSAS treatment. STUDY DESIGN: Seven patients, aged 36 to 61 years, were studied. The mean body mass index was normal. RESULTS: Surgical late complications (modified symphysis proprioception) occurred in 4 patients. No patient was improved in sleep problems. Retromaxilly and retromandibuly were found in all patients by cephalometric study. DISCUSSION: Our results are quite different from these described successfully by other centers. Geniopexy do not move maxillar and mandibular skeletal bones, which are retruded in our serie. This explains maybe our bad results. Actually, we propose for this patients maxillo-mandibular advancement.

Adult↗
PubMed1997

[Cephalometric analysis in the patients of TMJ ankylosis with OSAS: Skeletal morphology]

By cephalometric analysis of 18 normal men and 12 men who got TMJ ankylosis with obstructive sleep apnea syndrome(OSAS),the authors reported that there were cephalometric characteristics in the patients:the craniomaxillofacial bones displacement posteriorly and superiorly,and demonstrated that it is key to advance the patients' jaws and enlarge the upper airway space.

Journal Article↗
PubMed1997

[Cephalometric analysis in the patients of TMJ ankylosis with OSAS: Soft tissue morphology]

By cephalometric analysis of 18 normal men and 12 men who got TMJ ankylosis with obstructive sleep apnea syndrome(OSAS),the authors reported that there were cephalometric characteristics in the patients:the posterior airway space(PAS) decreased(P<0.001),and the rate of (TA+SPA)/OPA remarkably increased(P<0.001),so the two parameters are significant for the diagnosis and treatment of the patients.

Journal Article↗
PubMed1991

Reduction of nocturnal diuresis and natriuresis during treatment of obstructive sleep apnea (OSA) with nasal continuous positive air pressure (nCPAP) correlates to cGMP excretion.

In ten patients with severe obstructive sleep apnea (OSA) profound changes in renal function could be demonstrated at night during nCPAP therapy. Natriuresis and diuresis decreased by about 50% while creatinine excretion rate and urinary osmolality did not change. We found parallel changes in the excretion of ANP's second messenger cyclic guanosine monophosphate (cGMP) in a dose-response-related manner to natriuresis respectively diuresis. These data are in agreement with recently demonstrated decrease of nocturnal plasma levels of atrial natriuretic peptide (ANP) during nCPAP therapy in apneic patients. This may be an indicator for an increased cardiac volume load during obstructive apnea. The decrease of diuresis, natriuresis and cGMP excretion demonstrate the beneficial effects of nCPAP treatment on the cardiovascular system. Therefore measurements of cGMP excretion may be a useful parameter to assess the cardiovascular function of apneic patients before and during treatment.

Adult↗
PubMedDate not supplied

Sleep apnoea. Laser therapy for OSAS.

The standard treatments for obstructive sleep apnoea syndrome (OSAS) to date have been postural treatment, which involves the patient sleeping on the stomach; continuous positive airway pressure, using a nasal mask during the night to maintain a positive pressure to prevent collapse of the airway; and surgical uvolopalatopharyngoplasty (UPPP). This is a radical surgical procedure where the soft palate and uvula are excised. There are drawbacks to all of these procedures, either because patients may regard as unacceptable the position they must maintain in bed or the equipment required to be worn or because of surgical complications. This paper describes an alternative method of treatment that has shown good results and is less disturbing to the patient: laser resection of the palatopharynx. This procedure is relatively new to the UK and not as yet widely accepted by many doctors, although it has been performed on the continent for a number of years with documented results.

Humans↗
PubMed1993

Weight loss and OSA and pulmonary function in obesity.

Obstructive sleep apnea (OSA), daytime hypoxemia, and hypercapnia complicate obesity and are alleviated by weight loss. The flow-volume curve is a sensitive screening tool for most patients; the curve can monitor therapeutic efficacy of weight reduction.

Adult↗
PubMed1997

[Cardiorespiratory coupling in obstructive sleep apnea (OSA)].

Even if different mechanisms of various interactions during sleep are known, it is still unsolved by which mechanisms physiological reactions during sleep may start a pathophysiological course. Hypoxia, Hypercapnia and repetitive sympathetic elevations are well known elements in the control of the arterial resistance. Furthermore investigations in patients with sleep apnea showed changes of the pulsatile secretion pattern within the renin-angiotensin-system and the antinatriuretic peptides. These changes were reversible under nasal CPAP-therapy, nycturia as a frequent symptom disappeared. Nevertheless neither hypoxia nor intrathoracic pressure changes nor the arousals can assert the longterm influence on the blood pressure alone, a multifactorial confluence must be assumed. Further it is unclear how a tonic increase of the arterial blood pressure may occur in dependence of the REM- and NREM-sleep cycle changes as well as during daytime. First investigations in sleeping man seem to indicate, that a disturbance of the physiological coupling of breathing and circulation may present a pathogenetic element. Finally it remains open, whether the changes of the cardiorespiratory coupling during sleep of control persons and of patients with OSA are comparable, and whether they may be procured for an explanation of the pathogenesis of arterial and pulmonary hypertension. Further investigations in the control mechanisms of breathing and circulation related to the circuits of chemo- and baroreception, thresholds during wakefulness and sleep may be of decisive help to process the question, to what extent clinical states find a correlate in a disturbed cardiorespiratory coupling and, much more significantly, whether a disturbance in the physiological cardiorespiratory coupling appears already in early states of a disease. Sleep with ist complex physiology as well as with its characteristic pathophysiological phenomenon of sleep related breathing disorders has opened a new interdisciplinary field where tools like the polysomnography and electronic data analysis are used by physiologists, pathophysiologists as well as by physicians.

Adult↗