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Sample records for apnea obstructiva del

  1. Cirugía como tratamiento de la apnea obstructiva del sueño

    Directory of Open Access Journals (Sweden)

    P. M. Baptista

    Full Text Available El presión continua positiva en la vía aérea (CPAP nasal se considera como el tratamiento ideal para el tratamiento de Síndrome Apnea Obstructiva del Sueño (SAOS, debido a que es conservador y reversible, sin embargo, existe una pobre tasa de adherencia en su utilización a largo plazo, La cirugía podrá complementar de una manera importante aquellos casos en las cuales el CPAP no es tolerado. La cirugía para el SAOS se deberá realizar tomando en cuenta el grado de apnea obstructiva, el lugar de mayor obstrucción y la experiencia del equipo médico. Mientras más severo sea el SAOS se podrá ser más agresivo con la terapia quirúrgica. El lugar de obstrucción no deberá ser considerado de una manera simplista en la que se define un solo lugar de obstrucción, sino como una alteración general de la vía aérea donde el cirujano deberá actuar para remodelarlo de una manera efectiva. Se describen en el trabajo diversos tipos de cirugía y su eficacia en el SAOS de acuerdo al área anatómica comprometido (nariz, cirugía de adenoides, amígdalas, paladar blando, base de lengua, hipofaringe y el avance bimaxilar. La evidencia científica demuestra en los actuales momentos que la cirugía de reconstrucción de la vía aérea compite de una manera efectiva con el tratamiento médico.

  2. Síndrome de Apnea Obstructiva del Sueño como factor de riesgo para otras enfermedades

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    Héctor Guzmán Duchén

    2011-06-01

    Full Text Available El síndrome de apnea obstructiva del sueño es una enfermedad caracterizada por ciclos de apneas e hipopneas y microdespertares frecuentes durante la noche y así mismo hipersomnolencia diurna. Esta enfermedad conlleva altas incidencias en accidentes de tránsito como en el campo laboral, últimos estudios de esta patología seacompaña de complicaciones y desarrollo de diversas enfermedades tanto cardiovasculares como metabólicas y oftalmológicas entre otras.

  3. Apnea obstructiva del sueño: experiencia en el Hospital San Juan de Dios

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    Alejandra Flores-Badilla

    2014-03-01

    Full Text Available Objetivos: determinar las características epidemiológicas de los pacientes estudiados por apnea obstructiva del sueño (AOS en el Hospital San Juan de Dios, Costa Rica, de enero de 2005 a diciembre de 2011. Métodos: se trata de un estudio descriptivo-retrospectivo de los pacientes con el cuadro clínico de AOS, atendidos en Consulta Externa de Neumología del Hospital San Juan de Dios, de enero de 2005 a diciembre de 2011. La información se obtuvo de los expedientes médicos, por medio de una ficha de recolección de datos. Con base en los resultados se realizó el análisis estadístico. Resultados: la población total fue de 182 pacientes, de los cuales al 88% se le diagnosticó el síndrome en estudio. El género femenino predominó en la AOS de grado leve a moderado, y el masculino, en el severo. El aumento de la edad y el índice de masa corporal correlacionaron con la mayor probabilidad del diagnóstico de AOS (p < 0.01. Respecto a la comorbilidades presentes, hubo mayor porcentaje de hipertensión arterial (55,5% y la diabetes mellitus (40.3%, independientemente del grado de severidad. Los pacientes con grado severo tuvieron mayor índice en la escala de somnolencia diurna de Epworth. No se encontró asociación significativa entre AOS y enfermedad pulmonar obstructiva crónica, infarto agudo al miocardio, accidente vascular cerebral y arritmia. Conclusiones: este es el primer estudio que se realiza en el país sobre esta patología. La polisomnografía fue un método diagnóstico eficaz en nuestro medio y debería implementarse en otros hospitales de la seguridad social, con el fin de determinar la prevalencia del problema y ofrecer a los pacientes la terapéutica de presión positiva continua de la vía aérea. Los datos epidemiológicos obtenidos de la población, no distan de lo reportado a nivel internacional en lo que respecta a factores de riesgo y enfermedades concomitantes.

  4. Cirugía como tratamiento de la apnea obstructiva del sueño Surgery for obstructive sleep apnea

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    P. M. Baptista

    2007-01-01

    Full Text Available El presión continua positiva en la vía aérea (CPAP nasal se considera como el tratamiento ideal para el tratamiento de Síndrome Apnea Obstructiva del Sueño (SAOS, debido a que es conservador y reversible, sin embargo, existe una pobre tasa de adherencia en su utilización a largo plazo, La cirugía podrá complementar de una manera importante aquellos casos en las cuales el CPAP no es tolerado. La cirugía para el SAOS se deberá realizar tomando en cuenta el grado de apnea obstructiva, el lugar de mayor obstrucción y la experiencia del equipo médico. Mientras más severo sea el SAOS se podrá ser más agresivo con la terapia quirúrgica. El lugar de obstrucción no deberá ser considerado de una manera simplista en la que se define un solo lugar de obstrucción, sino como una alteración general de la vía aérea donde el cirujano deberá actuar para remodelarlo de una manera efectiva. Se describen en el trabajo diversos tipos de cirugía y su eficacia en el SAOS de acuerdo al área anatómica comprometido (nariz, cirugía de adenoides, amígdalas, paladar blando, base de lengua, hipofaringe y el avance bimaxilar. La evidencia científica demuestra en los actuales momentos que la cirugía de reconstrucción de la vía aérea compite de una manera efectiva con el tratamiento médico.Nasal continuous positive airway pressure (CPAP is considered an ideal treatment for treating Obstructive Sleep Apnea Syndrome (OSAS, due to its being conservative and reversible; however, there is a poor rate of adherence in its long-term use. Surgery can significantly complement those cases where CPAP is not tolerated. Surgery for OSAS must be carried out taking into account the degree of obstructive apnea, the place of greatest obstruction and the experience of the medical team. The more severe the OSAS, the more aggressive the surgical therapy can be. The place of obstruction must not be considered in a simplistic way, in which only one place of

  5. Hipertensión arterial resistente y síndrome de apneas-hipopneas obstructivas del sueño

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    Martínez Ocaña, Juan Carlos

    2016-01-01

    El 60-83% de los pacientes con hipertensión arterial resistente (HTAR) presentan un síndrome de apneas-hipopneas obstructivas del sueño (SAHOS). OBJETIVOS: El objetivo principal del trabajo fue estudiar en pacientes con HTAR y SAHOS el efecto del tratamiento con presión positiva continua en la vía aérea (CPAP) sobre la presión arterial (PA) medida mediante monitorización ambulatoria de 24 horas (MAPA). Además se estudiaron los efectos de la CPAP sobre la rigidez arterial, la función endo...

  6. Anestesia e apnéia obstrutiva do sono Anestesia y apnea obstructiva del sueño Anesthesia and obstructive sleep apnea

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    Charles Machado

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A manutenção da permeabilidade das vias aéreas superiores (VAS é fundamental para anestesia e para pacientes com apnéia obstrutiva do sono (AOS. Durante ambos os estados ocorre uma redução do tônus da musculatura faríngea. Identificar pacientes com AOS é importante a fim de prevenir riscos durante o período perioperatório. O objetivo deste trabalho foi apresentar uma revisão sobre a relação entre AOS e anestesia, levando em conta o planejamento da anestesia, enfatizando a importância da identificação da síndrome da apnéia e hipopnéia obstrutiva do sono (SAHOS. CONTEÚDO: A SAHOS ocorre principalmente por colapso total ou parcial da faringe, podendo levar a diminuição na saturação da oxiemoglobina e complicações cardiovasculares. Os principais fatores predisponentes são sexo masculino, obesidade, características crânio e orofaciais. Seu diagnóstico é clínico e polissonográfico, o que também quantifica a gravidade da AOS. Os pacientes com SAHOS especialmente acentuada podem apresentar problemas durante a intubação traqueal e sedação, estando alguns mais susceptíveis à ocorrência de hipóxia e hipercapnia, mesmo na vigência de pulmões normais. Os autores discutem a importância do diagnóstico prévio e tratamento da SAHOS na tentativa de reduzir o risco anestésico. CONCLUSÕES: O diagnóstico e tratamento prévio da SAHOS com pressão positiva contínua nas VAS podem reduzir complicações perioperatórias e influenciar na conduta anestésica e na recuperação pós-anestésica.JUSTIFICATIVA Y OBJETIVOS: El mantenimiento de la permeabilidad de las vías aéreas superiores (VAS es fundamental para la anestesia y para pacientes con apnea obstructiva del sueño (AOS. Durante los de los estados, ocurre una reducción del tono de la musculatura faríngea. Identificar pacientes con AOS es importante para prevenir riesgos durante el período perioperatorio. El objetivo de este

  7. Cirugía para el manejo del síndrome de apnea e hipopnea obstructiva del sueño y de la roncopatía: Revisión de 71 casos clínicos

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    Ojeda S,Alejandro; Pardo J,Javiera; Arroyo D,Michelle; Muñoz S,Daniel; Stott C,Carlos

    2011-01-01

    Introducción: El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) es una patología altamente prevalente y se asocia a importante comorbilidad cardiovascular. Su etiología es multifactorial. Dentro de las opciones terapéuticas, la cirugía de la vía aérea superior es una alternativa efectiva en casos seleccionados. Objetivo: Describir la experiencia del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile en cirugía de pacientes con diagnóstico de SAHOS. M...

  8. Guías prácticas de diagnóstico y tratamiento del síndrome de apneas e hipopneas obstructivas del sueño

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    Facundo Nogueira; Carlos Nigro; Hugo Cambursano; Eduardo Borsini; Julio Silio; Jorge Ávila

    2013-01-01

    El síndrome de apneas e hipopneas obstructivas del sueño (SAHOS) constituye una de las afecciones respiratorias crónicas de mayor relevancia, dada su elevada prevalencia en la población general y sus consecuencias clínicas. En 2001 la Asociación Argentina de Medicina Respiratoria (AAMR) publicó el Primer Consenso Argentino de Trastornos Respiratorios Vinculados al Sueño. Desde entonces se ha generado una gran cantidad de evidencia científica sobre esta enfermedad. Por tal motivo, la Sección S...

  9. Hemodinámica cerebral en el síndrome de apnea obstructiva del sueño.

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    Coloma Navarro, Ramón

    2014-01-01

    El síndrome de apnea/hiponea del sueño (SAHS) consiste en la presencia de obstrucciones completas (apneas) o incompletas (hipopneas) repetidas de la vía aérea superior (VAS) que aparecen durante el sueño y pueden acompañarse de caídas transitorias en la saturación de oxígeno (O2) y de microdespertares en el electroencefalograma (EEG). Aunque todavía quedan muchas incógnitas por resolver, existe hoy en día una base epidemiológica y fisiopatólogica sólida que relaciona el SAHS con un riesgo aum...

  10. FRECUENCIA DE PRESENTACIÓN DEL SÍNDROME DE PIERNAS INQUIETAS Y SU ASOCIACIÓN CON APNEA OBSTRUCTIVA DEL SUEÑO Restless legs syndrome, frequency and its association with obstructive sleep apnea syndrome

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    Édgar Osuna Suárez

    2009-01-01

    Full Text Available Antecedentes. La prevalencia del síndrome de piernas inquietas oscila entre el 2,5 y el 29 por ciento. En nuestro conocimiento no hay estudios que describan la correlación entre el síndrome de piernas inquietas (SPI y el de síndrome de apnea obstructiva del sueño (SAOS. Objetivos. Determinar la frecuencia de presentación del SPI en un grupo de pacientes adultos a quienes se les realizó un estudio polisomnográfico (PSG por condiciones diferentes al SPI, en la Clínica de Sueño del Hospital Universitario Fundación Santa Fe de Bogotá, en el período entre el 1º de enero y el 31 de diciembre del 2006, y determinar su correlación con la severidad del SAOS. Material y métodos. Se hizo un estudio de prevalencia analítica. Los pacientes llenaron un cuestionario en el que se incluyen preguntas relacionadas con los criterios diagnósticos del SPI y su frecuencia de presentación. Los pacientes fueron agrupados por género, edad e índice de masa corporal. Se evaluó la latencia para el inicio del sueño y se agruparon según la severidad del SAOS. Resultados. Se obtuvo una muestra de 301 pacientes, 72 por ciento hombres, de los cuales 43 cumplieron con los criterios diagnósticos para SPI. Se encontró una prevalencia global del 14,3 por ciento, para las mujeres fue del 18,3 por ciento y para los hombres del 12,8 por ciento. Se identificó una mayor prevalencia en el grupo de pacientes entre los 50- 59 años, tanto en el total de la población como en el grupo de pacientes hombres (18,4% y 16,4% respectivamente, en las mujeres la prevalencia fue mayor en el grupo mayor de 70 años (28,6%. La prevalencia fue mayor en el grupo de pacientes obesos en ambos géneros (p = 0,003. La latencia para el inicio del sueño fue más prolongada en los pacientes con SPI (p = 0,003. En relación con el grado de severidad del SAOS, se encontró una mayor frecuencia del SPI en mujeres con SAOS leve y moderado, en los hombres no se halló relaci

  11. Categorizaci?n para riesgo de apnea obstructiva del sue?o seg?n la escala de epworth y su correlaci?n con las medidas antropom?tricas en pacientes diab?ticos del Hospital Dr. Gustavo Dom?nguez en el mes de agosto a septiembre del 2014

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    V?sconez Viteri, Lorena

    2015-01-01

    El Apnea Obstructiva del Sue?o es una enfermedad de evoluci?n cr?nica e insidiosa que se caracteriza cl?nicamente por la triada: hipersomnia diurna, ronquidos y pausas de apnea, s?ntomas que est?n presente en la mayor?a de los pacientes seg?n lo indican estudios desde hace dos d?cadas, existiendo factores cl?nicos directos que la predisponen, entre ellos el ?ndice de masa corporal, per?metro abdominal, circunferencia de cuello. El objetivo de este estudio es relacionar la somnolencia diurn...

  12. Trastornos por déficit de atención y síndrome de apnea obstructiva del sueño en la edad pediátrica

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    Alexander Torres Molina

    2013-02-01

    Full Text Available El trastorno por déficit de atención con o sin hiperactividad es la entidad neuropsiquiátrica más frecuente en la infancia; sin embargo, su forma clínica más rara es la que se exhibe de forma aislada, es decir, limitada a las manifestaciones propias del trastorno. La asociación comórbida entre los trastornos respiratorios asociados al sueño y el trastorno por déficit de atención con o sin hiperactividad, afecta aproximadamente el 30 % de los pacientes, por lo que es necesario evaluar sistemáticamente a los niños con sospecha de dicho trastorno en busca de alteraciones del sueño, especialmente el síndrome de apnea obstructiva del sueño, ya que estos dos procesos comparten mecanismos neurobiológicos comunes, además de existir un solapamiento entre los síntomas de ambos. El diagnóstico y el tratamiento oportunos del síndrome de apnea obstructiva del sueño en los pacientes con manifestaciones clínicas compatibles con trastorno por déficit de atención con o sin hiperactividad, se asocia a menudo con una mejoría en los síntomas y una disminución de la necesidad de medicación estimulante.

  13. Perfil cardiovascular em pacientes com apneia obstrutiva do sono Perfil cardiovascular en pacientes con apnea obstructiva del sueño Cardiovascular profile in patients with obstructive sleep apnea

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    Fátima Dumas Cintra

    2011-04-01

    Full Text Available FUNDAMENTO: Apneia Obstrutiva do Sono (AOS é um fator de risco para várias condições cardiovasculares incluindo aumento na mortalidade cardiovascular. Sendo assim, é essencial o conhecimento das principais repercussões cardiovasculares dos distúrbios respiratórios do sono durante uma avaliação clínica. OBJETIVO: Analisar as características cardiovasculares de pacientes com AOS. MÉTODOS: Pacientes submetidos a polissonografia basal foram consecutivamente selecionados do banco de dados do Instituto do Sono entre março de 2007 e março de 2009. Todos os pacientes foram orientados a comparecer ao ambulatório para coleta de sangue, exame físico, eletrocardiograma de 12 derivações, espirometria, teste cardiopulmonar em esteira ergométrica e ecocardiograma transtorácico. O estudo foi aprovado pelo comitê de ética e pesquisa e registrado no site http://clinicaltrials.gov/ sob o número: NCT00768625. RESULTADOS: Foram analisados 261 pacientes e 108 controles. As principais características dos pacientes com AOS foram: obesidade, hipertensão, baixos níveis plasmáticos de lipoproteínas de alta densidade (HDL e aumento no diâmetro do átrio esquerdo quando comparados com controles (3,75 ± 0,42; 3,61 ± 0,41, p = 0,001, respectivamente. Essas características associadas correspondem a um acréscimo de 16,6 vezes na probabilidade de ocorrência de AOS independentemente do relato de algum sintoma dessa desordem, como sonolência ou ronco. CONCLUSÃO: Na amostra avaliada, o perfil cardiovascular dos pacientes com AOS mais encontrado foi: obesidade, hipertensão arterial, baixos níveis plasmáticos de HDL e átrio esquerdo com diâmetro aumentado.FUNDAMENTO: Apnea obstructiva del sueño (AOS es un factor de riesgo para diversas condiciones cardiovasculares, incluido el aumento en la mortalidad cardiovascular. Por tanto, es imprescindible conocer las principales repercusiones cardiovasculares de los trastornos respiratorios del sue

  14. Guías prácticas de diagnóstico y tratamiento del síndrome de apneas e hipopneas obstructivas del sueño

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    Facundo Nogueira

    2013-08-01

    Full Text Available El síndrome de apneas e hipopneas obstructivas del sueño (SAHOS constituye una de las afecciones respiratorias crónicas de mayor relevancia, dada su elevada prevalencia en la población general y sus consecuencias clínicas. En 2001 la Asociación Argentina de Medicina Respiratoria (AAMR publicó el Primer Consenso Argentino de Trastornos Respiratorios Vinculados al Sueño. Desde entonces se ha generado una gran cantidad de evidencia científica sobre esta enfermedad. Por tal motivo, la Sección Sueño, Oxigenoterapia y otros Cuidados Respiratorios Domiciliarios de la AAMR, se propuso actualizar su Consenso confeccionando estas Guías Prácticas de tratamiento de pacientes con SAHOS. Un grupo de trabajo de la Sección, expertos y especialistas en el tema, revisó la bibliografía y confeccionó estas guías orientadas a la resolución práctica de problemas clínicos que pueden surgir de la atención de pacientes con este síndrome. En su desarrollo se define el cuadro, los criterios diagnósticos y de gravedad; a su vez se describen sus factores de riesgo, las formas de presentación, epidemiología y consecuencias, fundamentalmente los efectos sobre la capacidad cognitiva, el aparato cardio-vascular y el metabolismo. Se detalla la metodología diagnóstica, sus distintas variables e indicaciones y los requisitos técnicos para su validación e interpretación. Por último se desarrollan las alternativas terapéuticas, así como también aspectos prácticos de su implementación. La intención de los autores ha sido la de generar una herramienta accesible de formación y difusión de estos trastornos que afectan la salud de la población.

  15. Maxillofacial Developmental and Occlusion Disorders in Children with Obstructive Sleep Apnea Syndrome Alteraciones del desarrollo maxilofacial y de la oclusión en el niño con síndrome de apnea obstructiva del sueño

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    Alexander Torres Molina

    2011-03-01

    Full Text Available The obstructive sleep apnea syndrome is a highly prevalent disease that affects approximately 2% of children and is considered a complex entity due to its somatic and cognitive impact. Occlusion and mouth, skull and facial alterations associated with this syndrome are a matter of concern both for specialists in maxillofacial surgery and orthodontists, who are playing an important role in the diagnosis and final treatment of this disease. Guilleminault scoring system allows to evaluate the severity of the anomalies of the facial skeleton and the dental occlusion in these patients, by relying on the physical examination and the cephalometry. Early diagnosis and appropriate therapy reverse maxillofacial developmental disorders in most of the cases.El síndrome de apnea obstructiva del sueño constituye una enfermedad de alta prevalencia, que afecta aproximadamente al 2 % de la población infantil, se considera una compleja entidad por su repercusión somática y cognoscitiva. Las alteraciones bucocraneofaciales y de la oclusión asociadas a este síndrome constituyen un tema de preocupación tanto para los especialistas en cirugía maxilofacial como para los ortodoncistas, los cuales han comenzado a jugar un papel importante en el diagnóstico y tratamiento definitivo de esta enfermedad. El sistema de puntuación de Guilleminault permite evaluar la severidad de las anomalías del esqueleto facial y de la oclusión dentaria en estos pacientes, al apoyarse en el examen físico y la cefalometría. El diagnóstico precoz y la terapéutica adecuada revierten las alteraciones del desarrollo maxilofacial en la mayoría de los casos.

  16. Revisión bibliográfica exploratoria sobre síndrome de apnea obstructiva del sueño y conducción profesional An exploratory literature review on obstructive sleep apnea syndrome and professional drivers

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    Mariholy Carolina Hernández García

    2012-06-01

    Full Text Available El síndrome de apnea-hipopnea del sueño es el más frecuente de los trastornos respiratorios que se producen durante el sueño, afectando alrededor del 4% de los adultos, y a casi 2 millones de personas en España. Se presenta con episodios repetidos de obstrucción de la vía aérea superior provocando un colapso del flujo de aire hacia los pulmones y síntomas como somnolencia diurna, trastornos respiratorios, cardiovasculares, psicológicos e intelectuales. La somnolencia al conducir es común entre conductores profesionales, afectando su rendimiento y la seguridad de la población. Se llevó a cabo una revisión bibliográfica exploratoria, para conocer la prevalencia de la patología en conductores profesionales, los factores del riesgo implicados, los métodos utilizados en su diagnóstico y su relación con los accidentes de tránsito. Se seleccionaron nueve bases de datos, PUBMED, IBECS, LILACS, COCHRANE LIBRARY, EMBASE, SCOPUS, SCIELO, WOS y WOK, para llevar a cabo la búsqueda entre Octubre 2011 y Enero 2012. Luego de aplicados los criterios de inclusión/exclusión se analizaron 12 artículos. La prevalencia del síndrome es similar en la mayoría de los estudios pero superior a la población general. Los factores de riesgo de mayor estudio e impacto fueron la obesidad, la somnolencia excesiva, los ronquidos. No existe consenso entre los test diagnósticos utilizados y su eficacia. Sin embargo el más utilizado ha sido la escala de Epworth (ESE. La relación siniestralidad y apnea del sueño ha sido poco estudiada en conductores profesionales.The sleep apnea-hypopnea syndrome is the most common respiratory disorders that occur during sleep, affecting about 4% of adults, and nearly 2 million people in Spain. It occurs with repeated episodes of upper airway obstruction causing a flow of air collapse into the lungs and symptoms such as daytime sleepiness, respiratory, cardiovascular, psychological and intellectual disorders. Sleepiness

  17. Relación entre hipertensión arterial sistémica y síndrome de apnea-hipopnea obstructiva del sueño y sus factores de riesgo asociados, en población hipertensa de un centro médico. Cali (Colombia) 2008.

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    González Hernández, Liza María; Castaño Castrillón, José Jaime; Herrera García, Valentina; Jiménez, Ángela María; Lentijo Hoyos, Pilar; Sierra Ramírez, Andrea; Zuluaga, Luz Marina

    2008-01-01

    Introducción: La relación causa efecto entre la hipertensión arterial sistémica y un mayor riesgo para desarrollar síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es aun incierta. El desconoci-miento de la influencia del SAHOS sobre la hipertensión arterial ha llevado al excesivo diagnostico de hipertensión arterial idiopática, desmotivando la búsqueda de la real causa subyacente, que en la mayo-ría de los casos puede deberse a trastornos del sueño. Materiales y métodos: En el pre...

  18. Percepción de calidad de vida relacionada con la salud en pacientes con síndrome de apnea e hipoapnea obstructiva del sueño

    OpenAIRE

    2015-01-01

    El objetivo de esta investigación es describir la calidad de vida y la calidad del sueño en los pacientes con diagnóstico de Síndrome de Apnea Hipoapnea del sueño, mediante el uso de un grupo de cuestionarios para obtener datos demográficos, la evaluación del grado de somnolencia diurna percibida, la percepción de la calidad del sueño y la percepción de la calidad de vida relacionada con la salud con encuestas en sus respectivas versiones validadas para Colombia.

  19. Avanços recentes do impacto da apneia obstrutiva do sono na hipertensão arterial sistêmica Avances recientes del impacto de la Apnea Obstructiva del Sueño en la Hipertensión Arterial Sistémica Recent advances of the impact of obstructive sleep apnea on systemic hypertension

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    Rodrigo P. Pedrosa

    2011-08-01

    Full Text Available A apneia obstrutiva do sono (AOS é uma condição clínica comum na população em geral, principalmente entre os pacientes portadores de doenças cardiovasculares. Mais do que um fenômeno local de obstrução das vias aéreas superiores, a AOS traz repercussões sistêmicas que podem incluir a hipóxia intermitente, a redução abrupta da pressão intratorácica e a ocorrência de microdespertares com fragmentação do sono. Nas últimas décadas, inúmeras evidências apontam de forma consistente a AOS como um importante fator envolvido na ocorrência de doenças cardiovasculares. Particularmente, a relação entre a AOS e a hipertensão arterial sistêmica (HAS é a que encontra um maior conjunto de evidências. Atualmente, encontram-se dados que consideram a AOS uma importante causa secundária de HAS. Mais do que isso, a AOS está independentemente associada a um pior controle pressórico, alteração do descenso noturno da pressão arterial e à presença de lesões de órgãos-alvo, tais como a hipertrofia do ventrículo esquerdo e a microalbuminúria. Estudos randomizados sugerem que o tratamento da AOS, especialmente com a pressão positiva contínua de vias aéreas superiores (CPAP, considerado o tratamento padrão para a AOS, promove redução significante da pressão arterial nas 24 horas, efeito esse mais significante no subgrupo de pacientes com HAS não controlada e nos pacientes com HAS resistente. A despeito de todas essas evidências, a AOS ainda continua sendo subdiagnosticada. O objetivo desta revisão é discutir os recentes avanços nos mecanismos fisiopatológicos, na apresentação clínica e no tratamento da AOS, e o benefício sobre a pressão arterial.La apnea obstructiva del sueño (AOS es una condición clínica común en la población en general, principalmente entre los pacientes portadores de enfermedades cardiovasculares. Más que un fenómeno local de obstrucción de las vías aéreas superiores, la AOS trae

  20. PREVALENCE AND FACTORS AFFECTING REM AND SLOW WAVE SLEEP REBOUND ON CPAP TITRATION STUDY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA Prevalencia de los factores que afectan el sueño REM y el brote de ondas lentas en los estudios con CPAP en apnea obstructiva del sueño

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    Edgar Osuna S

    2008-03-01

    .081. Conclusions. We suggest that an increase greater than 6% in REM sleep should be considered REM rebound, since 6.15 percent was the statistically significant difference between bPSG REM sleep and cPSG. The prevalence of RR in our group was 46 percent and the variables that contribute more to RR are REM sleep during bPSG, AHI at baseline and body mass index.Antecedentes. En pacientes con síndrome de apnea obstructiva del sueño (SAOS el tratamiento con CPAP produce un incremento en el sueño REM y el sueño profundo, pero no hay suficiente información acerca de la prevalencia del rebote de sueño REM en pacientes con SAOS y los posibles factores relacionados con este fenómeno. Objetivo. El rebote de sueño REM (RR y del sueño de ondas lentas (RSOL ha sido descrito como un fenómeno de frecuente presentación que ocurre durante la titulación de la presión del CPAP, pero la cantidad en el incremento del estado de sueño que lo califique como rebote no ha sido mencionado en la literatura. El objetivo del estudio fue determinar la prevalencia de RR y RSOL en nuestro centro de sueño e intentar definir RR y buscar los factores que puedan afectar el RR y el RSOL en la primera noche de titulación de CPAP. Material y métodos. Se incluyeron pacientes que tenían polisomnograma de base (bPSG y PSG con CPAP (cPAG realizados en un laboratorio del sueño. Se incluyeron 179 pacientes mayores de 18 años con índice de apneas-hipopneas (IAH mayor de 10/hora en el estudio de base, con titulación de CPAP adecuada. Se comparó los porcentajes de sueño REM y sueño profundo durante el bPSSG y cPSG. Se analizó la frecuencia de presentación y los factores que afectan el RR y el RSOL. Resultados. Se incluyeron 179 pacientes (M/F 118/61, con edad promedio de 48.6 años ±12.9 para hombres y 51.6±12.9 para mujeres. El intervalo entre el bPSG y el cPSG fue 45 días promedio. El promedio de sueño REM durante el bPSG fue 15.55 por ciento y durante el bPSG 21.57 por ciento. Se tomó seis por

  1. Distracción ósea: tratamiento de la apnea obstructiva en neonatos con micrognatia Mandibular distraction: treatment of obstructive apnea in neonates with micrognathia

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    Adoración Martínez Plaza

    2011-06-01

    Full Text Available Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher-Collins, síndrome de Nager, etc. con frecuencia van asociadas a hipoplasia mandibular grave, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural, en decúbito prono, puede ser necesario controlar la saturación de oxígeno, insertar un tubo nasofaríngeo e incluso intratraqueal. En casos más graves con pausas prolongadas y frecuentes de apnea, la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y, ocasionalmente, mortalidad. En los últimos 2 años, en la Unidad Multidisciplinaria de Labio y Fisura Palatina del Hospital Virgen de las Nieves de Granada, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular grave mediante distracción mandibular osteogénica, y este procedimiento se ha mostrado eficaz en la resolución del problema. Ha evitado la traqueostomía y se ha elongado la mandíbula en el plazo de 3-4 semanas. En este tiempo han desaparecido los problemas respiratorios obstructivos, así como también de la deglución, y los resultados estéticos obtenidos han resultado excelentes y las complicaciones, por el momento, mínimas.Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc. are frequently accompanied by severe mandibular hypoplasia, which can cause upper airway obstruction due to retroposition of the base of the tongue in the posterior pharyngeal space. The majority of patients respond to postural treatment in decubitus prono. It may be necessary to monitor oxygen saturation and insert a nasopharyngeal or even an endotracheal tube. Tracheostomy may be necessary in more serious cases with long and frequent apnea pauses, but it is associated with high morbidity and occasional mortality. In the last

  2. Beneficios de la distracción mandibular en neonatos con apnea del sueño

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    D.J. Caycedo-García

    2013-12-01

    Full Text Available La apnea obstructiva del sueño o hipoventilación obstructiva en neonatos, es distinta que en los adultos y también lo son su presentación, etiología y tratamiento. Se considera apnea del sueño cuando se produce 1 episodio de apnea por hora de más de 10 segundos de duración, con saturación menor del 87% e incremento del CO2. Existen varias causas, pero los factores anatómicos y neurofuncionales son la base del problema respiratorio superior que produce fallos en las fuerzas que contraen y dilatan la vía aérea. La retromicrognatia como causa anatómica, puede ser aislada o sindrómica. La hipoxemia y la hipercapnia aumentan la presión negativa intratorácica del paciente con la consecuencia de daño celular sin que se pueda cuantificar la gravedad de la lesión cerebral en esta etapa neonatal. En el presente estudio, observacional descriptivo, entre los años 2000 y 2011, en una serie de 49 pacientes neonatos de la Unidad de Cuidados Intensivos del Recién Nacido del Hospital Universitario del Valle y del Centro Médico Imbanaco de la ciudad de Cali, Colombia, pretendemos evidenciar los beneficios del tratamiento precoz de los neonatos que presentan retromicrognatia y apnea obstructiva o hipoventilación obstructiva, intervenidos quirúrgicamente mediante corticotomía, colocación de distractores y elongación mandibular, logrando que la apnea obstructiva desapareciera en un tiempo no superior a una semana y que la mejoría clínica de los recién nacidos con este diagnostico fuera evidente, evitando la traqueotomía y las posibles complicaciones y secuelas por hipoxia cerebral, a la vez que disminuyó la estancia hospitalaria.

  3. Maxillofacial Developmental and Occlusion Disorders in Children with Obstructive Sleep Apnea Syndrome Alteraciones del desarrollo maxilofacial y de la oclusión en el niño con síndrome de apnea obstructiva del sueño

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    Alexander Torres Molina

    2011-01-01

    The obstructive sleep apnea syndrome is a highly prevalent disease that affects approximately 2% of children and is considered a complex entity due to its somatic and cognitive impact. Occlusion and mouth, skull and facial alterations associated with this syndrome are a matter of concern both for specialists in maxillofacial surgery and orthodontists, who are playing an important role in the diagnosis and final treatment of this disease. Guilleminault scoring system allows to evaluate the sev...

  4. Síndrome de apnea del sueño (SAS Sleep apnea syndrome

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    Camilo José Borrego Abello

    1994-03-01

    Full Text Available Se describe el síndrome de apnea del sueño (SAS abarcando los aspectos históricos, signos y síntomas, las diversas modalidades (apneas obstructiva, central y mixta, complicaciones, principalmente cardiovasculares y cerebrovasculares y formas de tratamiento. Se hace énfasis en la ayuda diagnóstica del polisomnograma que ha permitido definir como SAS síntomas antes considerados inespecíficos y cuantificar su gravedad. Se describen las diversas medidas terapéuticas, locales y generales, recalcando los beneficios que se obtienen con la aplicación de los aparatos de respiración a presión positiva. Estos permiten tratamientos no invasivos que hacen desaparecer la totalidad de los síntomas y evitan los riesgos incrementados de trastornos cardiovasculares y accidentes laborales o de tránsito. Este grave síndrome afecta a un grupo grande de población por lo que su importancia es indudable.

    Different aspects of the sleep apnea síndrome (SAS are described, including history, clinical manifestations, clinical forms (obstructive, central and mixed, cardiovascular, cerebrovascular and other complications and treatment. With the use of the polysomnogram it has been possible to define non-specific symptoms as due to SAS and to quantitate their seriousness. Different therapeutic approaches are described, both local and systemic, with emphasis on the benefits obtained from the use of positive pressure breathing machines which control every manifestation of the syndrome and avoid the increased cardiovascular risks aswell as work and traffic accidents. This syndrome is important in terms of frequency and of increased death risk.

  5. Suspeita de Apneia Obstrutiva do Sono definida pelo Questionário de Berlim prediz eventos em pacientes com Síndrome Coronariana Aguda Sospecha de apnea obstructiva del sueño definida por el cuestionario de Berlín predice eventos en pacientes con síndrome coronario agudo Suspicion of Obstructive Sleep Apnea by Berlin Questionnaire predicts events in patients with Acute Coronary Syndrome

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    Eryca Vanessa S. de Jesus

    2010-09-01

    Full Text Available FUNDAMENTO: De um ponto de vista mecanístico, a apneia obstrutiva do sono (SAOS pode causar distúrbios extras à homeostase cardiovascular na presença de síndrome coronariana aguda (SCA. OBJETIVO: Investigar se um diagnóstico clínico padronizado de SAOS, em pacientes com SCA, prediz o risco de eventos cardiovasculares durante hospitalização. MÉTODOS: Em um estudo de coorte prospectivo, um grupo de 200 pacientes com diagnóstico de SCA estabelecido entre Setembro de 2005 e Novembro de 2007, foram estratificados pelo Questionário de Berlim (QB para o risco de SAOS (alto ou baixo risco. Foi testado se o subgrupo de alto risco para SAOS apresenta maior tendência à eventos cardiovasculares. O endpoint primário avaliado foi um desfecho composto de morte cardiovascular, eventos cardíacos isquêmicos recorrentes, edema pulmonar agudo e acidente vascular cerebral durante a hospitalização. RESULTADOS: Noventa e quatro (47% dos pacientes identificados pelo QB apresentavam suspeita de SAOS. Alto risco para SAOS estava associado com uma mortalidade mais elevada, embora sem diferença estatística (4,25% vs 0,94%; p=0,189, mas com uma estatisticamente significante maior incidência de desfecho composto de eventos cardiovasculares (18,08% vs 6,6%; p=0,016. No modelo de regressão logística, os preditores multivariados de desfecho composto de eventos cardiovasculares foram idade (OR = 1,048; IC95%: 1,008 a 1,090; p=0,019, fração de ejeção do VE (OR = 0,954; IC95%: 0,920 a 0,989; p=0,010, e risco mais elevado de SAOS (OR = 3,657; IC95%: 1,216 a 10,996; p=0,021. CONCLUSÃO: O uso de um questionário simples e validado (QB para identificar pacientes com risco mais elevado de SAOS pode ajudar a prever o desfecho cardiovascular durante a hospitalização. Além disso, nossos dados sugerem que SAOS é muito comum em pacientes com SCA.FUNDAMENTO: Desde un punto de vista mecanístico, la apnea obstructiva del sueño (SAOS puede ocasionar disturbios

  6. Determinantes del infradiagnóstico de la enfermedad pulmonar obstructiva crónica

    OpenAIRE

    Calle Rubio, Myriam

    2015-01-01

    La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad muy prevalente, que causa una gran morbimortalidad en el mundo y que es responsable de una importante carga económica y social. La Organización Mundial de la Salud (OMS) estimó en 1990 que 210 millones de personas padecían una EPOC (1). En España, el estudio EPISCAN, realizado en el 2007, mostró una prevalencia global de la EPOC del 10,2% (2). Una prevalencia que según el Global Burden of Disease Study (GBD) de 2010 ha ascend...

  7. Hipertensión arterial refractaria y apnea del sueño

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    Gustavo Quevedo

    2008-01-01

    Full Text Available El síndrome de apnea obstructiva del sueño (SAOS tiene un papel importante en la morbimortalidad cardiovascular. Se han sugerido muchos mecanismos para explicar la asociación mórbida entre el SAOS y la enfermedad cardiovascular, especialmente la hipertensión arterial (HTA. Alrededor de la mitad de los pacientes con SAOS padecen hipertensión arterial y la prevalencia de SAOS en pacientes hipertensos es mayor que la existente en la población general.En el presente caso se describe a un paciente con HTA refractaria al tratamiento farmacológico que evolucionó favorablemente luego del diagnóstico y el tratamiento del SAOS.

  8. Evaluaci??n de la memoria a corto plazo en pacientes con apnea del sue??o antes y despu??s del tratamiento con CPAP

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    S??nchez G??mez, Ana I.; Berm??dez S??nchez, Mar??a de la Paz; Buela-Casal,Gualberto

    2003-01-01

    El s??ndrome de apnea obstructiva del sue??o (SAOS) es un trastorno que se caracteriza por una obstrucci??n de la v??a respiratoria a??rea superior durante el sue??o aun cuando existe un adecuado esfuerzo respiratorio. Esta obstrucci??n dificulta la respiraci??n provocando entre otros s??ntomas, sue??o fragmentado y p??rdida o supresi??n de las fases de sue??o m??s profundas. Durante el d??a, la persona se queja de una sintomalog??a muy variada, en la que destacan principalmente la excesiva s...

  9. Why mandible distraction on neonates with sleep apnea? 47 cases

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    Diego José Caycedo

    2011-09-01

    Full Text Available La presentación, etiología y tratamiento de la apnea obstructiva del sueño/hipo ventilación obstructiva en neonatos es diferente que en los adultos. Se considera apnea de sueño un episodio/hora de más de 10 segundos, con saturación menor de 87% e incremento del CO2. Los factores anatómicos y neurofuncionales son causa de las alteraciones respiratorias superiores que producen falta de coordinación en las fuerzas que contraen y dilatan la vía aérea; la retro-micrognatia como causa anatómica puede ser aislada o sindrómica. La hipoxemia y la hipercapnia aumentan la presión negativa intratorácica con la consecuencia del daño celular sin poder cuantificar la lesión cerebral en esta etapa neonatal. Este estudio, observacional descriptivo, serie de casos, realizado entre los años 2000 y 2011 en 47 pacientes neonatos de la unidad de cuidados intensivos del recién nacido del Hospital Universitario del Valle y del Centro Médico Imbanaco de la ciudad de Cali, que presentaron retro-micrognatia y apnea obstructiva o hipoventilación obstructiva, fueron intervenidos quirúrgicamente con corticotomía, colocación de distractores y elongación mandibular para evidenciar que la apnea obstructiva desaparece en un tiempo no mayor a una semana y que comparado con tratamientos realizados con anterioridad en los recién nacidos con este diagnóstico, la mejoría clínica es evidente, se evita la traqueotomía, las posibles complicaciones y secuelas por hipoxia disminuyendo la estancia hospitalaria.

  10. Utility of ApneaLinkTM for the diagnosis of sleep apnea-hypopnea syndrome Utilidad del ApneaLinkT para el diagnóstico del síndrome apnea-hipopnea del sueño

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    Carlos A. Nigro

    2010-02-01

    Full Text Available Portable sleep studies may play an important role to take decisions on patients referred for suspicion of Sleep Apnea-Hypopnea Syndrome (SAHS. The aim of this study was to evaluate the diagnostic accuracy of automated analysis of ApneaLinkT in patients with suspicion of SAHS. All participants (75 performed the ApneaLink and polysomnography (PSG simultaneously in the sleep laboratory. The two recordings were interpreted blindly. The ApneaLink software calculated: (1 risk indicator (RI-a combination of apnea/hypopnea index (AHI plus inspiratory flow limitation events and (2 the AHI. ApneaLinkT and SAHS were defined in three ways: AHI or respiratory disturbance index (RDI = 5, 10 and 15 respectively. ROC curves analysis was performed. The sensitivity (S, specificity (E and positive and negative likelihood ratio (LR+, LR- for the different thresholds for RI or AHI were calculated; 66 patients were included (47 men, mean age 51, median RDI 10.6, mean BMI 29.3 kg/m². The best cut off points of RI were: SAHS = RDI = 5: RI > 9 (S 80%, E 100%, LR- 0.20; SAHS = RDI = 10: RI > 13 (S 92%, E 93%, LR+ 13.7 LR- 0.089; SAHS = RDI = 15 =: RI > 16 (S 93.5%, E 91%, LR+ 10.9, LR- 0.071. The AHI had a similar diagnostic accuracy to RI for the different definitions of SAHS. The RI and AHI obtained from automated analysis of ApneaLinkT were highly sensitive and specific to diagnose moderate to severe SAHS.Los equipos portátiles para estudios del sueño pueden tener un rol importante para tomar decisiones en pacientes con sospecha de Síndrome Apneas-Hipopneas del Sueño (SAHS. El objetivo del estudio fue evaluar la exactitud diagnóstica del análisis automático del ApneaLinkT en pacientes con sospecha de SAHS. Setenta y cinco sujetos realizaron simultáneamente el ApneaLinkT y una polisomnografía (PSG en el laboratorio de sueño. Los dos registros fueron interpretados en forma ciega. Un programa calculó: (1 el índice apnea/hipopnea (IAH, (2 el indicador de

  11. ¿Por qué distracción mandibular en neonatos con apnea de sueño? Informe de 47 casos

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    Diego José Caycedo

    2011-09-01

    Full Text Available La presentación, etiología y tratamiento de la apnea obstructiva del sueño/hipo ventilación obstructiva en neonatos esdiferente que en los adultos. Se considera apnea de sueño un episodio/hora de más de 10 segundos, con saturación menor de87% e incremento del CO2. Los factores anatómicos y neurofuncionales son causa de las alteraciones respiratorias superioresque producen falta de coordinación en las fuerzas que contraen y dilatan la vía aérea; la retro-micrognatia como causaanatómica puede ser aislada o sindrómica. La hipoxemia y la hipercapnia aumentan la presión negativa intratorácica con laconsecuencia del daño celular sin poder cuantificar la lesión cerebral en esta etapa neonatal. Este estudio, observacionaldescriptivo, serie de casos, realizado entre los años 2000 y 2011 en 47 pacientes neonatos de la unidad de cuidados intensivosdel recién nacido del Hospital Universitario del Valle y del Centro Médico Imbanaco de la ciudad de Cali, que presentaronretro-micrognatia y apnea obstructiva o hipoventilación obstructiva, fueron intervenidos quirúrgicamente con corticotomía,colocación de distractores y elongación mandibular para evidenciar que la apnea obstructiva desaparece en un tiempo nomayor a una semana y que comparado con tratamientos realizados con anterioridad en los recién nacidos con este diagnóstico,la mejoría clínica es evidente, se evita la traqueotomía, las posibles complicaciones y secuelas por hipoxia disminuyendo laestancia hospitalaria.

  12. Risk factors for post coronary artery bypass graft atrial fibrillation: role of obstructive sleep apnea

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    Amro Qaddoura

    2016-12-01

    Full Text Available Resumen En este capítulo comenzamos analizando la cirugía de revascularización miocárdica y su complicación más frecuente, la fibrilación atrial postoperatoria. Analizamos los principales factores de riesgo para la fibrilación atrial postoperatoria y luego discutimos detalladamente la apnea obstructiva del sueño como factor riesgo. En este empeño, describimos cómo se diagnostica la apnea obstructiva del sueño, su pato-fisiología en relación con la fibrilación atrial postoperatoria y los estudios clínicos que recientemente han investigado la asociación entre la apnea obstructiva del sueño y fibrilación atrial postoperatoria. Concluimos con las estrategias de prevención y tratamiento de la fibrilación atrial postoperatoria y la discusión de futuras recomendaciones investigativas.

  13. Composición corporal y variabilidad del ritmo cardiaco en pacientes con enfermedad pulmonar obstructiva crónica candidatos a rehabilitación respiratoria

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    Cristian Curilem Gatica

    2014-07-01

    Full Text Available La composición corporal es una metodología no invasiva, que nos entrega información acerca de la distribución de tejidos en la estructura corporal, además es un indicador del riesgo de mortalidad en pacientes con Enfermedad pulmonar obstructiva crónica. La variabilidad del ritmo cardiaco es una técnica que nos entrega información de la condición fisiológica autonómica, siendo reconocida como un indicador que se encuentra disminuido en una serie de enfermedades. El propósito de este estudio fue evaluar la composición corporal y la Variabilidad del ritmo cardiaco. La metodología utilizada es la de Debora Kerr (1988 avalada por Sociedad Internacional para avances en Cineantropometría para composición corporal y para Variabilidad del ritmo cardiaco los lineamientos descritos por la American Heart Association (1996. Se empleó equipamiento Roscraff, caliper Slimguide y reloj Polar RS 800CX. Se evaluaron 14 pacientes candidatos a rehabilitación respiratoria: Edad 76 ± 9,9 años; IMC 26,7 ± 3,9 kg/m²; Masa Muscular 26,1 ± 6,3 kg; Masa Ósea 8,1 ± 1,3 kg; Masa Adiposa 16,4 ± 3,6 kg; VEF1 54 ± 14 %. Un mayor perímetro de cintura e índice Cintura Cadera se asoció a una menor Variabilidad del ritmo cardiaca global. El componente óseo se relacionó positivamente con la Variabilidad del ritmo cardiaco y los pacientes con un mayor Volumen espiratorio forzado en el primer segundo presentaron un menor componente de alta frecuencia en la Variabilidad del ritmo cardiaco. En estos pacientes, la Variabilidad del ritmo cardiaco en forma global se encuentra reducida y se asocia con parámetros de riesgo cardiovascular.

  14. Análisis coste-efectividad de tipo probabilístico del tratamiento de la apnea del sueño Probabilistic cost-effectiveness analysis of the treatment of sleep apnea

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    Javier Mar

    2006-02-01

    Full Text Available Objetivo: En este trabajo se presenta la aplicación del análisis coste-efectividad de tipo probabilístico al tratamiento con presión continua en la vía respiratoria por vía nasal (nasal continuous positive airway pressure, nCPAP del síndrome de la apnea obstructiva del sueño (SAOS. Material y métodos: La base del estudio es un modelo de Markov probabilístico. Éste se caracteriza porque las variables se introducen en forma de distribuciones. El modelo se procesa mediante 2.000 simulaciones de Monte Carlo, cada una de las cuales calcula el coste y la efectividad incrementales. El resultado se analiza mediante el plano coste-efectividad, la curva de aceptabilidad, el beneficio neto y el valor esperado de la información perfecta. Resultados: La razón coste-efectividad del tratamiento con nCPAP media calculada es de 5.480 S/año de vida ajustado por calidad (AVAC. Utilizando como umbral de eficiencia la cifra de 30.000 €/AVAC, el análisis probabilístico muestra que en el 98,5% de las simulaciones el tratamiento con nCPAP es una práctica eficiente. El valor esperado de la información perfecta muestra que el parámetro que origina más incertidumbre en el resultado es la ganancia en calidad de vida producida por el tratamiento. Conclusiones: El análisis de tipo probabilístico ratifica el resultado de los estudios deterministas que caracterizan el tratamiento con nCPAP como una intervención eficiente. La ventaja añadida es que permite situar la incertidumbre en términos cuantitativos; en este caso la probabilidad de equivocarse es inferior al 5%. Además, el estudio muestra que para reducir esa incertidumbre la investigación debe centrarse en la mejora de la información referente a la calidad de vida.Objective: To describe the application of a probabilistic cost-effectiveness analysis to nasal continuous positive airway passage (nCPAP treatment of obstructive sleep apnea syndrome (OSAS. Material and Methods: The probabilistic

  15. Aplicación de un instrumento para la estratificación del paciente con enfermedad pulmonar obstructiva crónica descompensada en el Departamento de Urgencias

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    Luís Alberto Corona Martinez

    2012-05-01

    Full Text Available Fundamento: la enfermedad pulmonar obstructiva crónica constituye un problema de salud pública de enorme magnitud, lo cual no ha pasado inadvertido en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos. Objetivo: evaluar el proceso de aplicación de un instrumento para la estratificación del paciente con enfermedad pulmonar obstructiva crónica asistido en el Departamento de Urgencias. Métodos: el instrumento fue aplicado a 192 pacientes ingresados y egresados de la institución con diagnóstico de enfermedad pulmonar obstructiva crónica descompensada, en el periodo comprendido entre mayo de 2010 y abril de 2011; en la evaluación fueron utilizados varios indicadores de proceso y de resultado. Resultados: la utilización del instrumento se convirtió en una acción médica rápidamente incorporada y sistemáticamente empleada, aunque no se acompañó de mejoría progresiva en la calidad de la estratificación. El predominio de pacientes en la clase de riesgo elevado de desenlace adverso y altas probabilidades de recuperación estuvo determinado por un elevado número de pacientes con descompensación moderada y asociación a neumonía o insuficiencia cardiaca, los cuales en su mayoría fueron estratificados como riesgo moderado e ingresados en sala de Medicina, a pesar de lo cual la letalidad en ellos fue relativamente baja, al igual que la frecuencia de traslados a Unidades de Cuidados Intensivos de los pacientes inicialmente admitidos en sala (10 %. Conclusiones: los resultados obtenidos en el comportamiento de la letalidad y del índice de traslado a UCI sugieren la conveniencia de realizar modificaciones al instrumento de estratificación utilizado.

  16. Condición periodontal de pacientes con apnea obstructiva del sueño / Periodontal Status of Patients with Obstructive Sleep Apnea

    OpenAIRE

    Cuervo Monguí, Adriana; Pontificia Universidad Javeriana. Bogotá; Martínez Pastrana, María Constanza; Pontificia Universidad Javeriana. Bogotá; Sosa Quiroga, Gretty Marcela; Pontificia Universidad Javeriana. Bogotá; Hernández Torres, Melissa; Pontificia Universidad Javeriana. Bogotá; Latorre Uriza, Catalina; Pontificia Universidad Javeriana. Bogotá; Escobar Arregocés, Francina; Pontificia Universidad Javeriana. Bogotá; Velosa Porras, Juliana; Pontificia Universidad Javeriana. Bogotá

    2016-01-01

    RESUMEN. Antecedentes: Existen patologías sistémicas que tienen relación directa con la enfermedad periodontal, por esto se hace necesario poder identificarlas para controlarlas y así evitar que esta condición se agrave. Objetivo: Describir la condición periodontal de los pacientes que asistieron a estudio polisomnográfico. Métodos: Estudio descriptivo de corte transversal. La muestra incluyó 166 pacientes con estudio polisomnográfico previo; a quienes se les realizó el examen periodontal par...

  17. Enfermedad pulmonar obstructiva crónica

    OpenAIRE

    Reinaldo Pino Blanco; Orestes Álvarez Fernández; Juan De Dios Rivero Berovides

    2011-01-01

    La enfermedad pulmonar obstructiva crónica se ha convertido en una de las enfermedades crónicas atendidas con mayor frecuencia en la atención primaria de salud. Produce altas tasas de morbilidad y mortalidad en todo el mundo, con una evolución lenta aunque progresivamente mortal, a pesar de tratarse de una enfermedad prevenible, que depende en gran medida, del hábito de fumar. La prevalencia variará según el consumo de tabaco, y se espera que s...

  18. Diagnóstico y tratamiento del hábito tabáquico en pacientes con enfermedad pulmonar obstructiva crónica: estudio ADEPOCLE

    Directory of Open Access Journals (Sweden)

    Ana Beatriz de Abajo Larriba

    Full Text Available Introducción y objetivos: El tabaco es la principal causa de enfermedad pulmonar obstructiva crónica (EPOC. El objetivo de este estudio es estimar la prevalencia del tabaquismo y analizar cómo se diagnostican y se trata a los fumadores diagnosticados de EPOC. Métodos: estudio epidemiológico, transversal, multicéntrico (30 centros salud de la provincia de León. Incluyó pacientes mayores de 35 años diagnosticados y tratados de EPOC. Variables analizadas: edad, sexo, hábitat, datos antropométricos, tabaquismo, número de paquetes/año, cooximetría, dependencia (escala analógico-visual, motivación (test de Fagerström, autoeficacia, estado anímico, intentos previos, terapia cognitivo-conductual, tratamiento farmacológico (TSN, bupropión, vareniclina y recaídas. Los resultados se expresan con sus IC al 95,5%. Resultados: se incluyó a 833 pacientes, el 85,8% varones, edad media: 64,69 (53,66-75,61 años y 20,65 (4,47-36,8 años de evolución de la EPOC. El 86,67% (80,30-93,30 tenían antecedentes de tabaquismo (n = 722, de 35,26 (17,87-52,64 años de evolución, con consumo medio 28,36 (9,60-46,86 paquetes año, p < 0,001, siendo el 58% fumadores severos. El 57,4% (53,90-60,60 son exfumadores. El 29,3% (26,40-32,70 fumadores activos declarados vs. 35,11% (33,90-37,12 fumadores diagnosticados por cooximetría p < 0,05. Los 288 fumadores activos, presentaban baja motivación (49,80%, alta dependencia (49,5%, actitud negativa (52,60%, bajo estado de ánimo (32,05%, con 2,72 (1,74-3,67 intentos para dejar de fumar, p < 0,0001. La terapia conductivo-conductual (TCC combinado con tratamiento farmacológico se realizó en el 55,8% (52,2-54,9, p < 0,05; La intervención más efectiva fue TCC combinada con vareniclina logrando una abstinencia del 29,86%. En total dejaron de fumar un 51,05% (49,49-52,70 de los pacientes con EPOC, p < 0,001. Conclusiones: la prevalencia de tabaquismo en la EPOC en nuestro medio continúa siendo

  19. Síndrome de apnea hipopnea del sueño e ictus Sleep apnea-hypopnea syndrome and stroke

    Directory of Open Access Journals (Sweden)

    R. Muñoz

    2007-01-01

    Full Text Available Desde hace años se ha llamado la atención sobre la frecuente asociación entre el Síndrome de apnea hipopnea del Sueño (SAHS y el ictus. Disponemos de múltiples y muy diversos estudios epidemiológicos que señalan una posible relación causal. De forma paralela, a lo largo de estos años se ha incrementado el conocimiento de distintos mecanismos fisiopatológicos intermedios por los que teóricamente la apnea podría favorecer la aparición de isquemia cerebral. Entre estos destacaban un incremento de la presión arterial, la aparición de arritmias, cambios hemodinámicos de la circulación cerebral y un estado protrombótico. Asimismo, también se ha comprobado cómo el tratamiento con CPAP era beneficioso para normalizar algunas de estas alteraciones. Sin embargo, no ha sido hasta muy recientemente cuando, gracias a la aparición de diversos estudios prospectivos, se ha demostrado de forma fehaciente que el SAHS es un factor de riesgo que incrementa la posibilidad de padecer un ictus isquémico, de forma independiente a la presencia de otros factores de riesgo clásicos. En espera de nuevos estudios de intervención que confirmen si el tratamiento con CPAP reduce este riesgo, es importante incluir en la anamnesis de pacientes que hayan sufrido un ictus o un accidente isquémico transitorio la búsqueda de datos que nos hagan pensar en un SAHS y remitir a estos pacientes a valoración por el Servicio de Neumología en caso necesario.For many years attention has been drawn to the frequent association between sleep apnea-hypopnea syndrome and stroke. Numerous and very different epidemiological studies are available that point to a possible causal relation. In a parallel way, there has been an increase over these years in the knowledge of the different intermediate physiopathological mechanisms by which apnea could theoretically favour the appearance of cerebral ischemia. An increase in arterial pressure, the appearance of arrhythmias

  20. DESCRIPCIÓN DEL SÍNDROME DE SOBREPOSICIÓN (APNEA / HIPOPNEA OBSTRUCTIVA DEL SUEÑO -SAHS- Y ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA (EPOC EN UNA POBLACIÓN SELECCIONADA DE PACIENTES A DOS DIFERENTES ALTITUDES

    Directory of Open Access Journals (Sweden)

    Cano DJ

    2015-01-01

    Full Text Available Objective: To describe the architecture of sleep, breathing events and oxygenation in a selected population of patients with chronic obstructive pulmonary disease (COPD and obstructive sleep apnoea-hypopnoea syndrome (OSAHS in Burgos (800 m and Bogota (2640 m. Methodology: Study, retrospective. Patients with a diagnosis of stable COPD who underwent a polysomnography at the Hospital Universitario de Burgos (HUBU or Fundación Neumológica Colombiana (FNC. Databases of patients of both institutions, medical records and the results of baseline polysomnography, spirometry and arterial blood gases were reviewed, collecting variables related to sleep architecture, respiratory events and oxygenation. Results: Patients Burgos: n 17, 94.1% male, age 63.2 ± 8.8 years, BMI 31.28 ± 5.5 kg / m2. Spirometry FVC: 2.84 ± 0.9 liters (64.19 ± 17%, FEV1: 1.86 ± 0.7 liters (57.26 ± 18.2%, FEV1 / FVC 62.8 ± 6.6. Low sleep efficiency. Low percentage of NREM and REM. IAH 33.4 (IQR 16.2 to 65.2. Percentage of time with SpO2 <90%: 52.2 ± 35%. Oxygen desaturation index of 29 ± 19. Bogota patients: n 18, 55.6% male, age 69.1 ± 8.2 years. BMI 28.08 ± 4.1 kg / m2. FVC: 2.23 ± 0.7 liters (71.72 ± 12.1%, FEV1: 1.14 ± 0.49 liters (46.8 ± 13.2%, FEV1 / FVC 50.8 ± 9.9. Low sleep efficiency, low percentage of REM. IAH 19.3 (RIC 13 to 54.9. Percentage of time with SpO2 <90%: 60.8 ± 35.4%. Oxygen desaturation index 50.8 ± 29.1%. Conclusions: Two different groups of patients with overlap syndrome (OSAHS/COPD are presented. Clinical and oxygenation differences generate analysis in the diagnostic approach and evaluate reference values.

  1. Tracción de la base de la lengua mediante fijación para el tratamiento de la apnea del sueño

    Directory of Open Access Journals (Sweden)

    J.L. Cebrián Carretero

    2003-12-01

    Full Text Available El síndrome de apnea obstructiva del sueño (SAOS constituye en la actualidad un problema de salud importante, tanto por su prevalencia como por la morbilidad que provoca sobre el aparato cardiovascular y la calidad de vida del paciente. Actualmente, la base del tratamiento es la administración de presión positiva continua durante el sueño (CPAP que, si bien tiene una elevada eficacia, no es tolerada en muchos casos. Los tratamientos quirúrgicos han sido variados. En un principio se centraron en el sistema velofaríngeo con mejorías no superiores al 50% a largo plazo. En nuestro planteamiento terapéutico identificamos, mediante pruebas funcionales y de imagen, las regiones implicadas en cada caso. Entre ellas destaca la base de la lengua. La técnica que presentamos constituye una modificación a las ya descritas para el avance de la base lingual. Consiste en una fijación controlada de la misma a la cortical vestibular de la mandíbula con un punto de hilo de monofilamento pasado a través de dos orificios, sin necesidad de aditamentos especiales. Conseguimos una estabilización permanente con buenos resultados clínicos y polisomnográficos a largo plazo. Las complicaciones estuvieron en relación con problemas deglutorios en el postoperatorio inmediato.Sleep apnoea síndrome constitutes an important health problem because of its prevalence and impact over the cardiovascular system and quality of life of the patient. The classic conservative treatment remains to be the CPAP. Although it has a high efficacy, it is not well tolerated by the patient in many cases. The surgical treatments were initially devoted to the velopharyngeal complex, being definitive in only 50% of the cases. Our therapeutical approach consists on a thorough examination of the different areas affected in every case, one of which is the tongue base. The surgical technique we present constitutes a modification of others already described to advance the tongue base. It

  2. Posibles genes asociados a la obesidad y la apnea del sueño mediante el rastreo de snps a nivel de exoma

    OpenAIRE

    2015-01-01

    La obesidad actúa como factor de riesgo para la Apnea del Sueño, estas dos patologías severas, altamente prevalentes, no son diagnosticadas ni tratadas adecuadamente. Así mismo, no existe información acerca de las bases genéticas de la obesidad y Apnea del Sueño en Colombia. Este trabajo tiene como objetivo, identificar posibles SNPs asociados a obesidad y Apnea del Sueño, localizados en la región codificante para proteína del genoma de una cohorte de individuos colombianos. La asociación gen...

  3. Síndrome de apnea-hipopnea del sueño y enfermedad cardiovascular

    Directory of Open Access Journals (Sweden)

    B. Marín

    Full Text Available El síndrome de apnea-hipopnea del sueño se caracteriza por un cuadro de somnolencia diurna excesiva, trastornos cognitivos-conductuales, respiratorios, cardíacos, metabólicos o inflamatorios secundarios a episodios repetidos de obstrucción de la vía aérea superior durante el sueño. Numerosos estudios han demostrado que el SAHS se asocia a la presencia de hipertensión arterial y al desarrollo de enfermedades cardiovasculares. Asimismo se acepta un exceso de mortalidad asociado con el SAHS. Como mecanismos mediadores se consideran un aumento de actividad del sistema nervioso simpático, una disfunción endotelial, junto con fenómenos de estrés oxidativo, agregación plaquetaria y trombosis.

  4. Nuevos métodos de valoración de la Enfermedad Pulmonar Obstructiva Crónica, su adecuación a la evaluación del menoscabo y la incapacidad

    Directory of Open Access Journals (Sweden)

    Francisco Maneiro Higuera

    2015-09-01

    Full Text Available La enfermedad pulmonar obstructiva crónica es la patología crónica respiratoria más frecuente y que con más frecuencia puede producir incapacidad. La manera tradicional de evaluar la gravedad de la enfermedad es mediante la espirometría. Pero la presentación clínica de la enfermedad no es homogénea y se conoce que no hay una buena correlación entre los resultados de la espirometría y la situación clínica real del enfermo. En los últimos años se han desarrollado procedimientos para evaluar la enfermedad combinando varios parámetros, o sea haciendo una evaluación multidimensional. Esto consigue predecir mucho mejor el pronóstico y la gravedad de la patología. Los médicos que hacemos evaluación de la incapacidad debemos conocer y manejar estas herramientas para hacer nuestras valoraciones más precisas. Se presentan dos de estas herramientas la derivada de la Iniciativa GOLD y la desarrollada en España, la GesEPOC. Se explica su aplicación y su uso en la evaluación de la incapacidad.

  5. Síndrome de apnea-hipopnea del sueño y enfermedad cardiovascular Sleep apnea-hypopnea syndrome and cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    B. Marín

    2007-01-01

    Full Text Available El síndrome de apnea-hipopnea del sueño se caracteriza por un cuadro de somnolencia diurna excesiva, trastornos cognitivos-conductuales, respiratorios, cardíacos, metabólicos o inflamatorios secundarios a episodios repetidos de obstrucción de la vía aérea superior durante el sueño. Numerosos estudios han demostrado que el SAHS se asocia a la presencia de hipertensión arterial y al desarrollo de enfermedades cardiovasculares. Asimismo se acepta un exceso de mortalidad asociado con el SAHS. Como mecanismos mediadores se consideran un aumento de actividad del sistema nervioso simpático, una disfunción endotelial, junto con fenómenos de estrés oxidativo, agregación plaquetaria y trombosis.Sleep apnea-hypopnea syndrome is characterised by daytime sleepiness, cognitive-behavioural, respiratory, cardiac, metabolic or inflammatory disorders, secondary to repeated obstruction of the upper airway during sleep. Numerous studies have shown that SAHS is associated with the presence of arterial hypertension and the development of cardiovascular diseases. Similarly, there is an excess of mortality associated with SAHS. An increase in the activity of the sympathetic nervous system and endothelial dysfunction are considered as mediating mechanisms, together with phenomena of oxidative stress, platelet aggregation and thrombosis.

  6. Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres

    OpenAIRE

    María Soledad Rodríguez-Pecci; Javier de la Fuente-Aguado; Javier Montero-Tinnirello; Ana B. Sanjurjo-Rivo; Paula Sánchez-Conde; Francisco J. Fernández-Fernández

    2012-01-01

    La enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV) en una población de pacientes con EPOC. En este estud...

  7. Enfermedad pulmonar obstructiva crónica

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    Reinaldo Pino Blanco

    2011-01-01

    Full Text Available La enfermedad pulmonar obstructiva crónica se ha convertido en una de las enfermedades crónicas atendidas con mayor frecuencia en la atención primaria de salud. Produce altas tasas de morbilidad y mortalidad en todo el mundo, con una evolución lenta aunque progresivamente mortal, a pesar de tratarse de una enfermedad prevenible, que depende en gran medida, del hábito de fumar. La prevalencia variará según el consumo de tabaco, y se espera que siga aumentando en los próximos 25 años. La mortalidad y morbilidad son cada vez mayores, lo que supone un enorme gasto sanitario, social y personal, pero es una enfermedad potencialmente modificable, motivo por el que requiere de un abordaje multifactorial.Chronic Obstructive Pulmonary Disease has become one of the most frequently treated chronic diseases in primary health care. High rates of morbidity and mortality are worldwide related to this disease. Although it is a preventable disease closely related to smoking, its evolution is slow but progressively fatal. Prevalence varies according to tobacco consumption and is expected to increase in the next 25 years. Even when it is a potentially modifiable disease, mortality and morbidity are also increasing, causing a major health, social and personal spending. For all these reasons, a multifactorial approach is needed both, for health and social issues.

  8. COMPARACIÓN DEL USO DE ESTEROIDES CON EL MANEJO CONVENCIONAL DE LA EXACERBACIÓN DE LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRÓNICA Comparison of steroids use in conventional management of exacerbations of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ariel Pérez-Monroy¹

    2010-01-01

    Full Text Available Antecedentes. La enfermedad pulmonar obstructiva crónica es una patología común caracterizada por una limitación crónica, progresiva e irreversible al flujo aéreo, afecta millones de personas en el mundo. Objetivo. Evaluar el uso de dos esquemas de esteroides, en comparación con el tratamiento convencional, en exacerbaciones agudas no acidóticas de la enfermedad pulmonar obstructiva crónica. Material y métodos. Ciento seis pacientes de la Clínica Carlos Lleras Restrepo de Bogotá, con diagnóstico de enfermedad pulmonar obstructiva crónica exacerbada se evaluaron, siendo distribuidos en tres grupos: a Tratamiento convencional, b Hidrocortisona más esquema convencional y c Prednisolona más esquema convencional. Se valoró a las 72 horas el cambio porcentual en la medición del flujo-pico, la variación auscultatoria pulmonar y la percepción de mejoría clínica. Además, se consignó la estancia hospitalaria, la necesidad de tratamientos adicionales o ventilación mecánica y efectos colaterales. Resultados. No se encontraron diferencias significativas en la respuesta a los tres esquemas terapéuticos, salvo una mejor percepción subjetiva con la hidrocortisona. En el análisis por subgrupos la prednisona oral disminuyó la estancia hospitalaria, mejoró el flujo-pico espiratorio y la percepción subjetiva de síntomas en pacientes mayores de 80 años, con VEF1 menor o igual a 50% del predicho y que cursaron con una exacerbación severa. El género, la clase funcional basal, la causa y el tipo de la descompensación, el número de exacerbaciones-año y el número de paquetes-año, no influyeron en la respuesta a los tres grupos. El efecto secundario más frecuente con esteroides fue la hiperglicemia. Conclusión. Los esteroides sistémicos en forma global, no son mejores que el tratamiento convencional en exacerbaciones de EPOC. Sin embargo, la prednisona oral mejoró objetiva y subjetivamente las exacerbaciones severas, en los

  9. Comparación entre efectos del entrenamiento a fuerza y a resistencia en pacientes con enfermedad pulmonar obstructiva crónica (EPOC)

    OpenAIRE

    2001-01-01

    Nuestro objetivo fue demostrar el efecto beneficioso en la capacidad de ejercicio y en la sintomatología clínica de un programa específico de entrenamiento de la potencia muscular en pacientes con EPOC estable. Quisimos comparar el efecto del entrenamiento a fuerza con el obtenido con un programa tradicional de entrenamiento a resistencia, así como comprobar la aportación del entrenamiento conjunto, a potencia y resistencia frente a cada uno de ellos por s...

  10. Síndrome metabólico y sus componentes en pacientes con síndrome de apnea-hipoapnea del sueño Metabolic syndrome and its components in patients with sleep apnea syndrome

    OpenAIRE

    M. Tumbeiro; Acuña,A.; M. T. Alves; R. Dacal; Marcos, P.

    2011-01-01

    Fundamento. El síndrome de apnea-hipoapnea del sueño (SAHS) es un factor de riesgo reconocido de patología cardiovascular y la evidencia reciente sugiere que está relacionado con el síndrome metabólico (SM). El objetivo del estudio fue conocer la prevalencia de los componentes individuales del SM y del SM como entidad, en pacientes con sospecha clínica de SAHS, y ver si ambas entidades están en relación con la obesidad central. Material y métodos. Se estudiaron prospectivamente a 486 paciente...

  11. Ictericia obstructiva de causa maligna irresecable tras CPRE fallida: factores predictores del pronóstico: Tratamiento mediante drenaje guiado por ecoendoscopia versus drenaje percutáneo

    OpenAIRE

    2016-01-01

    JUSTIFICACIÓN Los pacientes con estenosis biliares de causa maligna presentan un mal pronóstico a corto plazo ya que la mayoría de ellos presentan una enfermedad avanzada en el momento del diagnóstico. Este hecho limita sus posibilidades terapéuticas, no pudiendo recibir tratamiento curativo y siendo subsidiarios únicamente de medidas paliativas. El manejo de estos pacientes es complejo ya que requieren una importante carga asistencial con una eficacia limitada por su corta expectativa de ...

  12. [Prevalence of silent cerebrovascular lesions in patients with obstructive sleep apnea syndrome].

    Science.gov (United States)

    Colla-Machado, Pedro E; Luzzi, Ariel A; Balian, Natalia R; Pigretti, Santiago G; Zurrú-Ganen, M Cristina; Cristiano, Edgardo; Valiensi, Stella M

    2016-02-01

    Introduccion. El sindrome de apnea/hipopnea obstructiva del sueño (SAHOS) confiere mayor riesgo de enfermedad cardiovascular, dada su asociacion con otros factores de riesgo vascular. Tanto el SAHOS como otros factores de riesgo vascular se asocian con lesiones cerebrales silentes. Objetivo. Evaluar la prevalencia de lesiones cerebrales silentes en pacientes con SAHOS. Pacientes y metodos. Se evaluo retrospectivamente una cohorte de 137 pacientes con SAHOS, con una edad media de 65 ± 12 años, el 45% mujeres. Las lesiones cerebrales silentes en resonancia magnetica se evaluaron con la escala visual de Fazekas, y se consigno la presencia de infartos corticales, lacunares y microsangrados. Resultados. La prevalencia de factores de riesgo vascular fue: hipertension, 64%; dislipidemia, 58%; diabetes, 18%; tabaquismo, 34%; ateromatosis carotidea, 26%; enfermedad coronaria, 13%; y fibrilacion auricular, 4%. El SAHOS fue leve en el 47%, moderado en el 31% y grave en el 22% de los casos. El 91% de los pacientes tenia hiperintensidades periventriculares y el 66% presentaba lesiones en la sustancia blanca subcortical. El valor medio del indice de apnea/hipopnea fue mayor en los pacientes con mayor carga de lesiones, aunque sin significacion estadistica. Conclusiones. Los pacientes con SAHOS presentan una elevada prevalencia de lesiones cerebrales silentes, fundamentalmente con un patron microangiopatico. Posiblemente esto se explique por la asociacion entre el SAHOS, la hipertension arterial y otros factores de riesgo vascular.

  13. Efectos del Síndrome de Apneas- Hipopneas del Sueño sobre la calidad de vida y la somnolencia diurna / Obstructive Sleep Apnea Syndrome Effects on Quality of Life and Daytime Sleepiness

    Directory of Open Access Journals (Sweden)

    Ana Isabel Sánchez Gómez

    2013-06-01

    Full Text Available El objetivo de esta investigación fue evaluar en pacientes con Síndrome de Apneas-Hipopneas del Sueño (SAHS, la calidad de vida y el impacto de la somnolencia diurna. Se incluyeron 100 sujetos (50 pacientes con SAHS y 50 sujetos sanos que respondieron al Cuestionario de Salud (SF-36, Cuestionario de Impacto Funcional del Sueño (FOSQ y a la Escala de Somnolencia de Epworth (ESE. Respecto al grupo control, el grupo clínico mostró diferencias estadísticamente significativas (p < 0.05 en la mayoría de las variables estudiadas. Los factores más influyentes fueron el índice de masa corporal, el índice de apneas-hipopneas y el índice de desaturación. Este estudio demuestra la importante repercusión que el SAHS tiene en la calidad de vida de los pacientes.

  14. Analisis del signo de Hoover en relacion con parametros funcionales, radiologicos y de radio de curvatura en pacientes con enfermedad pulmonar obstructiva cronica

    Directory of Open Access Journals (Sweden)

    M. E. Capria

    2003-10-01

    Full Text Available El propósito del presente trabajo fue: 1 relacionar el signo de Hoover SH (+ con diversos parámetros funcionales (espirometría y volúmenes pulmonares y radiológicos (radiografías posteroan-teriores, 2 caracterizar los cambios en el radio de curvatura y la eficiencia del diafragma, y restablecer relaciones con los parámetros funcionales y radiológicos. Se estudiaron 15 pacientes con EPOC (SH (+, n: 8. El radio de curvatura fue determinado en el hemidiafragma derecho en inspiración y espiración máximas. Los SH(+ se hallaron más severamente obstruidos (VEF1%, p 0.005% y con mayor atrapamiento aéreo (VR/CPT %, p 0.01. El radio espiratorio (Re fue mayor (p 0.05, y su eficiencia (1/Re, fue menor (p 0.05. El VEF1% correlacionó con el grado de hiperinflación según CPT % (r -0.58, p 0.022 y con el atrapamiento aéreo según VR% (r -0.77, p 0.0008. Los pacientes con menor VEF1% presentaron un Re mayor (r -0. 61, p 0.015 y menor eficiencia diafragmática en espiración (1/Re de acuerdo a: 1/Re = 0.093 cm-1 + 0.0012 cm-1 * VEF1% (r 0.688, p 0.0054. El VEF1 correlacionó con la movilidad diafragmática (r 0.71, p 0.003. La PaCO2 correlacionó con la CPT % (r 0.534, p 0.04, con el VR % (r 0.62, p 0.014 y con los parámetros radiológicos de hiperinflación (r 0.546, p 0.035 y atrapamiento aéreo (r 0.528, p 0.043. El SH(+ sugiere obstrucción bronquial severa, aplanamiento del diafragma, consiguiente aumento del radio de curvatura, menor movilidad y menor eficiencia.The purpose of the present study was: 1 to relate the Hoover sign -SH (+- with several functional (spirometry and lung volumes and radiographic (AP x-ray parameters, 2 to characterize the changes in diaphragmatic curvature radius and the efficiency and to establish some relationships with the functional and radiographic parameters. Fifteen patients with COPD (SH (+, n: 8 were studied. The radius was determined in the right hemidiaphragm after maximal inspired and expired x-ray. The

  15. Calidad de vida en la enfermedad pulmonar obstructiva crónica en fase estable

    OpenAIRE

    Plaza Rodríguez, Josué

    2015-01-01

    Trabajo Fin de Grado (TFG) ANTECEDENTES: La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad prevalente, infradiagnosticada, con elevada tasa de morbimortalidad y supone un problema de salud pública. Cursa con aumento progresivo de la sintomatología, condicionando la calidad de vida del paciente. Existen tratamientos no farmacol ógicos, como son la Fisioterapia Respiratoria, los programas de rehabilitación respiratoria o la educación terapéutica, ...

  16. LA NITRACIÓN DE PROTEÍNAS CONTRIBUYE A LA POTENCIACIÓN QUIMIOSENSORIAL DEL CUERPO CAROTÍDEO DE RATAS SOMETIDAS A HIPOXIA INTERMITENTE

    OpenAIRE

    MOYA CÉSPEDES, ESTEBAN ALEXIS

    2014-01-01

    La hipoxia se manifiesta en diferentes condiciones fisiológicas y patológicas en los seres vivos. Entre ellas, uno de los patrones de hipoxia más común es la hipoxia intermitente crónica que consiste en la ocurrencia de eventos de hipoxia de corta duración seguidos por episodios de normoxia, tal como ocurre en el síndrome de apnea obstructiva del sueño. Numerosos reportes demuestran que la hipoxia intermitente contribuye al desarrollo de alteraciones cardiovasculares e hiperten...

  17. Síndrome de apnea-hipopnea del sueño y factores de riesgo cardiovascular

    OpenAIRE

    Esquinas López, Cristina

    2013-01-01

    La síndrome de l'apnea - hipopnea del son (SAHS) és un trastorn comú que afecta entre el 4-6% dels homes i al 2-4% de les dones en la població general adulta. Els pacients amb aquesta síndrome tenen episodis repetits de col • lapse de la via aèria superior (VAS) durant el son donant lloc a episodis d'hipòxia - reoxigenació, despertars (arousals), increment de l’activitat neurovegetativa i canvis en la pressió intrapleural). Tot aquest conjunt de fenòmens fisiopatològics donen lloc a diverses...

  18. Bases fisiopatológicas del entrenamiento muscular en pacientes con enfermedad pulmonar obstructiva crónica Pathophysiological bases of muscular training in patients with chronic obstructive pulmonary disease

    OpenAIRE

    2011-01-01

    La disnea y la disminución de la capacidad de realizar ejercicio son los principales factores que limitan las actividades de la vida diaria en pacientes con enfermedades respiratorias crónicas. Los síntomas cardinales que limitan la capacidad de ejercicio en la mayoría de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) son la disnea y/o fatigabilidad, los cuales pueden ser ocasionados por trastornos de la ventilación alveolar e intercambio gaseoso, disfunción de los músculos ...

  19. Influencia de un programa de actividad física en niños y adolescentes obesos con apnea del sueño: protocolo de estudio

    OpenAIRE

    M. J. Aguilar Cordero; A. M. Sánchez López; N. Mur Villar; A. Sánchez Marenco; R. Guisado Barrilao

    2013-01-01

    Estudios recientes muestran un incremento alarmante en la tasa de sobrepeso/obesidad entre la población infanto-juvenil. La obesidad en la infancia se asocia con un importante número de complicaciones, como síndrome de apnea del sueño insulinorresistencia y diabetes tipo 2, hipertensión, enfermedad cardiovascular, algunos tipos de cáncer. Se estima que la prevalencia de apnea en niños es de un 2-3% en la población general, mientras que, en adolescentes obesos, varía entre el 13% y el 66%, seg...

  20. Enfermedad pulmonar obstructiva crónica entrenamiento domiciliario versus ambulatorio hospitalario

    OpenAIRE

    Enrique Jolly; Martín Sívori; Sara Villarreal; Marta Almeida; César Sáenz

    2014-01-01

    Existe poca experiencia sobre el efecto del entrenamiento domiciliario (rD) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). El objetivo de este trabajo fue comparar el efecto del rD sobre la tolerancia al ejercicio, disnea y calidad de vida versus el entrenamiento ambulatorio hospitalario (rH). Se compararon dos grupos de pacientes con EPOC. Ambos entrenaron durante 24 sesiones, 8 semanas. Antes y después del entrenamiento se realizaron: espirometría, cuestionarios de disnea ...

  1. Sleep Apnea

    Science.gov (United States)

    Sleep apnea is a common disorder that causes your breathing to stop or get very shallow. Breathing ... an hour. The most common type is obstructive sleep apnea. It causes your airway to collapse or ...

  2. Bases fisiopatológicas del entrenamiento muscular en pacientes con enfermedad pulmonar obstructiva crónica Pathophysiological bases of muscular training in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    FERNANDO SALDÍAS P

    2011-06-01

    Full Text Available La disnea y la disminución de la capacidad de realizar ejercicio son los principales factores que limitan las actividades de la vida diaria en pacientes con enfermedades respiratorias crónicas. Los síntomas cardinales que limitan la capacidad de ejercicio en la mayoría de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC son la disnea y/o fatigabilidad, los cuales pueden ser ocasionados por trastornos de la ventilación alveolar e intercambio gaseoso, disfunción de los músculos esqueléticos y/o falla cardiovascular. La ansiedad, falta de motivación y depresión también han sido asociadas a una menor capacidad de realizar ejercicio, probablemente afectando la percepción de los síntomas. La relación entre el estado psicológico y los trastornos del ánimo en pacientes con EPOC y la tolerancia al ejercicio es compleja y aún no ha sido completamente dilucidada. El origen de la limitación de la capacidad de ejercicio en pacientes con EPOC es multifactorial, por lo cual la separación de las variables involucradas con fines académicos no siempre es factible realizarlo en los pacientes. Los mecanismos patogénicos pueden relacionarse en forma compleja, a modo de ejemplo, el desacondicionamiento físico y la hipoxemia pueden contribuir a aumentar la ventilación alveolar ocasionando limitación del ejercicio de causa ventilatoria. Por lo tanto, el entrenamiento físico y el suplemento de oxígeno pueden reducir la limitación ventilatoria durante el ejercicio sin modificar la función pulmonar o la capacidad ventilatoria máxima. El análisis de los factores limitantes de la capacidad de ejercicio permite identificar trastornos potencialmente reversibles que pueden mejorar la calidad de vida de los enfermos, tales como la hipoxemia, broncoespasmo, insuficiencia cardiaca, arritmias, disfunción musculoesquelética y/o isquemia miocárdica. En esta revisión se examinan los principales mecanismos que contribuyen a la limitaci

  3. Sueño y patología: Hipersomnias, narcolepsia y síndromes de apnea del sueño.

    Directory of Open Access Journals (Sweden)

    Javier Espinar Sierra

    1990-01-01

    Full Text Available En el apartado de trastornos de excesiva somnolencia diurna se consideran tres grandes grupos patológicos: las hipersomnias, la narcolepsia y los síndromes de apnea del sueño. No está establecida de forma definitiva la prevalencia de cada uno de estos trastornos en la población general. Para la prevalencia de la apnea del sueño, se suele aceptar el 1 % obtenido por LAVIE (1981 entre los trabajadores industriales de Israel. DEMENT et al. (1973 obtuvieron una prevalencia para la narcolepsia del 0,07 % en una encuesta realizada en el área metropolitana de Los Angeles.

  4. Alteraciones endocrinometabólicas en la enfermedad pulmonar obstructiva crónica

    OpenAIRE

    Irene Torres-Sánchez; Marie Carmen Valenza; Fernando Carrasco; Irene Cabrera-Martos; Gerald Valenza-Demet; Marcelo Cano-Capellaci

    2013-01-01

    Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por obstrucción crónica del flujo aéreo y se asocia frecuentemente a alteraciones endocrino-metabólicas que empeoran la situación clínica del paciente y su pronóstico. El conocimiento en profundidad de estas alteraciones en los pacientes con EPOC permite llevar a cabo medidas preventivas, detección temprana e intervenciones nutricionales adecuadas. Objetivos: Analizar la prevalencia de comorbilidades endocrino-meta...

  5. Influencia de un programa de actividad física en niños y adolescentes obesos con apnea del sueño: protocolo de estudio

    Directory of Open Access Journals (Sweden)

    M. J. Aguilar Cordero

    2013-06-01

    Full Text Available Estudios recientes muestran un incremento alarmante en la tasa de sobrepeso/obesidad entre la población infanto-juvenil. La obesidad en la infancia se asocia con un importante número de complicaciones, como síndrome de apnea del sueño insulinorresistencia y diabetes tipo 2, hipertensión, enfermedad cardiovascular, algunos tipos de cáncer. Se estima que la prevalencia de apnea en niños es de un 2-3% en la población general, mientras que, en adolescentes obesos, varía entre el 13% y el 66%, según distintos estudios. Se asocia con la afectación de la función neurocognitiva, comportamiento, sistema cardiovascular, alteraciones metabólicas y del crecimiento. La apnea del sueño es un grave problema de salud pública que aumenta cuando los niños y adolescentes padecen sobrepeso y obesidad. Se postula el ejercicio de resistencia aeróbica como un tratamiento efectivo para la obesidad y la apnea de forma conjunta. El objetivo de este estudio es conocer si la actividad física en niños con sobrepeso/obesidad disminuye la apnea del sueño. Se realizará un estudio observacional, descriptivo, prospectivo, longitudinal con niños que padecen apnea del sueño y obesidad. El universo estará constituido por 60 niños y adolescentes con edades comprendidas entre 10 y 18 años que acudan a la consulta de endocrinología por tener obesidad en el Hospital Clínico San Cecilio de Granada durante el período de septiembre 2012-septiembre 2013. La muestra estará formada por niños y adolescentes que cumplan estas características y que sus padres/tutores hayan autorizado a través del consentimiento informado. La apnea del sueño se medirá en los niños mediante una polisomnografía y un cuestionario de calidad del sueño. También se hará una valoración nutricional a través de un cuestionario de frecuencia de consumo alimentario y una valoración antropométrica. De entre los resultados esperados están el bajar el sobrepeso y obesidad en los ni

  6. Efecto del síndrome de apnea e hipopnea infantil en la utilización de los servicios sanitarios

    OpenAIRE

    Soria Checa, Cristina Esmeralda

    2015-01-01

    En general se habla de Trastornos Respiratorios del Sueño (TRS) para abarcar un amplio grupo de procesos que van desde el ronquido, el síndrome de resistencia aumentada de la vía aérea superior, el síndrome de hipoventilación, hasta el síndrome de apnea e hipopnea del sueño (SAHS). Se define el SAHS, como un trastorno de la respiración durante el sueño caracterizado por una obstrucción parcial prolongada de la vía aérea superior (hipopnea) y/o una obstrucción completa intermitente (apnea ...

  7. La relación entre el asma y la enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Marcia Solano-Ortiz

    2007-01-01

    Full Text Available Asma y enfermedad pulmonar obstructiva crónica (EPOC son enfermedades pulmonares comunes con semejanzas y diferencias. Estudios genéticos recientes han dado información importante acerca de los múltiples loci susceptibles para cada enfermedad. Estudios del genoma han mostrado resultados similares en al menos una región cromosomal en ambas enfermedades, así como también evidencia de la interacción con factores ambientales (por ejemplo, el fumado activo en los pacientes con EPOC, o el pasivo en aquellos con asma. Existen pocos estudios recientes acerca del remodelamiento de la vía aérea y su importancia en pacientes asmáticos persistentes crónicos, lo que podría explicar de cierta forma la progresión de estas personas a enfermedades pulmonares obstructivas crónicas.

  8. Las células T reguladoras en la enfermedad pulmonar obstructiva crónica

    OpenAIRE

    Limón-Camacho,Leonardo; Solleiro-Villavicencio,Helena; Pupko-Sissa,Ilana; Lascurain,Ricardo; Vargas-Rojas,María Inés

    2013-01-01

    La exposición al humo del tabaco induce inflamación de las vías aéreas y es el principal factor de riesgo para desarrollar la enfermedad pulmonar obstructiva crónica (EPOC). En este proceso inflamatorio participan varias poblaciones celulares. Algunas fallas en la modulación de la respuesta inflamatoria han sido aceptadas como un factor para el desarrollo de esta enfermedad. Las células T reguladoras (Treg) son un tipo de linfocitos T CD4+ que modulan la respuesta inmune mediante contacto dir...

  9. Sleep Apnea (For Parents)

    Science.gov (United States)

    ... Feeding Your 1- to 2-Year-Old Obstructive Sleep Apnea KidsHealth > For Parents > Obstructive Sleep Apnea Print ... kids and teens can develop it, too. About Sleep Apnea Sleep apnea happens when a person stops ...

  10. Síndrome metabólico y sus componentes en pacientes con síndrome de apnea-hipoapnea del sueño Metabolic syndrome and its components in patients with sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    M. Tumbeiro

    2011-12-01

    Full Text Available Fundamento. El síndrome de apnea-hipoapnea del sueño (SAHS es un factor de riesgo reconocido de patología cardiovascular y la evidencia reciente sugiere que está relacionado con el síndrome metabólico (SM. El objetivo del estudio fue conocer la prevalencia de los componentes individuales del SM y del SM como entidad, en pacientes con sospecha clínica de SAHS, y ver si ambas entidades están en relación con la obesidad central. Material y métodos. Se estudiaron prospectivamente a 486 pacientes consecutivos, 359 hombres (73,9%, con una edad media de 57,3 ± 13,5 años y un índice de masa corporal (IMC de 32,1 ± 6,5 kg/m² con sospecha clínica de SAHS. El SAHS se diagnosticó por registro nocturno. Un Indice de Apnea-Hipoapnea (IAH > 5 era considerado diagnóstico de SAHS. El SM era diagnosticado siguiendo los criterios de la International Diabetes Federation. Resultados. De los pacientes estudiados 325 (66,9% eran SAHS de grado moderado-grave. El IAH medio fue de 30,2 ± 23,8. De 456 pacientes (93,8% teníamos datos para el diagnóstico de SM y su prevalencia fue del 64,7% (295 pacientes. En el análisis multivariante, tanto la edad como el perímetro abdominal se comportaron como predictores de SAHS y de SM (pBackground. Sleep Apnea Syndrome (SAHS represents a significant risk factor for the development of cardiovascular disease and evidence suggests a relation with Metabolic Syndrome (MS. The aim of this study was to determine the prevalence of individual components of MS and of MS as an entity, in patients with clinical suspicion of SAHS, and their relation to central obesity. Methods. We examined the records of 486 consecutive patients, 359 (73.9% men, with a mean age of 57.3 ± 13.5 years and a mean body mass index (BMI of 32.1 ± 6.5 kg/m², with clinical suspicion of SAHS. SAHS was diagnosed from the nocturnal register. An Apnea-Hipopnea Index (AHI > 5 was considered SAHS. MS was evaluated according to the diagnostic criteria of

  11. Manejo del SAHS mediante dispositivos de avance mandibular: Estudio preliminar Sleep apnea-hypopnea syndrome management using a mandibular advancement device: Preliminary study

    Directory of Open Access Journals (Sweden)

    Manuel Sánchez-Moliní

    2010-12-01

    Full Text Available El tratamiento que ha demostrado mayor eficacia en los pacientes con síndrome de apneas-hipopneas del sueño (SAHS es la presión positiva continua de la vía aérea (CPAP. Los mayores inconvenientes son la incomodidad y la sensación de claustrofobia, que en algunos pacientes provoca rechazo o intolerancia. Una alternativa son los dispositivos de avance mandibular (DAM, que insertados en las arcadas dentarias producen el avance de la mandíbula y de la lengua, aumentando el volumen de la vía aérea. Objetivo: Presentar nuestra experiencia en el tratamiento del SAHS mediante dispositivos de avance mandibular tipo Herbst. Metodología: Estudio de seguimiento prospectivo desde junio de 2006 hasta enero de 2009 de 7 pacientes del Área Hospitalaria Virgen Macarena con SAHS que rechazan el tratamiento con CPAP y a los que se ofrece tratamiento con DAM. Las variables analizadas son: índice de apneas-hipopneas por hora, índice de desaturaciones por hora, intensidad subjetiva del ronquido y el test de somnolencia de Epworth, antes del tratamiento y al menos 6 meses después desde el inicio de su uso. Utilizamos el test de Wilcoxon para detectar diferencias estadísticas significativas (pThe most effective treatment in patients with sleep apnea-hypopnea syndrome (SAHS is CPAP (continuous positive airway pressure. The main drawback of CPAP is the discomfort and claustrophobic sensation that it causes, which elicits rejection or intolerance by some patients. A non-surgical alternative to CPAP is the mandibular advancement device (MAD, which consists of a plastic splint inserted between the dental arches to shift the jaw and tongue forward and thus increase airway volume. Objective: Report our experience with the treatment of SAHS using the Herbst mandibular advancement device. Material and method: A prospective follow-up study was carried out from June 2006 until January 2009 at the Virgen Macarena University Hospital with 7 patients with SAHS who

  12. Síndrome de apnea-hipopnea del sueño: Concepto, diagnóstico y tratamiento médico Sleep apnea-hypopnea syndrome: Concept, diagnosis and medical treatment

    Directory of Open Access Journals (Sweden)

    V. M. Eguía

    2007-01-01

    Full Text Available El Síndrome de apneas-hipopneas del sueño (SAHS se caracteriza por somnolencia diurna excesiva, trastornos cardiorrespiratorios y cognitivos, secundarios a episodios repetidos de obstrucción de la vía aérea superior durante el sueño. Esta enfermedad es muy prevalente en la población general y tiene efectos deletéreos sobre el sistema cardiovascular; aumenta la incidencia de accidentes de tráfico a causa de la excesiva somnolencia, deteriora la calidad de vida y se asocia a un exceso de mortalidad. Suele afectar a pacientes obesos y los síntomas más importantes son los ronquidos y las pausas respiratorias repetidas. Cada apnea y/o hipopnea condiciona una puntual caída en la saturación que altera la media nocturna y termina ocasionando serios problemas cardiovasculares a medio-largo plazo. La desestructuración de la arquitectura del sueño conduce a la excesiva somnolencia diurna capaz de interferir en la vida socio-laboral. El diagnóstico se realiza mediante polisomnografía o poligrafía respiratoria, método abreviado válido para el 75% de casos. El tratamiento médico más eficaz es la aplicación de presión positiva en la vía aérea (CPAP que tiene escasos y leves efectos secundarios y es, en general, bien tolerado. Una vez adaptado el paciente debe realizarse un ajuste de la presión mediante polisomnografía o con las autoCPAP, capaces de variar la presión hasta la corrección de los eventos respiratorios. El papel de la atención primaria es fundamental en la sospecha del cuadro, la utilización correcta de los criterios de derivación y el control de los pacientes en tratamiento una vez adaptados.The sleep apnea-hypopnea syndrome (SAHS is characterised by daytime sleepiness, cardiorespiratory and cognitive disorders, secondary to repeated episodes of obstruction of the upper airway during sleep. This disease is highly prevalent in the general population and has damaging effects on the cardiovascular system; it increases

  13. obstructiva crónica (EPOC

    Directory of Open Access Journals (Sweden)

    Stefano Vinaccia

    2006-01-01

    Full Text Available Este artículo presenta los resultados de un estudio desarrollado en Colombia sobre la evaluación de la calidad de vida y sus relaciones con la ansiedaddepresión y el apoyo social en pacientes con diagnóstico de enfermedad pulmonar obstructiva crónica (epoc. Se evaluaron 60 personas con diagnóstico de epoc de diferentes ipss (Instituciones Prestadoras de Servicios de Salud de la ciudad de Medellín, Colombia. Para evaluar la calidad de vida se utilizó el Cuestionario SF36; la ansiedad-depresión fue evaluada mediante el Cuestionario HAD, y se usó el Cuestionario AS para medir apoyo social. No se evidenciaron niveles clínicamente significativos de ansiedad-depresión, la calidad de vida de las funciones físicas fueron las más afectadas especialmente el rol físico (trabajo, estudio en el cuestionario sf36 y en relación al apoyo social se observaron niveles muy altos. En general, hubo alta confiabilidad en todo el estudio.

  14. Síndrome de Apneas Hipopneas del Sueño. ¿Asesino silencioso? Revisión de la literatura.

    OpenAIRE

    Rey de Castro Mujica, Jorge

    2012-01-01

    El Síndrome de Apneas-Hipopneas del Sueño (SAHS) consiste en la aparición de episodios recurrentes que limitan el paso del aire durante el sueño, como consecuencia de una alteración anatómico-funcional de la vía aérea superior que conduce a su colapso, provocando descensos de la saturación de oxihemoglobina y microdespertares dando lugar a un sueño no reparador, somnolencia diurna excesiva, trastornos neuropsiquiátricos, respiratorios y cardiacos (1,2). Sin duda, el SAHS no tratado está asoci...

  15. Sleep Apnea

    Science.gov (United States)

    ... of other risk factors linked to a higher risk of heart disease. The conditions that make up metabolic syndrome include high blood pressure, abnormal cholesterol, high blood sugar and an increased waist circumference. Complications with medications and surgery. Obstructive sleep apnea ...

  16. Apnea of prematurity

    Science.gov (United States)

    Apnea - newborns; AOP; As and Bs; A/B/D; Blue spell - newborns; Dusky spell - newborns; Spell - newborns; Apnea - neonatal ... particular those who were born early, may have apnea, including: If their brain is not fully developed ...

  17. Pediatric sleep apnea

    Science.gov (United States)

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... During sleep, all of the muscles in the body become more relaxed. This includes the muscles that help keep ...

  18. Sleep Apnea Information Page

    Science.gov (United States)

    ... Page You are here Home » Disorders » All Disorders Sleep Apnea Information Page Sleep Apnea Information Page Search Disorders Search NINDS SEARCH ... Institutes of Health (NIH) conduct research related to sleep apnea in laboratories at the NIH, and also ...

  19. Obstructive sleep apnea - adults

    Science.gov (United States)

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  20. Validez y confi abilidad del instrumento “Medición de la autoeficacia percibida en apnea del sueño” - SEMSA. Versión en español

    Directory of Open Access Journals (Sweden)

    Erika Marcela Mateus-Galeano

    2016-01-01

    Full Text Available Objetivo:determinar la validez y la consistencia interna del instrumento“Medición de la autoeficacia percibida en apnea del sueño”- SEMSA, versión en español, diseñado por Weaver et al.Materiales y métodos:estudio de tipo descriptivo metodológico; se deter-minó la validez facial y de contenido con panel de expertos y un literato bilingüe. La muestra de la validez de constructo y consistenciainterna fue de 151 pacientes con síndrome de apnea hipopnea del sueño que usaron el tratamiento de presión positiva continua en la víaaérea (CPAP.Resultados:la validez facial mostró un índice de aceptabilidad superior en las tres categorías evaluadas. En la validez decontenido, 23 ítems alcanzaron un nivel de aceptabilidad satisfactorio y los 4 ítems restantes fueron susceptibles de modificación. En lavalidez de constructo, el análisis factorial exploratorio determinó tres factores con una varianza total explicada de 52,2%. La consistenciainterna por el alfa de Cronbach fue 0,90 para la escala total y para cada dimensión mayor de 0,84.Discusión:la varianza total explicadacomparándola con el estudio original fue mayor y el alfa de Cronbach fue similar tanto en la escala total como dimensional.Conclusión:el instrumento Self Efficacy Measure Sleep Apnea, válido y homogéneo en el contexto urbano colombiano, es una herramienta relevante yobjetiva acerca de las perspectivas del paciente con síndrome de apnea hipopnea del sueño sobre los riesgos asociados, el beneficio deltratamiento y el cumplimiento en el uso de presión positiva (CPAP, a pesar de las barreras percibidas.

  1. Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres Chronic obstructive pulmonary disease: differences between men and women

    OpenAIRE

    María Soledad Rodríguez-Pecci; Javier de la Fuente-Aguado; Javier Montero-Tinnirello; Ana B. Sanjurjo-Rivo; Paula Sánchez-Conde; Francisco J. Fernández-Fernández

    2012-01-01

    La enfermedad pulmonar obstructiva crónica (EPOC) ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV) en una población de pacientes con EPOC. En este estud...

  2. Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres

    Directory of Open Access Journals (Sweden)

    María Soledad Rodríguez-Pecci

    2012-06-01

    Full Text Available La enfermedad pulmonar obstructiva crónica (EPOC ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV en una población de pacientes con EPOC. En este estudio prospectivo observacional de corte transversal, se incluyeron pacientes con EPOC ingresados consecutivamente entre el 1 de septiembre de 2008 al 1 de marzo de 2010. Se registraron edad, sexo, habito tabáquico, factores de riesgo y enfermedad cardiovascular, tratamiento y gravedad de la EPOC. Se midió índice tobillo-brazo (ITB y se realizó Euroqol-5D. Se incluyeron 246 pacientes (195 hombres. Los hombres fueron más ex fumadores (68.7% vs. 15.7%, p < 0.001, tuvieron un VEF1 menor (48.7% ± 15.7 vs. 58.2% ± 10.9 de teórico, p < 0.001 y mayor frecuencia de cardiopatía isquémica (16.4% vs. 5.9%, p = 0.04. Las mujeres presentaron más prevalencia de EPOC sin exposición al tabaco (64.7% vs. 7.2%, p < 0.001, más síntomas de ansiedad y depresión (p = 0.004 e ITB alterado en menor frecuencia (20% vs. 41.6%, p = 0.01. Concluimos que hubo diferencias en la EPOC en relación al sexo, con compromiso pulmonar y cardiovascular más grave en hombres y más síntomas de ansiedad y depresión en mujeres.

  3. Factores de riesgo para el síndrome metabólico en una población con apnea del sueño: evaluación en un grupo de pacientes de Granada y provincia; estudio GRANADA Risk factors for metabolic syndrome in a population with sleep apnea: evaluation in a population of Granada; the Granada study

    Directory of Open Access Journals (Sweden)

    M.ª C. Valenza

    2012-08-01

    Full Text Available Introducción: El síndrome metabólico se está convirtiendo en uno de los principales problemas de salud pública del siglo XXI. Se considera que la aparición del síndrome metabólico está determinada por la interacción de factores genéticos, ambientales y nerviosos centrales (disfunción de los centros hipotalámicos de hambre y saciedad que generan dos alteraciones metabólicas importantes: la resistencia a la acción de la insulina y la obesidad visceral. La relación de este síndrome, que concentra en la actualidad al mundo científico, con las alteraciones del sueño sigue siendo un punto sin esclarecer. Aunque se ha teorizado sobre la relación causa efecto, se desconoce aún su interrelación convirtiéndose su estudio en un objetivo primario de la investigación epidemiológica. Muestra y métodos: Se reclutaron 1016 sujetos que acudieron al servicio de Fisiología Respiratoria del Hospital Universitario "San Cecilio" de Granada (España por sospecha de Apnea de Sueño. Resultados: Se encontró una correlación significativa (p Introduction: The Metabolic Syndrome is one of the first health problems in the public health of the century. It's consider that the beginning of the syndrome is determined by numerous factors that developed two main metabolic disturbances: the insulin resistance and the central obesity. This relationship is concentrating the scientific world. As the cause-effect relationship has to be answered, the epidemiologic research has focused on without results. Material and methods: 1,016 subjects were recruited in the sleep disorders laboratory in San Cecilio Hospital with sleep apnea suspicion. Results: Significant correlation (p < 0,001 was found between sleep apnea severity and nocturnal saturation values and the different metabolic disturbances related to the metabolic syndrome (Hypertension, Diabetes and obesity. By the contrary, we doesn't found significant differences between No-Sleep apnea group and

  4. Enfermedades del sueño en el recién nacido Sleep disorders in the newborn

    Directory of Open Access Journals (Sweden)

    Israel Alfonso

    2007-01-01

    Full Text Available Las enfermedades del sueño se clasifican en disomnias, parasomnias, enfermedades del sueño asociadas con enfermedades médicas y psiquiátricas, y las propuestas enfermedades del sueño. Solo las parasomnias han sido estudiadas como tales en el recién nacido. Las parasomnias que ocurren en el recién nacido son el síndrome de apnea infantil del sueño, el síndrome de hipoventilación congénita central, el síndrome de muerte infantil súbita, y el mioclono neonatal benigno del sueño. Bajo el término de síndrome de apnea infantil del sueño se agrupan tres entidades: (1 el síndrome de apnea del prematuro, (2 el síndrome de evento que pone en peligro la vida del niño asociado con apnea, y (3 la apnea obstructiva del sueño. El síndrome de hipoventilación central congénito puede estar asociado a otras enfermedades del sistema autónomo tales como la enfermedad de Hirschsprung (síndrome de Haddad y la dismotilidad esofágica, y a tumores del sistema nervioso simpático, especialmente al neuroblastoma. La implementación de la posición supina para dormir y el no fumar en los hogares ha disminuido la frecuencia del síndrome de muerte súbita infantil a 0.85 por 1.000 nacimientos. El mioclono neonatal benigno del sueño debe considerarse en todo recién nacido con un examen normal entre los episodios de mioclonia cuyos episodios sólo ocurren durante el sueño. Esta entidad puede confundirse con status epilepticus, porque los eventos pueden asociarse a aumentos de la frecuencia cardíaca. El uso de las benzodiazepinas puede prolongar la duración de los eventos mioclónicos.Sleep disorders are classified in dyssomnias, parasomnias, sleep disorder associated with medical and psychiatric disorders and proposed sleep disorders. Only the parasomnias have been studied as such in the newborn period. The parasomnias that occur in this age group are infant sleep apnea, congenital central hypoventilation syndrome, sudden infant death syndrome

  5. Plan de alta para personas con enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Luz Marina Céspedes Salgado

    2006-01-01

    Full Text Available El plan de alta busca asegurar unos cuidados acordes con las necesidades y los requerimientos de la persona una vez egresa de la institución de salud, y debe constituirse en una guía básica en especial para la atención de aquéllos con patologías crónicas, como es la enfermedad pulmonar obstructiva crónica, que por su complejidad demanda múltiples cuidados para asegurar una intervención integral con miras al logro de una mejor adaptación, a identificar posibles complicaciones y a mejorar su calidad de vida. La experiencia de haber asumido el rol de hija y enfermera de un padre con enfermedad pulmonar obstructiva crónica (EPOC, y la alta incidencia de esta enfermedad, motivaron la elaboración de este plan de alta; fueron muchos los cuidados y muchas las necesidades y los cuestionamientos que se daban día a día, desde asegurar una adecuada comunicación hasta un conocimiento de los signos y síntomas de urgencia que indicaban una exacerbación, del uso adecuado de los medicamentos, de la importancia de la oxigenoterapia a largo plazo, de proporcionarle una dieta acorde con las recomendaciones y un ambiente favorable para sus condiciones de salud para, en últimas, alcanzar un entorno armónico, físico, familiar y espiritual.

  6. Perspectivas actuales en el tratamiento del Síndrome de Apneas-Hipopneas del Sueño (SAHS) y dificultades para su implementación en nuestro medio.

    OpenAIRE

    Rey de Castro Mujica, Jorge

    2013-01-01

    El Síndrome de Apneas-Hipopneas del Sueño (SAHS) es un trastorno serio de curso crónico caracterizado por episodios repetidos de colapso parcial o total de la vía aérea superior presentados durante el dormir. La interrupción y fraccionamiento del sueño produce excesiva somnolencia diurna (ESD). La información relacionada a su prevalencia indica que este desorden es común y puede fluctuar entre 2-4 % de los adultos en la edad media de la vida (1-3). Debido a su asociación con alteraciones neur...

  7. La relación entre el asma y la enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Marcia Solano-Ortiz

    2007-01-01

    Full Text Available Asma y enfermedad pulmonar obstructiva crónica (EPOC son enfermedades pulmonares comunes con semejanzas y diferencias. Estudios genéticos recientes han dado información importante acerca de los múltiples loci susceptibles para cada enfermedad. Estudios del genoma han mostrado resultados similares en al menos una región cromosomal en ambas enfermedades, así como también evidencia de la interacción con factores ambientales (por ejemplo, el fumado activo en los pacientes con EPOC, o el pasivo en aquellos con asma. Existen pocos estudios recientes acerca del remodelamiento de la vía aérea y su importancia en pacientes asmáticos persistentes crónicos, lo que podría explicar de cierta forma la progresión de estas personas a enfermedades pulmonares obstructivas crónicas.Asthma and COPD are common pulmonary diseases with similarities and differences. Recent genetic studies have given important information about multiple susceptible loci for both diseases. Studies of the genome have showed similar results in at least a chromosomal region in both diseases and demonstrate the interaction the environmental factors (for example, active smoking in the patients with COPD, or passive smoking in those with asthma. Currently there are few recent studies about airway remodelling and its importance in chronic persistent asthmatic patients, this might explain in some way the progression of these persons to chronic obstructive pulmonary diseases.

  8. Apnea monitor (image)

    Science.gov (United States)

    An apnea monitor checks the heart rate and respiration of the baby to make sure he or she is ... When either one falls below normal levels, the apnea monitor beeps to notify the care provider that ...

  9. American Sleep Apnea Association

    Science.gov (United States)

    American Sleep Apnea Association Learn About the CPAP Assistance Program About ASAA News about ASAA Who we are Leadership Team Supporting the ASAA Financials Learn Healthy sleep Sleep apnea Other sleep disorders Personal stories Treat Test Yourself ...

  10. What Is Sleep Apnea?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Is Sleep Apnea? Español Sleep apnea (AP-ne-ah) is ... many people. Rate This Content: NEXT >> Featured Video Sleep Apnea Research: The HeartBeat Study 06/07/2012 ...

  11. Urolitiasis obstructiva en ovinos: estudio de caso

    OpenAIRE

    2010-01-01

    Un ovino macho de 5 meses de edad fue presentado para su estudio patológico. La historia clínica del animal incluía: postración, dificultad para incorporarse, distensión abdominal severa, pérdida de apetito, estranguria, poliaquiuria y hematuria. A la necropsia se observó la presencia de 8 litros aproximadamente de orina en cavidad abdominal y una membrana fibrino-hemorrágica flotante adherida a la vejiga a nivel de la lesión de ruptura, por una sobre distensión provocada por la presencia obs...

  12. Vivir con la enfermedad pulmonar obstructiva crónica avanzada: el impacto de la disnea en los pacientes y cuidadores

    Directory of Open Access Journals (Sweden)

    Xavier Costa

    2016-12-01

    Conclusiones: La atención adecuada de los pacientes con enfermedad pulmonar obstructiva crónica, más allá de las medidas farmacológicas para controlar los síntomas respiratorios, pasa por la comprensión del sufrimiento, las pérdidas y las limitaciones que provoca en sus vidas y las de sus cuidadores. Un abordaje paliativo, holístico y cercano a sus vivencias reales, junto al empoderamiento para la adaptación a los síntomas debilitantes, podría contribuir a una vida mejor en la etapa final de la enfermedad.

  13. Concordancia entre capacidad vital lenta y capacidad vital forzada en pacientes con enfermedad pulmonar obstructiva crónica o con sospecha de ella

    OpenAIRE

    Hidalgo Martínez, Patricia

    2010-01-01

    Objetivo. Determinar la concordancia en términos de consistencia entre la capacidad vital lenta y la capacidad vital forzada en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) o remitidos por sospecha de EPOC. Diseño. Estudio de concordancia en términos de consistencia entre la capacidad vital lenta (CVL) y la capacidad vital forzada (CVF) en pacientes con EPOC o remitidos por sospecha de EPOC. Lugar. Se llevó a cabo en el Laboratorio de Función Pulmonar del Hospital Universitari...

  14. La utilidad del monitoreo Holter con saturación de oxígeno en la valoración de pacientes con sospecha de apnea del sueño

    Directory of Open Access Journals (Sweden)

    Vivien Araya - Gómez

    2014-06-01

    Full Text Available Justificación: los trastornos respiratorios asociados con el sueño son frecuentes. Entre ellos la apnea del sueño ocupa un lugar importante como problema de salud, pues está asociada con la aparición de arritmias, trastornos metabólicos, hipertensión arterial y cardiopatía isquémica. La detección tiene cierto grado de dificultad, puesto que métodos como la polisomnografía pueden ser complejos y costosos. El objetivo de este trabajo es presentar la experiencia con el uso del monitoreo ambulatorio de la saturación de oxígeno de 24 horas (OxyholterR, como método de detección inicial de pacientes con este síndrome. Metodología: estudio descriptivo de los principales hallazgos en los registros de OxyholterR realizados en el Centro Car­diológico Integral entre el año 2005 y 2013, en pacientes con sospecha clínica de apnea del sueño. Por lo tanto se analizó la presencia de las alteraciones en la saturación de oxígeno nocturno según edad y sexo. Y se clasificó dichas alteraciones con base en la duración e intensidad. Se analizó la presencia de arritmias durante los periodos de sueño. Resultados: en 494 estudios, la edad promedio general fue de 65 años, la distribución por género fue: 279 (56 % hombres y 215 (43 % mujeres. Un 10 % (51 casos de los estudios fueron normales, un 90 % (443 casos mostró alteración significa­tiva en la saturación y en estos, el tiempo con saturación de O2 baja fue menor de 30 minutos en 43 % de los pacientes y mayor de 30 minutos en 57 % de los pacientes. En un 33 % la disminución en la saturación fue leve (Saturación O2 80-88%, en un 39 % moderada (Saturación O2 70-79 % y en un 28 % severa (Saturación O2<69 %. De los casos con saturación nocturna baja, en 88 (20 % se documentaron arritmias de predominio nocturno. Conclusiones: la apnea del sueño es un problema de salud frecuente en la población adulta. Existen casos leves y otros severos. El monitoreo ambulatorio Holter con

  15. [Obstructive sleep apnea syndromes].

    Science.gov (United States)

    Poirrier, R

    1993-01-01

    Snoring and excessive sleepiness are the hallmarks of obstructive sleep apnea syndrome but other clinical manifestations are present and a precise assessment of the disease involves clear definitions of the various kinds of apnea. Several pathogenetic factors (functional, anatomical, neurological, genetical) are still being discussed. However new insights of the pathophysiology of apneas allow more reliable treatments. Central nervous and cardiovascular complications as well as the traumatic morbidity, associated with excessive daytime sleepiness, make it a major public health problem.

  16. Evaluación de la eficacia de dos intervenciones educativas a corto plazo sobre las técnicas ed inhalación en pacientes con enfermedad pulmonar obstructiva crónica. Estudio TECEPOC

    OpenAIRE

    Vázquez Alarcón, Rubén Luciano

    2014-01-01

    En diversos estudios se ha observado que más del 85% de los pacientes no utiliza los inhaladores correctamente y que el entrenamiento repercute positivamente en su uso. Objetivos: Evaluar la eficacia de dos intervenciones educativas para mejorar la técnica de inhalación en 465 pacientes con EPOC (Enfermedad Pulmonar Obstructiva Crónica) de 9 centros de salud del Distrito Sanitario de Málaga-Guadalhorce y del Área Sanitaria Málaga Este-Axarquía. Evaluar la influencia de las preferencias so...

  17. Adherencia al tratamiento con presión positiva continua nasal en pacientes con síndrome de apnea/hipoapnea del sueño Compliance with continuous positive airway pressure therapy in patients with sleep apnea/hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Claudio W. Gallego

    2004-10-01

    Full Text Available Se evalúan prospectivamente los factores predictores y nivel de cumplimiento del tratamiento con presión positiva continua nasal (CPAP en un grupo de pacientes con síndrome de apnea del sueño. Valora efectos adversos y estado del equipamiento: interfase siliconada (IS, máscara-conectores (M-C, tubuladura (TU y arnés (A. Se incluyeron pacientes con >3meses de tratamiento, se registraron las horas de encendido mediante el contador horario al inicio, 2 y 4 meses. Definimos paciente cumplidor (C+ al que usara el CPAP >4h/d y >5d/semana. De los 46 pacientes estudiados (hombres 34; edad 62±9 años; IMC 33±7kg/m²; IAH 38±18/h; inicio 2.1±1.7años; CPAP 9±1.4cmH2O, 34 tenían contador horario y 24 (71% eran C+. El motivo de consulta fue: hipersomnolencia (65%, ronquido (39%, apneas vistas por cónyuge (28%. Entre C+ y C- no hallamos diferencias significativas en edad, IMC, presión de CPAP, tiempo de tratamiento, IAH, y clasificación de Epworth pre-tratamiento. Las horas de uso referidas vs. medidas para C+ y C- fueron 6.6±1 vs. 6.1±1 (p=0.02 y 5.6±1 vs 2.4±1 (p1año de uso, observamos un menor porcentaje de elementos categorizados como óptimos (87 a 44%, 74 a 44%, 83 a 44%, 91 a 78%, respectivamente. Los defectos más frecuentes fueron: endurecimiento de IS, rajaduras en IS, M-C y TU, conexiones flojas. El estudio confirma la importancia del monitoreo objetivo en pacientes con CPAP. Especial atención merece la presencia de efectos adversos y el control del estado del equipo que podrían afectar el tratamiento eficaz.Predictive factors and compliance level were evaluated in a group of patients with sleep apnea syndrome under CPAP treatment, assessing side effects and equipment condition: silicone interface (SI, mask-conectors (M-C, air tube (AT and head strap (HS. Patients with >3mo treatment were included, clock counter reading was registered at the beginning, 2 and 4 mo. Patients were considered compliant (C+ when usage was >4h

  18. Snoring and Sleep Apnea

    Science.gov (United States)

    ... relations staff at newsroom@entnet.org . Insight into sleeping disorders and sleep apnea Forty-five percent of normal adults snore ... Witnessed episodes of breath pauses or apnea during sleep • Daytime sleepiness or fatigue • High ... disease • History of a stroke What treatments are available? ...

  19. Complex Sleep Apnea Syndrome

    Directory of Open Access Journals (Sweden)

    Muhammad Talha Khan

    2014-01-01

    Full Text Available Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour persist or emerge when obstructive events are extinguished with positive airway pressure (PAP and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous cositive airway pressure (CPAP related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therap, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs.

  20. Obstructive sleep apnea therapy

    NARCIS (Netherlands)

    Hoekema, A.; Stegenga, B.; Wijkstra, P. J.; van der Hoeven, J. H.; Meinesz, A. F.; de Bont, L. G. M.

    2008-01-01

    In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned

  1. Salud mental en el adulto mayor: trastornos neurocognitivos mayores, afectivos y del sueño

    Directory of Open Access Journals (Sweden)

    Tania Tello-Rodríguez

    Full Text Available RESUMEN Existen numerosos factores biológicos, psicológicos y sociales con impacto más o menos prominente en la salud mental de las personas adultas mayores. Aparte de componentes derivados de los procesos normales de envejecimiento o de la coocurrencia de enfermedades médicas diversas, eventos como la muerte de un ser querido, la jubilación o la discapacidad, contribuyen significativamente a una variedad de problemas mentales o emocionales en esta fase del ciclo vital. Los problemas más frecuentes afectan las esferas neurocognitiva, afectiva y onírica. Los trastornos neurocognitivos mayores reducen el rendimiento general del paciente y generan con ello exigentes necesidades de dependencia y cuidado cercano. Los trastornos afectivos pueden acentuarse por falta de apoyo familiar y disminución marcada de interacciones sociales que pueden dar lugar a un significativo aislamiento con conducta suicida resultante. La mayor frecuencia de trastornos del sueño como insomnio, somnolencia diurna y trastornos específicos como apnea obstructiva alteran significativamente la calidad de vida de esta población.

  2. Revisão integrativa da literatura sobre gestão do regime terapêutico em pacientes com doença pulmonar obstrutiva crônica Revisión integradora de la literatura sobre el manejo del régimen terapéutico en pacientes con enfermedad pulmonar obstructiva crónica Integrative literature review on treatment management in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    José Miguel dos Santos Castro Padilha

    2010-12-01

    Full Text Available Com este estudo pretende-se identificar qual a melhor estratégia de intervenção de enfermagem na promoção da gestão do regime terapêutico em pacientes com Doença Pulmonar Obstrutiva Crônica no ambiente hospitalar. Realizamos uma revisão integrativa da literatura dos anos 2006 a 2009. A partir da análise dos dados, constatamos que os estudos utilizam diferentes elementos e diferentes indicadores de efetividade para avaliarem as estratégias de intervenção utilizadas. Baseando-se nas evidências disponíveis, não é possível identificar qual a melhor estratégia. Desta revisão emerge a definição dos indicadores de resultado mais consensuais na avaliação da efetividade das estratégias de intervenção. Torna-se agora necessário desenvolver, implementar e avaliar a efetividade das estratégias de intervenção de enfermagem, recorrendo a estes indicadores, para definir qual a melhor estratégia de intervenção, baseada na evidência.Con este estudio, pretendemos identificar cuál es la mejor estrategia de intervención de enfermería en la promoción del manejo del régimen terapéutico en pacientes con Enfermedad Pulmonar Obstructiva Crónica, en el ambiente hospitalario. Realizamos una revisión integradora de la literatura de los años 2006 a 2009. A partir del análisis de los datos, constatamos que los estudios utilizan diferentes elementos y diferentes indicadores de efectividad para evaluar las estrategias de intervención utilizadas, no siendo posible identificar cuál es la mejor estrategia basada en la evidencia disponible. De esta revisión surge la definición de los indicadores de resultado más consensuales en la evaluación de la efectividad de las estrategias de intervención. Se vuelve ahora necesario desarrollar, implementar y evaluar la efectividad de las estrategias de intervención de enfermería, recurriendo a tales indicadores, para definir cuál es la mejor estrategia basada en la evidencia

  3. Central sleep apnea

    Science.gov (United States)

    ... diagnose an underlying medical condition. A sleep study (polysomnography) can confirm sleep apnea. Other tests that may ... MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow us Disclaimers Copyright Privacy ...

  4. Ictericia obstructiva secundaria a migración de fragmentos de hepatocarcinoma a la vía biliar

    OpenAIRE

    Hepp K,Juan; Balbontín M,Paulina; ARMAS M,RODOLFO; NAVARRETE G,CLAUDIO; Ríos R,Horacio; HUMERES A,ROBERTO; Rodríguez M,Gabriela; Roa E,Iván

    2010-01-01

    La ictericia obstructiva es una presentación poco común en un hepatocarcinoma (HC). Cuando en estos casos existe ictericia, habitualmente se debe a daño progresivo por cirrosis, o a infiltración tumoral extensa. El crecimiento o vaciamiento tumoral hacia la vía biliar se ha descrito ocasionalmente como causa de ictericia obstructiva. En raras ocasiones, puede tratarse de fragmentos de hepatocarcinoma que migran hacia la vía biliar, obstruyéndola. Presentamos un caso de ictericia obstructiva p...

  5. Síndrome de apneas-hipoapneas del sueño y factores de riesgo en el niño y el adolescente: revisión sistemática

    OpenAIRE

    M. J. Aguilar Cordero; A. M. Sánchez López; N. Mur Villar; García García, I; R. Guisado Barrilao

    2013-01-01

    El síndrome de apneas-hipoapneas del sueño, en lo adelante (SAHS) es una alteración que actualmente afecta a un número elevado de niños y adolescentes. Esta revisión tiene como objetivo evaluar los factores que generan esta alteración y el riesgo de padecer otro tipo de enfermedad asociada al SAHS. Los artículos seleccionados para ser incluidos en esta revisión se identificaron a través de GOOGLE SCHOLAR con un total de 50 artículos. La validez de los artículos estuvo dada por el grado de evi...

  6. Alteraciones endocrinometabólicas en la enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Irene Torres-Sánchez

    2013-08-01

    Full Text Available Introducción: La enfermedad pulmonar obstructiva crónica (EPOC se caracteriza por obstrucción crónica del flujo aéreo y se asocia frecuentemente a alteraciones endocrino-metabólicas que empeoran la situación clínica del paciente y su pronóstico. El conocimiento en profundidad de estas alteraciones en los pacientes con EPOC permite llevar a cabo medidas preventivas, detección temprana e intervenciones nutricionales adecuadas. Objetivos: Analizar la prevalencia de comorbilidades endocrino-metabólicas en pacientes con EPOC y los factores de riesgo que favorecen la aparición de dichas enfermedades. Métodos: Se desarrolló una estrategia de búsqueda exhaustiva de la literatura limitada a los últimos diez años, en las bases de datos PubMed, Scopus y ScienceDirect, usando las palabras clave "endocrine metabolic disorders AND COPD", "endocrine disorders AND COPD" y "metabolic disorders AND COPD". En el análisis bibliográfico se excluyeron aquellos artículos cuyo título o contenido no se correspondía con el objetivo del presente estudio, así como los artículos duplicados en las bases de datos. Finalmente, tras una profunda lectura crítica, fueron seleccionados y analizados 17 artículos. Resultados: El análisis de los artículos ha mostrado una relación significativa entre la EPOC y la presencia de alteraciones endocrino-metabólicas tales como diabetes mellitus, síndrome metabólico, obesidad, osteoporosis e hipogonadismo. Los autores coinciden en la alta prevalencia de estas comorbilidades, que influyen de forma diferente en el desarrollo de la EPOC. Conclusiones: Debido a la alta prevalencia y asociación con la EPOC, estas comorbilidades han de ser tenidas en cuenta por el profesional sanitario, ya que pueden afectar su abordaje, intervención y resultados.

  7. Enfermedad pulmonar obstructiva crónica entrenamiento domiciliario versus ambulatorio hospitalario

    Directory of Open Access Journals (Sweden)

    Enrique Jolly

    2014-08-01

    Full Text Available Existe poca experiencia sobre el efecto del entrenamiento domiciliario (rD en pacientes con enfermedad pulmonar obstructiva crónica (EPOC. El objetivo de este trabajo fue comparar el efecto del rD sobre la tolerancia al ejercicio, disnea y calidad de vida versus el entrenamiento ambulatorio hospitalario (rH. Se compararon dos grupos de pacientes con EPOC. Ambos entrenaron durante 24 sesiones, 8 semanas. Antes y después del entrenamiento se realizaron: espirometría, cuestionarios de disnea (MRC, Mahler y Borg y calidad de vida (St. George y SF-36, pruebas de ejercicio submáximas (caminata 6 minutos, shuttle de resistencia y resistencia en cicloergómetro -tiempo límite-Tlim y máximas (shutlle test-ST- y cardiopulmonar. El grupo rH realizó ejercicios aeróbicos y de fuerza para miembros inferiores (MI y superiores (MS. El grupo rD realizó caminatas al 70% de la velocidad alcanzada en ST y ejercicios de fuerza para MI y MS. Se aleatorizaron 25 rH y 25 rD. La condición basal fue similar en ambos grupos. El Tlim aumentó 125% (p = 0.0001 para grupo rH y 63% (p = 0.0011 para rD, sin diferencias entre sí. También mejoraron distancia en shuttle resistencia (77%, p = 0.0421 en grupo rH y 79%, p = 0.0197 en rD y distancia en prueba 6 minutos (12% en rD, p = 0.0135. El puntaje en cuestionario St. George se redujo solo en el grupo rH (p = 0.0034; en el rD abandonaron 32% vs. 20% en el rH (p = 0.4521. El entrenamiento domiciliario resultó tan eficaz como el ambulatorio hospitalario en pacientes con EPOC, aunque con mayor tendencia al abandono.

  8. Psoriasis and Sleep Apnea

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Khalid, Usman; Gislason, Gunnar Hilmar

    2015-01-01

    STUDY OBJECTIVES: Psoriasis and sleep apnea are associated with significant morbidity and mortality. Although both diseases have been linked with systemic inflammation, studies on their potential bidirectional association are lacking. We investigate the potential association between psoriasis...... and sleep apnea. METHODS: All Danish citizens age 18 y or older between January 1, 1997 and December 31, 2011 (n = 5,522,190) were linked at individual level in nationwide registries. Incidence rates (IRs) per 10,000 person-years were calculated and incidence rate ratios (IRRs) adjusted for age, sex......, socioeconomic status, smoking history, alcohol abuse, medication, and comorbidity were estimated by Poisson regression. RESULTS: There were 53,290, 6,885, 6,348, and 39,908 incident cases of mild psoriasis, severe psoriasis, psoriatic arthritis, and sleep apnea, respectively. IRRs (95% confidence interval...

  9. Psoriasis and Sleep Apnea

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Khalid, Usman; Gislason, Gunnar Hilmar

    2016-01-01

    STUDY OBJECTIVES: Psoriasis and sleep apnea are associated with significant morbidity and mortality. Although both diseases have been linked with systemic inflammation, studies on their potential bidirectional association are lacking. We investigate the potential association between psoriasis...... and sleep apnea. METHODS: All Danish citizens age 18 y or older between January 1, 1997 and December 31, 2011 (n = 5,522,190) were linked at individual level in nationwide registries. Incidence rates (IRs) per 10,000 person-years were calculated and incidence rate ratios (IRRs) adjusted for age, sex......, socioeconomic status, smoking history, alcohol abuse, medication, and comorbidity were estimated by Poisson regression. RESULTS: There were 53,290, 6,885, 6,348, and 39,908 incident cases of mild psoriasis, severe psoriasis, psoriatic arthritis, and sleep apnea, respectively. IRRs (95% confidence interval...

  10. Validación colombiana del cuestionario de Berlín

    Directory of Open Access Journals (Sweden)

    Irina Goretty Polanía-Dussan

    2013-09-01

    Full Text Available Resumen Antecedentes. El síndrome de apnea hipopnea obstructiva del sueño es un cuadro clínico con múltiples comorbilidades y complicaciones. Habitualmente no se diagnostica, por lo cual se debe contar con herramientas que permitan identificar a los pacientes con alto riesgo; entre ellas se encuentra el cuestionario de Berlín. Objetivo. Validar el cuestionario de Berlín en Colombia. Materiales y métodos. Se tomaron individuos que acudieron a centros de sueño en Bogotá y estudiantes universitarios. Seis fases: traducción y retrotraducción del cuestionario de Berlín original, validación de apariencia (expertos, n=14, consistencia interna (n=212, validez de criterio y discriminante (n=212 con polisomnografía paralela, reproducibilidad (n=74. Resultados. El cuestionario de Berlín validado localmente tiene una sensibilidad del 87%, especificidad del 70%, valor predictivo positivo del 98%, valor predictivo negativo del 21%, LR+ 2,9, LR- de 18 y un área bajo la curva de 0,7856. La consistencia interna obtuvo un coeficiente alfa de Cronbach de 0,7257. La reproducibilidad encontró un kappa de 0,8150 (Prob>Z=0,0000. Conclusiones. El cuestionario de Berlín está adaptado a las condiciones de vida urbana de la población adulta colombiana, es sensible, específico y tiene una alta reproducibilidad y consistencia interna, de tal manera que es confiable, válido y se correlaciona con la polisomnografía, en forma clínica y estadísticamente significativa.

  11. Rodent models of sleep apnea.

    Science.gov (United States)

    Davis, Eric M; O'Donnell, Christopher P

    2013-09-15

    Rodent models of sleep apnea have long been used to provide novel insight into the generation and predisposition to apneas as well as to characterize the impact of sleep apnea on cardiovascular, metabolic, and psychological health in humans. Given the significant body of work utilizing rodent models in the field of sleep apnea, the aims of this review are three-fold: first, to review the use of rodents as natural models of sleep apnea; second, to provide an overview of the experimental interventions employed in rodents to simulate sleep apnea; third, to discuss the refinement of rodent models to further our understanding of breathing abnormalities that occur during sleep. Given mounting evidence that sleep apnea impairs cognitive function, reduces quality of life, and exacerbates the course of multiple chronic diseases, rodent models will remain a high priority as a tool to interrogate both the pathophysiology and sequelae of breathing related abnormalities during sleep and to improve approaches to diagnosis and therapy.

  12. Obstructive Sleep Apnea

    OpenAIRE

    Brass, Steven D.; Ho, Matthew L.

    2006-01-01

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because o...

  13. ESTUDIO RETROSPECTIVO DE LAS AFECCIONES OBSTRUCTIVAS DE LAS VÍAS AÉREAS SUPERIORES EN EQUINOS ADULTOS PRESENTADOS A LA CLÍNICA PARA GRANDES ANIMALES DE LA UNIVERSIDAD NACIONAL DE COLOMBIA ENTRE 1993 Y 2007

    OpenAIRE

    Martínez, D. A.; Oliver, O. J.

    2012-01-01

    Se analizaron 44 historias de equinos admitidos en la Clínica de Grandes Animales de la Universidad Nacional de Colombia entre I-1993 y II-2007, para determinar las entidades obstructivas más prevalentes en el tracto respiratorio superior (cavidad nasal, faringe y laringe). Se determinó que el desplazamiento dorsal del paladar blando, la hemiplejia laríngea, la hiperplasia linfoide faríngea y las neoplasias fueron las entidades más prevalentes con 38,64%, 34,09%, 18,18% y 9,09%, respectivamen...

  14. Enfermedad pulmonar obstructiva crónica por exposición al humo de biomasa

    Directory of Open Access Journals (Sweden)

    Matías Lopez

    Full Text Available En este artículo se discute la relación existente entre la enfermedad pulmonar obstructiva crónica (EPOC y el humo de biomasa. Más de la mitad de la población utiliza biomasa como combustible principal, sobre todo en áreas rurales y en países en vías de desarrollo donde su uso llega hasta el 80%. La inhalación del humo de biomasa crea un estado inflamatorio crónico, que se acompaña de una activación de metaloproteinasas y una reducción de la movilidad mucociliar. Esto podría explicar la gran asociación existente entre la exposición a biomasa y EPOC, revelada por estudios observacionales y epidemiológicos provenientes de países en vías de desarrollo y de países desarrollados. En esta revisión exploramos también las diferencias entre la EPOC causada por tabaco y por biomasa, y encontramos que, a pesar de las diferencias fisiopatológicas, la mayoría de las características clínicas, calidad de vida y mortalidad fueron parecidas. En los últimos diez años se han realizado intervenciones para disminuir la exposición a biomasa mediante el uso de cocinas mejoradas y combustibles limpios, sin embargo, estas estrategias todavía no han sido exitosas debido a su incapacidad para reducir los niveles de contaminación a niveles recomendados por la Organización Mundial de la Salud, y por su falta de uso. Por lo tanto, hay una necesidad urgente de ensayos de campo aleatorios, cuidadosamente realizados, para determinar la verdadera gama de reducciones de contaminación potencialmente alcanzables, la probabilidad de su uso y los beneficios a largo plazo en la reducción de la gran carga mundial de EPOC

  15. Diferencias clínicas y polisomnográficas entre obesos y no obesos con síndrome de apneas-hipopneas del sueño Clinical and polysomnographyc differences between obese and non obese patients with obstructive sleep apnea-hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Jorge Rey de Castro

    2011-12-01

    Full Text Available Objetivos. Describir las diferencias clínicas y polisomnográficas en pacientes obesos y no obesos con diagnóstico del síndrome de apneas-hipopneas del sueño (SAHS. Materiales y métodos. A los pacientes incluidos se les realizó un examen físico, se aplicó la escala de somnolencia de Epworth (ESE y además se les realizó una polisomnografía. Se consideró obeso si el índice de masa corporal (IMC era mayor o igual a 30 kg/m2. Resultados. Se analizaron 408 pacientes con SAHS, de estos, 119 (47 % fueron obesos. El SAHS fue leve en 101 (25 %, moderado en 91 (22 % y severo en 216 (53 %. No hubo diferencias por sexo, edad y puntaje ESE al compararse obesos con no obesos. La diferencias del perímetro cervical y presencia de somnolencia según ESE fue significativamente mayor en obesos. Estos tuvieron mayor comorbilidad en términos de dislipidemia, hipertensión arterial y enfermedad coronaria. De las variables polisomnográficas, los índices de eventos respiratorios fueron mayores en obesos, asimismo fueron peores los valores de saturación de oxígeno. No hubo diferencias en el resto de variables. El análisis de regresión mostró asociación entre la obesidad y la severidad del SAHS. Conclusiones. El SAHS no es una enfermedad limitada a la población obesa, aunque esta última tienen mayor comorbilidad y formas más severas de enfermedad.Objectives. To describe the clinical and polysomnographyc differences between obese and non- obese patients with obstructive sleep apnea-hypopnea (OSAH syndrome. Materials and methods. A physical examination, the Epworth Sleepiness Scale (ESS and a polysomnography were performed to all included patients. Obesity was defined as a body mass index (BMI of ≥ 30 kg/m2. Results. 408 patients with OSAH were analyzed, out of these, 119 (47 % were obese. OSAH was mild in 101 (25 %, moderate in 91 (22 % and severe in 216 (53 %. There were no age, sex and EES score differences between obese and non

  16. Apnea of prematurity

    Directory of Open Access Journals (Sweden)

    Piermichele Paolillo

    2013-06-01

    Full Text Available Apnea of prematurity (AOP is one of the most frequent pathologies in the Neonatal Intensive Care Unit, with an incidence inversely related to gestational age. Its etiology is often multi factorial and diagnosis of idiopathic forms requires exclusion of other underlying diseases. Despite being a self-limiting condition which regresses with the maturation of the newborn, possible long-term effects of recurring apneas and the degree of desaturation and bradycardia who may lead to abnormal neurological outcome are not yet clarified. Therefore AOP needs careful evaluation of its etiology and adequate therapy that can be both pharmacological and non-pharmacological. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

  17. System for controlling apnea

    Science.gov (United States)

    Holzrichter, John F

    2015-05-05

    An implanted stimulation device or air control device are activated by an external radar-like sensor for controlling apnea. The radar-like sensor senses the closure of the air flow cavity, and associated control circuitry signals (1) a stimulator to cause muscles to open the air passage way that is closing or closed or (2) an air control device to open the air passage way that is closing or closed.

  18. Obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Steven D. Brass

    2011-11-01

    Full Text Available Obstructive sleep apnea (OSA affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual’s risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  19. Obstructive sleep apnea.

    Science.gov (United States)

    Ho, Matthew L; Brass, Steven D

    2011-11-29

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  20. Apnea of Prematurity (For Parents)

    Science.gov (United States)

    ... other babies. The apnea of prematurity does not cause brain damage. A healthy baby who is apnea free for a week will probably never have AOP again. Although sudden infant death syndrome (SIDS) does happen more often in premature infants, no relationship between AOP and SIDS has ...

  1. Síndrome de apneas-hipoapneas del sueño y factores de riesgo en el niño y el adolescente: revisión sistemática

    Directory of Open Access Journals (Sweden)

    M. J. Aguilar Cordero

    2013-12-01

    Full Text Available El síndrome de apneas-hipoapneas del sueño, en lo adelante (SAHS es una alteración que actualmente afecta a un número elevado de niños y adolescentes. Esta revisión tiene como objetivo evaluar los factores que generan esta alteración y el riesgo de padecer otro tipo de enfermedad asociada al SAHS. Los artículos seleccionados para ser incluidos en esta revisión se identificaron a través de GOOGLE SCHOLAR con un total de 50 artículos. La validez de los artículos estuvo dada por el grado de evidencias demostrado, por las recomendaciones que dejan y por la aplicabilidad a nuestro contexto. Esta revisión ha considerado los estudios que investigan el SAHS en niños y adolescentes. También se han tenido en cuenta los que relacionan esta alteración con la obesidad, la hipertensión arterial, la actividad física y otras variables. Los estudios demuestran que el SAHS está relacionado con la obesidad infantil y aumenta el riesgo de enfermedades cerebrocardiovascular. También se evidencia que disminuye la capacidad física y la calidad de vida de niños y adolescentes. Los aspectos psicológicos también se ven afectados, lo que influye en el rendimiento académico, que es inferior al de los niños sanos. Así pues, es importante un diagnóstico precoz del SAHS pediátrico, de modo que se eviten las alteraciones asociadas.

  2. Disfunció Muscular en Malalts amb malaltia Pulmonar Obstructiva Crònica (MPOC)

    OpenAIRE

    Coronell Coronell, Carlos Gustavo

    2006-01-01

    La Enfermedad Pulmonar Obstructiva Crónica (EPOC), presenta signos y síntomas sistémicos que se han venido explorando desde hace algún tiempo. La presente Tesis Doctoral estudia la disfunción que presentan los músculos respiratorios y periféricos, específicamente el cuádriceps de los pacientes con EPOC. Esta disfunción muscular afecta las actividades de la vida diaria, la tolerancia al ejercicio, limita la calidad de vida y disminuye la expectativa de vida de estos pacientes. Una de las posib...

  3. Plan de alta para personas con enfermedad pulmonar obstructiva crónica

    OpenAIRE

    Luz Marina Céspedes Salgado; Ximena Sáenz Montoya

    2006-01-01

    El plan de alta busca asegurar unos cuidados acordes con las necesidades y los requerimientos de la persona una vez egresa de la institución de salud, y debe constituirse en una guía básica en especial para la atención de aquéllos con patologías crónicas, como es la enfermedad pulmonar obstructiva crónica, que por su complejidad demanda múltiples cuidados para asegurar una intervención integral con miras al logro de una mejor adaptación, a identificar posibles complicacio...

  4. Nuevo consenso argentino de la enfermedad pulmonar obstructiva crónica

    OpenAIRE

    2003-01-01

    Debido al aumento de la morbi-mortalidad de la enfermedad pulmonar obstructiva crónica (EPOC), especialistas en medicina respiratoria actualizan los conocimientos básicos acerca de esta enfermedad desde el último Consenso llevado a cabo en 1994 para efectuar recomendaciones para su diagnóstico, prevención y tratamiento. Los autores revisan la definición de EPOC, conjuntamente con los últimos conocimientos de la fisiopatología de la enfermedad. Se resume la presentación clínica, diagnóstico po...

  5. Consenso intersociedades para el manejo de infecciones respiratorias: bronquitis aguda y enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Gustavo Lopardo

    2013-04-01

    Full Text Available La Sociedad Argentina de Infectología convocó a otras sociedades científicas para elaborar una guía práctica y actualizada para el manejo del tratamiento antibiótico de las bronquitis agudas (BA y los episodios de reagudización de enfermedad pulmonar obstructiva crónica (EPOC, con el objetivo de promover el uso racional de los recursos diagnósticos y terapéuticos. La BA se caracteriza por la inflamación del árbol bronquial que afecta tanto a adultos como a niños sin enfermedades pulmonares crónicas, siendo de origen viral en la mayoría de los casos. El diagnóstico es clínico, debiéndose diferenciar de los episodios de neumonía adquirida en la comunidad. El tratamiento de los episodios de BA es fundamentalmente sintomático. En huéspedes inmunocomprometidos, con enfermedades crónicas respiratorias o cardíacas y en adultos mayores con comorbilidades debe evaluarse el requerimiento de tratamiento antibiótico caso por caso. Se define como exacerbación de la EPOC al cambio agudo en la situación clínica basal del paciente más allá de la variabilidad diaria, que cursa con aumento de la disnea, aumento de la expectoración, expectoración purulenta, o cualquier combinación de estos tres síntomas, y que precisa un cambio terapéutico. La presencia de uno de estos síntomas se define como episodio leve, dos como moderado y tres como grave. En un 50 a 75% de las exacerbaciones de EPOC se aísla en el esputo un agente infeccioso. En los episodios moderados y graves debe iniciarse tratamiento antibiótico. Amoxicilina-inhibidor de betalactamasas, macrólidos y fluoroquinolonas se encuentran entre las opciones terapéuticas.

  6. Clinical manifestations of sleep apnea

    OpenAIRE

    Stansbury, Robert C.; Strollo, Patrick J.

    2015-01-01

    Obstructive sleep apnea (OSA) may manifest in a number of ways from subtle intrusion into daily life to profound sleepiness, snoring, witnessed apneas and other classic symptoms. Although there is increasing evidence suggesting OSA can adversely affect health in a variety of ways, this disorder remains underdiagnosed. The most well-escribed health consequences of OSA relate to the cardiovascular system. Hypertension and arrhythmias have a strong association with OSA, and evidence suggests tha...

  7. Nuevo consenso argentino de la enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    R. J. Gene

    2003-10-01

    Full Text Available Debido al aumento de la morbi-mortalidad de la enfermedad pulmonar obstructiva crónica (EPOC, especialistas en medicina respiratoria actualizan los conocimientos básicos acerca de esta enfermedad desde el último Consenso llevado a cabo en 1994 para efectuar recomendaciones para su diagnóstico, prevención y tratamiento. Los autores revisan la definición de EPOC, conjuntamente con los últimos conocimientos de la fisiopatología de la enfermedad. Se resume la presentación clínica, diagnóstico por imágenes y evaluación funcional. Se enfatiza la importancia del diagnóstico precoz mediante la exploración funcional y la prevención a través de la cesación del tabaquismo, única medida capaz de alterar la evolución. Se describen las estrategias para dejar de fumar, así como el tratamiento farmacológico y no farmacológico. En el primero, la administración de broncodilatadores inhalados -anticolinérgicos, beta 2 agonistas adrenérgicos o ambos- son la primera opción. Los broncodilatadores de acción prolongada mejoran la adherencia al tratamiento y su efectividad. Los corticoides inhalados se indican en pacientes con marcada obstrucción al flujo aéreo y respuesta conocida a corticoides. Su uso disminuye la frecuencia de las exacerbaciones. La vacunación antigripal anual está recomendada en todos los pacientes. Con respecto a las intervenciones no farmacológicas, la cirugía del enfisema se recomienda en especiales circunstancias. La rehabilitación que incluya ejercicios, kinesioterapia y nutrición, es una herramienta útil en pacientes con limitación en la actividad física habitual. La oxigenoterapia domiciliaria prolongada mejora la sobrevida de pacientes con hipoxemia crónica severa. Otras intervenciones terapéuticas como la ventilación no invasiva domiciliaria tienen indicación muy específica. Las exacerbaciones agudas deben ser tratadas agresivamente con oxígeno, corticoides, antibióticos, asociación de

  8. Childhood Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    R Dayal

    2014-03-01

    Full Text Available Obstructive sleep apnea (OSA is a common condition in childhood and can result insevere complications if left untreated. It is showing a rising trend in India. A significantassociation with obesity has been observed; however, some children with enlargedtonsils and/or adenoids may even be underweight. The patient usually presents withsnoring and other respiratory problems like mouth breathing, choking and gaspingepisodes in night. Poor school performance and neurocognitive deficits have beenreported. Pulmonary hypertension and cor pulmonale are seen in severe cases. Besidesthe history and clinical examination, for definitive diagnosis an overnightpolysomnographic evaluation is the gold standard. In all cases, the specific treatmentranges from simple lifestyle modifications and medications to surgeries likeadenotonsillectomy. Early diagnosis is vital.Key words: Childhood OSA, Obesity, adenotonsillar hypertrophy

  9. Enfermedad obstructiva crónica (EPOC y comorbilidades

    Directory of Open Access Journals (Sweden)

    Fernando De la Iglesia Martínez

    2012-03-01

    Full Text Available Las agudizaciones de la EPOC y la insuficiencia cardiaca (IC constituyen la principal causa de hospitalización en los servicios de Medicina interna en España. Además ambas entidades frecuentemente coexisten. La EPOC es una entidad que muy habitualmente trasciende el ámbito pulmonar y se asocia con un elevado número de enfermedades que afectan a dis-tintos órganos. Ente ellas están la cardiopatía isquémica, la enfermedad cerebrovascular, las infecciones pulmonares recidivantes, etc. En tal si-tuación tiene un papel relevante el tabaco como principal factor de riesgo para desarrollar EPOC y también agente etiológico principal en otros pro-cesos y también por la capacidad del mismo como inductor de reacciones inflamatorias, que hace que la EPOC comparta muchas características comunes con gran variedad de procesos sistémicos. No obstante, tal agente no explica totalmente la incidencia incrementada en la EPOC de otras entidades como la depresión o la diabetes mellitus. En cualquier caso la presencia de EPOC con otros procesos comórbidos incrementa la mortalidad y dificulta el manejo asistencial.

  10. Sleep apnea hypopnea syndrome and liver injury

    Institute of Scientific and Technical Information of China (English)

    TIAN Jian-li; ZHANG Yun; CHEN Bao-yuan

    2010-01-01

    Objective A general review was made of studies involving: (1) the relationship between sleep apnea hypopneasyndrome/sleep apnea style intermittent hypoxia and liver injury and (2) the mechanism that causes the liver injury.Data sources The data used in this review were mainly from Medline and PubMed published in English from 1993 toFebruary 2009. The search term was "sleep apnea hypopnea syndrome".Study selection (1) Clinical and laboratory evidence that sleep apnea hypopnea syndrome and sleep apnea styleintermittent hypoxia leads to liver injury; (2) the mechanism that causes the liver injury.Results The effect of sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia on the liver functionis characterized by serum aminotransferase elevation. The liver histological injury includes hepatic steatosis, hepatocyteballooning, lobular inflammation, lobular necrosis, and liver fibrosis. Sleep apnea hypopnea syndrome and sleep apneastyle intermittent hypoxia can cause insulin resistance and oxidative stress.Conclusions Sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia can lead to chronic liverinjury, which, in most cases, is shown as nonalcoholic fatty liver disease. Insulin resistance and oxidative stress causedby sleep apnea hypopnea syndrome and sleep apnea style intermittent hypoxia play an important role in the mechanismof chronic liver disease development.

  11. Interacción microorganismo-paciente en la enfermedad pulmonar obstructiva crónica

    OpenAIRE

    Millares Costas, Laura; Sabrià Leal, Miquel

    2014-01-01

    A pesar de que tradicionalmente se pensaba que la vía aérea era estéril, hoy en día, gracias a las nuevas técnicas de microbiología independientes de cultivo, se sabe que presenta una microbiota característica, que podría estar alterada en los procesos patológicos. Además, la presencia de microorganismos potencialmente patógenos en la vía aérea de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) es un hecho reconocido durante muchos años, sin embargo su efecto no está definido...

  12. [Infantile apnea. The etiopathogenic aspects. I].

    Science.gov (United States)

    Târdea, A

    1989-01-01

    The paper reports on etiopathogenesis aspects of apnea, on the basis of the literature data. After showing the importance of the problem and the definitions accepted, the author presents the physiological and physiopathological framework of the breathing control. The paper deals with apnea and periodic breathing associated with evident diseases and procedures, and idiopathic apnea. The central, obstructive and mixed types of apnea and their characteristics are described. The final part of the paper dwells on other mechanisms involved in apnea: gastroesophageal flux, endorphines, increased serum level of catecholamines and abnormal awakening hypoxic threshold, tobacco and coffee consumption.

  13. Enfermedad pulmonar obstructiva: diferencias entre hombres y mujeres Chronic obstructive pulmonary disease: differences between men and women

    Directory of Open Access Journals (Sweden)

    María Soledad Rodríguez-Pecci

    2012-06-01

    Full Text Available La enfermedad pulmonar obstructiva crónica (EPOC ha aumentado su prevalencia en el sexo femenino. Los casos de mujeres se describen como más sintomáticas. A pesar de que la EPOC se ha vinculado a elevado riesgo cardiovascular, hay pocos estudios sobre diferencias por sexo. El objetivo de nuestro estudio fue determinar la influencia del sexo sobre calidad de vida y síntomas, tratamiento, factores de riesgo y enfermedad cardiovascular (ECV en una población de pacientes con EPOC. En este estudio prospectivo observacional de corte transversal, se incluyeron pacientes con EPOC ingresados consecutivamente entre el 1 de septiembre de 2008 al 1 de marzo de 2010. Se registraron edad, sexo, habito tabáquico, factores de riesgo y enfermedad cardiovascular, tratamiento y gravedad de la EPOC. Se midió índice tobillo-brazo (ITB y se realizó Euroqol-5D. Se incluyeron 246 pacientes (195 hombres. Los hombres fueron más ex fumadores (68.7% vs. 15.7%, p Chronic obstructive pulmonary disease (COPD has increased its prevalence in females. Women have been described as more symptomatic. There are few studies considering gender differences in COPD. The aim of our study was to determine the influence of gender on quality of life, symptoms, treatment, risk factors and cardiovascular disease in a population of patients with COPD. In this prospective observational cross-sectional study, the included COPD patients were consecutively admitted between September 1, 2008 to March 1, 2010. We registered age, sex, smoking history, risk factors and cardiovascular disease, treatment and severity of COPD. We measured ankle-brachial index (ABI and performed EuroQol-5D. Two hundred forty six patients were included (195 men. There were more former smokers among men (68.7% vs. 15.7%, p < 0.001, men had a lower FEV1 (48.7% ± 15.7 vs. 58.2% ± 10.9 of theoretical, p < 0.001 and higher frequency of ischemic heart disease (16.4% vs. 5.9%, p = 0.04. Women showed a higher

  14. Enfermedad Cardiovascular (ECV) y Enfermedad Pulmonar Obstructiva Crónica (EPOC): Uso de beta bloqueadores en pacientes con EPOC.

    OpenAIRE

    Casallas Osorio, José Alex

    2013-01-01

    Tradicionalmente los beta-bloqueadores se han contraindicado en los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Sin embargo el uso de estos fármacos se asocia a beneficios y mejores resultados en pacientes con enfermedades cardiovasculares, hipertensión, insuficiencia cardiaca, enfermedad coronaria y EPOC. Es muy frecuente encontrar pacientes con una o mas de estas enfermedades al mismo tiempo.

  15. [Evaluation of sleep apnea syndromes].

    Science.gov (United States)

    Poirrier, R

    1993-01-01

    The evaluation of sleep apnea syndrome is based on polysomnography. Different sensor and recording techniques are reported. Some widely used neurophysiological and cardiorespiratory analysis criteria are proposed. Many sleep laboratories develop ambulatory and automatized methods for screening breathing disorders associated with sleep. The main principles of these approaches are briefly reviewed.

  16. Pneumothorax and pneumoperitoneum during the apnea test: how safe is this procedure? Pneumotorax y pneumoperitoneo durante el test de apnea: cuán seguro es este procedimiento?

    Directory of Open Access Journals (Sweden)

    GUSTAVO SAPOSNIK

    2000-09-01

    Full Text Available Apnea test is a crucial requirement for determining the diagnosis of brain death (BD. There are few reports considering clinical complications during this procedure. We describe a major complication during performing the apnea test. We also analyse their practical and legal implications, and review the complications of this procedure in the literature. A 54 year-old man was admitted for impaired consciousness due to a massive intracerebral hemorrhage. Six hours later, he had no motor response, and all brainstem reflexes were negative. The patient fulfilled American Academy of Neurology (AAN criteria for determining BD. During the apnea test, the patient developed pneumothorax, pneumoperitoneum, and finally cardiac arrest. Apnea test is a necessary requirement for the diagnosis of brain death. However, it is not innocuous and caution must be take in particular clinical situations. Complications during the apnea test could be more frequent than reported and may have practical and legal implications. Further prospective studies are necessary to evaluate the frequency and nature of complications during this practice.El test de apnea (AT es un requerimiento esencial para el diagnóstico de muerte encefálica. Hay pocos estudios que consideren complicaciones clínicas relacionadas con este procedimiento. Describimos un paciente que desarrolló una complicación mayor mientras se efectuaba el test de apnea. Realizamos una revisión de las complicaciones relacionadas con este procedimiento en la literatura. CASO CLÍNICO: Un hombre de 54 años fue admitido por deterioro del sensorio debido a una hemorragia intracerebral. Seis horas posteriores, el paciente no tenía respuesta motora, y todos los reflejos del tronco cerebral estaban abolidos. El paciente cumplía con los criterios diagnósticos de Muerte Encefálica de acuerdo a lo establecido por la Academia Americana de Neurología. Durante el test de apnea, el paciente desarrolla s

  17. Severe Obstructive Sleep Apnea Due to Massive Cervical Lipohypertrophy.

    Science.gov (United States)

    Ugurlu, Alper Mete; Ersozlu, Tolga; Basat, Salih Onur; Ceran, Fatih

    2015-09-01

    Obstructive sleep apnea is a difficult problem to deal with. Many studies on the pathogenesis of obstructive sleep apnea were performed in the past, and we present cervical lipohypertrophy causing severe obstructive sleep apnea in this article.

  18. Apnea of prematurity: challenges and solutions

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    Picone S

    2014-06-01

    Full Text Available Simonetta Picone, Roberto Aufieri, Piermichele PaolilloDivision of Neonatology and Neonatal Intensive Care, Department of Maternal and Child Health, Casilino General Hospital, Rome, ItalyAbstract: Apnea of prematurity is a developmental disorder that frequently affects preterm infants, especially those with lower gestational age. Even if apnea of prematurity is by definition a self-limiting condition, it can cause serious problems during the hospital stay and can potentially have long-term neurological and cognitive consequences depending on the severity and intensity of the episodes. The diagnosis of apnea of prematurity can be made only after excluding a number of diseases of the preterm infant in which apnea may be an epiphenomenon. Etiological diagnosis is essential for selection of appropriate treatment, which may be nonpharmacological or involve use of drugs.Keywords: apnea of prematurity, idiopathic and secondary apnea, caffeine

  19. Apneas observed in trisomy 18 neonates should be differentiated from epileptic apneas.

    Science.gov (United States)

    Fukasawa, Tatsuya; Kubota, Tetsuo; Tanaka, Masaharu; Asada, Hideyuki; Matsusawa, Kaname; Hattori, Tetsuo; Kato, Yuichi; Negoro, Tamiko

    2015-03-01

    Many children with trisomy 18 have apneas from the neonatal period. It has been reported that some children with trisomy 18 have epilepsy, including epileptic apneas. However, no previous report has described epileptic apneas in trisomy 18 neonates. We retrospectively reviewed the clinical records of neonates with trisomy 18 who were born at Anjo Kosei Hospital between July 2004 and October 2013 and investigated whether they had epileptic apneas during the neonatal period and whether antiepileptic drugs (AEDs) were effective for treating them. We identified 16 patients with trisomy 18. Nine patients who died within 3 days of birth were excluded. Five of the remaining seven patients had apneas. All five patients underwent electroencephalograms (EEGs) to assess whether they suffered epileptic apneas. Three of the five patients had EEG-confirmed seizures. In two patients, the apneas corresponded to ictal discharges. In one patient, ictal discharges were recorded when she was under mechanical ventilation, but no ictal discharges that corresponded to apneas were recorded after she was extubated. AEDs were effective for treating the apneas and stabilizing the SpO2 in all three patients. Among neonates with trisomy 18 who lived longer than 3 days, three of seven patients had EEG-confirmed seizures. AEDs were useful for treating their epileptic apneas and stabilizing their SpO2. Physicians should keep epileptic apneas in mind when treating apneas in neonates with trisomy 18.

  20. Obstructive sleep apnea in ischemic stroke patients

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    Aliye Tosun

    2008-01-01

    Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.

  1. [Orthodontic contribution in sleep apnea].

    Science.gov (United States)

    Raskin, S; Limme, M; Poirrier, R; Lacroix, A; Bonnet, S; Jeusette, M; Lecloux, G; Lahaye, T

    1997-01-01

    This study details the role that the orthodontist can play, when faced with sleeping obstructive apneas and snoring phénomena. Of special importance are knowledge of cranio-facial growth, radiographic exam and cephalometric analysis: they mainly help to understand all the aspects of this specific syndrome, and reveal the interest for a neuro-orthodontic or a neuro-surgical orthodontic approach.

  2. Coagulability in Obstructive Sleep Apnea

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    Christina Liak

    2011-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea (OSA is a common disorder that affects both quality of life and cardiovascular health. The causal link between OSA and cardiovascular morbidity/mortality remains elusive. One possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity.

  3. Estudio comparativo de los efectos producidos por la hipoxia crónica intermitente en ratas jóvenes (3 meses) y viejas (24 meses)

    OpenAIRE

    Quintero Coca, Miguel

    2015-01-01

    La apnea obstructiva del sueño (AOS) afecta aproximadamente al 3-7% de la población adulta, aumentando su frecuencia con el aumento de la edad. La AOS se asocia con frecuencia con patologías cardiovasculares, metabólicas y neuropsiquiátricas constituyendo el síndrome de apnea obstructiva del sueño (SAOS). La exposición de animales experimentales a episodios de hipoxia crónica intermitente (HCI) se puede utilizar como modelo de hipoxia recurrente que remeda los episodios de desaturación de oxi...

  4. Sleep apnea in stroke: Diagnosis, consequences & treatment

    NARCIS (Netherlands)

    Aaronson, J.A.

    2016-01-01

    Obstructive sleep apnea (OSA) is the most common sleep disorder in stroke, but is often left unrecognized and untreated. When left untreated, OSA is thought to contribute to decreased recovery from stroke. The main objectives of this thesis were 1) to improve early recognition of sleep apnea in stro

  5. Mecanismos de acción y resistencia a glucocorticoides en asma y enfermedad pulmonar obstructiva crónica

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    Alcibey Alvarado-González

    2013-12-01

    Full Text Available El asma bronquial y la enfermedad pulmonar obstructiva crónica son dos problemas mayores de salud: su incidencia se encuentra en aumento y representan, indiscutiblemente, una causa importante de morbilidad y mortalidad a nivel mundial. Los glucocorticoides se han posicionado como la droga de elección en el tratamiento de padecimientos inmunológicos e inflamatorios crónicos, como el asma bronquial y la enfermedad obstructiva crónica. Estas drogas suprimen la inflamación en múltiples vías moleculares, característica que les confiere destacada eficacia. Su principal acción en dosis terapéuticas se produce por la transrepresión de genes inflamatorios activos, mediante el reclutamiento y actividad de la enzima histona-desacetilasa-2 y la remodelación de la cromatina. En dosis altas, funcionan más bien como transactivadores, acetilando las histonas y estimulando la transcripción de genes antinflamatorios, y potencialmente, también de varios genes relacionados con efectos secundarios. Además, se les reconoce acciones postranscripcionales, que modifican la estabilidad de secuencias de ARN mensajero. A pesar de esto, una respuesta disminuida a los glucocorticoides se presenta en pacientes con asma severa, en asmáticos que fuman y en quienes tienen enfermedad pulmonar obstructiva crónica. Varios mecanismos moleculares de resistencia a glucocorticoides han sido identificados. Se están investigando otros tratamientos antinflamatorios que permitan controlar los síntomas de estos pacientes, así como drogas que puedan revertir los mecanismos moleculares de la resistencia. Problemáticamente, estas terapias podrían ser demasiado específicas para resultar eficaces, como es el caso de los esteroides disociados, en el que es difícil separar efectos antinflamatorios y secundarios.

  6. Clinical manifestations of sleep apnea.

    Science.gov (United States)

    Stansbury, Robert C; Strollo, Patrick J

    2015-09-01

    Obstructive sleep apnea (OSA) may manifest in a number of ways from subtle intrusion into daily life to profound sleepiness, snoring, witnessed apneas and other classic symptoms. Although there is increasing evidence suggesting OSA can adversely affect health in a variety of ways, this disorder remains underdiagnosed. The most well-escribed health consequences of OSA relate to the cardiovascular system. Hypertension and arrhythmias have a strong association with OSA, and evidence suggests that treatment of OSA in patients with refractory hypertension and in patients planning cardioversion for atrial fibrillation may be of particularly importance. Significant associations between heart failure and OSA as well as complex sleep apnea have also been well-described. Cerebrovascular insult, impaired neurocognition, and poorly controlled mood disorder are also associated with in OSA. Therapy for OSA may ameliorate atherosclerotic progression and improve outcomes post-cerebrovascular accident (CVA). OSA should be considered in patients complaining of poor concentration at work, actual or near-miss motor vehicle accidents, and patients with severe sleepiness as a component of their co-morbid mood disorders. The metabolic impact of OSA has also been studied, particularly in relation to glucose homeostasis. Also of interest is the potential impact OSA has on lipid metabolism. The adverse effect untreated OSA has on glucose tolerance and lipid levels has led to the suggestion that OSA is yet another constituent of the metabolic syndrome. Some of these metabolic derangements may be related to the adverse effects untreated OSA has on hepatic health. The cardiovascular, neurocognitive, and metabolic manifestations of OSA can have a significant impact on patient health and quality of life. In many instances, evidence exists that therapy not only improves outcomes in general, but also modifies the severity of co-morbid disease. To mitigate the long-term sequela of this disease

  7. Mild obstructive sleep apnea: beyond the AHI

    Directory of Open Access Journals (Sweden)

    Lee-Iannotti J

    2014-07-01

    Full Text Available No abstract available. Article truncated at 150 words. A common conundrum faced by sleep medicine practitioners is how to manage the large group of patients with mild sleep apnea. Many patients are referred for sleep evaluation, with symptoms thought to be due to obstructive sleep apnea (OSA. Often polysomnography demonstrates only mild sleep apnea, and the clinician and patient are faced with the dilemma of whether to use continuous positive airway pressure (CPAP therapy or an oral appliance. In making this important decision the clinician incorporates the commonly used definition of mild sleep apnea as an apnea-hypopnea index of between 5 and 14 apneas or hypopneas per hour of sleep. Moderate sleep apnea is defined as 15-29 events per hour, and severe is 30 and above events per hour. These arbitrary thresholds originated in the early 1980s when knowledge of this condition was in its infancy and little was known about the long term health effects. The definition ...

  8. ESTUDIO RETROSPECTIVO DE LAS AFECCIONES OBSTRUCTIVAS DE LAS VÍAS AÉREAS SUPERIORES EN EQUINOS ADULTOS PRESENTADOS A LA CLÍNICA PARA GRANDES ANIMALES DE LA UNIVERSIDAD NACIONAL DE COLOMBIA ENTRE 1993 Y 2007

    Directory of Open Access Journals (Sweden)

    D. A. Martínez

    2012-01-01

    Full Text Available Se analizaron 44 historias de equinos admitidos en la Clínica de Grandes Animales de la Universidad Nacional de Colombia entre I-1993 y II-2007, para determinar las entidades obstructivas más prevalentes en el tracto respiratorio superior (cavidad nasal, faringe y laringe. Se determinó que el desplazamiento dorsal del paladar blando, la hemiplejia laríngea, la hiperplasia linfoide faríngea y las neoplasias fueron las entidades más prevalentes con 38,64%, 34,09%, 18,18% y 9,09%, respectivamente; el desplazamiento dorsal del paladar blando fue más común en animales de raza Paso Colombiano, lo que se atribuye a la posición recogida de cabeza y cuello durante el ejercicio. La hemiplejía laríngea, al igual que el desplazamiento, fue más común en animales de raza Paso Colombiano cuando se consideraron las razas individualmente; sin embargo, fueron los animales de las razas de deporte los más afectados (73,33%. Los hallazgos mencionados son semejantes a los reportados en la literatura.

  9. Obstructive Sleep Apnea in MPS

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    Abhijit Ricky Pal MBBChir, MA, MD, FRCS(ORL-HNS

    2015-11-01

    Full Text Available The mucopolysaccharidoses (MPSs are a group of inherited, metabolic disorders characterized by progressive multisystem accumulation of partially degraded glycosaminoglycans. This manifests with multilevel airway obstruction, presenting with obstructive sleep apnea (OSA. We systematically reviewed the literature to determine the severity and prevalence of OSA in MPS based on polysomnography analysis. Fifteen studies with 294 participants met the inclusion criteria for review. The pretreatment prevalence of OSA in MPS was 81% with a mean apnea–hypopnea index (AHI of 10.4. Patients with MPS I are most significantly affected, with 75% suffering with moderate to severe OSA (mean AHI, 16.6. Enzyme replacement therapy (ERT results in an almost significant reduction in OSA in MPS I (P = .06, while adenotonsillar surgery significantly improves AHI (P = .002. Obstructive sleep apnea least affects MPS III. There is a lack of long-term post-ERT and hematopoietic stem cell transplant data relating to OSA outcomes in this population, with further prospective studies required to determine the ongoing response to treatment.

  10. Sleep Apnea and Heart Disease, Stroke

    Science.gov (United States)

    ... Aortic Aneurysm More Sleep Apnea and Heart Disease, Stroke Updated:Mar 14,2017 Plain old snoring can ... and is associated with high blood pressure , arrhythmia , stroke and heart failure . Heart disease is the leading ...

  11. Asthma and Obstructive Sleep Apnea

    Institute of Scientific and Technical Information of China (English)

    Yi-Xian Qiao; Yi Xiao

    2015-01-01

    Objective:To get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology,pathophysiology,and clinical manifestation and then summarizing the latest progress on diagnosis and treatment.Data Sources:Articles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms "OSA" and “asthma'" as the main keywords.Highly regarded older publications were also included.Study Selection:Information about the features of the two diseases in common,the pathophysiologic association between them and their current treatments from the literature search were identified,retrieved,and summarized.Results:Both OSA and asthma are very prevalent conditions.The incidences of them have kept on rising in recent years.Asthma is often accompanied by snoring and apnea,and OSA often combines with asthma,as well.They have many predisposing and aggravating factors in common.Possible shared direct mechanistic links between them include mechanical effects,intermittent hypoxia,nerve reflex,inflammation,leptin,etc.Indirect mechanistic links include medication,nose diseases,smoking,obesity,and gastroesophageal reflux disease.Since OSA presents many similar features with nocturnal asthma,some scholars termed them as a sole syndrome "alternative overlap syndrome,"and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure.Conclusions:OSA and asthma are closely associated in pathogenesis,symptoms,and therapies.With the growing awareness of the relationship between them,we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients.Further studies are still needed to guide the clinical works.

  12. Entrenamiento muscular inspiratorio en el paciente con enfermedad pulmonar obstructiva crónica Inspiratory muscle training in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    GRAÇA PINHEIRO DE C

    2011-06-01

    Full Text Available Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC tienen debilidad de los músculos respiratorios, lo cual contribuye a la disnea, hipoxemia, hipercapnia, desaturación nocturna y limitación de la actividad física. Durante el ejercicio se ha demostrado que aumenta el trabajo del diafragma en pacientes con EPOC y utilizan una mayor proporción de la presión inspiratoria máxima (PImax comparado con los sujetos sanos. Elpatrón respiratorio anormal de los pacientes con EPOC está relacionado con la sensación de disnea durante el ejercicio y, potencialmente, podría inducir a la fatiga muscular respiratoria. Sin embargo, la fatiga del diafragma no se ha demostrado después de un ejercicio intenso. Los estudios en pacientes con EPOC han demostrado cambios adaptativos en las fibras musculares del diafragma que tienen mayor capacidad oxidativa y resistencia a la fatiga. De este modo, existen argumentos contradictorios en relación al beneficio clínico obtenido con el entrenamiento de los músculos inspiratorios (EMI en pacientes con EPOC. El EMI aislado o como complemento de ejercicios de reacondicionamiento general aumenta significativamente la fuerza muscular inspiratoria y la resistencia a la fatiga, disminuyendo significativamente la disnea en reposo y durante el ejercicio. Además, los estudios sugieren que el EMI tiende a mejorar la capacidad funcional para realizar ejercicio, efecto favorable que no alcanzó significación estadística. El análisis de subgrupos ha demostrado mayor beneficio clínico del EMI en los pacientes con debilidad muscular inspiratoria. De esta revisión se concluye que el entrenamiento muscular inspiratorio puede ser útil en pacientes seleccionados con enfermedad pulmonar obstructiva crónica, que tienen disfunción muscular inspiratoria comprobada, insertado en un programa de rehabilitación integral. El efecto sobre la capacidad de realizar ejercicio aún no ha sido determinado. En resumen, el

  13. Enfermedad pulmonar obstructiva crónica severa y malnutrición: efecto sobre la sintomatología y la función

    Directory of Open Access Journals (Sweden)

    Laura López-López

    Full Text Available Introducción: las alteraciones en el estado nutricional en pacientes con enfermedad pulmonar obstructiva crónica (EPOC son frecuentes. La sintomatología y la funcionalidad de estos enfermos pueden estar relacionadas con la nutrición, incrementando su gravedad en los sujetos con malnutrición. Objetivos: el objetivo de esta investigación fue profundizar sobre el perfil clínico del paciente con EPOC malnutrido y relacionar el estado nutricional con la funcionalidad y con los síntomas de estos pacientes. Métodos: se desarrolló un estudio observacional en pacientes con EPOC severo. Se valoró el estado de dependencia, la calidad de vida, las comorbilidades y la ansiedad y depresión. La función respiratoria se valoró con el volumen espiratorio forzado en el primer segundo y la escala de Borg modificada y el estado nutricional, con el Mini Nutritional Assessment. La sintomatología fue evaluada mediante el Leicester Cough Questionnaire y el London Chest Activity of Daily Living Scale. Resultados: 154 sujetos fueron incluidos en este estudio, 98 de ellos fueron varones. Un grupo de 71 sujetos mostraron malnutrición y un grupo de 83 sujetos un estado nutricional normal. La comparación entre los grupos mostró características clínicas significativamente diferentes (p < 0,05. El análisis mostró diferencias significativas en la disnea (p = 0,043, así como en las subescalas de funcionalidad relacionadas con sintomatología respiratoria autocuidado (p = 0,040, actividades de ocio (p = 0,019 y la puntuación total (p = 0,031, siendo peores en los sujetos malnutridos. Conclusión: los pacientes con EPOC malnutridos presentan más síntomas y peores niveles de funcionalidad que los pacientes con EPOC con estado nutricional normal.

  14. Effect of the definition of hypopnea on apnea/hypopnea index Influencia de la definición de hipopnea sobre el índice apnea/hipopnea

    Directory of Open Access Journals (Sweden)

    C. A. Nigro

    2003-04-01

    Full Text Available The objective of this study was to determine whether different decreases in oxygen saturation (SaO2 or the presence of electroencephalographic arousals (EEGA in the definition of hypopnea modify hypopnea index and apnea/hypopnea index and the prevalence of obstructive sleep apnea/hypopnea syndrome (OSAHS. A total of 20 polysomnographies performed in patients with OSAHS were analyzed. There are four different definitions of hypopnea: > 30% reduction in airflow or 50% decrease in abdominal movement associated with ¯SaO2 > 3% (type 1; ¯ SaO2 > 3% or EEGA (type 2; ¯ SaO2 > 4% (type 3; ¯ SaO2 > 4% or EEGA (type 4. The prevalence of OSAHS was calculated for an apnea/hypopnea index (AHI > 10 and > 15. Hypopnea index (HI and AHI types 2 and 4 were higher than type 3 (HI: type 2: 20±10.6, type 4: 18.6±10, type 3: 11.4±10, p 0.05. The prevalence of OSAHS was 30-55% in type 3, 70-85% in type 4 (p 0.05. In our patient´s population, the presence of EEGA in the definition of hypopnea significantly increased the HI, the AHI and the prevalence of OSAHS when associated with a > 4% decrease in SaO2.El objetivo del estudio fue evaluar si diferentes niveles de descenso de la saturación de O2 (SaO2 o la presencia de micro-despertares electroencefalográficos (MDEEG en la definición de hipopnea, modifican el índice de apnea/hipopnea y la prevalencia del síndrome apnea/hipopnea del sueño (SAHS. Se analizaron 20 polisomnografias de pacientes con SAHS. Hipopnea (H se definió de cuatro formas: descenso del flujo aéreo >30% o caída del 50% del movimiento abdominal asociado a: ¯ SaO2 > 3% (tipo 1 ; ¯ SaO2 > 3% o MDEEG (tipo 2; ¯ SaO2 > 4% (tipo 3; ¯ SaO2 > 4% o MDEEG (tipo 4. La prevalencia del SAHS se calculó para un índice apnea/hipopnea (IAH > 10 y > 15. El índice hipopnea (IH, el IAH tipo 2 y 4 fue mayor respecto al tipo 3 (IH: tipo 2: 20±10.6, tipo 4: 18.6±10, tipo 3: 11.4±10, p 0.05. La prevalencia de SAHS fue del 30-55% con el tipo 3, 70

  15. Management of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    V K Vijayan

    2014-03-01

    Full Text Available Obstructive Sleep Apnea (OSA is an important public health problem and is associatedwith considerable morbidity and mortality. Therefore, treatment of this condition is ofparamount importance. The treatment of OSA includes general and behaviouralmeasures, mechanical measures including continuous positive airway pressure(CPAP, Bilevel positive airway pressure (BiPAP and Oral Appliances (OA,pharmacological treatment and surgical procedures. Continuous positive airwaypressure (CPAP treatment reverses the repetitive upper airway obstruction of sleepapnea and associated daytime sleepiness and is the most effective treatment for OSA.However maintaining patient adherence to CPAP therapy is a challenge. Weight lossshould be recommended to overweight patients with OSA, as it has been shown thatweight reduction has additional health benefits. Treatment of underlying medicalconditions such as hypothyroidism or acromegaly has profound effect onapnea/hypopnea index. A subset of patients with OSA may benefit from supplementaloxygen and positional therapy. Presently, there are no effective pharmacotherapeuticagents for treatment of patients with OSA and the role of surgical treatment in OSA iscontroversial. However, pharmacological treatment of persisting residual sleepiness,despite adequate positive airway pressure therapy delivery and adherence, is indicatedand may improve daytime sleepiness.Key words : CPAP, Oral appliances, Modafinil, CPAP complianceUvulopalatopharyngoplasty, positional therapy

  16. Adipocytokines in sleep apnea syndrome

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    Wysocka E

    2009-12-01

    Full Text Available Abstract Objective Biomarkers of adipose tissue may affect glucose and lipid metabolism and present pro-inflammatory properties, thus could be involved in the pathobiochemistry of cardiovascular disease (CVD. The coexistence of sleep apnea syndrome (OSA and metabolic risk factors of CVD is worth explaining. The aim of the study was to compare the serum adipocytokines in subjects with and without OSA, who had all elevated body mass index (BMI. Methods Overweight (BMI: 25.0-29.9 kg/m2 and obese (BMI: 30.0-39.9 kg/m2 OSA-suspected Caucasian males, aged 30-63, with no acute disease or chronic disorder underwent polysomnographic evaluation to select OSA-positive (AHI ≥ 5 and OSA-negative (AHI Results A decreased resistin level was observed in Over-OSA-Pos vs. Over-OSA-Neg subjects (P = 0.037 as well as in Obese-OSA-Pos vs. Obese-OSA-Neg (P = 0.045. No differences in leptin concentrations were observed. A positive correlation between leptin and BMI was in both overweight subgroups and a negative one between resistin and fasting glucose was in both obese subgroups. Conclusions OSA may decrease the serum resistin level in subjects with excess body mass and also may contribute to glucose metabolism, but has no influence on the leptin level.

  17. Sleep apnea in active acromegaly.

    Science.gov (United States)

    Hart, T B; Radow, S K; Blackard, W G; Tucker, H S; Cooper, K R

    1985-05-01

    Previous case reports have shown an association between acromegaly and the sleep apnea syndrome (SAS). Some of the patients described had central SAS, raising the possibility that an elevation of the growth hormone (GH) level may cause a defect in respiratory drive. We determined the prevalence of SAS in 21 patients with a history of acromegaly. We separated them into two groups based on serum GH concentrations. Ten patients had active acromegaly (mean GH concentration, 62.2 ng/mL; range, 12.6 to 148 ng/mL), while 11 patients had inactive acromegaly (mean GH, 3.2 ng/mL; range, 0.7 to 6.4 ng/mL). Four of the ten patients with active acromegaly had SAS; none of the 11 patients with inactive acromegaly had SAS. Three patients with SAS had the purely obstructive type, and one had the mixed central and obstructive type. The hypercapnic ventilatory response was normal in all patients tested and was not influenced by the GH level. We conclude that SAS is associated with active acromegaly and that the GH level does not affect the hypercapnic ventilatory response. The absence of SAS in successfully treated patients suggests that it may resolve after a normal GH level is restored.

  18. Obstructive sleep apnea and inflammation.

    LENUS (Irish Health Repository)

    McNicholas, Walter T

    2012-02-01

    The pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS) is not fully understood but is likely multifactorial in origin. Inflammatory processes play an important role in the pathogenesis of atherosclerosis, and circulating levels of several markers of inflammation have been associated with future cardiovascular risk. These include cell adhesion molecules such as intercellular adhesion molecule-1 and selectins, cytokines such as tumour necrosis factor alpha and interleukin 6, chemokines such as interleukin 8, and C-reactive protein. There is also increasing evidence that inflammatory processes play an important role in the cardiovascular pathophysiology of OSAS and many of the inflammatory markers associated with cardiovascular risk have been reported as elevated in patients with OSAS. Furthermore, animal and cell culture studies have demonstrated preferential activation of inflammatory pathways by intermittent hypoxia, which is an integral feature of OSAS. The precise role of inflammation in the development of cardiovascular disease in OSAS requires further study, particularly the relationship with oxidative stress, metabolic dysfunction, and obesity.

  19. [Obstructive sleep apnea features and occupational fitness of railway workers].

    Science.gov (United States)

    Buniatyan, M S; Belozerova, N V; At'kov, O Yu

    2016-01-01

    The article covers prevalence of obstructive sleep apnea syndrome, its role in health disorders of workers engaged into railway safety. The authors analyzed present standards of occupational fitness in workers performing critically important operating activities and methods of occupational selection with possible obstructive sleep apnea syndrome. I stage recommendations are suggested in diagnosis of obstructive sleep apnea syndrome in workers engaged into railway safety. Obstructive sleep apnea syndrome appeared to threaten operators' activity, to cause accidents, to early disablement due to life-threatening complications, to unsuitability for the occupation due to diseases connected with obstructive sleep apnea syndrome (arterial hypertension, diabetes mellitus, metabolic syndrome, cardiac rhythm and conductivity disorders, obesity).

  20. [The sleep obstructive apnea and hypopnea syndromes].

    Science.gov (United States)

    Cambron, L; Roelants, F; Deflandre, E; Raskin, S; Poirrier, R

    2004-01-01

    Since two decades, sleep breathing disorders are more wisely recognized by the Belgian medical community. Among these, the Obstructive Sleep Apnea Syndrome (OSA) is the best known but its frontiers with others syndromes such as the Upper Airway Resistance Syndrome (UARS), the Central Sleep Apnea Syndrome (CSAS) or the Overlap Syndrome are still matter of discussion. Its causes are plurifactorial, and many recent publications draw the attention to its long term effects in the cardiovascular and neuropsychiatric fields. This article summarizes the present definitions and features associated with OSA, from clinical and neurophysiological perspectives, and the different consequences to which untreated or underdiagnosed patients are exposed.

  1. Obstructive sleep apnea syndrome and cardiovascular problems

    Directory of Open Access Journals (Sweden)

    Zuhal Arıtürk Atılgan

    2011-06-01

    Full Text Available Obstructive sleep apnea syndrome (OSAS is defined as repeated episodes of upper airway occlusion during sleep with consequent excessive daytime sleepiness. Recently, relationship has been found between cardiovascular disease and OSAS. Therefore OSAS has become more popular today. OSAS is associated with the pathogenesis of cardiovascular disease. A large number of studies have demonstrated that OSAS is an independent risk factor of cardiovascular morbidity and mortality. Sleep apnea was shown to be associated with hypertension, ischemic heart disease, stroke, pulmonary hypertension, cardiac arrhythmia, and cardiovascular mortality

  2. Obstructive sleep apnea treatment with dental appliance.

    Science.gov (United States)

    Reimão, R; De Gouveia, M M; Pestana, M C; Lopes, S R; Papaiz, E G; Papaiz, L F

    1994-12-01

    The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS) is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS). Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.

  3. Sex differences in sleep apnea predictors and outcomes from home sleep apnea testing

    Science.gov (United States)

    Cairns, Alyssa; Poulos, Greg; Bogan, Richard

    2016-01-01

    Study objectives To evaluate sex differences in predictors of obstructive sleep apnea (OSA) as per outcomes from home sleep apnea testing. Design This was a retrospective analysis of a large repository of anonymous test results and pretest risk factors for OSA. Setting and patients A total of 272,705 patients were referred for home sleep apnea testing from a variety of clinical practices for suspected sleep disordered breathing across North America from 2009 to 2013. Interventions Not applicable. Measurements and results Predictors of OSA (apnea hypopnea index4%≥5) were evaluated by multiple logistic regression; sex differences were evaluated by interaction effects. Middle age was the single most robust predictor of OSA for both sexes and was particularly foretelling for females (PInsomnia, depression, and use of sleep medication, although more commonly reported in females, did not predict OSA. Hypertension, although equally reported by both sexes, performed better as a predictor in females (Pmenopausal status in OSA screening tools. PMID:27418861

  4. Comparison of full-night and ambulatory polysomnography with ApneaGraph in the subjects with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Karaloğlu, Furkan; Kemaloğlu, Yusuf K; Yilmaz, Metin; Ulukavak Çiftçi, Tansu; Çiftçi, Bülent; Bakkal, Faruk K

    2017-01-01

    The localization of the obstruction is crucial in determining the appropriate surgical treatment for obstructive sleep apnea syndrome (OSAS); ApneaGraph has been introduced for diagnosis of OSAS and localization of airway obstruction level. This study aims to evaluate the diagnostic value of ApneaGraph for both clinical staging and site of obstruction. Thirty male OSAS patients were prospectively enrolled in this clinical trial. The following parameter were included to the study: Body mass indexes and neck circumferences of the subjects, Epworth sleepiness scale, site of obstruction detected by flexible endoscopy and ApneaGraph, apnea hypopnea index (AHI), apnea index, hypopnea index, maximal oxygen desaturation and average oxygen saturation which were detected by both polysomnography (PSG) and ApneaGraph devices. Our data presented that, although AHI measured by ApneaGraph and PSG were significantly correlated; severity stages of the subjects were different in 44 % of the subjects when based on AHI of ApneaGraph, compared to PSG. Majority of the changes were from severe OSAS to mild or moderate levels. Similar dominant collapse levels were detected in 64 % of the subjects by both devices. It was seen that transpalatal obstruction was better correlated between ApneaGraph and flexible endoscopy. As a conclusion, we might assume that ApneaGraph can be used as a screener for OSAS and it appears to be a more reliable device to confirm dominancy of palatal level obstruction.

  5. Acromegaly and sleep apnea: cephalometric evaluations.

    Science.gov (United States)

    Bruwier, A; Albert, A; Beckers, A; Limme, M; Poirrier, R

    2011-06-01

    Lateral teleradiography is a standard and quick examination. It has enabled us to define differences as regards to the craniofacial morphology between 20 acromegalic patients and 20 control subjects. The height of the mandibular ramus (from the posterior condyle point to the gonion point) increases significantly with the acromegalic patient and the cranial base angle (basion-superior tuberculum sellae-M point) is more extended. As acromegalic patients are more subject to sleep apnea (30% prevailing), the relationship between the amount of sleep apnea and hypopnea (AHI) in an acromegalic patient and his bone, tissue and hormone factors has been researched, in order to act on the causes of sleep apnea. It has emerged that confronting craniofacial bones and soft tissues factors enables a good prediction of the apnea and hypopnea index. Of course, we can find again the potential action of growth hormone (GH) but only in fifth place in importance order. The tongue, which increases in volume with the GH impact, is in a too short "lingual enclosure" (reduced length of the mandibular horizontal branch).

  6. Nocturnal apnea in Chiari type I malformation

    NARCIS (Netherlands)

    Aarts, L.A.; Willemsen, M.A.A.P.; Vandenbussche, N.L.; Gent, R. van

    2011-01-01

    A 4-year-old girl presented with sleep-disordered breathing. Her parents described breathing pauses of up to 20 s and progressive tiredness during the day. Obstructive apneas from an enlarged adenoid were thought to be the most probable cause. However, an adenotomy did not resolve the problem. Polys

  7. 21 CFR 868.2377 - Apnea monitor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Apnea monitor. 868.2377 Section 868.2377 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES... rate and other physiological parameters linked to the presence or absence of adequate respiration....

  8. Always Tired? You May Have Sleep Apnea

    Science.gov (United States)

    ... actually make sleep apnea worse, including many for insomnia, anxiety or severe pain," he says. This article appears on FDA's Consumer Updates page , which features the latest on all FDA-regulated products. Updated: March ... Supplements Drugs Food Medical Devices Nutrition Radiation-Emitting Products Tobacco Products Vaccines, Blood & Biologics ...

  9. Portable Prescreening System for Sleep Apnea

    DEFF Research Database (Denmark)

    Guul, Martin Kjær; Jennum, Poul; Sørensen, Helge Bjarup Dissing

    2016-01-01

    for sleep apnea is at high risk or low risk of having OSA. A new test setup was developed containing an Android based smartphone, the built in accelerometer, and a microphone. To ease the clinical analysis of the data a MATLAB based graphical user interface has been developed visualizing the data allowing...

  10. Portable prescreening system for sleep apnea

    DEFF Research Database (Denmark)

    Guul, Martin Kjaer; Jennum, Poul; Sorensen, Helge B D

    2016-01-01

    for sleep apnea is at high risk or low risk of having OSA. A new test setup was developed containing an Android based smartphone, the built in accelerometer, and a microphone. To ease the clinical analysis of the data a MATLAB based graphical user interface has been developed visualizing the data allowing...

  11. High prevalence of obstructive sleep apnea in Marfan's syndrome

    Institute of Scientific and Technical Information of China (English)

    Mo Li; He Quanying; Wang Yinna; Dong Birong; He Jinhan

    2014-01-01

    Objective To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan's syndrome,and discuss some proposed potential mechanisms for this relationship.Data sources The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013.The search term was "Marfan's syndrome and sleep apnea".Study selection Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan's syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan's syndrome,and coexisting obstructive sleep apnea.Results A high prevalence of obstructive sleep apnea exists in patients with Marfan's syndrome.The potential reasons are craniofacial abnormalities and lax upper airway muscles,which lead to high nasal airway resistance and upper airway collapse.Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms.The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan's syndrome.Conclusions Obstructive sleep apnea is strongly associated with Marfan's syndrome.Craniofacial abnormalities and lax upper airway are the main mechanisms.Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture.Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan's syndrome.

  12. Qué se investiga en relación a enfermedad pulmonar obstructiva crónica en Chile CHRONIC OBSTRUCTIVE PULMONARY DISEASE RESEARCH IN CHILE

    Directory of Open Access Journals (Sweden)

    MANUEL OYARZÚN G.

    2002-07-01

    Full Text Available Con el propósito de conocer qué se investiga sobre enfermedad pulmonar obstructiva (EPOC en Chile, se realizó una búsqueda bibliográfica acerca de las publicaciones en revistas biomédicas de investigaciones sobre EPOC realizadas en Chile. Se revisó los índices MEDLINE y LILACS entre 1982 y 2001. Además, se revisó los resúmenes que comunican investigaciones sobre EPOC presentados a los 5 últimos Congresos Anuales Chilenos sobre Enfermedades Respiratorias. Los temas más frecuentes de las publicaciones en extenso sobre EPOC fueron entrenamiento de los músculos inspiratorios (28%, seguidos por actividad física en pacientes con EPOC (18%, uso de ventilación mecánica no invasiva (15% y tratamientos con fármacos. En los resúmenes el orden de frecuencia de los tópicos investigados en EPOC fue: entrenamiento físico (30%, uso de ventilación mecánica no invasiva (20%, entrenamiento de los músculos inspiratorios (13% e investigación experimental en animales. La proporción numérica entre el promedio anual de resúmenes del trienio 1997-99/promedio de anual publicaciones del trienio 1999-2001 fue de 2,9: 1, sugiriendo que de tres resúmenes presentados solo uno logra ser publicado en extenso. A pesar que en Chile se está realizando una valiosa investigación sobre el funcionamiento de los músculos respiratorios en EPOC, se necesita mejorar e incrementar la investigación clínica y epidemiológica, a fin de obtener un mejor conocimiento de nuestros pacientes con EPOCIn order to have information on what is researched about chronic obstructive pulmonary disease (COPD in Chile, a search about Chilean publications in biomedical on COPD research was carried out. MEDLINE and LILACS indices were reviewed from 1982 to 2001. Additionally, the research abstracts on COPD research presented at the five last Chilean Annual Meetings on Respiratory Diseases were also reviewed. The most frequent research topics on COPD in full papers published in

  13. Sleep apnea-hypopnea quantification by cardiovascular data analysis

    CERN Document Server

    Camargo, Sabrina; Anteneodo, Celia; Kurths, Juergen; Penzel, Thomas; Wessel, Niels

    2014-01-01

    Sleep apnea is the most common sleep disturbance and it is an important risk factor for cardiovascular disorders. Its detection relies on a polysomnography, a combination of diverse exams. In order to detect changes due to sleep disturbances such as sleep apnea occurrences, without the need of combined recordings, we mainly analyze systolic blood pressure signals (maximal blood pressure value of each beat to beat interval). Nonstationarities in the data are uncovered by a segmentation procedure, which provides local quantities that are correlated to apnea-hypopnea events. Those quantities are the average length and average variance of stationary patches. By comparing them to an apnea score previously obtained by polysomnographic exams, we propose an apnea quantifier based on blood pressure signal. This furnishes an alternative procedure for the detection of apnea based on a single time series, with an accuracy of 82%.

  14. Ictal central apnea and bradycardia in temporal lobe epilepsy complicated by obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Yoko Nishimura

    2015-01-01

    Full Text Available We describe the case of a 12-year-old boy who developed temporal lobe epilepsy (TLE with daily complex partial seizures (CPS and monthly generalized seizures. Moreover, he frequently snored while asleep since early childhood. Polysomnography (PSG revealed severe obstructive sleep apnea with apnea–hypopnea index (AHI of 37.8/h. Video-PSG with simultaneous electroencephalography (EEG recording captured two ictal apneic episodes during sleep, without any motor manifestations. The onset of rhythmic theta activity in the midtemporal area on EEG was preceded by the onset of apnea by several seconds and disappeared soon after cessation of central apnea. One episode was accompanied by ictal bradycardia of <48 beats/min which persisted for 50 s beyond the end of epileptic activity. After treatment with carbamazepine and tonsillectomy/adenoidectomy, the seizures were well controlled and AHI decreased to 2.5/h. Paroxysmal discharges also disappeared during this time. Uncontrolled TLE complicated by sleep apnea should be evaluated for the presence of ictal central apnea/bradycardia.

  15. Manejo nutricional en los programas de rehabilitación respiratoria de los pacientes con enfermedad pulmonar obstructiva crónica Nutritional management in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    XIMENA ORELLANA G

    2011-06-01

    Full Text Available Se estima que al menos un tercio de los pacientes con enfermedad pulmonar obstructiva crónica moderada y severa tienen una alteración significativa en su composición corporal, lo cual se asocia con efectos clínicos deletéreos y con una mayor mortalidad. Sin embargo, hay evidencia insuficiente para respaldar que los pacientes que participan en un programa de rehabilitación respiratoria se beneficien en forma significativa de las intervenciones nutricionales dietarias, farmacológicas o la asociación de ambas, aunque aparentemente los últimos estudios publicados parecen sugerirlo. La recomendación actual es establecer desde que el paciente ingresa a un programa de rehabilitación respiratoria tanto el diagnóstico nutricional mediante la determinación del índice de masa corporal como el riesgo nutricional que corresponde a una baja involuntaria significativa de peso en determinado intervalo de tiempo, entregando al paciente un plan de alimentación y educación individualizado que debiera tener una duración mínima de 12 semanas.It is estimated that at least one third of patients with moderate to severe Chronic Obstructive Pulmonary Disease (COPD have a significant alteration of their body composition, which is associated with deleterious clinical effects and higher mortality. However, there is a lack of evidence to support that dietary, pharmacological or both nutritional interventions have significant clinical benefits in COPD patients who are participating in a pulmonary rehabilitation program. At the present time the recommendation is to establish a nutritional diagnosis of the COPD patients from the beginning of the pulmonary rehabilitation program using the measurement of body mass index (BMI and the estimation of the nutritional risk, which means a significant weight loss during a given period of time, followed by an individualized dietary and educational supplementation guide during at least 12 weeks.

  16. Obstructive sleep apnea treatment with dental appliance

    Directory of Open Access Journals (Sweden)

    Rubens Reimão

    1994-12-01

    Full Text Available The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS. Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.

  17. Qué se investiga en relación a enfermedad pulmonar obstructiva crónica en Chile CHRONIC OBSTRUCTIVE PULMONARY DISEASE RESEARCH IN CHILE

    OpenAIRE

    MANUEL OYARZÚN G.

    2002-01-01

    Con el propósito de conocer qué se investiga sobre enfermedad pulmonar obstructiva (EPOC) en Chile, se realizó una búsqueda bibliográfica acerca de las publicaciones en revistas biomédicas de investigaciones sobre EPOC realizadas en Chile. Se revisó los índices MEDLINE y LILACS entre 1982 y 2001. Además, se revisó los resúmenes que comunican investigaciones sobre EPOC presentados a los 5 últimos Congresos Anuales Chilenos sobre Enfermedades Respiratorias. Los temas más frecuentes de las publi...

  18. Atrial fibrillation in obstructive sleep apnea

    OpenAIRE

    Goyal, Sandeep K; Sharma, Abhishek

    2013-01-01

    Atrial fibrillation (AF) is a common arrhythmia with rising incidence. Obstructive sleep apnea (OSA) is prevalent among patients with AF. This observation has prompted significant research in understanding the relationship between OSA and AF. Multiple studies support a role of OSA in the initiation and progression of AF. This association has been independent of obesity, body mass index and hypertension. Instability of autonomic tone and wide swings in intrathoracic pressure are seen in OSA. T...

  19. Comparing Pressures Required to Abolish Snoring and Sleep Apnea

    Directory of Open Access Journals (Sweden)

    V Hoffstein

    2001-01-01

    Full Text Available OBJECTIVE: Snoring and obstructive sleep apnea share similar pathogenesis and similar response to treatment with continuous positive airway pressure (CPAP. The purpose of this study was to compare pressures required to abolish apneas (POSA with pressures required to abolish snoring (PSNOR.

  20. Obstructive Sleep Apnea Syndrome: Pathogenetic Aspects and Treatment

    NARCIS (Netherlands)

    H. Boot (Hendrik)

    2000-01-01

    textabstractAlmost twenty years ago obstmctive sleep apnea was considered to be a medical curiosity that was of little importance, and snoring was merely the subject of humor than one of serious investigation. Although the clinical manifestations of sleep apnea syndrome have been described as early

  1. Características clínicas y funcionales según género de pacientes con enfermedad pulmonar obstructiva crónica Clinical and functional characteristics of COPD according to gender

    Directory of Open Access Journals (Sweden)

    JORGE DREYSE D

    2008-01-01

    Full Text Available La prevalencia, al igual que la mortalidad de la enfermedad pulmonar obstructiva crónica (EPOC, ha aumentado en las mujeres. Esto último sugiere que la enfermedad sería más grave en el sexo femenino. El propósito de este estudio fue evaluar si existen diferencias en la gravedad según género en 95 pacientes (38 mujeres con EPOC ingresados consecutivamente a un protocolo de seguimiento. Evaluamos la magnitud del tabaquismo, características demográficas, gravedad según VEF1 e índice BODE y compromiso de la calidad de vida. Los resultados no demostraron diferencias entre hombres y mujeres en ninguno de los índices de gravedad. Sin embargo, la magnitud del tabaquismo fue inferior en las mujeres que en los hombres (35,5 ± 19,4 vs 45,7 ± 21 paquetes-año; p = 0,02. Nuestros resultados sugieren una mayor susceptibilidad de las mujeres para desarrollar EPOC, pero no demuestran que la gravedad de la enfermedad dependa del géneroChronic obstructive pulmonary disease (COPD prevalence is continuously rising infernales. In addition, mortality due to COPD is higher in females, suggesting that women may develop a more severe disease than males. Our aim was to study possible differences in disease severity according to gender in 95 COPD patients (38 females consecutively recruited to participate in a follow up protocol. Severity of COPD was assessed by FEV1, BODE index and the impairment of quality of life was measured with the Saint George's respiratory questionnaire (SGRQ and the chronic respiratory questionnaire (CRQ. We found no differences according to gender in any of the severity indices studied. However, female smoked significantly less than males (35.5 ± 19.4 versus 45.7 ± 21 pack-year; p = 0.02. Our results suggest that women are more susceptible to develop COPD than men, without differences in disease severity

  2. Obstructive sleep apnea hypopnea syndrome:a proinflammatory disorder

    Institute of Scientific and Technical Information of China (English)

    HAN Fang

    2007-01-01

    @@ Obstructive sleep apnea hypopnea syndrome (OSAHS) is a rather frequent disorder affecting 2%-4% of the general population. Large cohort studies have confirmed that obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular disease (CVD), including myocardial infarction, hypertension, stroke and so on. For example, Sleep Heart Health Study (SHHS) demonstrated that the prevalence of CVD (including myocardial infarction, angina, coronary revascularization, heart failure, stroke) was 1.42 times greater in patients with OSA (apnea/hypopnea index (AHI)>11 events/hour) than in those without OSA.1 However, the exact mechanisms linking sleep apnea to cardiovascular morbidity remain unclear. Two studies2,3 published in this issue of the Journal measured a series of subclinical inflammatory factors in patients with OSA, and added new evidence linking sleep apnea to cardiovascular morbidity.

  3. 5-hydroxytryptamine-mediated apnea caused by the habenular nucleus

    Institute of Scientific and Technical Information of China (English)

    Min Wang; Weihong Lin; Jinghua Wang; Min Huang; Chunyong Wang; Mingxian Li; Shao Wang

    2011-01-01

    5-hydroxytryptamine contributes to the control of activities of the dilator muscle in the upper respiratory tract, and is derived from the raphe nuclei, in which the habenular nucleus exerts a sustained inhibitory effect. In the present study, respiratory motion curve of the genioglossus muscle and peripheral 5-hydroxytryptamine changes were observed following L-glutamate stimulation of the habenular nucleus of adult Wistar rats. Results showed that the rats had apnea and decreased plasma 5-hydroxytryptamine content after the neurons in habenular nucleus were excited. Genioglossus muscle electromyogram amplitude and integral were significantly reduced. The genioglossus myoelectric activity and respiratory motion curve were similar to obstructive sleep apnea syndrome, thus confirming that the habenular nucleus is the key nucleus involved in the pathogenesis of obstructive sleep apnea syndrome, and is the primary regulated center in the raphe nuclei. Stimulation of the habenular nucleus may suppress 5-hydroxytryptamine release and result in apnea, which is similar to obstructive sleep apnea syndrome.

  4. Sleep Apnea and the Risk of Incident Gout

    Science.gov (United States)

    Zhang, Yuqing; Peloquin, Christine E.; Dubreuil, Maureen; Roddy, Edward; Lu, Na; Neogi, Tuhina; Choi, Hyon K.

    2016-01-01

    Objective Sleep apnea is associated with hyperuricemia owing to hypoxia-induced nucleotide turnover. We undertook this study to assess the relationship between incident sleep apnea and the risk of incident gout. Methods Using data from The Health Improvement Network in the UK, we identified individuals with a first-ever physician diagnosis of sleep apnea. For each patient with sleep apnea, up to 5 individuals without sleep apnea were matched by sex, age, birth year, and body mass index (within ±0.5 kg/m2). We estimated the incidence rates of gout and examined the relationship between sleep apnea and the risk of incident gout using a Cox proportional hazards model, adjusting for potential confounders. In addition, we assessed the rate difference in gout due to sleep apnea using an additive hazard model. Results Among 9,865 patients with newly diagnosed sleep apnea and 43,598 matched individuals without sleep apnea, we identified 270 incident cases of gout over 1 year of followup, resulting in incidence rates of 8.4 per 1,000 person-years and 4.8 per 1,000 person-years, respectively. The crude and multivariable rate ratios of incident gout in patients with sleep apnea were 1.7 (95% confidence interval [95% CI] 1.3, 2.2) and 1.5 (95% CI 1.1, 2.1), respectively. The corresponding rate differences between patients with sleep apnea and the comparison cohort were 3.6 (95% CI 1.6, 5.6) and 2.8 (95% CI 0.7, 4.9) per 1,000 person-years. The effect of sleep apnea persisted across subgroups. Conclusion This general population–based study indicates that sleep apnea is independently associated with an increased risk of incident gout. Future research should examine the potential benefits of correcting sleep apnea–induced hypoxia on the risk of hyperuricemia and gout flares. PMID:26477891

  5. Consequences of Obstructive Sleep Apnea in Children.

    Science.gov (United States)

    Blechner, Michael; Williamson, Ariel A

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) has various negative health and behavioral consequences in the pediatric population. As shown in adults, there are metabolic derangements such as obesity, insulin sensitivity, dyslipidemia, and metabolic syndrome, as well as cardiovascular derangements like hypertension, chronic inflammation, endothelial dysfunction, ventricular size/function abnormalities, and even elevated pulmonary arterial pressures, that can be seen in children with OSAS. The first two sections will discuss the metabolic and cardiovascular consequences on OSAS in children. The last section summarizes selected studies and reviews on the behavioral, neurocognitive and academic consequences of OSAS in children.

  6. Oxígenoterapia y rehabilitación respiratoria en el paciente con enfermedad pulmonar obstructiva crónica Oxygen therapy and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    JUAN CÉSPEDES G

    2011-06-01

    Full Text Available Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC a menudo tienen dificultad respiratoria severa que les impide realizar sus actividades cotidianas. Los programas de rehabilitación pulmonar mejoran la capacidad de ejercicio, disminuyen la disnea y mejoran la calidad de vida. En adición, el uso de oxígeno ha demostrado una reducción de la demanda ventilatoria y mejorías en el metabolismo, la función muscular y la función cardiovascular. La combinación de entrenamiento muscular y suplemento de oxígeno puede proporcionar un beneficio adicional. En este capitulo se evaluó la evidencia científica que existe en cuanto al beneficio del uso del suplemento de oxigeno en la rehabilitación respiratoria en pacientes con EPOC. Se recomendó el uso de suplemento de oxígeno en todo paciente con EPOC e hipoxemia de reposo durante el entrenamiento muscular (calidad de la evidencia A, recomendación fuerte. Así también, en los pacientes con EPOC y sin hipoxemia de reposo se recomienda utilizar suplemento de oxígeno durante la rehabilitación respiratoria, porque permite tolerar durante mayor tiempo el entrenamiento muscular y reduce la disnea (calidad de la evidencia B, recomendación débil.Patients with chronic obstructive pulmonary disease (COPD often have severe shortness of breath that prevents them from performing their everyday activities. Pulmonary rehabilitation programs improve capacity exercise, decrease breathlessness and enhance quality of life. In addition, the use of oxygen has been demonstrated to reduce ventilatory demand and to induce improvements in metabolism, muscle function, and cardiovascular function. The combination of exercise training and supplemental oxygen may provide additional benefit. This chapter therefore evaluated the scientific evidence regarding the beneficial effect of supplemental oxygen in the pulmonary rehabilitation of patients with COPD. Supplemental oxygen should be recommended in all COPD

  7. Entrenamiento muscular de las extremidades inferiores en el paciente con enfermedad pulmonar obstructiva crónica Lower extremity exercise training in the rehabilitation of patients with chronic obstructive pulmonary diseas

    Directory of Open Access Journals (Sweden)

    DIEGO VARGAS B

    2011-06-01

    Full Text Available Diversos estudios han demostrado que la pobre tolerancia al ejercicio de los pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC es de origen multifactorial. Sin embargo, un importante factor limitante del ejercicio en los pacientes con EPOC es la disfunción muscular periférica, sobre todo de los músculos de las extremidades inferiores, que se caracteriza por atrofia muscular y reducida resistencia a la fatiga dado por alteraciones morfológicas y metabólicas de los músculos periféricos. En este capitulo se evaluó la evidencia científica que existe en cuanto a los beneficios del entrenamiento muscular de extremidades inferiores (EEII en la rehabilitación respiratoria en pacientes con EPOC. También se revisan las características técnicas de dicho entrenamiento. Se recomienda la realización de entrenamiento muscular de EEII en rehabilitación respiratoria de pacientes con EPOC. El entrenamiento muscular de extremidades inferiores otorga significativos beneficios a los pacientes con EPOC en cuanto a disminuir la disnea, mejorar la capacidad de ejercicio y la calidad de vida (calidad de la evidencia A, recomendación fuerte. El entrenamiento de EEII de alta intensidad y con intervalos produce significativos beneficios fisiológicos.Several studies have shown that poor exercise tolerance in Chronic Obstructive Pulmonary Disease (COPD patients is multifactorial in origin. However, a major exercise-limiting factor in COPD is peripheral muscle dysfunction, particularly the muscles of the lower extremities, characterized by atrophic muscles and reduced fatigue resistance due to morphological and metabolic alterations of peripheral muscles. This chapter therefore evaluated the scientific evidence regarding the beneficial effect of lower extremities exercise in the pulmonary rehabilitation in COPD patients. The technical characteristics of this exercise training were also reviewed. Exercise training of lower limbs was recommended in

  8. Childhood Obesity and Obstructive Sleep Apnea

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    Indra Narang

    2012-01-01

    Full Text Available The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA, occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG, is characterised by snoring, recurrent partial (hypopneas or complete (apneas obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA.

  9. Sleep apnea syndrome in endocrine clinics.

    Science.gov (United States)

    Ceccato, F; Bernkopf, E; Scaroni, C

    2015-08-01

    Obstructive sleep apnea syndrome (OSAS) is a chronic condition with a high prevalence (up to 7 % of the general population) characterized by frequent episodes of upper airway collapse while sleeping. Left untreated, OSAS can cause severe complications, including systemic hypertension, cardiovascular disease, stroke, and abnormal glucose metabolism. This review aims to summarize the close links between OSAS, endocrinology, and metabolism. In patients with metabolic syndrome, OSAS is an independent risk factor for the onset of type 2 diabetes and a worsening glycemic control. The accumulation of adipose tissue in the neck and limited chest wall dynamics, hypoxia, and local micro-inflammation link visceral obesity closely with OSAS. There is now an abundance of convincing data indicating that promoting lifestyle changes, improving sleep hygiene, and adjusting diet can ameliorate both metabolic syndrome and OSAS, especially in obese patients. The incidence of OSAS in acromegaly is high, though GH treatments seem to be unrelated to the onset of apnea in GH-deficient individuals. Prospective studies have suggested an association between hypertension and OSAS because intermittent nocturnal hypoxia prompts an increase in sympathetic tone, endothelial dysfunction, and vascular inflammation: aldosterone excess may have a pathophysiological role, and some authors have reported that treating OSAS leads to a modest, but significant, reduction in blood pressure.

  10. Health Promotion in Obstructive Sleep Apnea Syndrome

    Science.gov (United States)

    Corrêa, Camila de Castro; Blasca, Wanderléia Quinhoneiro; Berretin-Felix, Giédre

    2015-01-01

    Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: “Health Promotion,” “Sleep Disorders,” “Primary Prevention,” “Health Education,” and “Obstructive Sleep Apnea Syndromes.” Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices. PMID:25992174

  11. BMI in patients with obstructive sleep apnea

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    Dobrowolska-Zarzycka Magdalena

    2015-12-01

    Full Text Available Obstructive sleep apnea (OSA is a disease of multicasual etiology. The risk factors include obesity, among other issues. Hence, it is extremely important to determine the effect of body weight on the severity of OSA. The aim of the study was to evaluate the influence of the body weight expressed as body mass index (BMI, on the value of upper airways diameter and on the AHI (Apnea-Hypopnea Index value. The study was comprised of 41 patients diagnosed with OSA by way of polysomnography. Each patient was first examine via a lateral cephalometric image of the skull, which served to measure the upper and lower diameter of the upper airways. BMI was also calculated for each patient. Statistical analysis was carried out in accordance with Pearson’s correlation coefficient test. Our work demonstrated a negative correlation between BMI and the diameter of the upper airways, and a positive correlation between BMI and AHI value. We thus put forward that the increase in body weight in patients with OSA can contribute to the severity of the disease, regardless of the fact that it may not lead to a reduction of the lumen of the upper airways.

  12. Adenotonsillectomy for childhood sleep apnea: CAT

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    Cristian Papuzinski Aguayo

    2013-11-01

    Full Text Available Introduction. Obstructive sleep apnea hypopnea syndrome (OSAHS in children is associated with numerous adverse cognitive and behavioral consequences. The most common risk factor identified for OSAHS is tonsillar enlargement, and primary treatment is adenotonsillectomy. Aim. To compare the efficacy of early adenotonsillectomy versus watchful waiting, on cognitive, behavioral, quality of life and sleep outcomes in children with OSAHS. Patients and Methods. We critically appraised the Marcus (2013 article, a multicenter, single masked, randomized, controlled study in seven sleep centers. Results. After a seven month follow-up, the rate of spontaneous remission in polysomnographic parameters control group shows that 46% of children spontaneously revert untoward outcomes, compared to 79% of children in the intervention group. Reviewer’s conclusion. Adenotonsillar surgery for the treatment of obstructive sleep apnea in school-age children does not significantly improve attention or executive function, but it does improve some behavioral outcomes, quality of life, and polysomnographic variables. However, this improvement was also observed in a high proportion of children who received no treatment, mainly regarding polysomnographic variables. Thus surgery does not appear to be necessary to reduce symptoms.

  13. Quantitative Effects of Trunk and Head Position on the Apnea Hypopnea Index in Obstructive Sleep Apnea

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    van Kesteren, Ellen R.; van Maanen, J. Peter; Hilgevoord, Anthony A.J.; Laman, D. Martin; de Vries, Nico

    2011-01-01

    Study Objectives: To test the hypothesis that head position, separately from trunk position, is an additionally important factor for the occurrence of apnea in obstructive sleep apnea (OSA) patients. Design: Prospective cohort study. Setting: St. Lucas Andreas Hospital, Amsterdam, the Netherlands. Patients and Participants: Three hundred patients referred to our department because of clinically suspected OSA. Interventions: N/A Measurements and Results: Patients underwent overnight polysomnography with 2 position sensors: one on the trunk, and one in the mid-forehead. Of the 300 subjects, 241 were diagnosed with OSA, based on an AHI > 5. Of these patients, 199 could be analyzed for position-dependent OSA based on head and trunk position sensors (AHI in supine position twice as high as AHI in non-supine positions): 41.2% of the cases were not position dependent, 52.3% were supine position dependent based on the trunk sensor, 6.5% were supine position dependent based on the head sensor alone. In 46.2% of the trunk supine position-dependent group, head position was of considerable influence on the AHI (AHI was > 5 higher when the head was also in supine position compared to when the head was turned to the side). Conclusions: The results of this study confirm our hypothesis that the occurrence of OSA may also be dependent on the position of the head. Therefore in patients with a suspicion of position-dependent OSA, sleep recording with dual position sensors placed on both trunk and head should be considered. Citation: van Kesteren ER; van Maanen JP; Hilgevoord AAJ; Laman DM; de Vries N. Quantitative effects of trunk and head position on the apnea hypopnea index in obstructive sleep apnea. SLEEP 2011;34(8):1075-1081. PMID:21804669

  14. Lack of effect of sleep apnea on oxidative stress in obstructive sleep apnea syndrome (OSAS patients.

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    M Simiakakis

    Full Text Available PURPOSE: The aim of this study was to evaluate markers of systemic oxidative stress and antioxidant capacity in subjects with and without OSAS in order to investigate the most important factors that determine the oxidant-antioxidant status. METHODS: A total of 66 subjects referred to our Sleep laboratory were examined by full polysomnography. Oxidative stress and antioxidant activity were assessed by measurement of the derivatives of reactive oxygen metabolites (d-ROMs and the biological antioxidant capacity (BAP in blood samples taken in the morning after the sleep study. Known risk factors for oxidative stress, such as age, sex, obesity, smoking, hypelipidemia, and hypertension, were investigated as possible confounding factors. RESULTS: 42 patients with OSAS (Apnea-Hypopnea index >15 events/hour were compared with 24 controls (AHI<5. The levels of d-ROMS were significantly higher (p = 0.005 in the control group but the levels of antioxidant capacity were significantly lower (p = 0.004 in OSAS patients. The most important factors predicting the variance of oxidative stress were obesity, smoking habit, and sex. Parameters of sleep apnea severity were not associated with oxidative stress. Minimal oxygen desaturation and smoking habit were the most important predicting factors of BAP levels. CONCLUSION: Obesity, smoking, and sex are the most important determinants of oxidative stress in OSAS subjects. Sleep apnea might enhance oxidative stress by the reduction of antioxidant capacity of blood due to nocturnal hypoxia.

  15. The Danish National Database for Obstructive Sleep Apnea

    DEFF Research Database (Denmark)

    Jennum, Poul Jørgen; Larsen, Preben; Cerqueira, Charlotte;

    2016-01-01

    AIM: The aim of the Danish National Database for Obstructive Sleep Apnea (NDOSA) was to evaluate the clinical quality (diagnostic, treatment, and management) for obstructive sleep apnea and obesity hypoventilation syndrome in Denmark using a real-time national database reporting to the Danish...... departments was involved in the management of sleep apnea in Denmark for the purpose of quality improvement. CONCLUSION: The NDOSA has proven to be a real-time national database using diagnostic and treatment procedures reported to the Danish National Patient Registry....... National Patient Registry. STUDY POPULATION: All patients diagnosed with obstructive sleep apnea or obesity hypoventilation syndrome at public and private in- and out-hospital departments in Denmark were included. MAIN VARIABLES: The NDOSA contains information about baseline characteristics, comorbidity...

  16. Sleep Apnea and Cognitive Function in Heart Failure

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    Krysten M. Knecht

    2012-01-01

    Full Text Available Background. Prior research indicates that heart failure (HF patients exhibit significant cognitive deficits on neuropsychological testing. Sleep apnea is associated with both HF and reduced cognitive function, but the combined impact of these conditions on cognitive function is unknown. Methods. In the current study, 172 older adults with a dual diagnosis of HF and sleep apnea or HF alone completed a battery of cognitive tests measuring attention, executive functioning, and memory. Results. Relative to patients with HF alone, persons with both HF and sleep apnea performed worse on measures of attention after adjusting for demographic and medical variables. Conclusions. The current findings suggest that HF patients with comorbid sleep apnea may be at greater risk for cognitive impairment relative to HF patient without such history. Further work is needed to clarify mechanisms for these findings and to determine whether the interactive effects on cognitive function lead to poorer patient outcomes.

  17. Type I Chiari malformation presenting central sleep apnea.

    Science.gov (United States)

    Kitamura, Takuro; Miyazaki, Soichiro; Kadotani, Hiroshi; Kanemura, Takashi; Okawa, Masako; Tanaka, Toshihiko; Komada, Ichiro; Hatano, Taketo; Suzuki, Hideaki

    2014-04-01

    Sleep apnea is a rare but a well-known clinical feature of type I Chiari malformation. It may be obstructive or central in nature. Sleep apnea in patients with type I Chiari malformation rarely presents without accompanying neurological signs or symptoms. We here report a case of a 10-year-old girl who presented with central sleep apnea without any other neurological signs but was ultimately diagnosed with type I Chiari malformation. The patient initially showed mild improvement in symptoms after administration of an acetazolamide. Finally, posterior fossa decompression dramatically improved her respiratory status during sleep, both clinically and on polysomnography. This case suggests that type I Chiari malformation should be considered in the differential diagnoses of central apneas in children, even if there are no other neurological signs and symptoms. Furthermore, sagittal craniocervical magnetic resonance imaging may be necessary for a definitive diagnosis.

  18. Sleep Apnea and Nocturnal Cardiac Arrhythmia: A Populational Study

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    Fatima Dumas Cintra

    2014-11-01

    Full Text Available Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart® system. Results: A total of 767 participants (461 men with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001. After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.

  19. Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes

    OpenAIRE

    Foster, Gary D.; Sanders, Mark H.; Millman, Richard; Zammit,Gary; Borradaile, Kelley E.; Newman, Anne B.; Thomas A. Wadden; Kelley, David; Wing, Rena R.; Pi Sunyer, F. Xavier; Darcey, Valerie; Kuna, Samuel T.; ,

    2009-01-01

    OBJECTIVE To assess the risk factors for the presence and severity of obstructive sleep apnea (OSA) among obese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Unattended polysomnography was performed in 306 participants. RESULTS Over 86% of participants had OSA with an apnea-hypopnea index (AHI) ≥5 events/h. The mean AHI was 20.5 ± 16.8 events/h. A total of 30.5% of the participants had moderate OSA (15 ≤ AHI

  20. Brain Injury Following Repetitive Apnea in Newborn Piglets

    Science.gov (United States)

    Schears, Gregory; Creed, Jennifer; Antoni, Diego; Zaitseva, Tatiana; Greeley, William; Wilson, David F.; Pastuszko, Anna

    Repetitive apnea is associated with a significant increase in extracellular dopamine, generation of free radicals as determined by o-tyrosine formation and increase in Fluoro-Jade staining of degenerating neurons. This increase in extracellular dopamine and of hydroxyl radicals in striatum of newborn brain is likely to be at least partly responsible for the neuronal injury and neurological side effects of repetitive apnea.

  1. Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis

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    F. J. Michel De la Rosa

    2005-01-01

    Full Text Available Además del asma ocupacional y las enfermedades derivadas de la inhalación aguda, otras enfermedades obstructivas también reconocen un origen laboral. Aunque en la actualidad la bisinosis es una enfermedad rara en España, describimos las características de la misma por su interés histórico dentro de las enfermedades respiratorias de origen laboral y porque todavía sigue vigente en los países en vías de desarrollo. La bronquitis crónica también puede estar relacionada con la exposición laboral a polvos y humos, con frecuencia denominada "bronquitis industrial". La relación ocupacional de la EPOC ha sido más controvertida a lo largo de la historia, pero en la actualidad esta relación está aceptada; describimos la evidencia actual que sustenta esta relación. En último lugar, describimos la bronquitis eosinofílica sin asma, entidad descrita por primera vez en 1989 y que en ocasiones también puede tener un origen laboral, compartiendo agentes etiológicos con el asma ocupacional.Besides occupational asthma and diseases derived from acute inhalation, other obstructive diseases also have an occupational origin. Although at present byssinosis is a rare disease in Spain, we describe its characteristics because of its historical interest amongst occupational respiratory diseases and because it is still relevant in developing countries. Chronic bronchitis can also be related to exposure at work to dust and smoke, and is often referred to as "industrial bronchitis". Historically, the relation of CPOD to occupation has been subject to controversy, but nowadays this relationship is accepted; we describe the present evidence supporting this relationship. Finally, we describe eosinophilic bronchitis without asthma, an entity that was described for the first time in 1989 and that can sometimes have an occupational origin, sharing aetiological agents with occupational asthma.

  2. Entrenamiento de las extremidades superiores en el paciente con enfermedad pulmonar obstructiva crónica Upper extremity exercise training in the rehabilitation of patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    MANUEL DE LA PRIDA C

    2011-06-01

    Full Text Available En los pacientes con enfermedad pulmonar obstructiva crónica (EPOC se observa una reducción de la capacidad de generación de fuerza de los grupos musculares de las extremidades superiores (EESS y de la pared torácica comparado con sujetos sanos. Existen evidencias que el ejercicio de las EESS se asocia a un significativo costo metabólico y ventilatorio que es particularmente evidente en los pacientes con EPOC moderada a severa. Clínicamente, estos pacientes tienen disnea y fatiga con actividades sencillas de la vida diaria. En este capitulo se evaluó la evidencia científica que existe en cuanto a los beneficios del entrenamiento muscular de EESS en la rehabilitación respiratoria en pacientes con EPOC. Las características técnicas de dicho entrenamiento también fueron revisadas. Se recomendó la realización de entrenamiento muscular de EESS en la rehabilitación respiratoria de pacientes con EPOC, por cuanto mejora la capacidad de ejercicio, reduce la ventilación y el consumo de oxígeno (calidad de la evidencia: B, fuerza de la recomendación: moderada. El entrenamiento muscular de EESS puede ser asociado al entrenamiento muscular de extremidades inferiores por cuanto se obtienen mejores resultados para el paciente. Los ejercicios de EESS pueden realizarse sin apoyo, con carga incremental o carga constante.In patients with chronic obstructive pulmonary disease (COPD showed a reduction in force generating capacity of the muscle groups of the upper extremities (UE and the chest wall compared with healthy subjects. Also, there is evidence that the exercise of the UE is associated with significant metabolic and ventilatory cost, this is particularly evident in patients with moderate and severe COPD. Clinically, patients have a significant increase in dyspnea and fatigue for simple activities of daily life.This chapter therefore evaluated the scientific evidence regarding the beneficial effect of upper extremities exercise in the

  3. [Treatment of obstructive sleep apnea syndromes].

    Science.gov (United States)

    Poirrier, R

    1993-01-01

    The detection, correction or withdrawal of any cause or associated factor including obesity, drugs or alcohol is essential in the treatment of obstructive sleep apnea syndrome. Treatment is mainly mechanical or surgical, but not medical. Nasal continuous positive airway pressure (NCPAP) has now largely replaced tracheostomy and successful long-term domestic use of this method has been reported on many occasions. Oropharyngeal surgery can solve a large part of social snoring problems. However criteria for procedure selection and evaluation of results are still needed to clarify the indication of this operation in patients with full clinical expression of the syndrome. In this regard, a comprehensive preoperative evaluation and a logical approach to the reconstruction of the upper-airway has recently led to the association of palatopharyngoplasty and maxillo-mandibular surgery, with an excellent long-term success rate.

  4. Sleep apneas and high altitude newcomers.

    Science.gov (United States)

    Goldenberg, F; Richalet, J P; Onnen, I; Antezana, A M

    1992-10-01

    Sleep and respiration data from two French medical high altitude expeditions (Annapurna 4,800 m and Mt Sajama 6,542 m) are presented. Difficulties in maintaining sleep and a SWS decrease were found with periodic breathing (PB) during both non-REM and REM sleep. Extent of PB varied considerably among subjects and was not correlated to the number of arousals but to the intercurrent wakefulness duration. There was a positive correlation between the time spent in PB and the individual hypoxic ventilatory drive. The relation between PB, nocturnal desaturation, and mountain sickness intensity are discussed. Acclimatization decreased the latency toward PB and improved sleep. Hypnotic benzodiazepine intake (loprazolam 1 mg) did not worsen either SWS depression or apneas and allowed normal sleep reappearance after acclimatization.

  5. Obstructive sleep apnea in Treacher Collins syndrome.

    Science.gov (United States)

    Akre, Harriet; Øverland, Britt; Åsten, Pamela; Skogedal, Nina; Heimdal, Ketil

    2012-01-01

    The aim of the present study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) among the Norwegian population with Treacher Collins syndrome (TCS). A secondary aim was to establish whether TCS phenotype severity is associated with OSAS severity. A prospective case study design was used. Individuals who were 5 years old and above with a known diagnosis of TCS in Norway were invited to participate in a study. The study included genetic testing, medical and dental examinations and polysomnography. All participants demonstrated disturbed respiration during sleep; 18/19 met the diagnostic criteria for OSAS. Subjectively evaluated snoring was not a reliable predictor of OSAS. We found no significant association between TCS phenotype severity and the severity of OSAS. OSAS is common in TCS, but there is no association with the phenotype severity. Individuals diagnosed with TCS must undergo sleep studies to identify the presence of OSAS.

  6. Pierre Robin sequence and obstructive sleep apnea

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    Rubens Reimão

    1994-12-01

    Full Text Available The case of a 12-year-old female patient with Pierre Robin sequence is reported, in which reduction of the pharyngeal airway leads to obstructive sleep apnea syndrome (OSAS and excessive daytime sleepiness. Radiological evaluation, computerized tomography and magnetic resonance image showed bilateral temporomandibular ankylosis. Cephalometric data evidenced marked reduction of the posterior airway space. Three all-night polysomnographic evaluations detected severe OSAS with decrease in oxygen saturation. The Multiple Sleep Latency Test (MSLT perfomed on two separate days objectively quantified the excessive daytime sleepiness with short sleep latencies; stage REM was not present. Polysomnography, MSLT and thorough radiologic studies, in this case, made it possible to determine the severity of OSAS, the site of obstruction, and the associated malformations.

  7. Genetic associations with obstructive sleep apnea traits in Hispanic/Latino Americans

    Science.gov (United States)

    Obstructive sleep apnea is a common disorder associated with increased risk for cardiovascular disease, diabetes, and premature mortality. Although there is strong clinical and epidemiologic evidence supporting the importance of genetic factors in influencing obstructive sleep apnea, its genetic bas...

  8. Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences

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    Carlos Zamarrón

    2009-01-01

    Full Text Available Carlos Zamarrón1, Vanesa García Paz1, Emilio Morete1, Felix del Campo Matías21Servicio de Neumología, Hospital Clínico Universitario de Santiago, Santiago, Spain; 2Servicio de Neumologia, Hospital Universitario Rio Ortega de Vallaclolid, Vallaclolid, SpainAbstract: Obstructive sleep apnea syndrome (OSAS and chronic obstructive pulmonary disease (COPD are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep.Keywords: chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, overlap syndrome, sleep, cardiovascular disease

  9. Reversibilidad espirométrica en pacientes con enfermedad pulmonar obstructiva crónica: ¿Debe emplearse 200 ó 400 µg de salbutamol? Spirometric reversibility in COPD patients: 200 or 400 mg salbutamol should be used?

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    Jorge Manríquez

    2006-09-01

    Full Text Available La óptima dosis de salbutamol que se debe emplear para evaluar la reversibilidad espirométrica en pacientes con enfermedad pulmonar obstructiva crónica (EPOC no ha sido establecida, por lo que 200 ó 400 mg son corrientemente utilizados. El propósito del presente estudio fue evaluar el efecto de ambas dosis de salbutamol en un grupo de pacientes con enfermedad leve a grave. El estudio incluyó a 40 pacientes con EPOC estable a los cuales se les realizó una espirometría antes y 15 minutos después de recibir en orden aleatorio 200 ó 400 µg de salbutamol en dos días consecutivos. Los cambios se evaluaron en valores absolutos y en porcentaje del valor teórico. Se midió los cambios en VEF1, CVF, capacidad vital lenta (CVL y capacidad inspiratoria (CI. Se consideró clínicamente significativo un aumento igual o mayor al 10% del valor teórico. No se observó diferencias en los valores absolutos post broncodilatador entre las dos dosis como tampoco expresados en porcentaje del valor teórico. Además, la proporción de pacientes que respondieron con 200 y 400 µg de salbutamol fue similar. Esto fue particularmente importante cuando se incluyó en el análisis todas las variables relacionadas con el cambio de volumen (CVL, CVF y CI. Concluimos que para evaluar la reversibilidad espirométrica en pacientes con EPOC, 200 µg de salbutamol son tan efectivos como 400 µgThe optimal dose of salbutamol for testing spirometric reversibility in patients with chronic obstructive pulmonary disease (COPD has not been determined and either 200 or 400 µg are commonly used. The purpose of the present study is to test both doses in a group of patients with mild to severe COPD. Forty stable COPD patients were included to receive in random order both doses of salbutamol, with spirometry being performed before and after 15 min of their administration. Absolute and percent predicted changes were evaluated. For the latter, an increase in forced expiratory

  10. Classification algorithms for predicting sleepiness and sleep apnea severity.

    Science.gov (United States)

    Eiseman, Nathaniel A; Westover, M Brandon; Mietus, Joseph E; Thomas, Robert J; Bianchi, Matt T

    2012-02-01

    Identifying predictors of subjective sleepiness and severity of sleep apnea are important yet challenging goals in sleep medicine. Classification algorithms may provide insights, especially when large data sets are available. We analyzed polysomnography and clinical features available from the Sleep Heart Health Study. The Epworth Sleepiness Scale and the apnea-hypopnea index were the targets of three classifiers: k-nearest neighbor, naive Bayes and support vector machine algorithms. Classification was based on up to 26 features including demographics, polysomnogram, and electrocardiogram (spectrogram). Naive Bayes was best for predicting abnormal Epworth class (0-10 versus 11-24), although prediction was weak: polysomnogram features had 16.7% sensitivity and 88.8% specificity; spectrogram features had 5.3% sensitivity and 96.5% specificity. The support vector machine performed similarly to naive Bayes for predicting sleep apnea class (0-5 versus >5): 59.0% sensitivity and 74.5% specificity using clinical features and 43.4% sensitivity and 83.5% specificity using spectrographic features compared with the naive Bayes classifier, which had 57.5% sensitivity and 73.7% specificity (clinical), and 39.0% sensitivity and 82.7% specificity (spectrogram). Mutual information analysis confirmed the minimal dependency of the Epworth score on any feature, while the apnea-hypopnea index showed modest dependency on body mass index, arousal index, oxygenation and spectrogram features. Apnea classification was modestly accurate, using either clinical or spectrogram features, and showed lower sensitivity and higher specificity than common sleep apnea screening tools. Thus, clinical prediction of sleep apnea may be feasible with easily obtained demographic and electrocardiographic analysis, but the utility of the Epworth is questioned by its minimal relation to clinical, electrocardiographic, or polysomnographic features.

  11. Efectividad de la ventilación mecánica no invasiva en el tratamiento del síndrome de distrés respiratorio del adulto

    OpenAIRE

    2015-01-01

    Introducción. El uso de la ventilación mecánica no invasiva (VMNI) en el tratamiento del paciente con enfermedad pulmonar obstructiva crónica agudizado y en el edema agudo de pulmón cardiogénico, está ampliamente aceptado, sin embargo, su utilidad en el tratamiento de la insuficiencia respiratoria aguda hipoxémica y, sobre todo, en las formas más graves, como es el síndrome de distrés respiratorio agudo (SDRA), es controvertida. Objetivos. Los objetivos principales de este estudio fuero...

  12. Impacto de las novedades terapéuticas para el tratamiento de la enfermedad pulmonar obstructiva crónica y el asma en atención primaria de Madrid, entre 1996 y 2005 Impact of new therapeutic products for the treatment of chronic obstructive pulmonary disease and asthma in primary care in Madrid between 1996 and 2005

    Directory of Open Access Journals (Sweden)

    Cristina Rodríguez Escolar

    2008-04-01

    Full Text Available Objetivos: Analizar la tendencia de utilización de nuevos medicamentos para el tratamiento de las enfermedades obstructivas de las vías aéreas en atención primaria de Madrid entre 1996 y 2005, y evaluar su impacto en términos de oferta, consumo y costes. Métodos: Estudio de utilización de medicamentos de novedades terapéuticas del grupo R03 («medicamentos para enfermedades obstructivas de las vías aéreas» prescritos por médicos de atención primaria de Madrid, durante 1996 y 2005. Los datos de consumo y gasto a PVP provienen de la facturación de recetas. El consumo se expresa en dosis diarias definidas por 1.000 habitantes y día. Resultados: La oferta experimenta pocas variaciones cuantitativas aunque de gran interés cualitativo, al desaparecer fármacos sin utilidad terapéutica y comercializarse 6 novedades terapéuticas. En el año 2005, la utilización de estas últimas genera el 28,03% del total del consumo y el 79% de los costes. Las novedades de mayor impacto son salmeterol/fluticasona y tiotropio. Conclusiones: La oferta de medicamentos mejora cualitativamente al desaparecer los fármacos sin utilidad terapéutica. La prescripción de novedades terapéuticas tiene un gran impacto sobre el consumo total de los medicamentos del grupo R03 y, sobre todo, en los costes generados, dado su elevado su precio; sin embargo, aportan limitadas ventajas terapéuticas. Los nuevos medicamentos se han incorporado a gran velocidad a la prescripción.Objectives: To analyze the trend of use of new drugs for the treatment of chronic obstructive pulmonary disease in primary care of Madrid (Spain between 1996 and 2005, and to evaluate its impact in terms of supply, use and costs. Methods: Drug utilization study of new products of the R03 group (Anatomical Therapeutic Chemical Classificaction System: drugs for obstructive airway diseases prescribed by doctors of primary care of Madrid, during 1996 and 2005. Information on drug utilization and

  13. Sleep apnea-hypopnea quantification by cardiovascular data analysis.

    Directory of Open Access Journals (Sweden)

    Sabrina Camargo

    Full Text Available Sleep disorders are a major risk factor for cardiovascular diseases. Sleep apnea is the most common sleep disturbance and its detection relies on a polysomnography, i.e., a combination of several medical examinations performed during a monitored sleep night. In order to detect occurrences of sleep apnea without the need of combined recordings, we focus our efforts on extracting a quantifier related to the events of sleep apnea from a cardiovascular time series, namely systolic blood pressure (SBP. Physiologic time series are generally highly nonstationary and entrap the application of conventional tools that require a stationary condition. In our study, data nonstationarities are uncovered by a segmentation procedure which splits the signal into stationary patches, providing local quantities such as mean and variance of the SBP signal in each stationary patch, as well as its duration L. We analysed the data of 26 apneic diagnosed individuals, divided into hypertensive and normotensive groups, and compared the results with those of a control group. From the segmentation procedure, we identified that the average duration , as well as the average variance , are correlated to the apnea-hypoapnea index (AHI, previously obtained by polysomnographic exams. Moreover, our results unveil an oscillatory pattern in apneic subjects, whose amplitude S* is also correlated with AHI. All these quantities allow to separate apneic individuals, with an accuracy of at least 79%. Therefore, they provide alternative criteria to detect sleep apnea based on a single time series, the systolic blood pressure.

  14. The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea

    Science.gov (United States)

    Pıhtılı, Aylin; Bingöl, Züleyha; Kıyan, Esen

    2017-01-01

    Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study. Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity) and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001), oxygen desaturation index (p<0.001) and sleep time with SpO2<90% (p<0.001) were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001) and lowest SpO2 (p<0.001) were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high. PMID:28251022

  15. Genioglossus fatigue in obstructive sleep apnea.

    LENUS (Irish Health Repository)

    McSharry, David

    2012-08-15

    Obstructive sleep apnea (OSA) is a prevalent disorder that may cause cardiovascular disease and fatal traffic accidents but the pathophysiology remains incompletely understood. Increased fatigability of the genioglossus (the principal upper airway dilator muscle) might be important in OSA pathophysiology but the existing literature is uncertain. We hypothesized that the genioglossus in OSA subjects would fatigue more than in controls. In 9 OSA subjects and 9 controls during wakefulness we measured maximum voluntary tongue protrusion force (Tpmax). Using surface electromyography arrays we measured the rate of decline in muscle fiber conduction velocity (MFCV) during an isometric fatiguing contraction at 30% Tpmax. The rate of decline in MFCV provides an objective means of quantifying localized muscle fatigue. Linear regression analysis of individual subject data demonstrated a significantly greater decrease in MFCV in OSA subjects compared to control subjects (29.2 ± 20.8% [mean ± SD] versus 11.2 ± 20.8%; p=0.04). These data support increased fatigability of the genioglossus muscle in OSA subjects which may be important in the pathophysiology of OSA.

  16. Resistant Hypertension and Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Akram Khan

    2013-01-01

    Full Text Available Hypertension (HTN is a modifiable, highly prevalent risk factor for cardiovascular morbidity and renal dysfunction worldwide. In the United States, HTN affects one in three adults, contributes to one out of every seven deaths and to nearly half of all cardiovascular disease-related deaths. HTN is considered resistant when the blood pressure remains above goal despite lifestyle modification and administration of three antihypertensive agents of different classes including a diuretic. Large population-based studies have suggested that obstructive sleep apnea (OSA is a risk factor for resistant HTN. The mechanism proposed is a pattern of intermittent hypoxia associated with hyperaldosteronism, increased sympathetic tone, endothelial dysfunction, and inflammation. In this review we discuss the association between OSA and resistant HTN, the physiologic mechanisms linking OSA with resistant HTN, and the effect of continuous positive airway pressure therapy (CPAP on blood pressure in patients with resistant HTN. While the reduction in blood pressure with CPAP is usually modest in patients with OSA, a decrease of only a few mmHg in blood pressure can significantly reduce cardiovascular risk. Patients presenting to a center specializing in management of hypertension should be screened and treated for OSA as a potentially modifiable risk factor.

  17. Wireless remote monitoring system for sleep apnea

    Science.gov (United States)

    Oh, Sechang; Kwon, Hyeokjun; Varadan, Vijay K.

    2011-04-01

    Sleep plays the important role of rejuvenating the body, especially the central nervous system. However, more than thirty million people suffer from sleep disorders and sleep deprivation. That can cause serious health consequences by increasing the risk of hypertension, diabetes, heart attack and so on. Apart from the physical health risk, sleep disorders can lead to social problems when sleep disorders are not diagnosed and treated. Currently, sleep disorders are diagnosed through sleep study in a sleep laboratory overnight. This involves large expenses in addition to the inconvenience of overnight hospitalization and disruption of daily life activities. Although some systems provide home based diagnosis, most of systems record the sleep data in a memory card, the patient has to face the inconvenience of sending the memory card to a doctor for diagnosis. To solve the problem, we propose a wireless sensor system for sleep apnea, which enables remote monitoring while the patient is at home. The system has 5 channels to measure ECG, Nasal airflow, body position, abdominal/chest efforts and oxygen saturation. A wireless transmitter unit transmits signals with Zigbee and a receiver unit which has two RF modules, Zigbee and Wi-Fi, receives signals from the transmitter unit and retransmits signals to the remote monitoring system with Zigbee and Wi-Fi, respectively. By using both Zigbee and Wi-Fi, the wireless sensor system can achieve a low power consumption and wide range coverage. The system's features are presented, as well as continuous monitoring results of vital signals.

  18. Operation and control software for APNEA

    Energy Technology Data Exchange (ETDEWEB)

    McClelland, J.H.; Storm, B.H. Jr.; Ahearn, J. [Lockheed-Martin Specialty Components, Largo, FL (United States)] [and others

    1997-11-01

    The human interface software for the Lockheed Martin Specialty Components (LMSC) Active/Passive Neutron Examination & Analysis System (APENA) provides a user friendly operating environment for the movement and analysis of waste drums. It is written in Microsoft Visual C++ on a Windows NT platform. Object oriented and multitasking techniques are used extensively to maximize the capability of the system. A waste drum is placed on a loading platform with a fork lift and then automatically moved into the APNEA chamber in preparation for analysis. A series of measurements is performed, controlled by menu commands to hardware components attached as peripheral devices, in order to create data files for analysis. The analysis routines use the files to identify the pertinent radioactive characteristics of the drum, including the type, location, and quantity of fissionable material. At the completion of the measurement process, the drum is automatically unloaded and the data are archived in preparation for storage as part of the drum`s data signature. 3 figs.

  19. Obstructive sleep apnea syndrome accompanied by diabetes mellitus.

    Science.gov (United States)

    Nagai, Takashi; Imamura, Makoto; Iwasaki, Yasuki; Mori, Masatomo

    2003-01-01

    A 66-year-old man with diabetes mellitus was hospitalized with sleeping and dyspnea. Polysomnography determined an apnea hypopneas index (AHI) of 56/hr and that the events occurred in association with continued diaphragm electromyogram activity and thoraco-abdominal wall movement. Obstructive sleep apnea syndrome was then diagnosed and nasal continuous positive airway pressure (nCPAP) (11cmH2O) was set. AHI subsequently became 21/hr. Six months' later, uvulopalatopharyngoplasty (UPPP) for the narrowing middle pharynx was performed and the AHI became 7/hr. After starting nCPAP and UPPP, body weight and insulin resistance had decreased. Treatment for sleep apnea may improve insulin resistance in diabetes mellitus.

  20. Sexual function in female patients with obstructive sleep apnea

    DEFF Research Database (Denmark)

    Giraldi, Annamaria G.E.; Petersen, Marian; Kristensen, Ellids;

    2011-01-01

    function and distress are sparse. Aim. To investigate sexual dysfunction and sexual distress in female patients with obstructive sleep apnea and to determine which factors are of importance for their sexual function. Methods. We investigated 80 female patients (ages 28–64) admitted to a sleep laboratory...... and who after investigation received a diagnosis of obstructive sleep apnea. All subjects answered questions drawn from three self-administered questionnaires on sexuality. The results were compared with a population sample (N = 240). Main Outcome Measure. Data from nocturnal respiratory recordings....... Female Sexual Function Index, Female Sexual Distress Scale and four questions from Life Satisfaction-11 (Lisat-11). Results. Female Sexual Function Index indicated that obstructive sleep apnea patients were at a higher risk for having sexual difficulties. Female Sexual Distress Scale showed significantly...

  1. Evaluation of neuromuscular activity in patients with obstructive sleep apnea using chin surface electromyography of polysomnography

    Institute of Scientific and Technical Information of China (English)

    YIN Guo-ping; YE Jing-ying; HAN De-min; WANG Xiao-yi; ZHANG Yu-huan; LI Yan-ru

    2013-01-01

    Background It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis.Currently,there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea.This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition.Methods The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea.The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value,where the percent compensated electromyography value =(normal breath surface electromyography-apnea surface electromyography)/normal breath surface electromyography,and the percent compensated electromyography values among subjects were compared.The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined.Results The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R2=0.382,P <0.001).Conclusions Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea.The neuromuscular contribution is different among subjects with obstructive sleep apnea.

  2. The Influence of a Mandibular Advancement Plate on Polysomnography in Different Grades of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Antti Raunio

    2015-03-01

    Full Text Available Objectives: The purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective. Material and Methods: A total of 68 patients with obstructive sleep apnea syndrome (OSAS including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD and monitored with polysomnography. Results: 25 of the 31 mild, 15 of the 23 moderate and 2 of the 14 severe OSAS patients were cured of their OSAS if a post treatment apnea-hypopnea index of less than 5 is regarded as cured. The odds ratios for success with MAD therapy are 3 for women over men, 14.9 for mild obstructive sleep apnea, 5.42 for moderate obstructive sleep apnea if severe obstructive sleep apnea is assigned an odds ratio of 1. Conclusions: The use of the apnea-hypopnea index alone is useful in mild and moderate disease to predict the effectiveness of mandibular advancement device. Treatment with a mandibular advancement device is very effective in treating mild and moderate obstructive sleep apnea. Conservative treatment with a mandibular advancement device can be successful in less severe grades of sleep apnea and may be an alternative for non-surgical patients with severe obstructive sleep apnea intolerant of Continuous Positive Airway Pressure management.

  3. Obstructive sleep apnea is associated with increased arterial stiffness in severe obesity.

    Science.gov (United States)

    Seetho, Ian W; Parker, Robert J; Craig, Sonya; Duffy, Nick; Hardy, Kevin J; Wilding, John P H

    2014-12-01

    Obstructive sleep apnea is associated with obesity and metabolic syndrome, leading to greater cardiovascular risk. Severely obese patients with obstructive sleep apnea may still be at risk of adverse health outcomes, even without previous cardiovascular disease. Pulse wave analysis non-invasively measures peripheral pulse waveforms and derives measures of haemodynamic status, including arterial stiffness, augmentation pressure and subendocardial viability ratio. We hypothesized that the presence of obstructive sleep apnea in severe obesity, even in the absence of an antecedent history of cardiovascular disease, would affect measurements derived from pulse wave analysis. Seventy-two severely obese adult subjects [obstructive sleep apnea 47 (body mass index 42 ± 7 kg m(-2) ), without obstructive sleep apnea (non-OSA) 25 (body mass index 40 ± 5 kg m(-2) )] were characterised using anthropometric, respiratory and cardio-metabolic parameters. Groups were similar in age, body mass index and gender. More subjects with obstructive sleep apnea had metabolic syndrome [obstructive sleep apnea 60%, without obstructive sleep apnea (non-OSA) 12%]. Those with obstructive sleep apnea had greater arterial stiffness, augmentation pressure and decreased subendocardial viability ratio (all P cardiovascular risk independently of metabolic abnormalities. The presence of obstructive sleep apnea in severe obesity identifies a group at high cardiovascular risk; clinicians should ensure that risk factors are managed appropriately in this group whether or not treatment of obstructive sleep apnea is offered or accepted by patients.

  4. Evaluation of Autonomic Dysfunction in Obstructive Sleep Apnea Syndrome

    Directory of Open Access Journals (Sweden)

    Ahmet Turan Evlice

    2012-04-01

    Full Text Available The nervous system, which controls the body's internal organs is called Autonomic Nervous System. Parkinson's disease, vascular diseases, diabetes mellitus and Guilllain-Barre syndrome cause to disotonomia. Recent studies has been shown, obstructive sleep apnea syndrome cause to disotonomia too. To investigate disotonomia in in obstructive sleep apnea syndrome , should be preferred the methods like analysis of heart rate variability and sympathetic skin response which have low cost and easy applicability. Thus, it will be possible to prevent morbidity and mortality due to autonomic dysfuncion. [Archives Medical Review Journal 2012; 21(2.000: 109-121

  5. Ventilación no invasiva y rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica Noninvasive ventilation and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    FRANCISCO ARANCIBIA H

    2011-06-01

    Full Text Available Se ha demostrado que la rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica (EPOC aumenta la capacidad de ejercicio y reduce la disnea. En la mayoría de los pacientes con discapacidad, la intensidad del ejercicio durante las sesiones de entrenamiento se ve limitada por la capacidad de la bomba ventilatoria. La ventilación no invasiva (VNI ha sido utilizada con mucho éxito en pacientes con EPOC que presentan una exacerbación de su enfermedad. No obstante, su beneficio en pacientes con EPOC estable o en rehabilitación respiratoria está en discusión. En este capitulo se evaluó la evidencia científica que existe en cuanto al beneficio de la ventilación no invasiva (VNI en la rehabilitación respiratoria. Se revisó la modalidad y las características de la VNI en cuanto a cuando realizarla -si durante el entrenamiento o nocturna-. Se recomendó la utilización de la ventilación no invasiva en rehabilitación respiratoria en pacientes seleccionados, con EPOC en etapa grave o avanzada, y en aquellos con respuestas subóptimas al entrenamiento. La utilización de la ventilación no invasiva debe ser preferentemente nocturna, y utilizando presión de soporte inspiratorio, la cual puede permitir alcanzar una mejor tolerancia al ejercicio, una mejoría del intercambio gaseoso y una disminución de la sobrecarga de los músculos respiratorios y la disnea. (calidad de la evidencia B, fuerza de la recomendación: moderada.In patients with chronic obstructive pulmonary disease (COPD, pulmonary rehabilitation has been demonstrated to increase exercise capacity and reduce dyspnea. In the most disabled patients, the intensity of exercise during the training sessions is limited by ventilatory pump capacity. Non-invasive ventilation (NIV support has been used successfully in patients with exacerbation of COPD. However, its benefit in patients with stable COPD or in a pulmonary rehabilitation program is under discussion

  6. Tongue Volume Influences Lowest Oxygen Saturation but Not Apnea-Hypopnea Index in Obstructive Sleep Apnea.

    Directory of Open Access Journals (Sweden)

    Sang Hyeon Ahn

    Full Text Available The aim of this study was to identify correlations between sleep apnea severity and tongue volume or posterior airway space measured via three-dimensional reconstruction of volumetric computerized tomography (CT images in patients with obstructive sleep apnea (OSA for use in predicting OSA severity and in surgical treatment. We also assessed associations between tongue volume and Mallampati score.Snoring/OSA male patients (n = 64 who underwent polysomnography, cephalometry, and CT scans were enrolled in this retrospective study. OSA was diagnosed when the apnea-hypopnea index (AHI was greater than 5 (mild 5-14; moderate 15-29; severe>30. The patients were also categorized into the normal-mild group (n = 22 and the moderate-severe group (n = 42. Using volumetric CT images with the three-dimensional reconstruction technique, the volume of the tongue, posterior airway space volume, and intra-mandibular space were measured. The volumes, polysomnographic parameters, and physical examination findings were compared, and independent factors that are related to OSA were analysed.No associations between tongue volume or posterior airway space and the AHI were observed. However, multivariate linear analyses showed that tongue volume had significantly negative association with lowest O2 saturation (r = 0.365, p = 0.027. High BMI was related to an increase in tongue volume. Modified Mallampati scores showed borderline significant positive correlations with absolute tongue volume (r = 0.251, p = 0.046 and standardized tongue volume (absolute tongue volume / intramandibular area; r = 0.266, p = 0.034. Between the normal-mild and moderate-severe groups, absolute tongue volumes were not different, although the standardized tongue volume in the moderate-severe group was significantly higher.Absolute tongue volume showed stronger associations with lowest O2 saturation during sleep than with the severity of AHI. We also found that high BMI was a relevant factor for

  7. Neurocognitive impairment in obstructive sleep apnea.

    Science.gov (United States)

    Lal, Chitra; Strange, Charlie; Bachman, David

    2012-06-01

    Obstructive sleep apnea syndrome (OSAS) is a common disorder with far-reaching health implications. One of the major consequences of OSAS is an impact on neurocognitive functioning. Several studies have shown that OSAS has an adverse effect on inductive and deductive reasoning, attention, vigilance, learning, and memory. Neurocognitive impairment can be measured objectively with tests such as the Wechsler Adult Intelligence Scale-Revised, the Psychomotor Vigilance Task, the Steer Clear Performance Test, and tests of repetitive finger tapping. In children, OSAS may cause attention-deficit hyperactivity disorder in addition to behavioral problems and learning disabilities. Risk factors for cognitive impairment include increasing age, male sex, apolipoprotein E ε4 allele positivity, current cigarette smoking, obesity, hypertension, diabetes mellitus, metabolic syndrome, Down syndrome, hypothyroidism, significant alcohol consumption, stroke, and the use of psychoactive medications. At a cellular level, OSAS likely causes cognitive impairment through intermittent hypoxia, hormonal imbalance, and/or systemic inflammation, either independently or via the resultant endothelial dysfunction that occurs. Excessive daytime sleepiness should be measured and minimized in all studies of neurocognitive impairment. Recent studies have used functional and structural neuroimaging to delineate the brain areas affected in patients with OSAS with neurocognitive dysfunction. A common finding in several of these studies is decreased hippocampal volume. Other affected brain areas include the frontal and parietal lobes of the brain, which show focal reductions in gray matter. These changes can be reversed at least partially with the use of CPAP, which highlights the importance of early recognition and treatment of OSAS. The currently available data in this field are quite limited, and more research is needed.

  8. Obstructive Sleep Apnea and Lipid Abnormalities

    Science.gov (United States)

    Karkinski, Dimitar; Georgievski, Oliver; Dzekova-Vidimliski, Pavlina; Milenkovic, Tatjana; Dokic, Dejan

    2017-01-01

    BACKGROUND: There has been a great interest in the interaction between obstructive sleep apnea (OSA) and metabolic dysfunction, but there is no consistent data suggesting that OSA is a risk factor for dyslipidemia. AIM: The aim of this cross-sectional study was to evaluate the prevalence of lipid abnormalities in patients suspected of OSA, referred to our sleep laboratory for polysomnography. MATERIAL AND METHODS: Two hundred patients referred to our hospital with suspected OSA, and all of them underwent for standard polysomnography. All patients with respiratory disturbance index (RDI) above 15 were diagnosed with OSA. In the morning after 12 hours fasting, the blood sample was collected from all patients. Blood levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL), were determined in all study patients. In the study, both OSA positive and OSA negative patients were divided according to the body mass index (BMI) in two groups. The first group with BMI ≤ 30 kg/m^2 and the second group with BMI > 30 kg/m^2. RESULTS: OSA positive patients with BMI ≤ 30 kg/m^2 had statistically significant higher levels of triglycerides and total cholesterol, and statistically significant lower level of HDL compared to OSA negative patients with BMI ≤ 30. There were no statistically significant differences in age and LDL levels between these groups. OSA positive patients with BMI > 30 kg/m^2 had higher levels of triglycerides, total cholesterol and LDL and lower levels of HDL versus OSA negative patients with BMI > 30 kg/m^2, but without statistically significant differences. CONCLUSION: OSA and obesity are potent risk factors for dyslipidemias. OSA could play a significant role in worsening of lipid metabolism in non-obese patients. But in obese patients, the extra weight makes the metabolic changes of lipid metabolism, and the role of OSA is not that very important like in non-obese patients. PMID

  9. Depression and Obstructive Sleep Apnea (OSA

    Directory of Open Access Journals (Sweden)

    O'Hara Ruth

    2005-06-01

    Full Text Available Abstract For over two decades clinical studies have been conducted which suggest the existence of a relationship between depression and Obstructive Sleep Apnea (OSA. Recently, Ohayon underscored the evidence for a link between these two disorders in the general population, showing that 800 out of 100,000 individuals had both, a breathing-related sleep disorder and a major depressive disorder, with up to 20% of the subjects presenting with one of these disorders also having the other. In some populations, depending on age, gender and other demographic and health characteristics, the prevalence of both disorders may be even higher: OSA may affect more than 50% of individuals over the age of 65, and significant depressive symptoms may be present in as many as 26% of a community-dwelling population of older adults. In clinical practice, the presence of depressive symptomatology is often considered in patients with OSA, and may be accounted for and followed-up when considering treatment approaches and response to treatment. On the other hand, sleep problems and specifically OSA are rarely assessed on a regular basis in patients with a depressive disorder. However, OSA might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to appropriate pharmacological treatment. Furthermore, an undiagnosed OSA might be exacerbated by adjunct treatments to antidepressant medications, such as benzodiazepines. Increased awareness of the relationship between depression and OSA might significantly improve diagnostic accuracy as well as treatment outcome for both disorders. In this review, we will summarize important findings in the current literature regarding the association between depression and OSA, and the possible mechanisms by which both disorders interact. Implications for clinical practice will be discussed.

  10. Sleep board review question: insomnia in obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Budhiraja R

    2013-11-01

    Full Text Available No abstract available. Article truncated after first page. What is the estimated prevalence of insomnia symptoms in patients with obstructive sleep apnea? 1. Less than 1% 2. 5%-10% 3. 20-30% 4. 40%-60% 5. Greater than 80%

  11. Predictors of obstructive sleep apnea-hypopnea treatment outcome

    NARCIS (Netherlands)

    Hoekema, A.; Doff, M. H. J.; de Bont, L. G. M.; van der Hoeven, J. H.; Wijkstra, P. J.; Pasma, H. R.; Stegenga, B.

    2007-01-01

    Oral appliance therapy is an alternative to continuous positive airway pressure (CPAP) for treating the obstructive sleep apnea-hypopnea syndrome. However, the ability to pre-select suitable candidates for either treatment is limited. The aim of this study was to assess the value of relevant variabl

  12. 77 FR 25226 - Proposed Recommendations on Obstructive Sleep Apnea

    Science.gov (United States)

    2012-04-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION... withdrawing its proposed regulatory guidance for obstructive sleep apnea (OSA) and request for comment as published on April 20, 2012. The Agency is still in the process of carefully reviewing the...

  13. Snoring & sleep apnea : A population study in Italian women

    NARCIS (Netherlands)

    Ferini-Strambi, L; Zucconi, M; Castronovo, [No Value; Garancini, P; Oldani, A; Smirne, S

    1999-01-01

    The aim of this cross-sectional study was to evaluate the prevalence of sleep-disordered breathing by means of a validated portable instrument (MESAM IV) and to investigate the relationship between snoring and sleep apnea in a sample of Italian middle-aged female population. We randomly chose 750 su

  14. Ischemic Preconditioning of One Forearm Enhances Static and Dynamic Apnea

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Rasmussen, Mads Reinholdt; Jattu, Timo;

    2014-01-01

    .05). CONCLUSIONS: We conclude that while the effect of ischemic preconditioning (of one forearm) on ergometer rowing was minimal, probably because of reduced muscle oxygenation during the warm-up, ischemic preconditioning does enhance both static and dynamic apnea, supporting that muscle ischemia is an important...

  15. Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea syndrome

    OpenAIRE

    Carlos Zamarrón; Luis Valdés Cuadrado; Rodolfo Álvarez-Sala

    2013-01-01

    Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there m...

  16. Compensatory Head Posture Changes in Patients with Obstructive Sleep Apnea

    Institute of Scientific and Technical Information of China (English)

    TONG Maorong; XIA Xirong; Hiroki SAKAKIBARA; Susumu SUETSUGU

    2000-01-01

    The upper airway narrowing and changes in head posture and their relationship with apnea severity in patients with obstructive sleep apnea (OSA) were investigated. In 86 male OSA patients and 37 healthy men, one-night polysomnographic examination was performed and a lateral cephalogram by digital image processing system was taken in each subject. Fifteen variables concerning the upper airway dimensions, area and head postures were measured by using a computer software (NIH Image). The results showed that upper airway dimensions in the OSA group at all levels were significantly smaller than those in the control group and the results hold true when the age and body mass index were well controlled in these two groups. Significant forward inclination of the cervical column was found in the patients with an apnea index (AI) greater than 35episodes/h. And changes in the head posture variables in the whole study group were significantly correlated with AI and airway dimensions at various levels. It was suggested that there exist significant and extensive upper airway narrowing in OSA patients even in upright position and awake state; And as the apnea severity progresses, patients may assume certain compensatory head postures in an attempt to maintain an adequate airway patency.

  17. Clinical symptoms of sleep apnea syndrome and automobile accidents

    DEFF Research Database (Denmark)

    Haraldsson, P O; Carenfelt, C; Diderichsen, Finn

    1990-01-01

    Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by ca...

  18. SINDROME DE APNEAS/HIPOPNEAS DURANTE EL SUEÑO EN EDAD PEDIÁTRICA

    Directory of Open Access Journals (Sweden)

    Navazo Eguía A

    2006-08-01

    Full Text Available SUMMARY:Sleep disordered breathing (SDB is a common condition in children. Sleep Apnea/Hypopnea syndrome (SAHS in children is a frequent sleep disorder, with a prevalence estimated to be 1 - 3% of all children. The most frequent cause of SAHS in children is the adenotonsillar hypertrophy. SAHS in children can result in severe complications if left untreated such as impaired physical growth, delayed development, poor school performance and in severe cases, hypertension and cor pulmonale, nevertheless, yet it is an under recognized condition. The gold standard diagnostic technique is the nocturnal polysomnography (PSG, guidelines for performing laboratory-based polysomnography in children have been established, the sleep laboratory should be a nonthreatening environment and personnel with pediatric training should record, score and interpret the study. The diagnostic criteria for SAHS in adults is not useful for diagnosis of SAHS in children. Adenotonsillectomy is the most common treatment for children with SAHS.RESUMEN:Los trastornos respiratorios del sueño en los niños, en particular el Síndrome de Apneas/Hipopneas durante el sueño (SAHS, es una patología frecuente, que afecta entre el 1 - 3% de la población infantil, siendo su causa más frecuente la hipertrofia adenoamigdalar. Es una enfermedad infradiagnosticada y que conlleva importantes complicaciones como son alteraciones del crecimiento, alteraciones cognitivas e incluso en casos severos Cor Pulmonale. La polisomnografía nocturna (PSG, es la técnica diagnóstica de elección para el diagnóstico del SAHS en los niños, pero en la población infantil es necesario tener en cuenta una serie de consideraciones, como son la edad de la población que se estudia, entorno adecuado y la necesidad de técnicos entrenados en el cuidado de los niños. Los criterios diagnósticos del SAHS para adultos no son útiles en los niños. El tratamiento de elección en los niños con SAHS es la

  19. Length of Individual Apnea Events Is Increased by Supine Position and Modulated by Severity of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Timo Leppänen

    2016-01-01

    Full Text Available Positional obstructive sleep apnea (OSA is common among OSA patients. In severe OSA, the obstruction events are longer in supine compared to nonsupine positions. Corresponding scientific information on mild and moderate OSA is lacking. We studied whether individual obstruction and desaturation event severity is increased in supine position in all OSA severity categories and whether the severity of individual events is linked to OSA severity categories. Polygraphic recordings of 2026 patients were retrospectively analyzed. The individual apnea, and hypopnea durations and desaturation event depth, duration, and area of 526 included patients were compared between supine and nonsupine positions in different OSA severity categories. Apnea events were 6.3%, 12.5%, and 11.1% longer (p<0.001 in supine compared to nonsupine position in mild, moderate, and severe OSA categories, respectively. In moderate and severe OSA categories desaturation areas were 5.7% and 25.5% larger (p<0.001 in supine position. In both positions the individual event severity was elevated along increasing OSA severity category (p<0.05. Supine position elevates apnea duration in all and desaturation area in moderate and severe OSA severity categories. This might be more hazardous for supine OSA patients and therefore, estimation of clinical severity of OSA should incorporate also information about individual event characteristics besides AHI.

  20. Inflammatory cytokines in pediatric obstructive sleep apnea

    Science.gov (United States)

    Huang, Yu-Shu; Guilleminault, Christian; Hwang, Fang-Ming; Cheng, Chuan; Lin, Cheng-Hui; Li, Hsueh-Yu; Lee, Li-Ang

    2016-01-01

    Abstract Pediatric obstructive sleep apnea (OSA) is associated with chronic systemic inflammation and with cognitive impairments. This study aimed to investigate the status of proinflammatory cytokines, particularly interleukin 17 (IL-17) and interleukin 23 (IL-23) and cognition in pediatric OSA. Controls and OSA children participated in the study. Exclusion criteria were adenotonsillectomy, heart, neurological and severe psychiatric diseases, craniofacial syndromes, and obesity. Polysomnogram was followed by serum testing for inflammatory markers and neurocognitive tests such as continuous performance task (CPT) and Wisconsin card sorting test, questionnaires, analyses of plasma high-sensitivity C-reactive protein (HS-CRP), tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6), IL-17, and IL-23. Seventy-nine, 4 to 12-year-old subjects in 2 groups ended the study: 47 nonobese OSA children (mean age = 7.84 ± 0.56 years, body mass index [BMI] = 16.95 ± 0.47 kg/m2, BMI z-score = 0.15 ± 0.21, and mean apnea–hypopnea index [AHI] = 9.13 ± 1.67 events/h) and 32 healthy control children (mean age = 7.02 ± 0.65 years, with BMI = 16.55 ± 0.58 kg/m2, BMI z-score = −0.12 ± 0.27, and mean AHI = 0.41 ± 0.07 event/h) were enrolled. Serum cytokine analyses showed significantly higher levels of HS-CRP, IL-17, and IL-23 in OSA children (P = 0.002, P = 0.024, and P = 0.047). Regression test showed significant influence of HS-CRP, TNF-α, IL-6, IL-17, and specifically IL-23, with the continuous performance test and Wisconsin card sorting test. OSA children have abnormal levels of IL-17, an interleukin related to T helper 17 cells, a T helper cell involved in development of autoimmunity and inflammation. This high expression level may contribute to the complications of pediatric OSA; we also found a significant influence of inflammatory cytokines, particularly IL-23, on abnormal neurocognitive testing. PMID

  1. Proyecto de Investigación: Beneficios de una Intervención Integral de Enfermería en pacientes con Enfermedad Pulmonar Obstructiva Crónica( EPOC)

    OpenAIRE

    Cabero Pérez, Silvia

    2014-01-01

    Con este proyecto se pretende mostrar los beneficios de una intervención integral de enfermería en pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) respecto a una mejora en la disnea, en la capacidad de ejercicio y en la calidad de vida relacionada con la salud (CVRS), así como en la disminución de los niveles de ansiedad y de depresión. Asimismo se intentará demostrar que intervenciones de este tipo disminuyen la utilización de los servicios sanitarios y la frecuencia de las exac...

  2. Hipercoagulabilidad y daño endotelial en pacientes con enfermedad pulmonar obstructiva crónica en fase estable Hypercoagulability state and endotelial injury in stable chronic obstructive pulmonary disease patients

    OpenAIRE

    M. A. Aibar; K. Laborda; F. Conget; Cornudella, R

    2010-01-01

    La enfermedad pulmonar obstructiva crónica es en la actualidad la cuarta causa de muerte en nuestro país. El principal agente causal de la enfermedad es el tabaco, cuyos efectos sobre el árbol bronquial no se limitan al parénquima pulmonar sino que además lesionan la pared endotelial, lo que podría contribuir a la aparición de trombosis, isquemia o hipertensión pulmonar. En nuestro trabajo se estudia la existencia de un estado protrombótico en estos pacientes caracterizado por la activación d...

  3. Oxígenoterapia y rehabilitación respiratoria en el paciente con enfermedad pulmonar obstructiva crónica Oxygen therapy and pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

    OpenAIRE

    JUAN CÉSPEDES G; FRANCISCO ARANCIBIA H

    2011-01-01

    Los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) a menudo tienen dificultad respiratoria severa que les impide realizar sus actividades cotidianas. Los programas de rehabilitación pulmonar mejoran la capacidad de ejercicio, disminuyen la disnea y mejoran la calidad de vida. En adición, el uso de oxígeno ha demostrado una reducción de la demanda ventilatoria y mejorías en el metabolismo, la función muscular y la función cardiovascular. La combinación de entrenamiento muscular y...

  4. Medium Increased Risk for Central Sleep Apnea but Not Obstructive Sleep Apnea in Long-Term Opioid Users: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Filiatrault, Marie-Lou; Chauny, Jean-Marc; Daoust, Raoul; Roy, Marie-Pier; Denis, Ronald; Lavigne, Gilles

    2016-01-01

    Study Objective: Opioids are associated with higher risk for ataxic breathing and sleep apnea. We conducted a systematic literature review and meta-analysis to assess the influence of long-term opioid use on the apnea-hypopnea and central apnea indices (AHI and CAI, respectively). Methods: A systematic review protocol (Cochrane Handbook guidelines) was developed for the search and analysis. We searched Embase, Medline, ACP Journal Club, and Cochrane Database up to November 2014 for three topics: (1) narcotics, (2) sleep apnea, and (3) apnea-hypopnea index. The outcome of interest was the variation in AHI and CAI in opioid users versus non-users. Two reviewers performed the data search and extraction, and disagreements were resolved by discussion. Results were combined by standardized mean difference using a random effect model, and heterogeneity was tested by χ2 and presented as I2 statistics. Results: Seven studies met the inclusion criteria, for a total of 803 patients with obstructive sleep apnea (OSA). We compared 2 outcomes: AHI (320 opioid users and 483 non-users) and 790 patients with CAI (315 opioid users and 475 non-users). The absolute effect size for opioid use was a small increased in apnea measured by AHI = 0.25 (95% CI: 0.02–0.49) and a medium for CAI = 0.45 (95% CI: 0.27–0.63). Effect consistency across studies was calculated, showing moderate heterogeneity at I2 = 59% and 29% for AHI and CAI, respectively. Conclusions: The meta-analysis results suggest that long-term opioid use in OSA patients has a medium effect on central sleep apnea. Citation: Filiatrault ML, Chauny JM, Daoust R, Roy MP, Denis R, Lavigne G. Medium increased risk for central sleep apnea but not obstructive sleep apnea in long-term opioid users: a systematic review and meta-analysis. J Clin Sleep Med 2016;12(4):617–625. PMID:26943709

  5. Maxillomandibular Advancement in Obstructive Sleep Apnea Syndrome Patients: a Restrospective Study on the Sagittal Cephalometric Variables

    OpenAIRE

    2013-01-01

    ABSTRACT Objectives The present retrospective study analyzes sagittal cephalometric changes in patients affected by obstructive sleep apnea syndrome submitted to maxillomandubular advancement. Material and Methods 15 adult sleep apnea syndrome (OSAS) patients diagnosed by polysomnography (PSG) and treated with maxillomandubular advancement (MMA) were included in this study. Pre- (T1) and postsurgical (T2) PSG studies assessing the apnea/hypopnea index (AHI) and the lowest oxygen saturation (L...

  6. Sleep apnea risk among Mexican American and non-Hispanic white stroke survivors

    Science.gov (United States)

    Skolarus, Lesli E.; Lisabeth, Lynda D.; Morgenstern, Lewis B.; Burgin, William; Brown, Devin L.

    2011-01-01

    Background and purpose Sleep apnea is a modifiable independent stroke risk factor and is associated with poor stroke outcomes. Mexican Americans have a higher incidence of stroke than non-Hispanic whites. In a biethnic community, we sought to determine the frequency of screening, testing and treatment of sleep apnea among stroke survivors, and to compare self-perceived risk of sleep apnea with actual risk. Methods A survey was mailed to ischemic stroke survivors in the Brain Attack Surveillance in Corpus Christi (BASIC) project. The survey included the validated sleep apnea screening tool, the Berlin questionnaire, and queried the frequency of sleep apnea screening by symptoms, formal sleep testing, and treatment. Self-perceived risk and actual high risk of sleep apnea were compared using McNemar’s test. Results Of the 193 respondents (49% response rate), 54% were Mexican American. Forty-eight percent of respondents had a high risk of sleep apnea based on the Berlin questionnaire, while only 19% thought they were likely to have sleep apnea (p<0.01). There was no difference in proportion of respondents at high risk of sleep apnea between Mexican Americans and non-Hispanic whites (48% vs. 51%, p=0.73). Less than 20% of respondents had undergone sleep apnea screening, testing or treatment. Conclusions Stroke survivors perceive their risk of sleep apnea to be lower than their actual risk. Despite a significant proportion of both Mexican American and non-Hispanic white stroke survivors at high risk of sleep apnea, few undergo symptom screening, testing or treatment. Both stroke survivors and physicians may benefit from educational interventions. PMID:22156693

  7. Correlation between the oropharyngo-laryngoscopic findings and the severity of obstructive sleep apnea

    OpenAIRE

    Priscila Sequeira Dias; Maria Helena Araujo-Melo; Denise Duprat Neves; Lucas Neves de Andrade Lemes; Manuela Salvador Mosciaro; Sandro Bedoya

    2015-01-01

    Objective: To correlate anatomical and functional changes of the oral cavity, pharynx and larynx to the severity of obstructive sleep apnea syndrome (OSAS). Methods : We conducted a cross-sectional study of 66 patients of both genders, aged between 21 and 59 years old with complaints of snoring and / or apnea. All underwent full clinical evaluation, including physical examination, nasolarybgoscopy and polisonography. We classified individuals into groups by the value of the apnea-hypopnea i...

  8. LA TELEMEDICINA EN EL DIAGNOSTICO Y TRATAMIENTO DE LOS TRASTORNOS RESPIRATORIOS DEL SUEÑO

    Directory of Open Access Journals (Sweden)

    José Cordero Guevara.

    2004-01-01

    Full Text Available We review the current state of the diagnosis and treatment of the sleep-apnea syndrome in relation to the instrument telematics available. The advance poligraphy systems, the not supervised polysomnography at home, combined with videoconference could be effective with an inferior cost in the diagnosis and treatment of the sleep apnea syndrome (SAS. The importance of the research, development and technological innovation in this area, will allow to introduce systems that allow a greater yield of the laboratory polysomnography, approaching the average east population of diagnose and treatment. RESUMEN: Se revisa el estado actual del diagnóstico y tratamiento del síndrome de apnea e hipopnea del sueño en relación con los medios telemáticos disponibles. Los sistemas de poligrafia avanzada, tipo polisomnografía domiciliaria no supervisada (PSG-DNS apoyado con teleconsulta por videoconferencia podria ser eficaz con un coste inferior en el diagnóstico y tratamiento del síndrome de apneas hipopneas del sueño (SAHS. La importancia de la investigacion, desarrollo e innovación tecnológica en este área, permitirá implantar sistemas que permitan un mayor rendimiento de las Unidades del Sueño, acercando a la población este medio de diagnostico y tratamiento.

  9. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.

    Science.gov (United States)

    McEvoy, R Doug; Antic, Nick A; Heeley, Emma; Luo, Yuanming; Ou, Qiong; Zhang, Xilong; Mediano, Olga; Chen, Rui; Drager, Luciano F; Liu, Zhihong; Chen, Guofang; Du, Baoliang; McArdle, Nigel; Mukherjee, Sutapa; Tripathi, Manjari; Billot, Laurent; Li, Qiang; Lorenzi-Filho, Geraldo; Barbe, Ferran; Redline, Susan; Wang, Jiguang; Arima, Hisatomi; Neal, Bruce; White, David P; Grunstein, Ron R; Zhong, Nanshan; Anderson, Craig S

    2016-09-01

    Background Obstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. Methods After a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. Results Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. Conclusions Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease. (Funded by the National Health and

  10. A home sleep apnea screening device with time-domain signal processing and autonomous scoring capability.

    Science.gov (United States)

    Jin, Jiayi; Sánchez-Sinencio, Edgar

    2015-02-01

    Current solutions of sleep apnea diagnosis require the patient to undergo overnight studies at a specialized sleep laboratory. Due to such inconvenience and high cost, millions of sleep apnea patients remain undiagnosed and thus untreated. Based on a micro-electro-mechanical systems (MEMS) sensor and an effective apnea detection algorithm, we propose a low-cost single-channel apnea screening solution applicable in the comfort of patients' homes. A prototype device was designed and assembled including a MEMS sensor for measuring the patient's nasal air flows, and a time-domain signal processing IC for apnea detection and autonomous scoring. The IC chip was fabricated in standard 0.5- μm CMOS technology. The proposed device was tested for both respiratory rhythm detection and sleep apnea screening under clinical environment. Apnea-hypopnea indices (AHI) were scored to indicate severity of sleep apnea conditions. Test results suggest that the proposed device can be a valuable screening solution for the broader public with undiagnosed apnea conditions.

  11. Apnea Detection Method for Cheyne-Stokes Respiration Analysis on Newborn

    Science.gov (United States)

    Niimi, Taiga; Itoh, Yushi; Natori, Michiya; Aoki, Yoshimitsu

    2013-04-01

    Cheyne-Stokes respiration is especially prevalent in preterm newborns, but its severity may not be recognized. It is characterized by apnea and cyclical weakening and strengthening of the breathing. We developed a method for detecting apnea and this abnormal respiration and for estimating its malignancy. Apnea was detected based on a "difference" feature (calculated from wavelet coefficients) and a modified maximum displacement feature (related to the respiratory waveform shape). The waveform is calculated from vertical motion of the thoracic and abdominal region during respiration using a vision sensor. Our proposed detection method effectively detects apnea (sensitivity 88.4%, specificity 99.7%).

  12. Obstructive Sleep Apnea Severity and Overnight Body Fluid Shift before and after Hemodialysis

    Science.gov (United States)

    Forni Ogna, Valentina; Mihalache, Alexandra; Pruijm, Menno; Halabi, Georges; Phan, Olivier; Cornette, Françoise; Bassi, Isabelle; Haba Rubio, José; Burnier, Michel; Heinzer, Raphaël

    2015-01-01

    Background and objectives Obstructive sleep apnea is associated with significantly increased cardiovascular morbidity and mortality. Fluid overload may promote obstructive sleep apnea in patients with ESRD through an overnight fluid shift from the legs to the neck soft tissues. Body fluid shift and severity of obstructive sleep apnea before and after hemodialysis were compared in patients with ESRD. Design, setting, participants, & measurements Seventeen patients with hemodialysis and moderate to severe obstructive sleep apnea were included. Polysomnographies were performed the night before and after hemodialysis to assess obstructive sleep apnea, and bioimpedance was used to measure fluid overload and leg fluid volume. Results The mean overnight rostral fluid shift was 1.27±0.41 L prehemodialysis; it correlated positively with fluid overload volume (r=0.39; P=0.02) and was significantly lower posthemodialysis (0.78±0.38 L; P<0.001). There was no significant difference in the mean obstructive apnea-hypopnea index before and after hemodialysis (46.8±22.0 versus 42.1±18.6 per hour; P=0.21), but obstructive apnea-hypopnea index was significantly lower posthemodialysis (−10.1±10.8 per hour) in the group of 12 patients, with a concomitant reduction of fluid overload compared with participants without change in fluid overload (obstructive apnea-hypopnea index +8.2±16.1 per hour; P<0.01). A lower fluid overload after hemodialysis was significantly correlated (r=0.49; P=0.04) with a lower obstructive apnea-hypopnea index. Fluid overload—assessed by bioimpedance—was the best predictor of the change in obstructive apnea-hypopnea index observed after hemodialysis (standardized r=−0.68; P=0.01) in multivariate regression analysis. Conclusions Fluid overload influences overnight rostral fluid shift and obstructive sleep apnea severity in patients with ESRD undergoing intermittent hemodialysis. Although no benefit of hemodialysis on obstructive sleep apnea severity

  13. Respuesta ventilatoria al ejercicio post-entrenamiento de miembros superiores en la enfermedad pulmonar obstructiva crónica

    Directory of Open Access Journals (Sweden)

    Martín Sívori

    2013-02-01

    Full Text Available Está poco estudiada la modificación de la respuesta ventilatoria al ejercicio de miembros superiores (MS post-entrenamiento en la EPOC. Se realizó un estudio prospectivo, aleatorio y controlado en pacientes con EPOC, entrenando un grupo los miembros inferiores (GC y otro adicionalmente los MS (GM. Se comparó la respuesta ventilatoria al ejercicio de MS pre y post-entrenamiento. Se estudiaron 43 pacientes, 84% varones, estadio GOLD II (moderado 6 (14%, GOLD III (grave 15 (35% y GOLD IV (muy grave 22 (51%. Veintiocho pacientes completaron el estudio. Post-entrenamiento: se observó en el grupo GM (N = 14 incrementos del V T isotiempo (p < 0.0001 y del % de capacidad inspiratoria (CI isotiempo (8.8%, p = 0.001, mayores Ti isotiempo (29.3%, p = 0.022 y Ti/Tot isotiempo (37.4%, p = 0.0004 al ejercicio de MS. Se redujo el Te isotiempo (26%, p = 0.009. La CI isotiempo se incrementó (p = 0.01. Post-entrenamiento: en el grupo GC (N = 14 se incrementó el V T/Ti isotiempo (66.86%, p = 0.0005, y disminuyeron el Ti isotiempo (27.9%, p = 0.015 y el Ti/Tot isotiempo (22.74%, p = 0.00016 al ejercicio de MS. Se observó correlación moderada entre la Δ de frecuencia respiratoria y la Δ de CI al ejercicio de MS, post-entrenamiento solo para el grupo GM (r = -0.53, p< 0.001. Comparando ambos grupos en la respuesta al ejercicio de MS, se observó en el grupo GM, reducción del Te isotiempo (p = 0.049 y del V T/Ti (p = 0.0015, mayores Ti isotiempo (p = 0.0019, Ti/tot isotiempo (p = 0.000076 y CI (% predictivo, p = 0.01. El entrenamiento de MS modificó la respuesta ventilatoria, y también redujo el atrapamiento aéreo que se generó por el ejercicio de MS en la EPOC.

  14. Variables psicosociales asociadas a la adherencia terapeútica en pacientes con enfermedad pulmonar obstructiva crónica (EPOC)

    OpenAIRE

    Alonso Gil, Laura

    2015-01-01

    Actualmente, la EPOC es una de las las enfermedades que causa más mortalidad. Una buena adherencia al tratamiento asegura una reducción del avance de la enfermedad y una disminución de los costes personales y sociales. Muchos estudios han abordado este problema en otras enfermedades. Sin embargo, en la EPOC, existen pocos estudios que analicen los factores asociados. El objetivo de este estudio es explorar la influencia de un conjunto de variables psico-sociales en la adherencia al tratam...

  15. Ejercicio aeróbico y de fuerza en personas con una enfermedad pulmonar obstructiva (epoc): estudio de caso

    OpenAIRE

    Blas, Lara; Castillo, Daniel; Lacalzada, Oscar; Iturricastillo, Aitor

    2016-01-01

    El objetivo del estudio fue describir las respuestas fisiológicas de pacientes con EPOC en cada una de las sesiones de un programa de entrenamiento físico de ocho semanas y analizar los efectos producidos por el programa en el rendimiento físico de estos pacientes. En este estudio participaron cuatro personas a las que se les diagnosticó EPOC (64±6 años). Se realizó un test (T1) de 6 minutos de caminata (6MWT) para determinar la capacidad cardiovascular de los participantes y, después de ocho...

  16. Alteration of the renal regulatory hormonal pattern during experimental obstructive jaundice Alteración del patrón hormonal regulatorio renal durante la ictericia obstructiva experimental

    Directory of Open Access Journals (Sweden)

    F. J Padillo

    2009-06-01

    Full Text Available Objective: the alteration of hormones regulating sodium and water status is related to renal failure in obstructive jaundice (OJ. Experimental design: OJ was induced by common bile duct ligation. Samples were obtained from the control (SO and OJ groups at 24 and 72 hours, and at 7 days. Different parameters related to biliary obstruction, liver and renal injury, and vasoactive mediators such as renin, aldosterone, endothelin-1 (ET-1 and prostaglandin E2 (PGE2 were studied. Results: bile duct ligation caused an increase in total bilirubin (p < 0.001 and alkaline phosphatase (AP (p < 0.001. The SO and OJ groups had the same values for diuresis, renin, and creatinine clearance at 24 h. However, animals with OJ had a lower sodium concentration in urine than SO animals (p < 0.01, as well as an increase in aldosterone levels (p < 0.03. ANP levels were moderately increased during OJ but did not reach statistical significance when compared to the SO group. In contrast, OJ animals showed a rise in serum ET-1 concentration (p < 0.001 and increased PGE2 in urine (p < 0.001. Conclusions: biliary obstruction induced an increase in ET-1 release and PGE2 urine excretion. These hormones might play a role during the renal complications associated with renal disturbances that occur during OJ.

  17. Role of Sensory Stimulation in Amelioration of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Mak Adam Daulatzai

    2011-01-01

    Full Text Available Obstructive sleep apnea (OSA, characterized by recurrent upper airway (UA collapse during sleep, is associated with significant morbidity and disorders. Polysomnogram is employed in the evaluation of OSA and apnea-hypopnea number per hour reflects severity. For normal breathing, it is essential that the collapsible UA is patent. However, obstruction of the UA is quite common in adults and infants. Normally, important reflex mechanisms defend against the UA collapse. The muscle activity of UA dilators, including the genioglossus, tensor palatini (TP, and pharyngeal constrictors, is due to the integrated mechanism of afferent sensory input → to motor function. Snoring is harsh breathing to prevent UA obstruction. Unfortunately, snoring vibrations, pharyngeal suction collapse, negative pressure, and hypoxia cause pathological perturbations including dysfunctional UA afferent sensory activity. The current paper posits that peripheral sensory stimulation paradigm, which has been shown to be efficacious in improving several neurological conditions, could be an important therapeutic strategy in OSA also.

  18. The effect of sleep apnea on plasma and urinary catecholamines.

    Science.gov (United States)

    Dimsdale, J E; Coy, T; Ziegler, M G; Ancoli-Israel, S; Clausen, J

    1995-06-01

    Numerous studies have suggested an alteration of sympathetic nervous system functioning in sleep apnea. However, most of these studies did not control for confounding factors such as diet, obesity, hypertension and anti-hypertensive medications. We examined plasma and urinary catecholamines in 43 patients, including hypertensive and normotensive individuals with and without sleep apnea. Hypertensive patients were studied at least 3 weeks following tapering of anti-hypertensive medication. All patients consumed similar diets and were of similar age and level of obesity. Twenty-four-hour urinary norepinephrine levels were significantly higher in apneics (58.2 ng vs. 40.2 ng in nonapneics, p sleep and in the morning (p < 0.05).

  19. Mechanisms of endothelial dysfunction in obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Amy Atkeson

    2008-12-01

    Full Text Available Amy Atkeson, Sanja JelicDivision of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NYAbstract: Endothelial activation and inflammation are important mediators of accelerated atherogenesis and consequent increased cardiovascular morbidity in obstructive sleep apnea (OSA. Repetitive episodes of hypoxia/reoxygenation associated with transient cessation of breathing during sleep in OSA resemble ischemia/reperfusion injury and may be the main culprit underlying endothelial dysfunction in OSA. Additional factors such as repetitive arousals resulting in sleep fragmentation and deprivation and individual genetic suseptibility to vascular manifestations of OSA contribute to impaired endothelial function in OSA. The present review focuses on possible mechanisms that underlie endothelial activation and inflammation in OSA.Keywords: endothelial, obstructive sleep apnea, inflammation, dysfunction

  20. Cardiovascular Complications of Sleep Apnea: Role of Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Mohammad Badran

    2014-01-01

    Full Text Available Obstructive sleep apnea (OSA occurs in 2% of middle-aged women and 4% of middle-aged men with a higher prevalence among obese subjects. This condition is considered as an independent risk factor for cerebrovascular and cardiovascular diseases. One of the major pathophysiological characteristics of OSA is intermittent hypoxia. Hypoxia can lead to oxidative stress and overproduction of reactive oxygen species, which can lead to endothelial dysfunction, a hallmark of atherosclerosis. Many animal models, such as the rodent model of intermittent hypoxia, mimic obstructive sleep apnea in human patients and allow more in-depth investigation of biological and cellular mechanisms of this condition. This review discusses the role of oxidative stress in cardiovascular disease resulting from OSA in humans and animal models.

  1. Prolonged apnea following modified electroconvulsive therapy with suxamethonium

    Directory of Open Access Journals (Sweden)

    T M Omprakash

    2011-01-01

    Full Text Available A 36-year-old male from an urban middleclass family with strained relationship among family members was referred from a corporate hospital for further management of psychological problem. As he was attempting suicide repeatedly, Electroconvulsive Therapy (ECT was planned. After preoperative assessment and preparation, modified ECT was done with thiopentone and 0.5 mg/kg of suxamethonium. Apnea following suxamethonium was prolonged for 2 hours. Subsequent enquiry revealed that patient was treated for organophosphate poisoning and was on ventilator support for 15 days. This was concealed by the relatives. On searching patient previous records, Butyrylcholinesterase levels were very low, i.e., 350 u/l (normal reference range is 5 500 - 12 500 u/l. Prolonged suxamethonium apnea should be anticipated in patients with recent history of organophosphate poisoning; it is advisable to estimate the levels of butyrylcholinesterase and avoid suxamethonium in patients with low enzyme levels.

  2. Genetics of obstructive sleep apnea/hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    Zhang Dongmei; Xiao Yi; Luo Jinmei

    2014-01-01

    Objective To have a better understanding of genetic contributions to the development of obstructive sleep apnea hypopnea syndrome (OSAHS) by reviewing studies on its genetic basis.Data sources A comprehensive search of the PubMed literature without restriction on the publication date was carried out using terms "obstructive sleep apnea" and "candidate genes" or "genetics".Study selection Articles were selected if they were an original research paper or meta analysis of the genetic factors of OSAHS.Results Four intermediate phenotypes were described and several candidate genes that may determine the expression and severity of OSAHS were reviewed.Conclusion Multiple gene-gene interactions occurring in genes that affect obesity,craniofacial structure,ventilator control and asleep-awake pattern may influence the expression of OSAHS in a suitable environment.

  3. Clinical Practice Guidelines for Severe Chronic Obstructive Pulmonary Disease. Guía de práctica clínica para el tratamiento de la enfermedad pulmonar obstructiva crónica grave.

    Directory of Open Access Journals (Sweden)

    Inti Santana Carballosa

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Severe Chronic Obstructive Pulmonary Disease. This concept includes simple chronic bronchitis, asthmatic bronchitis, chronic obstructive bronchitis, and pulmonary emphysema; although this two last are the most commonly included. Risk factors, classification and treatment are commented, stressing the strategy of mechanical ventilation and the indications for mechanical invasive and no invasive ventilation. It includes assessment guidelines focused on the most important aspects to be accomplished.Guía de práctica clínica para el tratamiento de la enfermedad pulmonar obstructiva crónica grave. Término que encierra a la bronquitis crónica simple, bronquitis asmática, bronquitis obstructiva crónica y enfisema pulmonar; aunque son las dos últimas las más comúnmente incluidas. Se comentan los factores de riesgo, clasificación y tratamiento con énfasis en la estrategia de ventilación mecánica, así como las indicaciones de ventilación mecánica invasiva y no invasiva. Concluye con su guía de evaluación, enfocada en los aspectos más importantes a cumplir.

  4. Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

    Institute of Scientific and Technical Information of China (English)

    P(a)l Demeter; Katalin V(a)rdi Visy; P(a)l Magyar

    2005-01-01

    AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea.METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: "mild-moderate" (A)-AHI ≥5-30, n = 27, "severe" (B)-AHI >30, n = 30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms.RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in "severe" group (P = 0.0001).Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups.CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

  5. Cognitive profile and brain morphological changes in obstructive sleep apnea

    OpenAIRE

    Torelli, Federico; Moscufo, Nicola; Garreffa, Girolamo; Placidi, Fabio; Romigi, Andrea; Zannino, Silvana; Bozzali, Marco; Fasano, Fabrizio; Giulietti, Giovanni; Djonlagic, Ina; Malhotra, Atul; Marciani, Maria Grazia; Guttmann, Charles RG

    2010-01-01

    Obstructive sleep apnea (OSA) is accompanied by neurocognitive impairment, likely mediated by injury to various brain regions. We evaluated brain morphological changes in patients with OSA and their relationship to neuropsychological and oximetric data. Sixteen patients affected by moderate-severe OSA (age: 55.8±6.7 years, 13 males) and fourteen control subjects (age: 57.6±5.1 years, 9 males) underwent 3.0 Tesla brain magnetic resonance imaging (MRI) and neuropsychological testing evaluating ...

  6. Does obstructive sleep apnea associate with atrial fibrillation?

    Institute of Scientific and Technical Information of China (English)

    TAO Hai-long; LONG De-yong; DONG Jian-zeng; MA Chang-sheng

    2008-01-01

    @@ Obstructive sleep apnea(OSA)is a disorder in which transient obstruction fcomplete or partiall of the airway during sleep causes loud snoring,oxyhemoglobin desaturation and frequent arousal.1-4 OSA has been identified to relate to many cardiovascular diseases such as hypertension,coronary heart disease,heart failure,and cardiac arrhythmia.In this article,we attempt to discuss the association between OSA and atrial fibrillation (AF) while reviewing the recent data on OSA and AF.

  7. Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

    LENUS (Irish Health Repository)

    Lee, Ruth

    2011-03-01

    Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome.

  8. A device for the treatment of adult Sleep Apnea Syndrome

    OpenAIRE

    Wichmann, Mark William

    1988-01-01

    An electronically-controlled positive-displacement bellows-type air pump has been developed in the Bio-medical Engineering Laboratory for the treatment of adult Sleep Apnea Syndrome (SAS). An electronically-controlled positive-displacement pump has been employed in order to eliminate the pressure regulator and accompanying noise of present therapeutic devices. The positive-displacement pump is found to quietly and effectively provide the required airway pressures for the tre...

  9. Cardiac function and hypertension in patients with obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Bertolami A

    2014-08-01

    Full Text Available Adriana Bertolami, Carolina Gonzaga, Celso AmodeoSleep Laboratory of Dante Pazzanese Institute of Cardiology, Sao Paulo, BrazilAbstract: Cardiovascular disease is one of the major causes of death worldwide. Among its risk factors, obstructive sleep apnea (OSA is a common but still underestimated condition. OSA often coexists and interacts with obesity, sharing multiple pathophysiological mechanisms and subsequent cardiovascular risk factors, such as type 2 diabetes, dyslipidemia, systemic inflammation, and in particular hypertension. There is also evidence suggesting an increased risk of arrhythmia, heart failure, renal failure, acute myocardial infarction, stroke, and death. OSA is characterized by recurrent episodes of partial (hypopnea or complete interruption (apnea of breathing during sleep due to airway collapse in the pharyngeal region. The main mechanisms linking OSA to impaired cardiovascular function are secondary to hypoxemia and reoxygenation, arousals, and negative intrathoracic pressure. Consequently, the sympathetic nervous and the renin-angiotensin-aldosterone systems may be overestimulated, and blood pressure increased. Resistance to treatment for hypertension represents a growing issue, and given that OSA has been recognized as the major secondary cause of resistant hypertension, clinical investigation for apnea is mandatory in this population. Standard diagnosis includes polysomnography, and treatment for OSA should include control of risk factors for cardiovascular disease, including obesity. So far, continuous positive airway pressure is the treatment of choice for OSA, impacting positively on blood pressure goals; however, the impact on long-term follow-up and on cardiovascular disease should be better assessed.Keywords: obstructive sleep apnea, hypertension, cardiac function

  10. Obstructive Sleep Apnea, Hypertension, and Their Additive Effects on Atherosclerosis

    OpenAIRE

    Mario Francesco Damiani; Annapaola Zito; Pierluigi Carratù; Vito Antonio Falcone; Elioda Bega; Pietro Scicchitano; Marco Matteo Ciccone; Onofrio Resta

    2015-01-01

    Background and Aims. It is widely accepted that obstructive sleep apnea (OSA) is independently associated with atherosclerosis. Similar to OSA, hypertension (HTN) is a condition associated with atherosclerosis. However, to date, the impact of the simultaneous presence of OSA and HTN on the risk of atherosclerosis has not been extensively studied. The aim of this study was to evaluate the consequences of the coexistence of OSA and HTN on carotid intima-media thickness (IMT) and on inflammatory...

  11. Sleep Apnea Research in Animals. Past, Present, and Future.

    Science.gov (United States)

    Chopra, Swati; Polotsky, Vsevolod Y; Jun, Jonathan C

    2016-03-01

    Obstructive sleep apnea (OSA) is a common disorder that describes recurrent collapse of the upper airway during sleep. Animal models have been pivotal to the understanding of OSA pathogenesis, consequences, and treatment. In this review, we highlight the history of OSA research in animals and include the discovery of animals with spontaneous OSA, the induction of OSA in animals, and the emulation of OSA using exposures to intermittent hypoxia and sleep fragmentation.

  12. CPAP Treats Muscle Cramps in Patients with Obstructive Sleep Apnea

    OpenAIRE

    Westwood, Andrew J.; Spector, Andrew R.; Auerbach, Sanford H.

    2014-01-01

    We describe a case series of 4 patients with varying degrees of obstructive sleep apnea who incidentally had a history of nocturnal leg cramps. None of the patients had periodic limb movements during the study and denied symptoms consistent with restless legs syndrome. In 3 of the 4 patients, nocturnal leg cramps resolved with CPAP treatment for OSA, while the fourth patient noted near-resolution of cramping after starting CPAP. In patients presenting with muscle cramps, obstructive sleep apn...

  13. Obstructive Sleep Apnea Syndrome, Periodic Limb Movements and Related Factors

    Directory of Open Access Journals (Sweden)

    Osman Özgür Yalın

    2015-09-01

    Full Text Available OBJECTIVE: Obstructive sleep apnea syndrome (OSAS is characterized by nocturnal repetitive apnea episodes. Periodic limb movements (PLMs is nocturnal, stereotypic, repetitive movements of the lower extremities. The aim of this study was to investigate the presence of periodic limb movements in OSAS patients and correlation of PLM with OSAS severity. METHODS: One hundred and forty one OSAS suspected patients was enrolled into the study. All subjects’ blood pressure, heart rate measurements and neurologic examinations were made by the same neurologist. Sociodemographic characteristics were recorded. One night polysomnography (PSG was performed to all patients and results were analyzed. Apnea Hypopnea Index (AHI ≥ 5 subjects were accepted as OSAS, and PLM Index (PLMI ≥ 5 subjects were accepted as having PLM. RESULTS: One hundred and two patients were diagnosed as OSAS. The control group consisted of 39 patients who had normal polysomnographic findings. OSAS patients’ were older and body mass index (BMI were higher than the control group. Systolic blood pressure was higher in OSAS group. Alcohol use was determined as a risk factor for OSAS. PLM were more common in OSAS group than the control group (% 30,3 - % 10,2. PLM frequency was associated with the severity of OSAS. CONCLUSION: In OSAS patients presence of PLM was related with OSAS severity, higher systolic and diastolic blood pressure and REM sleep depletion. PLM in OSAS patients could be regarded as an indicator of disease severity and also could aware clinician for increased complication rates.

  14. Pure Obstructive Sleep Apnea Syndrome and Erectile Dysfunction

    Directory of Open Access Journals (Sweden)

    Cenk Gürbüz

    2011-11-01

    Full Text Available Objective: The aim of this study is to investigate the existence of erectile dysfunction in patients with obstructive sleep apnea syndrome (OSAS in which the other possible causes of erectile dysfunction were eliminated.Material and Methods: The study group consisted of 24 patients diagnosed as OSAS with polysomnographic evaluation, and 15 non-apneic controls (mean age; 41.0±8.8 and 42.3±7.9 year respectively whose comorbidities which might be associated with erectile dysfunction were excluded. Daytime sleepiness was evaluated by Epworth Sleepiness Scale (ESS and measurement of erectile function was performed by International Index of Erectile Function.Results: The rate of erectile dysfunction in OSAS and control groups were 54.2% and 33.3% respectively (p=0.204. The difference between mean erectile function scores of patient and control groups was non-significant (26.1±4.5 and 26.3±4.3 respectively, p=0.900. There was no correlation between erectile function scores and apnea hypnoea index (r=-0.140; p=0.395.Conclusion: Findings obtained from this study suggest that the high incidence of erectile dysfunction reported in OSAS patients seems to be related with concomitant comorbidities such as diabetes, atherosclerosis and neuroendocrine disorders rather than sleep apnea.

  15. Obstructive sleep apnea syndrome and cognitive impairment: effects of CPAP

    Directory of Open Access Journals (Sweden)

    Alessandra Giordano

    2011-10-01

    Full Text Available Obstructive Sleep Apnea Syndrome (OSAS is a sleep disorder characterised by repetitive episodes of upper airway obstruction (apnea or reduced airflow (hypopnoea despite persistent respiratory effort. Apnea is defined as the cessation of breathing for at least 10 seconds during sleep, while hypopnoea is defined as at least 30% reduction in airflow for 10 seconds associated with oxygen desaturation and sleep fragmentation. The presence in the general population is about 4%. The principal symptoms are: excessive daytime sleepiness (EDS, snoring, dry throat, morning headache, night sweats, gastro-esophageal reflux, and increased blood pressure.Long term complications can be: increased cardio-cerebrovascular risk and cognitive impairment such as deficiency in attention, vigilance, visual abilities, thought, speech, perception and short term memory.Continuous Positive Airway Pressure (CPAP is currently the best non-invasive therapy for OSAS.CPAP guarantees the opening of upper airways using pulmonary reflexive mechanisms increasing lung volume during exhalation and resistance reduction, decreasing electromyografical muscular activity around airways.The causes of cognitive impairments and their possible reversibility after CPAP treatment have been analysed in numerous studies. The findings, albeit controversial, show that memory, attention and executive functions are the most compromised cognitive functions.The necessity of increasing the patient compliance with ventilotherapy is evident, in order to prevent cognitive deterioration and, when possible, rehabilitate the compromised functions, a difficult task for executive functions.

  16. Depression, insomnia and sleep apnea in patients on maintenance hemodialysis

    Science.gov (United States)

    Rai, M.; Rustagi, T.; Rustagi, S.; Kohli, R.

    2011-01-01

    Depression and sleep disorders are more frequent in patients on maintenance hemodialysis (HD) than the general population, and are associated with reduced quality of life and increased mortality risk. The purpose of this study was to assess the prevalence of depression, sleep apnea, insomnia in patients on HD as well as depression in their primary caregiver and to correlate these with the demographic profile. A cross-sectional study was conducted among 69 patients on maintenance HD for more than 3 months. There was high p revalence of depression (47.8%), insomnia (60.9%), increased risk of sleep apnea (24.6%) and depression in caregiver (31.9%). Depression was significantly more in patients with low monthly income (P=0.03), those on dialysis for more than 1 year (P=0.001) and the unemployed (P=0.009). High-risk patients for sleep apnea tended to be males with low monthly income (P=0.02). Insomnia was significantly higher in patients who were on dialysis for more than 1 year (P=0.003). PMID:22022080

  17. Obstructive sleep apnea in chronic obstructive pulmonary disease patients.

    LENUS (Irish Health Repository)

    Lee, Ruth

    2012-02-01

    PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) represent two of the most prevalent chronic respiratory disorders and cardiovascular diseases are major co-morbidities in both. Co-existence of both disorders (overlap syndrome) occurs in 1% of adults and overlap patients have worse nocturnal hypoxemia and hypercapnia than COPD and OSA patients alone. The present review discusses recent data concerning the pathophysiological and clinical significance of the overlap syndrome. RECENT FINDINGS: The severity of obstructive ventilatory impairment and hyperinflation, especially the inspiratory capacity to total lung capacity (TLC) ratio, correlates with the severity of sleep-related breathing disturbances. Early treatment with continuous positive airway pressure (CPAP) improves survival, reduces hospitalization and pulmonary hypertension, and also reduces hypoxemia. Evidence of systemic inflammation and oxidative stress in COPD and sleep apnea provides insight into potential interactions between both disorders that may predispose to cardiovascular disease. Long-term outcome studies of overlap patients currently underway should provide further evidence of the clinical significance of the overlap syndrome. SUMMARY: Studies of overlap syndrome patients at a clinical, physiological and molecular level should provide insight into disease mechanisms and consequences of COPD and sleep apnea, in addition to identifying potential relationships with cardiovascular disease.

  18. 21 CFR 872.5570 - Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

    Science.gov (United States)

    2010-04-01

    ... devices for snoring and obstructive sleep apnea. 872.5570 Section 872.5570 Food and Drugs FOOD AND DRUG... apnea. (a) Identification. Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to...

  19. Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux?

    Institute of Scientific and Technical Information of China (English)

    Levent Ozturk; Zerrin Pelin

    2005-01-01

    @@ TO THE EDITOR In a tecent issue of World Journal of Gastroenterology,Demeter et al.[1],reported that in patients having both gastro-esophageal reflux disease(GERD)and obstructive sleep apnea(OSA),there was a positive correlation between endoscopic findings of GERD and the number of apneas and hypopneas per hour,namely apnea hypopnea index.

  20. Length of Individual Apnea Events Is Increased by Supine Position and Modulated by Severity of Obstructive Sleep Apnea

    OpenAIRE

    Timo Leppänen; Juha Töyräs; Anu Muraja-Murro; Salla Kupari; Pekka Tiihonen; Esa Mervaala; Antti Kulkas

    2016-01-01

    Positional obstructive sleep apnea (OSA) is common among OSA patients. In severe OSA, the obstruction events are longer in supine compared to nonsupine positions. Corresponding scientific information on mild and moderate OSA is lacking. We studied whether individual obstruction and desaturation event severity is increased in supine position in all OSA severity categories and whether the severity of individual events is linked to OSA severity categories. Polygraphic recordings of 2026 patients...

  1. Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients.

    Science.gov (United States)

    Mihalj, Mario; Lušić, Linda; Đogaš, Zoran

    2016-06-01

    It is unknown to what extent chronic intermittent hypoxaemia in obstructive sleep apnea causes damage to the motor and sensory peripheral nerves. It was hypothesized that patients with obstructive sleep apnea would have bilaterally significantly impaired amplitudes of both motor and sensory peripheral nerve-evoked potentials of both lower and upper limbs. An observational study was conducted on 43 patients with obstructive sleep apnea confirmed by the whole-night polysomnography, and 40 controls to assess the relationship between obstructive sleep apnea and peripheral neuropathy. All obstructive sleep apnea subjects underwent standardized electroneurographic testing, with full assessment of amplitudes of evoked compound muscle action potentials, sensory neural action potentials, motor and sensory nerve conduction velocities, and distal motor and sensory latencies of the median, ulnar, peroneal and sural nerves, bilaterally. All nerve measurements were compared with reference values, as well as between the untreated patients with obstructive sleep apnea and control subjects. Averaged compound muscle action potential and sensory nerve action potential amplitudes were significantly reduced in the nerves of both upper and lower limbs in patients with obstructive sleep apnea compared with controls (P motor and sensory peripheral nerves. Clinical/subclinical axonal damage exists in patients with obstructive sleep apnea to a greater extent than previously thought.

  2. Towards a clinical classification system for position-dependent obstructive sleep apnea

    NARCIS (Netherlands)

    Ravesloot, M.; Frank, M.H.; van Maanen, J.P.; Verhagen, E.A.; de Lange, J.; de Vries, N.; de Vries, N.; Ravesloot, M.; van Maanen, J.P.

    2015-01-01

    In this chapter, we discuss the various definitions of position-dependent obstructive apnea. The first was introduced in 1984 by Cartwright, who suggested that physicians should differentiate between patients with either positional (POSA) or non-positional obstructive sleep apnea. Treatment of POSA

  3. Undiagnosed obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis.

    NARCIS (Netherlands)

    Pijpers, M.; Poels, P.J.P.; Vaandrager, J.M.; Hoog, M. de; Berg, S.W. van den; Hoeve, H.J.; Joosten, K.F.

    2004-01-01

    Children with syndromal craniofacial synostosis have a high risk for obstructive sleep apnea syndrome. Early diagnosis and treatment can relieve symptoms and morbidity. Little is known about the development and natural history of obstructive sleep apnea syndrome through life. The aim of this study w

  4. Making Sense of Oxidative Stress in Obstructive Sleep Apnea: Mediator or Distracter in Brain Injury?

    Directory of Open Access Journals (Sweden)

    Jing eZhang

    2012-12-01

    Full Text Available Obstructive sleep apnea is increasingly recognized as an important contributor to cognitive impairment, metabolic derangements and cardiovascular disease and mortality. Identifying the mechanisms by which this prevalent disorder influences health outcomes is now of utmost importance. As the prevalence of this disorder steadily increases, therapies are needed to prevent or reverse sleep apnea morbidities now more than ever before. Oxidative stress is implicated in cardiovascular morbidities of sleep apnea. What role oxidative stress plays in neural injury and cognitive impairments has been difficult to understand without readily accessible tissue to biopsy in persons with and without sleep apnea. An improved understanding of the role oxidative stress plays in neural injury in sleep apnea may be developed by integrating information gained examining neural tissue in animal models of sleep apnea with key features of redox biochemistry and clinical sleep apnea studies where extra-neuronal oxidative stress characterizations have been performed. Collectively, this information sets the stage for developing and testing novel therapeutic approaches to treat and prevent, not only central nervous system injury and dysfunction in sleep apnea, but also the cardiovascular and potentially metabolic conditions associated with this prevalent, disabling disorder.

  5. [Could mouth breathing lead to obstructive sleep apnea syndromes. A preliminary study].

    Science.gov (United States)

    Raskin, S; Limme, M; Poirrier, R

    2000-01-01

    The aim of this preliminary work is to determine an easy method to diagnose "buccal breather" children and "nasal breather" children. Then, to establish a possible connection with the syndrome of obstructive sleep apnea. 22 children agreed to participate. Clinical, orthophonic, orthodontic, postural and polysomnographical exams have been carried out. The proposed clinical exam turns out to be a good means of diagnosing between buccal breathers and nasal breathers. The aerophonoscope reveals velar inadequacies in buccal breathers. The latter also present osseous discrepancies mainly in the mandible. The polysomnography reveals a higher apnea/hypopnea index and more agitated sleep in buccal breathers. Mandibular lowering movements are more frequent and similar to those of adults suffering from apnea. These elements similar to those encountered in adults suffering from apnea make us think that buccal breathing could be the origin of obstructive sleep apnea, several decades later.

  6. Dynamics of Snoring Sounds and Its Connection with Obstructive Sleep Apnea

    CERN Document Server

    Alencar, Adriano M; Oliveira, Carolina Beatriz; Vieira, Andre P; Moriya, Henrique T; Lorenzi-Filho, Geraldo

    2012-01-01

    Snoring is extremely common in the general population and when irregular may indicate the presence of obstructive sleep apnea. We analyze the overnight sequence of wave packets --- the snore sound --- recorded during full polysomnography in patients referred to the sleep laboratory due to suspected obstructive sleep apnea. We hypothesize that irregular snore, with duration in the range between 10 and 100 seconds, correlates with respiratory obstructive events. We find that the number of irregular snores --- easily accessible, and quantified by what we call the snore time interval index (STII) --- is in good agreement with the well-known apnea-hypopnea index, which expresses the severity of obstructive sleep apnea and is extracted only from polysomnography. In addition, the Hurst analysis of the snore sound itself, which calculates the fluctuations in the signal as a function of time interval, is used to build a classifier that is able to distinguish between patients with no or mild apnea and patients with mod...

  7. Chiari malformation and central sleep apnea syndrome: efficacy of treatment with adaptive servo-ventilation

    Directory of Open Access Journals (Sweden)

    Jorge Marques do Vale

    2014-10-01

    Full Text Available The Chiari malformation type I (CM-I has been associated with sleep-disordered breathing, especially central sleep apnea syndrome. We report the case of a 44-year-old female with CM-I who was referred to our sleep laboratory for suspected sleep apnea. The patient had undergone decompressive surgery 3 years prior. An arterial blood gas analysis showed hypercapnia. Polysomnography showed a respiratory disturbance index of 108 events/h, and all were central apnea events. Treatment with adaptive servo-ventilation was initiated, and central apnea was resolved. This report demonstrates the efficacy of servo-ventilation in the treatment of central sleep apnea syndrome associated with alveolar hypoventilation in a CM-I patient with a history of decompressive surgery.

  8. Validation of the System One RemStar Auto A-Flex for Obstructive Sleep Apnea Treatment and Detection of Residual Apnea-Hypopnea Index

    DEFF Research Database (Denmark)

    Gagnadoux, Frédéric; Pevernagie, Dirk; Jennum, Poul;

    2017-01-01

    : Sixty-one patients investigated in five centers for moderate to severe obstructive sleep apnea between May 2012 and June 2013 were invited to participate. Participants underwent two full-night attended polysomnograms in random order with manually titrated, fixed pressure CPAP versus APAP. RESULTS: Fifty......-three participants with a mean apnea-hypopnea index (AHI) of 45.9 ± 23 completed two sleep studies and were included in the analysis. There were significant but not clinically relevant differences between APAP and CPAP respectively: Apnea index [1.0 (2.8 ± .8), median (mean ± standard deviation)] versus [1.8 (5.......001) and the area under the curve was 0.988 (AHI cut-off value of 10). CONCLUSIONS: The new APAP modality was effective and residual apnea-hypopnea indices calculated by the device strongly correlated to those assessed by PSG....

  9. Sleep apnea syndrome: central sleep apnea and pulmonary hypertension worsened during treatment with auto-CPAP, but improved by adaptive servo-ventilation.

    Science.gov (United States)

    Ono, Hiroshi; Fujimoto, Hiroyuki; Kobayashi, Yoshinori; Kudoh, Shoji; Gemma, Akihiko

    2010-01-01

    In this 71-year-old man diagnosed as obstructive sleep apnea syndrome initially, the apnea-hypopnea index in polysomnography was 31.3/hour. He started auto-adjusted continuous positive airway pressure (auto-CPAP) treatment in July 2005 but developed congestive heart failure in December 2007. Pulmonary arterial pressure (PAP), estimated by echocardiography, was 71 mmHg. In January 2008, during simplified sleep examination with a breath-movement sensor under auto-CPAP, many central-type apneas were recognized. After replacing auto-CPAP with adaptive servo-ventilation (ASV), the apnea-hypopnea index was 5.3/hour and PAP became 36 mmHg after 3 months. It was thought that the increase of PAP was due to long-term inadequate use of auto-CPAP.

  10. Calidad de sueño autopercibida en pacientes con sospecha de trastornos respiratorios del sueño

    OpenAIRE

    Barco Gómez, Andrea

    2016-01-01

    El síndrome de apnea-hipopnea del sueño (SAHS) es una enfermedad frecuente, reconocida como un problema de salud pública. Presenta una compleja constelación de síntomas y signos derivados de la presencia de apneas recurrentes durante el sueño. El diagnóstico se basa en la polisomnografía (PSG) nocturna. Para su realización precisa dormir durante una noche en un ámbito hospitalario. Esto hace que a menudo el paciente refiera una mala calidad de sueño. Los objetivos del presente estudio son ...

  11. Redução da prevalência de apneia central em pacientes com insuficiência cardíaca sob uso de betabloqueador Reducción de la prevalencia de apnea central en pacientes con insuficiencia cardiaca bajo uso de betabloqueante Reduction of central sleep apnea in heart failure patients with beta-blockers therapy

    Directory of Open Access Journals (Sweden)

    Christiano Pereira Silva

    2010-02-01

    Full Text Available FUNDAMENTO: As apneias do sono são doenças frequentes em portadores de insuficiência cardíaca (IC. Estimativas da era pré-betabloqueador (BB apontam para uma prevalência de 45% de apneias centrais nestes pacientes. OBJETIVO: Avaliar a influência dos BB na prevalência das apneias centrais e sua interferência na qualidade do sono e de vida de portadores de IC. MÉTODOS: 65 pacientes portadores de IC foram submetidos a polissonografia diagnóstica.Os resultados da polissonografia foram avaliados de acordo com o uso ou não de BB. No dia do exame os pacientes responderam ao questionário de Minessota para qualidade de vida com IC. Após 6 e 12 meses da data da polissonografia, houve contato telefônico com todos os pacientes, para a repetição do questionário de Minessota. RESULTADOS: A prevalência de apneia do sono (IAH > 15/h foi de 46,1% na população total, porém a apneia central foi identificada em apenas 18,4% dos pacientes. O uso de BB, em análise multivariada, foi o único preditor de ocorrência de menor índice de apneia e hipopneia (IAH central (p=0,002, maior saturação (p=0,02 e menor dessaturação média de oxigênio (p=0,03. Além disso, o uso de BB foi preditor de melhor qualidade de vida após 6 e 12 meses (p=0,002 e 0,001 respectivamente e de menor número de hospitalizações nestes períodos (p=0,001 e p=0,05 respectivamente. CONCLUSÃO: O uso de BB reduziu a incidência de apneia central na população total, se compararmos com os dados da literatura. Além disto, os BB melhoraram parâmetros da qualidade do sono e de vida de portadores de IC.FUNDAMENTO: Las apneas del sueño son enfermedades frecuentes en portadores de insuficiencia cardiaca (IC. Una estimación de la era pre betabloqueante (BB señala hacia una prevalencia del 45% de apneas centrales en estos pacientes. OBJETIVO: Evaluar la influencia de los BB en la prevalencia de las apneas centrales y su interferencia en la calidad del sueño y de vida de

  12. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study

    Science.gov (United States)

    Pinto, José Antonio; Ribeiro, Davi Knoll; Cavallini, Andre Freitas da Silva; Duarte, Caue; Freitas, Gabriel Santos

    2016-01-01

    Introduction Obstructive sleep apnea (OSA) is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history. Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA) and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA. Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013. Results We evaluated 100 patients with OSA (84 men and 16 women) with a mean age of 50.05 years (range 19–75 years). The prevalence of comorbidities were hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (GERD) (18%), diabetes mellitus (15%), hypercholesterolemia (10%), asthma (4%), and no comorbidities (33%). Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA. Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI) values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations. PMID:27096019

  13. Innovative treatments for adults with obstructive sleep apnea.

    Science.gov (United States)

    Weaver, Terri E; Calik, Michael W; Farabi, Sarah S; Fink, Anne M; Galang-Boquiren, Maria T; Kapella, Mary C; Prasad, Bharati; Carley, David W

    2014-01-01

    Obstructive sleep apnea (OSA) affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical stimulation of the upper airway muscles. No drugs have been approved to treat OSA, but potential drug therapies have centered on increasing ventilatory drive, altering the arousal threshold, modifying loop gain (a dimensionless value quantifying the stability of the ventilatory control system), or preventing airway collapse by affecting the surface tension. An emerging approach is the application of cannabinoids to increase upper airway tone.

  14. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Pinto, José Antonio

    2016-03-01

    Full Text Available Introduction Obstructive sleep apnea (OSA is characterized by partial or complete recurrent upper airway obstruction during sleep. OSA brings many adverse consequences, such as hypertension, obesity, diabetes mellitus, cardiac and encephalic alterations, behavioral, among others, resulting in a significant source of public health care by generating a high financial and social impact. The importance of this assessment proves to be useful, because the incidence of patients with comorbidities associated with AOS has been increasing consistently and presents significant influence in natural disease history. Objective The objective of this study is to assess major comorbidities associated with obstructive sleep apnea (OSA and prevalence in a group of patients diagnosed clinically and polysomnographically with OSA. Methods This is a retrospective study of 100 charts from patients previously diagnosed with OSA in our service between October 2010 and January 2013. Results We evaluated 100 patients with OSA (84 men and 16 women with a mean age of 50.05 years (range 19–75 years. The prevalence of comorbidities were hypertension (39%, obesity (34%, depression (19%, gastroesophageal reflux disease (GERD (18%, diabetes mellitus (15%, hypercholesterolemia (10%, asthma (4%, and no comorbidities (33%. Comorbidities occurred in 56.2% patients diagnosed with mild OSA, 67.6% with moderate OSA, and 70% of patients with severe OSA. Conclusion According to the current literature data and the values obtained in our paper, we can correlate through expressive values obesity with OSA and their apnea hypopnea index (AHI values. However, despite significant prevalence of OSA with other comorbidities, our study could not render expressive significance values able to justify their correlations.

  15. Evaluation of Anthropometric and Metabolic Parameters in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Yaşar Yildirim

    2015-01-01

    Full Text Available Aims. Sleep disorders have recently become a significant public health problem worldwide and have deleterious health consequences. Obstructive sleep apnea (OSA is the most common type of sleep-related breathing disorders. We aimed to evaluate anthropometric measurements, glucose metabolism, and cortisol levels in patients with obstructive sleep apnea (OSA. Materials and Methods. A total of 50 patients with a body mass index ≥30 and major OSA symptoms were included in this study. Anthropometric measurements of the patients were recorded and blood samples were drawn for laboratory analysis. A 24-hour urine sample was also collected from each subject for measurement of 24-hour cortisol excretion. Patients were divided equally into 2 groups according to polysomnography results: control group with an apnea-hypopnea index (AHI <5 (n=25 and OSA group with an AHI ≥5 (n=25. Results. Neck and waist circumference, fasting plasma glucose, HbA1c, late-night serum cortisol, morning serum cortisol after 1 mg dexamethasone suppression test, and 24-hour urinary cortisol levels were significantly higher in OSA patients compared to control subjects. Newly diagnosed DM was more frequent in patients with OSA than control subjects (32% versus 8%, p=0.034. There was a significant positive correlation between AHI and neck circumference, glucose, and late-night serum cortisol. Conclusions. Our study indicates that increased waist and neck circumferences constitute a risk for OSA regardless of obesity status. In addition, OSA has adverse effects on endocrine function and glucose metabolism.

  16. Cognition and biomarkers of oxidative stress in obstructive sleep apnea

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    Leticia Viana Sales

    2013-04-01

    Full Text Available OBJECTIVES: The aim of this study was to investigate neuropsychological performance and biomarkers of oxidative stress in patients with obstructive sleep apnea and the relationships between these factors. METHODS: This was an observational, cross-sectional study of 14 patients (36.0±6.5 years old with obstructive sleep apnea and 13 controls (37.3±6.9 years old. All of the participants were clinically evaluated and underwent full-night polysomnography as well as neuropsychological tests. Blood samples were used to assay superoxide dismutase, catalase, glutathione and homocysteine, as well as vitamins E, C, B11 and B12. RESULTS: The patients performed poorly relative to the controls on several neuropsychological tests, such as the attention test and tests of long-term memory and working memory/executive function. They also had lower levels of vitamin E (p<0.006, superoxide dismutase (p<0.001 and vitamin B11 (p<0.001, as well as higher concentrations of homocysteine (p<0.02. Serum concentrations of vitamin C, catalase, glutathione and vitamin B12 were unaltered. Vitamin E levels were related to performance in the backward digit span task (F = 15.9; p = 0.002 and this correlation remained after controlling for age and body mass index (F = 6.3, p = 0.01. A relationship between superoxide dismutase concentrations and executive non-perseveration errors in the Wisconsin Card Sorting Test (F = 7.9; p = 0.01 was also observed. CONCLUSIONS: Decreased levels of antioxidants and lower performance on the neuropsychological tasks were observed in patients with obstructive sleep apnea. This study suggests that an imbalance between antioxidants and pro-oxidants may contribute to neuropsychological alterations in this patient population.

  17. Reduced respiratory neural activity elicits a long-lasting decrease in the CO2 threshold for apnea in anesthetized rats.

    Science.gov (United States)

    Baertsch, N A; Baker, T L

    2017-01-01

    Two critical parameters that influence breathing stability are the levels of arterial pCO2 at which breathing ceases and subsequently resumes - termed the apneic and recruitment thresholds (AT and RT, respectively). Reduced respiratory neural activity elicits a chemoreflex-independent, long-lasting increase in phrenic burst amplitude, a form of plasticity known as inactivity-induced phrenic motor facilitation (iPMF). The physiological significance of iPMF is unknown. To determine if iPMF and neural apnea have long-lasting physiological effects on breathing, we tested the hypothesis that patterns of neural apnea that induce iPMF also elicit changes in the AT and RT. Phrenic nerve activity and end-tidal CO2 were recorded in urethane-anesthetized, ventilated rats to quantify phrenic nerve burst amplitude and the AT and RT before and after three patterns of neural apnea that differed in their duration and ability to elicit iPMF: brief intermittent neural apneas, a single brief "massed" neural apnea, or a prolonged neural apnea. Consistent with our hypothesis, we found that patterns of neural apnea that elicited iPMF also resulted in changes in the AT and RT. Specifically, intermittent neural apneas progressively decreased the AT with each subsequent neural apnea, which persisted for at least 60min. Similarly, a prolonged neural apnea elicited a long-lasting decrease in the AT. In both cases, the magnitude of the AT decrease was proportional to iPMF. In contrast, the RT was transiently decreased following prolonged neural apnea, and was not proportional to iPMF. No changes in the AT or RT were observed following a single brief neural apnea. Our results indicate that the AT and RT are differentially altered by neural apnea and suggest that specific patterns of neural apnea that elicit plasticity may stabilize breathing via a decrease in the AT.

  18. Diagnosis and Treatment of Insomnia Comorbid with Obstructive Sleep Apnea.

    Science.gov (United States)

    Lack, Leon; Sweetman, Alexander

    2016-09-01

    Insomnia is often comorbid with obstructive sleep apnea. It reduces positive airway pressure (PAP) therapy acceptance and adherence. Comorbid patients show greater daytime impairments and poorer health outcomes. The insomnia often goes undiagnosed, undertreated, or untreated. Pharmacotherapy is not recommended for long-term treatment. Although care should be taken administering behavioral therapies to patients with elevated sleepiness, cognitive behavior therapy for insomnia (CBTi) is an effective and durable nondrug therapy that reduces symptoms and may increase the effectiveness of PAP therapy. Sleep clinics should be alert to comorbid insomnia and provide adequate diagnostic tools and clinicians with CBTi expertise.

  19. Heart rate recovery in patients with obstructive sleep apnea syndrome

    OpenAIRE

    KARAŞEN, Rıza Murat; ÇİFTÇİ, Bülent; Acar,Baran; YALÇIN, Ahmet Arif; GÜVEN, Selma FIRAT

    2014-01-01

    To demonstrate the effects of obstructive sleep apnea syndrome (OSAS) on baroregulatory function by using heart rate recovery (HRR) parameters. Materials and methods: Fifty-four moderate and severe OSAS patients were included in the study. HRR was defined as the difference in heart rate between peak exercise and 1 min later; a value of 18 beats/min was considered abnormal. OSAS patients were enrolled in the study as group 1 (normal HRR; n = 12) and group 2 (abnormal HRR, n = 42). Left ventr...

  20. Innovative treatments for adults with obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Weaver TE

    2014-11-01

    Full Text Available Terri E Weaver,1,2 Michael W Calik,1,2 Sarah S Farabi,1,2 Anne M Fink,1,2 Maria T Galang-Boquiren,2,3 Mary C Kapella,1,2 Bharati Prasad,2,4 David W Carley1,21Biobehavioral Health Science Department, College of Nursing, University of Illinois at Chicago; 2Center for Narcolepsy, Sleep and Health, University of Illinois at Chicago College of Nursing, 3Department of Orthodontics, University of Illinois at Chicago College of Dentistry, 4Sleep Center, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USAAbstract: Obstructive sleep apnea (OSA affects one in five adult males and is associated with significant comorbidity, cognitive impairment, excessive daytime sleepiness, and reduced quality of life. For over 25 years, the primary treatment has been continuous positive airway pressure, which introduces a column of air that serves as a pneumatic splint for the upper airway, preventing the airway collapse that is the physiologic definition of this syndrome. However, issues with patient tolerance and unacceptable levels of treatment adherence motivated the exploration of other potential treatments. With greater understanding of the physiologic mechanisms associated with OSA, novel interventions have emerged in the last 5 years. The purpose of this article is to describe new treatments for OSA and associated complex sleep apnea. New approaches to complex sleep apnea have included adaptive servoventilation. There is increased literature on the contribution of behavioral interventions to improve adherence with continuous positive airway pressure that have proven quite effective. New non-surgical treatments include oral pressure devices, improved mandibular advancement devices, nasal expiratory positive airway pressure, and newer approaches to positional therapy. Recent innovations in surgical interventions have included laser-assisted uvulopalatoplasty, radiofrequency ablation, palatal implants, and electrical

  1. Management of obstructive sleep apnea: A dental perspective

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    Padma Ariga

    2007-01-01

    Full Text Available Sleep disordered breathing is a term which includes simple snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA. Simple snoring is a common complaint affecting 45% of adults occasionally and 25% of adults habitually and is a sign of upper airway obstruction. Snoring has also been identified as a possible risk factor for hypertension, ischemic heart disease, and stroke. The role of dentistry in sleep disorders is becoming more significant, especially in co-managing patients with simple snoring and mild to moderate OSA. The practicing dental professional has the opportunity to assist patients at a variety of levels, starting with the recognition of a sleep-related disorder, referring patients to a physician for evaluation, and assisting in the management of sleep disorders. Obesity is the main predisposing factor for OSA. In nonobese patients, craniofacial anomalies like micrognathia and retrognathia may also predispose to OSA. Diagnosis of OSA is made on the basis of the history and physical examination and investigations such as polysomnography, limited channel testing, split-night testing, and oximetry. Nocturnal attended polysomnography, which requires an overnight stay in a sleep facility, is the standard diagnostic modality in determining if a patient has OSA. As far as treatment is concerned, the less invasive procedures are to be preferred to the more invasive options. The first and simplest option would be behavior modification, followed by insertion of oral devices suited to the patient, especially in those with mild to moderate OSA. Continuous positive airway pressure (CPAP and surgical options are chosen for patients with moderate to severe OSA. The American Academy of Sleep Medicine (AAOSM has recommended oral appliances for use in patients with primary snoring and mild to moderate OSA. It can also be used in patients with a lesser degree of oxygen saturation, relatively less day time sleepiness, lower frequency

  2. Sleep Endoscopy in the Evaluation of Pediatric Obstructive Sleep Apnea

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    Aaron C. Lin

    2012-01-01

    Full Text Available Pediatric obstructive sleep apnea (OSA is not always resolved or improved with adenotonsillectomy. Persistent or complex cases of pediatric OSA may be due to sites of obstruction in the airway other than the tonsils and adenoids. Identifying these areas in the past has been problematic, and therefore, therapy for OSA in children who have failed adenotonsillectomy has often been unsatisfactory. Sleep endoscopy is a technique that can enable the surgeon to determine the level of obstruction in a sleeping child with OSA. With this knowledge, site-specific surgical therapy for persistent and complex pediatric OSA may be possible.

  3. Radiological findings in patients with obstructive sleep apnea

    Energy Technology Data Exchange (ETDEWEB)

    Mello Junior, Carlos Fernando de; Guimaraes Filho, Helio Antonio; Gomes, Camila Albuquerque de Brito; Paiva, Camila Caroline de Amorim, E-mail: carlosfmello@hotmail.com [Universidade Federal da Paraiba UFPB, Joao Pessoa (Brazil)

    2013-01-15

    Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction occurring at the level of the pharynx during sleep. Although cephalometric analysis is an important method in the diagnosis of craniofacial deformities, CT and magnetic resonance imaging have been highlighted as the major imaging methods to investigate the possible causes of OSA, which, in most cases, is multifactorial. Magnetic resonance and CT both allow an excellent evaluation of the various anatomical planes of the site of obstruction, which enables better clinical assessment and surgical approach. This pictorial essay aims to describe the aspects that must be evaluated in the diagnostic imaging of patients presenting with the major predisposing factors for OSA. (author)

  4. An Odontoid Fracture Causing Apnea, Cardiac Instability, and Quadriplegia

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    Christian A. Bowers

    2012-01-01

    Full Text Available Odontoid fractures are typically associated with low rates of acute neurologic deficit and morbidity/mortality in nonelderly patients. In the patient in this case, traumatic injury triggered by a syncopal event led to a combined C1-C2 fracture and a fatal spinal cord injury with apnea, quadriplegia, and cardiovascular instability. We briefly review the anatomical basis for the pathophysiology of cardiac dysfunction following high-cervical spine injury and present an example of a worst-case scenario.

  5. Heart rate recovery in patients with obstructive sleep apnea syndrome

    OpenAIRE

    KARAŞEN, Rıza Murat; ÇİFTÇİ, Bülent; Baran ACAR; YALÇIN, Ahmet Arif; GÜVEN, Selma FIRAT

    2012-01-01

    To demonstrate the effects of obstructive sleep apnea syndrome (OSAS) on baroregulatory function by using heart rate recovery (HRR) parameters. Materials and methods: Fifty-four moderate and severe OSAS patients were included in the study. HRR was defined as the difference in heart rate between peak exercise and 1 min later; a value of 18 beats/min was considered abnormal. OSAS patients were enrolled in the study as group 1 (normal HRR; n = 12) and group 2 (abnormal HRR, n = 42). Left ventr...

  6. Effects of antihypertensives on arterial responses associated with obstructive sleep apneas

    Institute of Scientific and Technical Information of China (English)

    ZHONG Xu; XIAO Yi; Robert C. Basner

    2005-01-01

    Background Many patients with obstructive sleep apnea syndrome (OSAS) have complicated with hypertension and may be prescribed with antihypertension medications to control their blood pressure. But whether antihypertension medications can also decrease arterial stiffness or control the blood pressure increasing following obstructive events is not well described. This study aimed to investigate whether antihypertensive medications can ameliorate the changes in arterial stiffness and blood pressure associated with OSA. Methods Sixty-one OSAS patients [13 women, 48 men, mean age (53.4±12.3) years], 26 normotensive patients (N), 7 hypertensive patients on no antihypertension medications (H), and 28 hypertensive patients on various combination antihypertension therapy (HM), were prospectively diagnosed with standard nocturnal polysomnography. Beat-to-beat blood pressure was continuously recorded from the radial artery by applanation tonometry during baseline sleep. As a measure of arterial stiffness, arterial augmentation index (AAI) was calculated as the ratio of augmented systolic blood pressure (SBP) to pulse pressure and expressed as a percentage for the following conditions: awakening, the first 10 ("early apnea") and last 10 ("late apnea") cardiac cycles of obstructive events (apnea or hypopnea), and the first 15 cardiac cycles following event termination ("post apnea") for all events with nadir O2 saturation ≤89%. Results Systolic blood pressure (SBP) post-apnea [(142.74±13.06) mmHg (N), (137.06±26.56) mmHg (H), (136.94±14.1) mmHg (HM)] was significantly increased from awakening [(135.76±14.76) mmHg (N), (135.58±23.17) mmHg (H), (129.77±14.00) mmHg (HM)], early apnea [(130.53±12.65) mmHg (N),(124.47±24.97) mmHg (H), (126.04±13.12) mmHg (HM)], and late apnea [(129.8±12.68) mmHg(N), (124.78±25.15) mmHg (H),(124.48±13.82) mmHg (HM)] respectively (P<0.001, repeated measures ANOVA). AAI was significantly increased for the N group (P<0.001) from

  7. Sleep apnea syndrome. Examination of pharyngeal obstruction with high-speed MR and polysomnography

    Energy Technology Data Exchange (ETDEWEB)

    Suto, Y. [Dept. of Radiology, Tottori Univ. School of Medicine, Yonago (Japan); Inoue, Y. [Dept. of Neuropsychiatry, Tottori Univ. School of Medicine, Yonago (Japan)

    1995-05-01

    We attempted to determine the usefulness of high-speed MR imaging for evaluating the severity of sleep apnea syndrome (SAS) by comparing findings of pharyngeal obstruction obtained with high-speed MR with those of all-night polysomnography (PSG). A total of 33 patients with SAS underwent turbo-FLASH MR examination, while awake and after i.v. injection of hydroxyzine hydrochloride. Serial images were examined by cinemode. Pharyngeal findings on MR were divided into single-site obstruction (SO) at the velopharynx, multiple-site obstruction (MO), and no obstruction (NO). PSG findings were analyzed to determine the predominant type of apnea, severity as evaluated by an apnea index (AI), and the lowest SaO{sub 2} value during sleep. Seventy-five percent of the central apnea group had SO, and 70% of the mixed apneas had MO, while only 15% of the obstructed apneas had MO. The percentage of patients with severe SAS (AI of 20% or higher) was 48% for the SO, and 70% for the MO. The lowest SaO{sub 2} value tended to be low in the mixed apnea in the case of PSG, and tended to be low in the MO at MR examination. Analysis of pharyngeal dynamics using high-speed MR may provide some useful information for evaluating the severity of SAS. (orig.).

  8. Cephalometric and anthropometric data of obstructive apnea in different age groups

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    Paulo de Tarso Moura Borges

    2015-02-01

    Full Text Available Introduction: Patients with obstructive sleep apnea syndrome usually present with changes in upper airway morphology and/or body fat distribution, which may occur throughout life and increase the severity of obstructive sleep apnea syndrome with age. Objective: To correlate cephalometric and anthropometric measures with obstructive sleep apnea syndrome severity in different age groups. Methods: A retrospective study of cephalometric and anthropometric measures of 102 patients with obstructive sleep apnea syndrome was analyzed. Patients were divided into three age groups (≥20 and <40 years, ≥40 and <60 years, and ≥60 years. Pearson's correlation was performed for these measures with the apnea-hypopnea index in the full sample, and subsequently by age group. Results: The cephalometric measures MP-H (distance between the mandibular plane and the hyoid bone and PNS-P (distance between the posterior nasal spine and the tip of the soft palate and the neck and waist circumferences showed a statistically significant correlation with apnea-hypopnea index in both the full sample and in the ≥40 and <60 years age group. These variables did not show any significant correlation with the other two age groups (<40 and ≥60 years. Conclusion: Cephalometric measurements MP-H and PNS-P and cervical and waist circumfer- ences correlated with obstructive sleep apnea syndrome severity in patients in the ≥40 and <60 age group.

  9. Complications associated with the apnea test in the determination of the brain death

    Institute of Scientific and Technical Information of China (English)

    WU Xiao-liang; FANG Qiang; LI Li; QIU Yun-qing; LUO Ben-yan

    2008-01-01

    Background An apnea test is essentialin the clinical determination of brain death.This study was conducted to analyse complications associated with the apnea test in the determination of the brain death.Methods On 93 adult patients In coma in Zhejiang Province of China from January 2003 to December 2006,179 apnea tests were performed as a part of the determination of brain death.Potential risk conditions and complications were analysed during apnea tests.Results During apnea,sedous cardiac arrhythmia did not occur in all patients.Complications occurred in 37 of 179 (21%)apnea tests.Hypotension occurred in 30 patients(17%)and it was obsewed in 8/94(9%)tests with baseline value of systolic arterial blood pressure not less than 120 mmHg,and 22/85(26%)lass than 120 mmHg(P<0.05).Severe hypoxaemia occurred in 10 patients(6%)of which 3/138(2%)tests with baseline value of arterial oxygen pressure not less than 200 mmHg,and 7/41(17%)less than 200 mmHg(P<0.05).Conclusions This study demonstrated that complications occurred mostly in patients with inadequate baseline systolic arterial blood pressure and preoxygenation.Adequate precautions during the apnea tests may reduce the risk of cardiovascular and oxygenation complication.

  10. Propuesta de cuidado de enfermería al paciente con enfermedad pulmonar obstructiva crónica según la taxonomía nanda, nic, noc.

    OpenAIRE

    Fanny Esperanza Acevedo Gamboa; Juan Carlos Díaz Álvarez; Consuelo Ortiz Suarez

    2014-01-01

    El presente artículo de revisión temática sobre la enfermedad pulmonar obstructiva crónica pretende ser una guía y orientación al profesional de enfermería en diferentes contextos de cuidado. En ella se incorporan aspectos epidemiológicos, clasificación, seguida de la valoración de enfermería, justificación y la identificación de diagnósticos enfermeros de la North American Nursing Diagnosis (NANDA) y los relaciona con la Clasificación de Intervenciones de Enfermería (NIC= Nursing Interventio...

  11. Propuesta de cuidado de enfermería al paciente con enfermedad pulmonar obstructiva crónica según la taxonomía NANDA, NIC, NOC

    Directory of Open Access Journals (Sweden)

    Fanny Esperanza Acevedo Gamboa

    2013-07-01

    Full Text Available El presente artículo de revisión temática sobre la enfermedad pulmonar obstructiva crónica pretende ser una guía y orientación al profesional de enfermería en diferentes contextos de cuidado. En ella se incorporan aspectos epidemiológicos, clasificación, seguida de la valoración de enfermería, justificación y la identificación de diagnósticos enfermeros de la North American Nursing Diagnosis (NANDA y los relaciona con la Clasificación de Intervenciones de Enfermería (NIC= Nursing Interventions Classification y la Clasificación de resultados de enfermería (NOC= Nursing Outcomes Classification

  12. Sleep apnea, reproductive hormones and quality of sexual life in severely obese men.

    Science.gov (United States)

    Hammoud, Ahmad O; Walker, James M; Gibson, Mark; Cloward, Tom V; Hunt, Steven C; Kolotkin, Ronette L; Adams, Ted D; Meikle, A Wayne

    2011-06-01

    The effect of sleep apnea on the reproductive function of obese men is not entirely elucidated. The objective of this study was to define the effect of sleep apnea on the reproductive hormones and sexual function in obese men. This study included 89 severely obese men with BMI ≥35 kg/m2 considering gastric bypass surgery. Anthropometrics (weight, and BMI), reproductive hormones, and sleep studies were measured. The sexual quality of life was assessed using the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite). The mean age of our patients was 46.9 ± 11.0 years, the mean BMI was 47.8 ± 8.7 kg/m2 and the mean weight was 337.7 ± 62.4 lb. After correction for age and BMI, means of free testosterone per severity group of sleep apnea were as follows: no or mild sleep apnea 74.4 ± 3.8 pg/ml, moderate sleep apnea 68.6 ± 4.2 pg/ml, and severe sleep apnea 60.2 ± 2.92 pg/ml, P = 0.014. All other parameters of sleep apnea including hypopnea index, percent time below a SpO2 of 90%, and percent time below a SpO2 of 80% were also negatively correlated with testosterone levels after correction for age and BMI. BMI and presence of coronary artery disease decreased the sexual quality of life. Sleep apnea was associated with reduced sexual quality of life. In summary, sleep apnea negatively affects testosterone levels independent of BMI. Severely obese men had decreased sexual quality of life.

  13. Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation?

    Directory of Open Access Journals (Sweden)

    Michel Burihan Cahali

    2011-01-01

    Full Text Available OBJECTIVES: The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION: Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS: We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS: We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS: There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.

  14. [Danger or security of spontaneous apnea in relation with previous ventilation (author's transl)].

    Science.gov (United States)

    Brille, P; Milhaud, A

    1981-01-01

    Using a spectrometer for the study of exhaled gases and a monitor of transcutaneous oxygen pressure, our purpose has been to quantify our ideas about physiological apneas in the conscious voluntary adults. We compared the apneas, concerning the duration and the induced fall of peripheric oxygen pressure, after normoventilations in air and in oxygen, then after hyperventilations in air and in oxygen. These experiences confirm the tiny interest of previous normoventilation in oxygen compared with in air, the danger of hypoxemia by previous hyperventilation in air and the possibility of prolonged but safe apnea after hyperventilations in oxygen, that we can advocate in the induction of anaesthesia for some circumstances.

  15. Development of an apnea detection algorithm based on temporal analysis of thoracic respiratory effort signal

    Science.gov (United States)

    Dell'Aquila, C. R.; Cañadas, G. E.; Correa, L. S.; Laciar, E.

    2016-04-01

    This work describes the design of an algorithm for detecting apnea episodes, based on analysis of thorax respiratory effort signal. Inspiration and expiration time, and range amplitude of respiratory cycle were evaluated. For range analysis the standard deviation statistical tool was used over respiratory signal temporal windows. The validity of its performance was carried out in 8 records of Apnea-ECG database that has annotations of apnea episodes. The results are: sensitivity (Se) 73%, specificity (Sp) 83%. These values can be improving eliminating artifact of signal records.

  16. Coblation endoscopic lingual lightening (CELL) for obstructive sleep apnea.

    Science.gov (United States)

    Li, Hsueh-Yu; Lee, Li-Ang; Kezirian, Eric J

    2016-01-01

    This study investigated the feasibility, safety and efficacy of Coblation endoscopic lingual lightening (CELL) surgery for obstructive sleep apnea (OSA). This study was a retrospective case series in a tertiary referral sleep center. Twenty-five adults with moderate to severe OSA and determined to have retropalatal and tongue base obstruction based on Friedman tongue position III and fiberoptic endoscopy underwent CELL in combination with modified uvulopalatopharyngoplasty, known as relocation pharyngoplasty. CELL involves transoral resection of tongue base muscle tissue and lingual tonsil using Coblation under endoscopic guidance. The mean operation time for CELL was 42.6 ± 13.7 min. Total blood loss for CELL plus relocation pharyngoplasty was <50 ml in all patients. Mean postoperative pain score (sum of total pain scores/sum of total hospitalization day, visual analog scale, 0-10) was 2.6 ± 0.6. Postoperative bleeding and taste disturbance extending beyond 3 months occurred in one patient (4 %) individually. No patients reported tongue weakness or speech dysfunction. Epworth sleepiness scale improved from 9.6 ± 4.9 to 7.5 ± 4.3 (p = 0.023). Apnea-hypopnea index decreased from 45.7 ± 21.7 to 12.8 ± 8.2 events/hour (p < 0.001) 6 months after surgery. The overall response rate was 80 %. CELL is feasible, safe and effective in treating tongue base obstruction in OSA patients who underwent simultaneous relocation pharyngoplasty.

  17. [Epworth drowsiness scale value in obstructive sleep apnea syndrome].

    Science.gov (United States)

    Uribe Echevarría, E M; Alvarez, D; Giobellina, R; Uribe Echevarría, A M

    2000-01-01

    Hypersomnia is one of the most consulted symptoms among patients evaluated at sleep disorder centers and it is frequently related to obstructive sleep apnea syndrome (OSAS). Our hypothesis is that Epworth sleepiness scale (ESS) is the parameter with the greatest predictive value in the OSAS diagnosis. We compared patients with OSAS diagnosis to a control group. In both groups we compared ESS with body mass index (BMI), neck circumference (NC), waist perimeter (WP). Anthropometric index (BMI, NC and WC), were similar in both groups (p < 0.10). When we analyzed ESS, a score greater than 10 was observed in the OSAS group, with a significant difference between groups (p < 0.001). Epworth sleepiness scale yielded 60% of sensibility, 82% of specificity and a positive predictive value of 85%. The negative predictive value was 52%. Confidence index was 70%. The relationship between OSAS and ESS scale was significant (Pearson Chi-Square value 7.5). Odds Ratio for apneas was 15 and its confidence interval was lower than 1.5 and upper than 141. We conclude that with ESS score exceeding 10 points OSAS should be suspected.

  18. Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Montserrat Diaz-Abad

    2014-01-01

    Full Text Available Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP among Hispanics with obstructive sleep apnea (OSA. Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53±11 yrs; body mass index (BMI=45±9 kg/m2 with apnea-hypopnea index (AHI 33±30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P=0.006, income level (P<0.001, and employment status (P=0.03 between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P=0.03, P=0.004, and P=0.001, resp., as well as in Hispanics (P=0.02, P=0.02, P=0.03, resp.. Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.

  19. Obstructive sleep apnea: management considerations in psychiatric patients

    Directory of Open Access Journals (Sweden)

    Heck T

    2015-10-01

    Full Text Available Taryn Heck,1 Monica Zolezzi21Pharmacy Department, University of Alberta Hospital, Alberta Health Services, Edmonton, AB, Canada; 2Clinical Pharmacy and Practice, College of Pharmacy, Qatar University, Doha, QatarAbstract: Psychiatric disorders and obstructive sleep apnea (OSA are often comorbid. However, there is limited information on the impact of psychotropic medications on OSA symptoms, on how to manage psychiatric pharmacotherapy in patients presenting with OSA, or on the effectiveness and challenges of OSA treatments in patients with comorbid mental illness. As such, the objective of this article is to provide an overview of some epidemiological aspects of OSA and treatment considerations in the management of OSA in individuals with comorbid psychiatric disorders. Predefined keywords were used to search for relevant literature in electronic databases. Data show that OSA is particularly prevalent in patients with psychiatric disorders. The medical care that patients with these comorbidities require can be challenging, as some of the psychiatric medications used by these patients may exacerbate OSA symptoms. As such, continuous positive airway pressure continues to be the first-line treatment, even in patients with psychiatric comorbidity. However, more controlled studies are required, particularly to determine continuous positive airway pressure compliance in patients with mental illness, the impact of treating OSA on psychiatric symptoms, and the impact of the use of psychotropic medications on OSA symptoms.Keywords: obstructive sleep apnea, psychiatric disorders, comorbidity, psychotropic medications

  20. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery

    Science.gov (United States)

    Ishman, Stacey L.; Tawfik, Kareem O.; Smith, David F.; Cheung, Kristin; Pringle, Lauren M.; Stephen, Matthew J.; Everett, Tiffany L.; Stierer, Tracey L.

    2015-01-01

    Purpose: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. Methods: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. Results: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p Tawfik KO, Smith DF, Cheung K, Pringle LM, Stephen MJ, Everett TL, Stierer TL. Screening for pediatric obstructive sleep apnea before ambulatory surgery. J Clin Sleep Med 2015;11(7):751–755. PMID:25902820

  1. Evaluación clínica de los pacientes con enfermedad pulmonar obstructiva crónica en los programas de rehabilitación respiratoria Clinical evaluation of patients with chronic obstructive pulmonary disease in pulmonary rehabilitation programs

    Directory of Open Access Journals (Sweden)

    JUANA PAVIÉ G

    2011-06-01

    Full Text Available Los pacientes con Enfermedad Pulmonar Obstructiva crónica (EPOC son los mayores tributarios de los programas de rehabilitación respiratoria. En este capitulo se analiza la evaluación que requieren los pacientes con EPOC antes de ingresar al programa de rehabilitación respiratoria y la evidencia científica que existe en cuanto a sus beneficios. El método de evaluación recomendado es: una evaluación general, la función pulmonar, la tolerancia al ejercicio (prueba de caminata de 6 minutos, prueba de caminata incremental, la disnea (escala de Borg, escala del Medical Research Council modificada y los relacionados con la calidad de vida con el cuestionario de Saint George. Además, evaluación del índice BODE, evaluación psicológica y nutricional y una evaluación cardiovascular para descartar patología cardiaca que contraindique la rehabilitación. Efectuada la evaluación, se ingresa al paciente a un programa de rehabilitación respiratoria, el cual debe constar de un equipo multidisciplinario y debe incluir: 1 Educación de los pacientes y su familia; 2 Evaluación y entrenamiento muscular de extremidades inferiores, superiores y músculos respiratorios; 3 Soporte nutricional, y 4 Apoyo psicosocial. El programa de rehabilitación pulmonar proporciona importantes beneficios a los pacientes con EPOC en términos de reducción de la disnea, mejoría en la capacidad de ejercicio y en la calidad de vida (calidad de la evidencia A, recomendación fuerte. Se debe contar con espacio físico para la evaluación de los pacientes y con una sala de entrenamiento. Se recomienda que el programa de rehabilitación respiratoria debe ser personalizado y centrado en las necesidades del paciente y debe tener una duración de 6 a 12 semanas. La efectividad del programa es independiente del lugar donde se lleva a cabo y depende principalmente de su estructura. Es importante elaborar un estudio de estrategia y programa de control para evaluar su

  2. Clinical observation of glucose metabolism disorders in elderly patients with obstructive sleep apnea disorder

    Institute of Scientific and Technical Information of China (English)

    张蔷

    2013-01-01

    Objective To explore the correlation between obstructive sleep apnea hypoventilation syndrome (OSAHS) and glucose metabolism disorders in patients without diabetes mellitus.Methods A total of 88 patients with OSAHS but without diabetes mellitus from 2009 to 2011 in

  3. Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis.

    Science.gov (United States)

    Luyster, Faith S; Dunbar-Jacob, Jacqueline; Aloia, Mark S; Martire, Lynn M; Buysse, Daniel J; Strollo, Patrick J

    2016-01-01

    Few studies have investigated factors associated with continuous positive airway pressure (CPAP) treatment for sleep apnea from the patients' and their partners' perspective. This qualitative research study explored patients' and partners' experiences of CPAP and facilitators and barriers to CPAP use, and elicited suggestions for a first-time CPAP user program. Data from 27 participants were collected via four sleep apnea patient and four partner focus groups. Qualitative content analysis identified five themes: knowledge of sleep apnea, effects of sleep apnea, effects of CPAP, barriers and facilitators of CPAP, and ideas for a new user support program. Patients and partners emphasized the importance of partner involvement in the early CPAP treatment period. These data suggest consideration of a couple-oriented approach to improving CPAP adherence.

  4. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration.

    Science.gov (United States)

    Al Lawati, Nabil M; Patel, Sanjay R; Ayas, Najib T

    2009-01-01

    We will review the epidemiology, risk factors, and consequences of obstructive sleep apnea (OSA) and short/long sleep duration. Obstructive sleep apnea is a disease characterized by recurrent upper airway obstruction during sleep. Obstructive sleep apnea is common, with moderate to severe disease present in approximately 9% of middle aged men and 4% of women. The prevalence of OSA in certain patient populations (such as elderly patients, hypertensive patients, patients with coronary disease, and prebariatric surgery patients) is even greater. There are a number or risk factors for disease including obesity, male sex, and family history. Obstructive sleep apnea negatively impacts quality of life and is also associated with a number of adverse safety and health consequences including cardiovascular disease and motor vehicle crashes. Short habitual sleep duration can result in excessive daytime sleepiness and reduced neurocognitive function. Sleep loss may have long-term health consequences and may lead to premature death, cardiovascular disease, and the development of diabetes.

  5. Use of Electronic Data and Existing Screening Tools to Identify Clinically Significant Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Carl A Severson

    2015-01-01

    Full Text Available OBJECTIVES: To assess the ability of electronic health data and existing screening tools to identify clinically significant obstructive sleep apnea (OSA, as defined by symptomatic or severe OSA.

  6. Comparison of Polysomnographic and Portable Home Monitoring Assessments of Obstructive Sleep Apnea in Saskatchewan Women

    Directory of Open Access Journals (Sweden)

    JA Gjevre

    2011-01-01

    Full Text Available OBJECTIVES: To compare a commercially available, level III in-home diagnostic sleep test (Embletta, Embletta USA and in-laboratory polysomnography (PSG in women with suspected obstructive sleep apnea (OSA.

  7. Do Obstructive Sleep Apnea Syndrome Patients Underestimate Their Daytime Symptoms before Continuous Positive Airway Pressure Treatment?

    Directory of Open Access Journals (Sweden)

    Gabrielle Leclerc

    2014-01-01

    Full Text Available BACKGROUND: Daytime somnolence is an important feature of the obstructive sleep apnea (OSA hypopnea syndrome and is usually subjectively assessed using the Epworth Sleepiness Scale (ESS.

  8. Low-frequency oscillations and vasoreactivity of cortical vessels in obstructive sleep apnea during wakefulness

    DEFF Research Database (Denmark)

    Schytz, Henrik Winther; Jensen, Benedicte Ersted; Jennum, Poul;

    2013-01-01

    Effective nasal continuous positive airway pressure (CPAP) therapy reduces the cardiovascular outcomes associated with obstructive sleep apnea (OSA), but the mechanism behind this effect is unclear. We investigated if OSA patients during wakefulness showed signs of increased sympathetic activity...

  9. Qualidade de vida e bem-estar espiritual em pacientes com doença pulmonar obstrutiva crônica Calidad de vida y bien estar espiritual en pacientes con enfermedad pulmonar obstructiva crónica Quality of life and spiritual well-being in chronic obstructive pulmonary disease patients

    Directory of Open Access Journals (Sweden)

    Maíra Shiramizu da Silva

    2009-12-01

    Full Text Available Este estudo teve como objetivos avaliar a qualidade de vida relacionada à saúde (QVRS e o bem-estar espiritual (BEE de pacientes com doença pulmonar obstrutiva crônica (DPOC e analisar as relações entre QVRS e BEE. As versões em português do Seattle Obstructive Lung Disease Questionnaire (SOLDQ e do Spiritual Well-Being Scale (SWBS foram aplicadas por entrevista a 70 pacientes com DPOC em tratamento ambulatorial. Os domínios do SOLDQ com menor e maior escores foram: Função Física (37,29±17,19 e Satisfação com o Tratamento (68,75±28,05. O escore médio de 94,87±13,56 indica um nível moderado de BEE. O escore total do SWBS e o da subescala Bem-Estar Religioso correlacionaram-se positivamente com o domínio Satisfação com o Tratamento (p=0,007 e p=0,002, respectivamente. Correlação negativa foi encontrada entre Bem-Estar Religioso e Função Física (p=0,05. Pacientes com maior bem-estar religioso estavam mais satisfeitos com o tratamento e tinham pior funcionamento físico.En este estudio se evaluaron la calidad de vida relacionada con la salud (CVRS y el bienestar espiritual (BEE de pacientes con enfermedad pulmonar obstructiva crónica (EPOC y además la relación entre la CVRS y BEE. Setenta pacientes con EPOC en tratamiento ambulatorial fuerón entrevistados usando las versiones en portugués del Seattle Obstructive Lung Disease Questionnaire (SOLDQ y del Spiritual Well-Being Scale (SWBS. Las dimensiones del SOLDQ con puntuaciones más bajos y más altos fueron: Función Física (37,29 ± 17,19 y Satisfacción con el Tratamiento (68,75 ± 28,05. La puntuación media 94,87 ± 13,56 indica un nivel moderado de BEE. La puntuación total del Bienestar Religioso correlacionó positivamente con la Satisfacción con el Tratamiento (p = 0,007 y p = 0,002, respectivamente. Se encontró correlación negativa entre bienestar religioso y función físico (p = 0,05. Los pacientes con mayor bienestar religioso estaban más satisfechos

  10. End-tidal CO2 analysis in sleep apnea syndrome. Conditions for use.

    Science.gov (United States)

    Magnan, A; Philip-Joet, F; Rey, M; Reynaud, M; Porri, F; Arnaud, A

    1993-01-01

    The diagnosis of sleep apnea syndrome (SAS) requires expensive and complex instrumentation. The purpose of the present study was to determine the value of end-tidal CO2 (EtCO2) in screening for sleep apneas. Thirty-nine patients referred to our sleep laboratory because of suspected SAS and ten normal subjects were studied. The EtCO2 was measured using an infrared spectrometer (POET) designed for simultaneous measurement of CO2 and pulse oximetry. In 29 subjects, expired gas was sampled with a nasobuccal mask (Respiron) with lateral orifices. In the other 20 subjects, sampling was done with nasobuccal prongs (Criticare) comprising a four-channel plastic tube to the mouth and the nostrils. Data from an 8-h night were transferred the following day to a microcomputer (Apple Macintosh) for processing. Apnea was defined as an absence of detection of CO2 for more than 10 s. Conventional polysomnography was performed (Respisomnographe). The number of apneas in 8 h and the apnea index (number of apneas in 1 h) were calculated after visual analysis on the screen of the polysomnograph and also with EtCO2 analysis. For recordings made with a nasobuccal mask, the regression curve between the apnea indices computed with EtCO2 and polysomnography was an order 2 polynomial curve (r = 0.76; p < 0.001), with an inflection point at 39 apneas per hour. For recordings with nasobuccal prongs, the correlation was very significant (r = 0.95; p < 0.0001), and the regression curve was linear. The EtCO2 with nasobuccal prongs appears to be a simple and reliable method for screening for SAS.

  11. Reactive Oxygen Species Production in Peripheral Blood Neutrophils of Obstructive Sleep Apnea Patients

    OpenAIRE

    Guoda Pilkauskaite; Skaidrius Miliauskas; Raimundas Sakalauskas

    2013-01-01

    Obstructive sleep apnea (OSA) as well as obesity is associated with increased production of reactive oxygen species (ROS). Neutrophils produce great amounts of ROS. The aim was to evaluate peripheral blood neutrophils ROS production in men with OSA and to establish relations with disease severity and obesity. Methods. Forty-six men with OSA and 10 controls were investigated. OSA was confirmed by polysomnography (PSG), when apnea/hypopnea index was >5/h. Body mass index (BMI) was evaluated. Ne...

  12. High Mallampati score, obesity and obstructive sleep apnea: triple insult to lung function?

    Directory of Open Access Journals (Sweden)

    Nazia Uzma

    2014-07-01

    Full Text Available The paper assesses the combined effect of high Mallampati score, obesity and obstructive sleep apnea (OSA on lung function as measured by spirometry. Our results showed that the combination of sleep apnea, obesity and high Mallampati score resulted in a degree of restriction that was significantly greater than that produced by each factor alone. These observations underscore the importance of factoring in the Mallampati score in the assessment of respiratory disease.

  13. Chronic obstructive pulmonary disease and obstructive sleep apnea: overlaps in pathophysiology, systemic inflammation, and cardiovascular disease.

    LENUS (Irish Health Repository)

    McNicholas, Walter T

    2012-02-01

    Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome represent two of the most prevalent chronic respiratory disorders in clinical practice, and cardiovascular diseases represent a major comorbidity in each disorder. The two disorders coexist (overlap syndrome) in approximately 1% of adults but asymptomatic lower airway obstruction together with sleep-disordered breathing is more prevalent. Although obstructive sleep apnea syndrome has similar prevalence in COPD as the general population, and vice versa, factors such as body mass index and smoking influence relationships. Nocturnal oxygen desaturation develops in COPD, independent of apnea\\/hypopnea, and is more severe in the overlap syndrome, thus predisposing to pulmonary hypertension. Furthermore, upper airway flow limitation contributes to nocturnal desaturation in COPD without apnea\\/hypopnea. Evidence of systemic inflammation in COPD and sleep apnea, involving C-reactive protein and IL-6, in addition to nuclear factor-kappaB-dependent pathways involving tumor necrosis factor-alpha and IL-8, provides insight into potential basic interactions between both disorders. Furthermore, oxidative stress develops in each disorder, in addition to activation and\\/or dysfunction of circulating leukocytes. These findings are clinically relevant because systemic inflammation may contribute to the pathogenesis of cardiovascular diseases and the cell\\/molecular pathways involved are similar to those identified in COPD and sleep apnea. However, the pathophysiological and clinical significance of systemic inflammation in COPD and sleep apnea is not proven, and thus, studies of patients with the overlap syndrome should provide insight into the mechanisms of systemic inflammation in COPD and sleep apnea, in addition to potential relationships with cardiovascular disease.

  14. Problems associated with the apnea test in the diagnosis of brain death

    Directory of Open Access Journals (Sweden)

    Saposnik Gustavo

    2004-07-01

    Full Text Available Background: Brain death is the absence of all cortical functions, including the brainstem. The apnea test (AT is a necessary requisite to complete this diagnosis. Anecdotal reports describing hypotension and acidosis due to apnea test have been reported. However, there are few studies that evaluate complications or difficulties related to this procedure. Objective: To analyze medical problems associated with the apnea test. Methods and Patients: We analyzed clinical features, potential risk conditions, and problems in 129 brain dead patients during the apnea test. The diagnosis of brain death was made according to the American Academy of Neurology recommendations. Results: Clinical problems during the apnea test were detected in more than two thirds of patients, including: arterial hypotension (12%, acidosis (68%, and hypoxemia (23%. Four patients developed major complications, including: pneumothorax, cardiac arrest, bradycardia, atrial fibrillation and myocardial infarction. Conclusion: The apnea test is not an innocuous procedure. Complications during the AT are more common than reported and limit organ procurement for transplantation. Guidelines for performing the AT should be followed in order to avoid clinical complications.

  15. Homicidal behavior and sleep apnea: a case report and medicolegal discussion.

    Science.gov (United States)

    Nofzinger, E A; Wettstein, R M

    1995-11-01

    This case report documents the use of sleep apnea as a criminal defense for a man who fatally shot his wife during his usual sleeping hours. The defendant, who had severe sleep apnea as determined by a clinical evaluation and a polysomnographic study, admitted to shooting his wife but claimed that he was asleep at the time. Two physicians testified for the defense that the sleep apnea was of sufficient severity that the defendant may have had a confusional arousal related to the sleep apnea in which he could have shot his wife accidentally. Another physician, testifying for the prosecution, found no evidence to support this defense after a review of the patient's history and polysomnographic records and a review of relevant literature which may have linked sleep apnea with sleep-related violence. In this case, there was substantial apparent motive for the murder, including a past history of spousal and child abuse and a note written by the victim around the time of the shooting describing her intention to take the children and leave the suspect. The jury rejected the sleep apnea defense, handing down a first-degree murder verdict. In the discussion, we briefly review medicolegal issues related to the case as well as prospective guidelines for the medicolegal assessment of future cases.

  16. Dynamics of snoring sounds and its connection with obstructive sleep apnea

    Science.gov (United States)

    Alencar, Adriano M.; da Silva, Diego Greatti Vaz; Oliveira, Carolina Beatriz; Vieira, André P.; Moriya, Henrique T.; Lorenzi-Filho, Geraldo

    2013-01-01

    Snoring is extremely common in the general population and when irregular may indicate the presence of obstructive sleep apnea. We analyze the overnight sequence of wave packets - the snore sound - recorded during full polysomnography in patients referred to the Sleep Laboratory due to suspected obstructive sleep apnea. We hypothesize that irregular snore, with duration in the range between 10 and 100 s, correlates with respiratory obstructive events. We find that the number of irregular snores - easily accessible, and quantified by what we call the snore time interval index (STII) - is in good agreement with the well-known apnea-hypopnea index, which expresses the severity of obstructive sleep apnea and is extracted only from polysomnography. In addition, the Hurst analysis of the snore sound itself, which calculates the fluctuations in the signal as a function of time interval, is used to build a classifier that is able to distinguish between patients with no or mild apnea and patients with moderate or severe apnea.

  17. Obstructive sleep apnea-related symptoms in Japanese people with Down syndrome.

    Science.gov (United States)

    Ono, Junji; Chishaki, Akiko; Ohkusa, Tomoko; Sawatari, Hiroyuki; Nishizaka, Mari; Ando, Shin-ichi

    2015-12-01

    This study evaluated the prevalence of obstructive sleep apnea-related symptoms and assessed the relationship with obesity or unusual sleep postures in Down syndrome patients in Japan. We obtained the demographic characteristics, sleep postures, and obstructive sleep apnea-related symptoms experienced by 90 people as reported by their caregivers. Although 71% reported snoring and 59% arousals, obstructive sleep apnea-related symptoms were not significantly different between obese and non-obese participants. The youngest age group had the fewest obstructive sleep apnea-related symptoms, especially symptoms of snoring. The odds for arousal, nocturia, and apnea tended to be higher in the unusual sleep-postures group. Unusual sleep postures were most frequent in the group 6-15 years of age. People with Down syndrome might sleep in unusual postures to avoid upper airway obstruction caused by other anatomical factors. For nurses and other health professionals working in mainstream service, it is important to screen all persons with Down syndrome for symptoms suggestive of obstructive sleep apnea, particularly those six years of age and older, and to refer them for further evaluation for sleep disorders.

  18. Automated sleep scoring and sleep apnea detection in children

    Science.gov (United States)

    Baraglia, David P.; Berryman, Matthew J.; Coussens, Scott W.; Pamula, Yvonne; Kennedy, Declan; Martin, A. James; Abbott, Derek

    2005-12-01

    This paper investigates the automated detection of a patient's breathing rate and heart rate from their skin conductivity as well as sleep stage scoring and breathing event detection from their EEG. The software developed for these tasks is tested on data sets obtained from the sleep disorders unit at the Adelaide Women's and Children's Hospital. The sleep scoring and breathing event detection tasks used neural networks to achieve signal classification. The Fourier transform and the Higuchi fractal dimension were used to extract features for input to the neural network. The filtered skin conductivity appeared visually to bear a similarity to the breathing and heart rate signal, but a more detailed evaluation showed the relation was not consistent. Sleep stage classification was achieved with and accuracy of around 65% with some stages being accurately scored and others poorly scored. The two breathing events hypopnea and apnea were scored with varying degrees of accuracy with the highest scores being around 75% and 30%.

  19. Implications of Renal Denervation Therapy in Patients with Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Fernando Jaén-Águila

    2015-01-01

    Full Text Available Obstructive sleep apnea (OSA syndrome is a prevalent condition characterized by repeated episodes of obstruction of the upper airway, leading to intermittent hypoxemia and important endothelial and anatomical dysfunctions that cause cardiovascular and cerebrovascular disease. The finding of the relationship between OSA and hypertension, especially resistant hypertension (RHT, has increased the interest in therapeutic strategies that affect renal sympathetic activity in these patients. The observational studies published until now demonstrated that renal denervation therapy can reduce the severity of OSA syndrome. Renal sympathetic denervation (RDN could be a future therapeutic possibility for conditions other than RHT, such as atrial fibrillation, heart failure, obesity, and OSA syndrome, where renal sympathetic system plays an important physiological role. The aim of this review was to elucidate the implications of renal sympathetic activity in OSA syndrome.

  20. Impact of obstructive sleep apnea on cognitive performance

    Directory of Open Access Journals (Sweden)

    Felipe Cunha Bawden

    2011-08-01

    Full Text Available OBJECTIVE: To evaluate the impact of obstructive sleep apnea (OSA on cognition. METHOD: We compared the performance of 17 patients with polysomnographic diagnosis of OSA in brief cognitive tests to that of 20 healthy controls, matched for age and education. The testing battery included the Mini-Mental State Examination (MMSE, Brief Cognitive Screening Battery (BCSB, Digit-Symbol (DS and Phonemic Verbal Fluency (FAS. Anthropometric measures and scores from the Epworth Sleepiness Scale were also recorded. RESULTS: OSA patients performed significantly worse than controls in the MMSE, in memory items from the BCSB, in DS and also in FAS. OSA patients also exhibited higher body mass index, increased neck circumference and higher scores in Epworth Sleepiness Scale than controls. CONCLUSION: OSA significantly impairs cognitive performance, especially within the domains of attention, memory and executive functioning. These deficits may be detected by brief and easy-to-administer cognitive tests.

  1. Relationship between central sleep apnea and Cheyne-Stokes Respiration.

    Science.gov (United States)

    Flinta, Irena; Ponikowski, Piotr

    2016-03-01

    Central sleep apnea (CSA) in patients with heart failure (HF) occurs frequently and shows a serious influence on prognosis in this population. The key elements in the pathophysiology of CSA are respiratory instability with chronic hyperventilation, changes of arterial carbon dioxide pressure (pCO2) and elongated circulation time. The main manifestation of CSA in patients with HF is Cheyne-Stokes Respiration (CSR). The initial treatment is the optimization of HF therapy. However, many other options of the therapeutic management have been studied, particularly those based on positive airway pressure methods. In patients with heart failure we often can observe the overlap of CSA and CSR; we will discuss the differences between these forms of breathing disorders during sleep. We will also discuss when CSA and CSR occur independently of each other and the importance of CSR occurring during the daytime in context of CSA during the nighttime.

  2. Influence of smoking on sleep and obstructive sleep apnea syndrome.

    Science.gov (United States)

    Deleanu, Oana-Claudia; Pocora, Diana; Mihălcuţă, Stefan; Ulmeanu, Ruxandra; Zaharie, Ana-Maria; Mihălţan, Florin Dumitru

    2016-01-01

    The various ill effects that tobacco smoking has on health have been largely studied, particularly on vascular, neoplastic, and respiratory diseases. Lately, the discussion about the negative impact of cigarette smoking moved towards sleep medicine. Tobacco consumption has been associated with sleep disordered architecture, both during regular intake and after withdrawal. Its effects on sleep disordered breathing (SDB) and especially obstructive sleep apnea syndrome (OSAS) still remain a matter of debate. It is unclear whether smoking represents a risk factor for OSAS or whether smoking cessation has any beneficial effects on OSAS and its therapy. There seems to be a synergistic effect between smoking and OSAS, both causing an increase in cardiovascular morbidity. Future studies are needed in order to establish the strength of this association. We aim to review the literature regarding the consequences of smoking on sleep architecture and SDB, adding emphasis on OSAS clinical implications and treatment.

  3. Prediagnosis of Obstructive Sleep Apnea via Multiclass MTS

    Directory of Open Access Journals (Sweden)

    Chao-Ton Su

    2012-01-01

    Full Text Available Obstructive sleep apnea (OSA has become an important public health concern. Polysomnography (PSG is traditionally considered an established and effective diagnostic tool providing information on the severity of OSA and the degree of sleep fragmentation. However, the numerous steps in the PSG test to diagnose OSA are costly and time consuming. This study aimed to apply the multiclass Mahalanobis-Taguchi system (MMTS based on anthropometric information and questionnaire data to predict OSA. Implementation results showed that MMTS had an accuracy of 84.38% on the OSA prediction and achieved better performance compared to other approaches such as logistic regression, neural networks, support vector machine, C4.5 decision tree, and rough set. Therefore, MMTS can assist doctors in prediagnosis of OSA before running the PSG test, thereby enabling the more effective use of medical resources.

  4. Craniocervical Posture in Patients with Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Piccin, Chaiane Facco

    2016-07-01

    Full Text Available Introduction Obstructive Sleep Apnea (OSA is characterized by repeated episodes of upper airway obstruction during sleep. Objective The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI. Methods This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG, and 21 healthy subjects, who constituted the control group (CG. Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. Results The groups were homogeneous regarding gender (12 men and 9 women in each group, age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years, and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2. We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. Conclusion OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization.

  5. Predictors of obstructive sleep apnea in males with metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Nikolaos Papanas

    2010-04-01

    Full Text Available Nikolaos Papanas1, Paschalis Steiropoulos2, Evangelia Nena2, Argyris Tzouvelekis2, Athanasios Skarlatos2, Maria Konsta2, Vasileios Vasdekis3, Efstratios Maltezos1, Demosthenes Bouros21Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 2Sleep Laboratory, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 3Department of Statistics, Athens University of Economic and Business, Athens, GreeceAbstract: The aim of the present study was to examine the prevalence of metabolic syndrome (MS and its components among obstructive sleep apnea (OSA patients vs controls, as well as to investigate which of these components are strongly associated with the presence of OSA in subjects reporting symptoms indicating sleep-disordered breathing. Included were 83 consecutive male subjects, without known concomitant diseases, who visited an outpatient clinic of obesity, diabetes and metabolism. Based on polysomnography, these were divided into two groups: OSA patients (n = 53 and controls (n = 30. Parameters indicating MS, according to the NCEP ATP III criteria (blood pressure, waist circumference, glucose, triglycerides, and HDL-cholesterol levels were evaluated in both groups. The criteria for MS were fulfilled in 49 participants. Presence of MS was significantly correlated with the presence of OSA. However, after adjustment for BMI, only serum glucose was significantly associated with the presence of OSA (P = 0.002. Conversely, the presence of MS was associated with a significant reduction in percentage of slow-wave sleep (P = 0.030. In conclusion, these results provide further evidence for the association between OSA and MS. Between subjects with MS, elevated serum glucose levels indicate a higher probability for the presence of OSA. Keywords: diabetes mellitus, glucose, metabolic syndrome

  6. Obstructive sleep apnea and bone mineral density in obese patients

    Directory of Open Access Journals (Sweden)

    Mariani S

    2012-11-01

    Full Text Available Stefania Mariani,1 Daniela Fiore,1 Laura Varone,2 Sabrina Basciani,1 Agnese Persichetti,1 Mikiko Watanabe,1 Maurizio Saponara,3 Giovanni Spera,1 Costanzo Moretti,4 Lucio Gnessi11Department of Experimental Medicine, Section of Medical Physiopathology and Endocrinology, Sapienza University of Rome, Italy; 2Department of Environmental Biology, Sapienza University of Rome, Italy; 3Department of Otolaryngology, Audiology and Phonation, Sapienza University of Rome, Italy; 4Division of Endocrinology, Department of System Medicine, Section of Reproductive Endocrinology University of TorVergata, Fatebenefratelli Hospital "San Giovanni Calibita" Rome, ItalyContext: Obesity and its co-morbidities may adversely affect bone mineral density (BMD. Obstructive sleep apnea (OSA is a major complication of obesity. To date, the effects of OSA on BMD in obese patients have been poorly studied.Objective: To examine whether the severity of OSA independently correlates with BMD in obese patients.Methods: One hundred and fifteen obese subjects with OSA (Apnea/Hypopnea Index [AHI] ≥5 events per hour were included in the study. BMD was measured at lumbar spine, total hip, and femoral neck by dual energy X-ray absorptiometry. Body mass index, lean mass, and representative measures of metabolic syndrome (waist circumference, fasting plasma glucose, blood pressure, HDL-cholesterol, triglycerides and inflammation (ESR, CRP, fibrinogen were also evaluated.Results: BMD did not differ among obese individuals regardless of OSA severity. Correlation coefficient analysis for all the covariates showed a lack of association between AHI and BMD that was strongly influenced by age and weight.Conclusion: Our study does not support an independent association between AHI and BMD in obese patients. Controlled studies involving a greater number of patients are warranted.Keywords: obesity, polysomnography, metabolic syndrome

  7. Improved Apnea-Hypopnea Index and Lowest Oxygen Saturation After Maxillomandibular Advancement With or Without Counterclockwise Rotation in Patients With Obstructive Sleep Apnea

    DEFF Research Database (Denmark)

    Knudsen, Torben B.; Laulund, Anne Sofie; Ingerslev, Janne;

    2015-01-01

    Purpose: This study investigated whether patients with obstructive sleep apnea (OSA) who undergo maxillomandibular advancement (MMA) with counterclockwise (CCW) rotation compared with those who undergo MMA without CCW rotation have better outcomes. Materials and Methods: This was a systematic......- and postsurgical values of pharyngeal volume measured on computed tomogram or cone-beam computed tomogram and changes in Apnea-Hypopnea Index (AHI) and lowest oxygen saturation (LSAT) values after surgery. Datawere subjected to a meta-analysis based on odds ratios (OR) with 95% confidence intervals (CIs) and P...

  8. Prevalence and incidence of hypertension in obstructive sleep apnea patients and the relationship between obstructive sleep apnea and its confounders

    Institute of Scientific and Technical Information of China (English)

    FENG Jing; CHEN Bao-yuan

    2009-01-01

    @@ Based on available population-based studies, Obstructive Sleep Apnea (OSA) associated with accompanying daytime sleepiness affects 3% to 7% of adult men and 2% to 5% of adult women in the general population. In some population subsets, like obese or older people, this prevalence is even higher. The health risk in OSA patients shows a strong association with acute cardiovascular events such as stroke, myocardial infarction and nocturnal sudden death.1,2 And with chronic conditions such as coronary artery disease, heart failure, and especially, systemic hypertension.3,4 In this review, prevalence and incidence of hypertension in OSA patients and the relationships between OSA and its confounders are considered, and of course, these confounders are also generally taken as risk factors for hypertension.

  9. Análisis de los efectos metabólicos y nutricionales a largo plazo en la cirugía bariátrica

    OpenAIRE

    Aguado Pérez, Marta

    2015-01-01

    La obesidad constituye hoy en día uno de los principales problemas de salud pública en todos los países desarrollos debido al incremento de su prevalencia, al mayor riesgo de morbimortalidad por complicaciones médicas asociadas y al coste sanitario derivado de la misma. Es un importante factor de riesgo cardiovascular y se asocia con enfermedades como la diabetes mellitus, hipertensión arterial, dislipemia, síndrome de apnea obstructiva del sueño, ciertas formas de cáncer y es motivo de incap...

  10. Estudio comparativo de dos técnicas de cirugía bariática laparoscopica: bypass gástrico y gastrectomía vertical

    OpenAIRE

    Aragón Alonso, Aurora

    2016-01-01

    Introducción: La obesidad constituye un problema sanitario de primera magnitud, debido a su incidencia epidémica. La obesidad aumenta drásticamente el riesgo de desarrollar patologías como la enfermedad cardiovascular, diabetes mellitus tipo 2 (DM2), hipertensión (HTA), dislipemia y síndrome de apnea obstructiva del sueño (SAOS), entre otras. La cirugía bariátrica es el método más efectivo y duradero de tratamiento de los pacientes con obesidad mórbida. En el Hospital Clínico Universitari...

  11. Asistencia ventilatoria no invasiva domiciliaria nocturna en Pediatría PEDIATRIC NOCTURNAL NONINVASIVE VENTILATION ASSISTANCE AT HOME

    OpenAIRE

    2003-01-01

    La asistencia ventilatoria no invasiva domiciliaria nocturna (AVNIDN) se indica en insuficiencia respiratoria crónica (IRC), síndrome de apnea obstructiva del sueño (SAOS) y ocasionalmente por hipoventilación central y fibrosis quística. Se hace una revisión retrospectiva de 10 pacientes sometidos a esta técnica de soporte ventilatorio no invasivo durante un periodo de 6 años (1996-2002), describiendo las indicaciones, tipo de AVNIDN y el seguimiento. Sus edades fluctuaron entre 1 a 13 años; ...

  12. Effects of surgical correction of nasal obstruction in the treatment of obstructive sleep apnea.

    Science.gov (United States)

    Sériès, F; St Pierre, S; Carrier, G

    1992-11-01

    Negative upper airway pressure is thought to play a key role in the pathophysiology of obstructive sleep apnea. Because nasal resistance contributes to the increase of the transpharyngeal pressure gradient, we evaluated the effects of nasal surgery on sleep-related breathing abnormalities in 20 adults with obstructive sleep apnea. Polysomnographic studies were done before (baseline), and 2 to 3 mo after surgery (septoplasty, turbinectomy, and/or polypectomy). Nasal resistances were measured at these visits in 14 patients. Cephalometric measurements were obtained before surgery. Cephalometric abnormalities consisted in an increase in the distance from the mandibular plane to the hyoid bone (MP-H), a decrease in the space between the base of the tongue and the posterior soft tissues (PAS), a retroposition of the mandibule, and an increase in the length of the soft palate. Body weight did not change between the two studies. Nasal resistance decreased significantly after nasal surgery. The composition of the total sleep time spent in the rapid eye movement stage increased from 11.5 +/- 1.3% (mean +/- SEM) to 14 +/- 1.2% after surgery. For the group as the whole, there was no difference between baseline and postsurgical values in the frequency of respiratory disturbances (39.8 +/- 6.1, 36.8 +/- 5.9 n/h), the total apnea time (17.8 +/- 4.2, 15.4 +/- 2.8), the distribution of the apnea time within the different apnea types (obstructive and nonobstructive), and the severity of the nocturnal desaturations. Interestingly, apnea and apnea plus hypopnea indices returned to normal values (< 5 and 10, respectively) in four subjects with normal posterior soft tissues and mandibular plane to the hyoid bone distances.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Sleep Apnea Detection Based on Thoracic and Abdominal Movement Signals of Wearable Piezo-Electric Bands.

    Science.gov (United States)

    Lin, Yin-Yan; Wu, Hau-Tieng; Hsu, Chi-An; Huang, Po-Chiun; Huang, Yuan-Hao; Lo, Yu-Lun

    2016-12-07

    Physiologically, the thoracic (THO) and abdominal (ABD) movement signals, captured using wearable piezo-electric bands, provide information about various types of apnea, including central sleep apnea (CSA) and obstructive sleep apnea (OSA). However, the use of piezo-electric wearables in detecting sleep apnea events has been seldom explored in the literature. This study explored the possibility of identifying sleep apnea events, including OSA and CSA, by solely analyzing one or both the THO and ABD signals. An adaptive non-harmonic model was introduced to model the THO and ABD signals, which allows us to design features for sleep apnea events. To confirm the suitability of the extracted features, a support vector machine was applied to classify three categories - normal and hypopnea, OSA, and CSA. According to a database of 34 subjects, the overall classification accuracies were on average 75.9%±11.7% and 73.8%±4.4%, respectively, based on the cross validation. When the features determined from the THO and ABD signals were combined, the overall classification accuracy became 81.8%±9.4%. These features were applied for designing a state machine for online apnea event detection. Two event-byevent accuracy indices, S and I, were proposed for evaluating the performance of the state machine. For the same database, the S index was 84.01%±9.06%, and the I index was 77.21%±19.01%. The results indicate the considerable potential of applying the proposed algorithm to clinical examinations for both screening and homecare purposes.

  14. Effect of gender on the development of hypocapnic apnea/hypopnea during NREM sleep.

    Science.gov (United States)

    Zhou, X S; Shahabuddin, S; Zahn, B R; Babcock, M A; Badr, M S

    2000-07-01

    We hypothesized that a decreased susceptibility to the development of hypocapnic central apnea during non-rapid eye movement (NREM) sleep in women compared with men could be an explanation for the gender difference in the sleep apnea/hypopnea syndrome. We studied eight men (age 25-35 yr) and eight women in the midluteal phase of the menstrual cycle (age 21-43 yr); we repeated studies in six women during the midfollicular phase. Hypocapnia was induced via nasal mechanical ventilation for 3 min, with respiratory frequency matched to eupneic frequency. Tidal volume (VT) was increased between 110 and 200% of eupneic control. Cessation of mechanical ventilation resulted in hypocapnic central apnea or hypopnea, depending on the magnitude of hypocapnia. Nadir minute ventilation in the recovery period was plotted against the change in end-tidal PCO(2) (PET(CO(2))) per trial; minute ventilation was given a value of 0 during central apnea. The apneic threshold was defined as the x-intercept of the linear regression line. In women, induction of a central apnea required an increase in VT to 155 +/- 29% (mean +/- SD) and a reduction of PET(CO(2)) by -4.72 +/- 0.57 Torr. In men, induction of a central apnea required an increase in VT to 142 +/- 13% and a reduction of PET(CO(2)) by -3.54 +/- 0.31 Torr (P = 0.002). There was no difference in the apneic threshold between the follicular and the luteal phase in women. Premenopausal women are less susceptible to hypocapnic disfacilitation during NREM sleep than men. This effect was not explained by progesterone. Preservation of ventilatory motor output during hypocapnia may explain the gender difference in sleep apnea.

  15. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick

    2015-01-01

    Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  16. Indication of CPAP in Patients with Suspected Obstructive Sleep Apnea, Based on Clinical Parameters and a Novel Two-Channel Recording Device (ApneaLink: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Nigro

    2012-01-01

    Full Text Available Objective. To evaluate the accuracy and reliability of the medical decision based on the results of the hand scoring from a two-channel recording device (ApneaLink plus clinical data for the prescription of a CPAP assay in patients with suspected OSA. Methods. 39 subjects were assessed in the sleep laboratory with polysomnography and ApneaLink. The patients completed the Epworth sleepiness scale and a clinical history. Two blinded independent observers decided to prescribe CPAP according to the results of the PSG (gold standard, observer A, ApneaLink (alternative method, observer B, and the clinical parameters. Sensitivity and specificity of observer B on the indication of CPAP were calculated. The interobserver agreement for the indication of CPAP was assessed using kappa statistics. Results. 38 subjects were included (26 men, mean age 47.5, mean RDI 28.7, mean BMI 31.4 kg/m2. The prevalence of OSA was 84%. The sensitivity and specificity of observer B to initiate a CPAP trial were 90.6% and 100%, respectively. The interrater agreement for the prescription of CPAP was good (kappa: 0.75. Conclusion. This study has shown that the use of ApneaLink plus clinical data has made it possible to indicate CPAP reliably in most patients with high-clinical pretest for OSA.

  17. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony

    2015-01-01

    BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  18. Effects of sildenafil on autonomic nervous function during sleep in obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Christiane Neves

    2010-01-01

    Full Text Available OBJECTIVE: To evaluate the effects of sildenafil on the autonomic nervous system in patients with severe obstructive sleep apnea. METHODS: Thirteen male patients with severe obstructive sleep apnea (mean age 43±10 years with a mean body mass index of 26.7±1.9 kg/m² received a single 50-mg dose of sildenafil or a placebo at bedtime. All-night polysomnography and heart rate variability were recorded. Frequency domain analysis of heart rate variability was performed for the central five-minute sample of the longest uninterrupted interval of slow wave and rapid eye movement sleep, as well as for one-minute samples during apnea and during slow wave and rapid eye movement sleep after resumption of respiration. RESULTS: Compared to the placebo, sildenafil was associated with an increase in the normalized high-frequency (HFnu components and a decrease in the low/high-frequency components of the heart rate variability ratio (LF/HF in slow wave sleep (p<0.01 for both. Differences in heart rate variability parameters between one-minute post-apnea and apnea samples (Δ= difference between resumption of respiration and apnea were assessed. A trend toward a decreasing magnitude of ΔLF activity was observed during rapid eye movement sleep with sildenafil in comparison to placebo (p=0.046. Additionally, Δ LF/HF in SWS and rapid eye movement sleep was correlated with mean desaturation (sR= -0.72 and -0.51, respectively, p= 0.01 for both, and Δ HFnu in rapid eye movement sleep was correlated with mean desaturation (sR= 0.66, p= 0.02 and the desaturation index (sR= 0.58, p = 0.047. CONCLUSIONS: The decrease in arousal response to apnea/hypopnea events along with the increase in HFnu components and decrease in LH/HF components of the heart rate variability ratio during slow wave sleep suggest that, in addition to worsening sleep apnea, sildenafil has potentially immediate cardiac effects in patients with severe obstructive sleep apnea.

  19. Urodynamic changes in a female case of obstructive sleep apnea syndrome with enuresis: 7 years' follow-up

    Institute of Scientific and Technical Information of China (English)

    CAO Xia; HU Ke; CHEN Xue-qin; XIANYU Yun-yan; Lü Sheng-qi; LI Qing-quan

    2010-01-01

    @@ Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive upper airway occlusion resulting in apnea lasting 10 seconds or more. Clinical manifestations include snoring, daytime somnolence,intellectual deficiency, sexual impotence, and nocturnal polyuria. Enuresis associated with OSAS is suggested to be more common in children than in adults.1

  20. Hyperinflation is associated with lower sleep efficiency in COPD with co-existent obstructive sleep apnea.

    Science.gov (United States)

    Kwon, Jeff S; Wolfe, Lisa F; Lu, Brandon S; Kalhan, Ravi

    2009-12-01

    Prior research has shown that individuals with obstructive lung disease are at risk for sleep fragmentation and poor sleep quality. We postulated that patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (known as overlap syndrome) who have more severe lung disease, as measured by lung hyperinflation (inspiratory capacity/total lung capacity), would have greater sleep disturbances independent of traditional measures of sleep apnea. We performed a retrospective chart review of consecutive patients evaluated and treated in an academic pulmonary clinic for overlap syndrome. Pulmonary function tests and polysomnogram data were collected. Thirty patients with overlap syndrome were included in the analysis. We found significant univariable associations between sleep efficiency and apnea/hypopnea index (beta = -0.285, p = 0.01) and between sleep efficiency and lung hyperinflation (beta = 0.654, p = 0.03). Using multivariable linear regression, the relationship between sleep efficiency and lung hyperinflation remained significant (beta = 1.13, p = 0.02) after adjusting for age, sex, body mass index, apnea/hypopnea index, FEV(1)% predicted, oxygen saturation nadir, medications, and cardiac disease. We conclude that increased severity of hyperinflation is associated with worse sleep efficiency, independent of apnea and nocturnal hypoxemia. The mechanisms underlying this observation are uncertain. We speculate that therapies aimed at reducing lung hyperinflation may improve sleep quality in patients with overlap syndrome.

  1. The role of polysomnography in diagnosing and treating obstructive sleep apnea in pediatric patients.

    Science.gov (United States)

    Church, Gwynne D

    2012-01-01

    Obstructive sleep apnea in children is associated with serious neurocognitive and cardiovascular morbidity, systemic inflammation, and increased health care use, yet remains underdiagnosed. Although the prevalence of obstructive sleep apnea is 1-3% in the pediatric population, the prevalence of primary snoring (PS) is estimated to be 3-12%. The challenge for pediatricians is to differentiate PS from obstructive sleep apnea in a cost-effective, reliable, and accurate manner before recommending invasive or intrusive therapies, such as surgery or continuous positive airway pressure. The validity of polysomnography as the gold standard for diagnosing obstructive sleep apnea has been challenged, primarily related to concerns that abnormalities on polysomnography do not correlate well with adverse outcomes, that those abnormalities have statistical more than clinical significance, and that performing polysomnograms on all children who snore is a practical impossibility. The aim of this article is to review the clinical utility of diagnostic tests other than polysomnography to diagnose obstructive sleep apnea, to highlight the limitations and strengths of polysomnography, to underscore the threshold levels of abnormalities detected on polysomnography that correlate with morbidity, and to discuss what the practical implications are for treatment.

  2. Effect of caffeine citrate on the blood gas indexes in newborns with apnea

    Institute of Scientific and Technical Information of China (English)

    Chun-Yan Wu; Xiao-Jiao Wang; Yuan-Yuan Wang

    2015-01-01

    Objective:To explore the effect of caffeine citrate on the blood gas indexes in newborns with apnea.Methods: A total of 108 primary premature infants diagnosed with apnea were included in the study and randomized into the caffeine citrate treatment group and the aminophylline control group with 54 cases in each group. The apnea episode duration 72 h after medication, and the blood gas before medication and 24, 48, 72 h after medication between the two groups were compared.Results: The apnea episode duration 24, 48, 72 h after medication in the treatment group was significantly shorter than that in the control group. PaO2 24, 48, 72 h after medication in the treatment group was significantly higher than that in the control group, while PaCO2 was significantly reduced when compared with the control group.Conclusions:Caffeine citrate has achieved a significantly clinical effect in the treatment of newborn apnea, as a new therapeutic drug, is worthy of being widely recommended in the clinic.

  3. A new algorithm for detection of apnea in infants in neonatal intensive care units

    Science.gov (United States)

    Lee, Hoshik; Vergales, Brooke; Paget-Brown, Alix; Rusin, Craig; Moorman, Randall; Kattwinkel, John; Delos, John

    2011-03-01

    Apnea is a very common problem for premature infants: apnea of prematurity (AOP) occurs in >50% of babies whose birth weight is less than 1500 g, and AOP is found in almost all babies who are apnea, and also give many false alarms. We have created a new algorithm for detection of apnea. Respiration is monitored by continuous measurement of chest impedance (CI). However, the pulsing of the heart also causes fluctuations in CI. We developed a new adaptive filtering system to remove heart activity from CI, thereby giving much more reliable measurements of respiration. The new approach is to rescale the impedance measurement to heartbeat-time, sampling 30 times per interbeat interval. We take the Fourier transform of the rescaled signal, bandstop filter at 1 per beat to remove fluctuations due to heartbeats, and then take the inverse transform. The filtered signal retains all properties except the impedance changes due to cardiac filling and emptying. We convert the variance of CI into an estimated likelihood of apnea. This work is supported by NICHD 5RCZHD064488.

  4. Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome

    Institute of Scientific and Technical Information of China (English)

    Melissa Knauert; Sreelatha Naik; M.Boyd Gillespie; Meir Kryger

    2015-01-01

    Objective: To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome.Data sources: PubMed database for English-language studies with no start date restrictions and with an end date of September 2014.Methods: A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences.There were 106 studies that formed the basis of this analysis.Conclusions: Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death.These consequences result in significant economic burden.Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea.Implications for practice: Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies.Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed.

  5. Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome

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    Selahattin Akyol

    2015-07-01

    Full Text Available OBJECTIVE: Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome. METHODS: We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI: (1 AHIlow group: 5≤AHI30. RESULTS: The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all. Multiple linear regression analysis indicated that the MPV was associated with the AHI (β=0.500, p<0.001 and the high sensitivity C-reactive protein (hs-CRP level (β=0.194, p=0.010. CONCLUSION: The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome.

  6. Epidemiological and Pathogenic Relationship between Sleep Apnea and Ischemic Heart Disease

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    Carlos Carpio

    2013-01-01

    Full Text Available Obstructive sleep apnea is recognized as having high prevalence and causing remarkable cardiovascular risk. Coronary artery disease has been associated with obstructive sleep apnea in many reports. The pathophysiology of coronary artery disease in obstructive sleep apnea patients probably includes the activation of multiple mechanisms, as the sympathetic activity, endothelial dysfunction, atherosclerosis, and systemic hypertension. Moreover, chronic intermittent hypoxia and oxidative stress have an important role in the pathogenesis of coronary disease and are also fundamental to the development of atherosclerosis and other comorbidities present in coronary artery diseases such as lipid metabolic disorders. Interestingly, the prognosis of patients with coronary artery disease has been associated with obstructive sleep apnea and the severity of sleep disordered breathing may have a direct relationship with the morbidity and mortality of patients with coronary diseases. Nevertheless, treatment with CPAP may have important effects, and recent reports have described the benefits of obstructive sleep apnea treatment on the recurrence of acute heart ischaemic events in patients with coronary artery disease.

  7. Apnea test in the determination of brain death in patients treated with extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    Saucha, Wojciech; Sołek-Pastuszka, Joanna; Bohatyrewicz, Romuald; Knapik, Piotr

    2015-01-01

    Extracorporeal Membrane Oxygenation (ECMO) is a well-established method of support in patients with severe respiratory and/or circulatory failure. Unfortunately, this invasive method of treatment is associated with a high risk of neurological complications including brain death. Proper diagnosis of brain death is crucial for the termination of futile medical care. Currently, the legal system in Poland does not provide an accepted protocol for apnea tests for patients on ECMO support. Veno-arterial ECMO is particularly problematic in this regard because it provides both gas exchange and circulatory support. CO₂ elimination by ECMO prevents hypercapnia, which is required to perform an apnea test. Several authors have described a safe apnea test procedure in patients on ECMO. Maximal reduction of the sweep gas flow to the oxygenator should maintain an acceptable haemoglobin oxygenation level and reduce elimination of carbon dioxide. Hypercapnia achieved via this method should allow an apnea test to be conducted in the typical manner. In the case of profound desaturation and an inadequate increase in the arterial CO₂ concentration, the sweep gas flow rate may be increased to obtain the desired oxygenation level, and exogenous carbon dioxide may be added to achieve a target carbon dioxide level. Incorporation of an apnea test for ECMO patients is planned in the next edition of the Polish guidelines on the determination of brain death.

  8. Valor del estudio celular del esputo en el seguimiento de las enfermedades inflamatorias de la vía aérea

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    Juan Antonio Mazzei

    2012-08-01

    Full Text Available El análisis celular del esputo, espontáneo u obtenido mediante la técnica de esputo inducido, se ha transformado en una herramienta ampliamente difundida para la evaluación y orientación del tratamiento de las enfermedades inflamatorias de la vía aérea, principalmente asma, enfermedad pulmonar obstructiva crónica y bronquitis eosinofílica. Se han aportado evidencias sobre la utilidad de la técnica del esputo inducido, validada y estandarizada, para ser empleada en pacientes con dificultades para expectorar. Numerosas investigaciones dieron cuenta de la efectividad de basar las decisiones terapéuticas en el componente inflamatorio de la vía aérea mediante el recuento de células en el esputo. Varios estudios mostraron que, en pacientes con asma el análisis celular de esputo guía en la determinación de estrategias para disminuir las exacerbaciones y para mejorar la función pulmonar, aun en pacientes con asma grave, para disminuir el remodelamiento; también se ha descrito su utilidad en pacientes con EPOC, para la disminución de las exacerbaciones.

  9. Studies on the mechanism of obstructive sleep apnea.

    Science.gov (United States)

    Kukwa, A; Gromysz, H; Jernajczyk, U; Karczewski, W A

    1989-01-01

    Several observations indicate that the mylohyoid nerve (NV) may play a crucial part in the mechanisms of obstructive sleep apnea (OSA). The activity of this nerve normally counteracts the collapse of the upper airways during inspiration. Any reduction in this activity may thus facilitate the occurrence of apnoeic spells. We have studied the effects of ethanol and lung inflations on the activity of NV recorded along with the activities of phrenic and facial nerve in rabbits anaesthetised with chloralose-urethan, paralyzed with curare and artificially ventilated. Under the control conditions the NV exhibited phasic expiratory activity; after vagotomy and additional, inspiratory component was observed. Lung inflation strongly enhanced the expiratory activity of NV whereas both the phrenic and facial nerve activities (both phasic-inspiratory) were typically inhibited. An injection of 5 ml of 20% ethanol very strongly inhibited the NV activity. The results may confirm the importance of NV in the mechanism of OSA. The well-known fact that OSA patients are particularly sensitive to alcohol finds support in the response of NV activity to ethanol injection. The analysis of the patterns of discharges of the three outputs from the respiratory controller may additionally suggest that the Vth nerve nucleus is involved in the control of respiratory pattern.

  10. Sleep apnea and occupational accidents: Are oral appliances the solution?

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    Maria De Lourdes Rabelo Guimarães

    2014-01-01

    Full Text Available Background: Dental practitioners have a key role in the quality of life and prevention of occupational accidents of workers with Obstructive Sleep Apnea Syndrome (OSAS. Aim: The aim of this study was to review the impact of OSAS, the Continuous Positive Airway Pressure (CPAP therapy, and the evidence regarding the use of oral appliances (OA on the health and safety of workers. Materials and Methods: Searches were conducted in MEDLINE (PubMed, Lilacs and Sci ELO. Articles published from January 1980 to June 2014 were included. Results: The research retrieved 2188 articles and 99 met the inclusion criteria. An increase in occupational accidents due to reduced vigilance and attention in snorers and patients with OSAS was observed. Such involvements were related to excessive daytime sleepiness and neurocognitive function impairments. The use of OA are less effective when compared with CPAP, but the results related to excessive sleepiness and cognitive performance showed improvements similar to CPAP. Treatments with OA showed greater patient compliance than the CPAP therapy. Conclusion: OSAS is a prevalent disorder among workers, leads to increased risk of occupational accidents, and has a significant impact on the economy. The CPAP therapy reduces the risk of occupational accidents. The OA can improve the work performance; but there is no scientific evidence associating its use with occupational accidents reduction. Future research should focus on determining the cost-effectiveness of OA as well as its influence and efficacy in preventing occupational accidents.

  11. Importance of cephalographs in diagnosis of patients with sleep apnea

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    Nimma Vijaya Laxmi

    2015-01-01

    Full Text Available Introduction: Obstructive sleep apnea (OSA is considered to be a potentially life threatening disorder, which is characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The cephalometric method despite being a static, two-dimensional evaluation of dynamic three-dimensional structures of the head and neck is useful in diagnosing patients with OSA, as they have shown that significant differences exist between asymptomatic controls and patients with OSA. Aims and Objectives: This study is designed to compare and validate the craniofacial morphology in patients with OSA using lateral cephalometry in both upright and supine position. Materials and Methods: Sixty subjects participated in the study of which 30 were patients with OSA diagnosed by questionnaire and 30 were healthy control group with age range of 25–45 years. Results: The study group demonstrated an increased ANB, mandibular plane angles (GoGn-SN, lower anterior facial height which are statistically significant with a significant P < 0.05. Significant decrease in posterior airway space, increased soft palate length, tongue length, and thickness suggesting reduced airway space in supine posture. Conclusion: Evaluation of craniofacial morphology in OSA patients using lateral cephalometry helps in recognizing the morphological changes induced by altered sleep pattern and for appropriate treatment planning.

  12. Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

    Science.gov (United States)

    Camacho, Macario; Zaghi, Soroush; Chang, Edward T.; Song, Sungjin A.; Szelestey, Blake; Certal, Victor

    2016-01-01

    Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes) in adult obstructive sleep apnea (OSA) patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review) for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm) or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed. PMID:26925105

  13. Association of allergy/immunology and obstructive sleep apnea.

    Science.gov (United States)

    Calais, Charles J; Robertson, Brian D; Beakes, Douglas E

    2016-11-01

    Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse that results in nonrefreshing sleep, excessive daytime sleepiness, and, ultimately, adverse consequences on quality of life, the cardiovascular system, and neurocognitive performance. OSA has traditionally been linked to body habitus (obesity and increased neck circumference), racial demographics, alcohol, tobacco, and sedative use. Numerous other conditions are linked to OSA, which may have clinical relevance. Specifically, asthma and nasal obstructive syndromes, e.g., rhinitis, have been shown to be risk factors. This review used the anatomic homogeneity of the upper and lower airways as an explanation for the inflammatory conditions that underlie and interrelate rhinitis, asthma, and OSA. There is strong evidence that both immunoglobulin Emediated and irritant-induced inflammation in either airway location play a significant role in all three (OSA, rhinitis, and asthma). We highlighted pathophysiologic, chemical, and cellular factors that explain the distinct relationship among OSA, asthma, and rhinitis, with emphasis for increased provider vigilance of the other syndromes when a patient is diagnosed with either entity.

  14. Impact of obstructive apnea syndrome on upper airway respiratory muscles.

    Science.gov (United States)

    Svanborg, Eva

    2005-07-28

    This article reviews studies of upper airway muscles in humans, with emphasis on muscle fiber structural and electrophysiological changes observed in patients with obstructive sleep apnea syndrome (OSAS). The concept of OSAS as a progressive disease is discussed and also possible causes. These include local nervous lesions in the upper airway, both motor and sensory. Previous muscle biopsy studies have given evidence for motor neuron lesions such as, e.g., the phenomenon of type grouping in histological sections. New data obtained with concentric needle EMG recordings from the palatopharyngeus muscles are also presented. In 10/12 OSAS patients there were typical findings indicating motor neuropathy (reduced EMG activity at maximal voluntary effort, long and polyphasic motor-unit potentials and, in two cases, spontaneous denervation activity), whereas such findings were only present in 3/15 patients with habitual snoring. This supports the hypothesis that progression from habitual snoring to the clinical disease of OSAS could be attributed to peripheral neurogenic lesions.

  15. Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence Based Proposal

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    Macario Camacho

    2016-01-01

    Full Text Available Objective. To search for articles evaluating the use of tracheostomies (either permanent stomas or tracheostomy tubes in adult obstructive sleep apnea (OSA patients and to evaluate the potential for the use of mini tracheostomies as treatment for OSA. Study Design. Systematic review. Methods. Nine databases were searched from inception through July 21, 2015. Results. The overall tracheostomy search yielded 516 articles, of which eighteen studies provided polysomnographic data. No study was identified (empty review for the use of mini tracheostomies for treating OSA. The mini tracheostomy search yielded ninety-five articles which describe findings for either mini tracheostomy kits (inner cannula diameter of 4 mm or the performance of mini tracheotomies. Six articles described the use of mini tracheostomies as a temporary procedure to relieve acute upper airway obstruction and none described the use for OSA. For tracheostomy stomal sites, suturing the skin directly to the tracheal rings with defatting can minimize stomal site collapse. The smallest tracheostomy stomal size that can successfully treat OSA has not been described. Conclusion. Mini tracheostomies as small as 4 mm have been successfully used in the short term to relieve upper airway obstruction. Given that polysomnography data are lacking, additional research is needed.

  16. Obstructive Sleep Apnea, Hypertension, and Their Additive Effects on Atherosclerosis

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    Mario Francesco Damiani

    2015-01-01

    Full Text Available Background and Aims. It is widely accepted that obstructive sleep apnea (OSA is independently associated with atherosclerosis. Similar to OSA, hypertension (HTN is a condition associated with atherosclerosis. However, to date, the impact of the simultaneous presence of OSA and HTN on the risk of atherosclerosis has not been extensively studied. The aim of this study was to evaluate the consequences of the coexistence of OSA and HTN on carotid intima-media thickness (IMT and on inflammatory markers of atherosclerosis (such as interleukin- [IL-] 6 and pentraxin- [PTX-] 3. Methods. The study design allowed us to define 4 groups: (1 controls (n=30; (2 OSA patients without HTN (n=30; (3 HTN patients without OSA (n=30; (4 patients with OSA and HTN (n=30. In the morning after portable monitoring (between 7 am and 8 am, blood samples were collected, and carotid IMT was measured. Results. Carotid IMT, IL-6, and PTX-3 in OSA normotensive patients and in non-OSA HTN subjects were significantly higher compared to control subjects; in addition, in OSA hypertensive patients they were significantly increased compared to OSA normotensive, non-OSA HTN, or control subjects. Conclusions. OSA and HTN have an additive role in the progression of carotid atherosclerosis and in blood levels of inflammatory markers for atherosclerosis, such as interleukin-6 and pentraxin-3.

  17. Circulating adhesion molecules in obstructive sleep apnea and cardiovascular disease.

    Science.gov (United States)

    Pak, Victoria M; Grandner, Michael A; Pack, Allan I

    2014-02-01

    Over 20 years of evidence indicates a strong association between obstructive sleep apnea (OSA) and cardiovascular disease. Although inflammatory processes have been heavily implicated as an important link between the two, the mechanism for this has not been conclusively established. Atherosclerosis may be one of the mechanisms linking OSA to cardiovascular morbidity. This review addresses the role of circulating adhesion molecules in patients with OSA, and how these may be part of the link between cardiovascular disease and OSA. There is evidence for the role of adhesion molecules in cardiovascular disease risk. Some studies, albeit with small sample sizes, also show higher levels of adhesion molecules in patients with OSA compared to controls. There are also studies that show that levels of adhesion molecules diminish with continuous positive airway pressure therapy. Limitations of these studies include small sample sizes, cross-sectional sampling, and inconsistent control for confounding variables known to influence adhesion molecule levels. There are potential novel therapies to reduce circulating adhesion molecules in patients with OSA to diminish cardiovascular disease. Understanding the role of cell adhesion molecules generated in OSA will help elucidate one mechanistic link to cardiovascular disease in patients with OSA.

  18. Neuroendocrine Alterations in Obese Patients with Sleep Apnea Syndrome

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    Fabio Lanfranco

    2010-01-01

    Full Text Available Obstructive sleep apnea syndrome (OSAS is a serious, prevalent condition that has significant morbidity and mortality when untreated. It is strongly associated with obesity and is characterized by changes in the serum levels or secretory patterns of several hormones. Obese patients with OSAS show a reduction of both spontaneous and stimulated growth hormone (GH secretion coupled to reduced insulin-like growth factor-I (IGF-I concentrations and impaired peripheral sensitivity to GH. Hypoxemia and chronic sleep fragmentation could affect the sleep-entrained prolactin (PRL rhythm. A disrupted Hypothalamus-Pituitary-Adrenal (HPA axis activity has been described in OSAS. Some derangement in Thyroid-Stimulating Hormone (TSH secretion has been demonstrated by some authors, whereas a normal thyroid activity has been described by others. Changes of gonadal axis are common in patients with OSAS, who frequently show a hypogonadotropic hypogonadism. Altogether, hormonal abnormalities may be considered as adaptive changes which indicate how a local upper airway dysfunction induces systemic consequences. The understanding of the complex interactions between hormones and OSAS may allow a multi-disciplinary approach to obese patients with this disturbance and lead to an effective management that improves quality of life and prevents associated morbidity or death.

  19. Pathophysiologic Mechanisms of Cardiovascular Disease in Obstructive Sleep Apnea Syndrome

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    Carlos Zamarrón

    2013-01-01

    Full Text Available Obstructive sleep apnea syndrome (OSAS is a highly prevalent sleep disorder, characterized by repeated disruptions of breathing during sleep. This disease has many potential consequences including excessive daytime sleepiness, neurocognitive deterioration, endocrinologic and metabolic effects, and decreased quality of life. Patients with OSAS experience repetitive episodes of hypoxia and reoxygenation during transient cessation of breathing that provoke systemic effects. Furthermore, there may be increased levels of biomarkers linked to endocrine-metabolic and cardiovascular alterations. Epidemiological studies have identified OSAS as an independent comorbid factor in cardiovascular and cerebrovascular diseases, and physiopathological links may exist with onset and progression of heart failure. In addition, OSAS is associated with other disorders and comorbidities which worsen cardiovascular consequences, such as obesity, diabetes, and metabolic syndrome. Metabolic syndrome is an emerging public health problem that represents a constellation of cardiovascular risk factors. Both OSAS and metabolic syndrome may exert negative synergistic effects on the cardiovascular system through multiple mechanisms (e.g., hypoxemia, sleep disruption, activation of the sympathetic nervous system, and inflammatory activation. It has been found that CPAP therapy for OSAS provides an objective improvement in symptoms and cardiac function, decreases cardiovascular risk, improves insulin sensitivity, and normalises biomarkers. OSAS contributes to the pathogenesis of cardiovascular disease independently and by interaction with comorbidities. The present review focuses on indirect and direct evidence regarding mechanisms implicated in cardiovascular disease among OSAS patients.

  20. The consolidation of implicit sequence memory in obstructive sleep apnea.

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    Eszter Csabi

    Full Text Available Obstructive Sleep Apnea (OSA Syndrome is a relatively frequent sleep disorder characterized by disrupted sleep patterns. It is a well-established fact that sleep has beneficial effect on memory consolidation by enhancing neural plasticity. Implicit sequence learning is a prominent component of skill learning. However, the formation and consolidation of this fundamental learning mechanism remains poorly understood in OSA. In the present study we examined the consolidation of different aspects of implicit sequence learning in patients with OSA. We used the Alternating Serial Reaction Time task to measure general skill learning and sequence-specific learning. There were two sessions: a learning phase and a testing phase, separated by a 10-hour offline period with sleep. Our data showed differences in offline changes of general skill learning between the OSA and control group. The control group demonstrated offline improvement from evening to morning, while the OSA group did not. In contrast, we did not observe differences between the groups in offline changes in sequence-specific learning. Our findings suggest that disrupted sleep in OSA differently affects neural circuits involved in the consolidation of sequence learning.

  1. The bidirectional interactions between psoriasis and obstructive sleep apnea.

    Science.gov (United States)

    Hirotsu, Camila; Nogueira, Heloisa; Albuquerque, Rachel G; Tomimori, Jane; Tufik, Sergio; Andersen, Monica L

    2015-12-01

    Psoriasis is a chronic inflammatory skin disorder which can impair general routine activities and has been closely related to poor quality of life. Pruritus and scratching are frequently observed, occurring mainly during sleep and precipitating nighttime arousals. Indeed, sleep quality has been shown to be negatively affected in psoriatic patients, in a close relationship with stress exposure and immune response. Although psoriasis is known to impair sleep, leading to insomnia, its association with obstructive sleep apnea (OSA) is controversial. Similarly, OSA is considered a multifactorial inflammatory disease, characterized by intermittent hypoxia, sleep fragmentation and autonomic dysfunction, with important outcomes on the cardiovascular and metabolic systems. Importantly, immunological activities and pro-inflammatory cytokines play a prominent role in both OSA and psoriasis. Currently it is not clear whether OSA is a risk factor for psoriasis development or if psoriasis is a possible predictor of OSA. Thus, our main purpose is to provide an overview of this intriguing relationship and show the current link between psoriasis and OSA in a bidirectional relationship.

  2. Information processing speed in obstructive sleep apnea syndrome: a review.

    Science.gov (United States)

    Kilpinen, R; Saunamäki, T; Jehkonen, M

    2014-04-01

    To provide a comprehensive review of studies on information processing speed in patients with obstructive sleep apnea syndrome (OSAS) as compared to healthy controls and normative data, and to determine whether continuous positive airway pressure (CPAP) treatment improves information processing speed. A systematic review was performed on studies drawn from Medline and PsycINFO (January 1990-December 2011) and identified from lists of references in these studies. After inclusion criteria, 159 articles were left for abstract review, and after exclusion criteria 44 articles were fully reviewed. The number of patients in the studies reviewed ranged from 10 to 157 and the study samples consisted mainly of men. Half of the studies reported that patients with OSAS showed reduced information processing speed when compared to healthy controls. Reduced information processing speed was seen more often (75%) when compared to norm-referenced data. Psychomotor speed seemed to be particularly liable to change. CPAP treatment improved processing speed, but the improvement was marginal when compared to placebo or conservative treatment. Patients with OSAS are affected by reduced information processing speed, which may persist despite CPAP treatment. Information processing is usually assessed as part of other cognitive functioning, not as a cognitive domain per se. However, it is important to take account of information processing speed when assessing other aspects of cognitive functioning. This will make it possible to determine whether cognitive decline in patients with OSAS is based on lower-level or higher-level cognitive processes or both.

  3. [Study of chemosensitivity in patients believed to have sleep apnea syndrome].

    Science.gov (United States)

    Costes, F; Court-Fortune, I; Fournel, P; Vergnon, J M; Emonot, A; Geyssant, A

    1995-01-01

    We performed polysomnography and measured hypoxic ventilatory (HVR), hypercapnic ventilatory responses (HCVR) in 42 patients (60 +/- 11 years) with obesity and a clinical suspicion of sleep apnea syndrome (SAS) in order to determine whether an altered chemosensitivity was associated with SAS. The apnea/hypopnea index was 38 +/- 20 events per hour of sleep in 28 patients (SAS+ group) and less than 10 in the 14 others (SAS- group). The 2 groups differed only by a lower waking PaO2 in SAS+ as compared to SAS- (71.0 +/- 9 vs 77.4 +/- 8 mmHg, p obesity and SAS there is no difference in chemosensitivity due to the presence of sleep apnea and that CPAP therapy does not alter these measurements. These results suggest no direct effect of SAS on chemosensitivity in the population studied.

  4. A 45-year-old man with excessive daytime somnolence, and witnessed apnea at altitude

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    Welsh CH

    2011-04-01

    Full Text Available A sleepy man without sleep apnea at 1609m (5280 feet had disturbed sleep at his home altitude of 3200m (10500 feet. In addition to common disruptors of sleep such as psychophysiologic insomnia, restless leg syndrome, alcohol and excessive caffeine use, central sleep apnea with periodic breathing can be a significant cause of disturbed sleep at altitude. In symptomatic patients living at altitude, a sleep study at their home altitude should be considered to accurately diagnose the presence and magnitude of sleep disordered breathing as sleep studies performed at lower altitudes may miss this diagnosis. Treatments options differ from those to treat obstructive apnea. Supplemental oxygen is considered by many to be first-line therapy.

  5. Screening of Obstructive Sleep Apnea with Empirical Mode Decomposition of Pulse Oximetry

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    Schlotthauer, Gastón; Larrateguy, Luis D; Milone, Diego H

    2014-01-01

    Detection of desaturations on the pulse oximetry signal is of great importance for the diagnosis of sleep apneas. Using the counting of desaturations, an index can be built to help in the diagnosis of severe cases of obstructive sleep apnea-hypopnea syndrome. It is important to have automatic detection methods that allows the screening for this syndrome, reducing the need of the expensive polysomnography based studies. In this paper a novel recognition method based on the empirical mode decomposition of the pulse oximetry signal is proposed. The desaturations produce a very specific wave pattern that is extracted in the modes of the decomposition. Using this information, a detector based on properly selected thresholds and a set of simple rules is built. The oxygen desaturation index constructed from these detections produces a detector for obstructive sleep apnea-hypopnea syndrome with high sensitivity ($0.838$) and specificity ($0.855$) and yields better results than standard desaturation detection approach...

  6. [EFFECTS OF WEIGHT LOSS AFTER BARIATRIC SURGERY ON PULMONARY FUNCTION TESTS AND OBSTRUCTIVE SLEEP APNEA IN MORBIDLY OBESE WOMEN].

    Science.gov (United States)

    Santiago, Ana; Carpio, Carlos; Caballero, Paloma; Martín-Duce, Antonio; Vesperinas, Gregorio; Gómez de Terreros, Francisco; Gómez Mendieta, M A; Álvarez-Sala, Rodolfo; García de Lorenzo, Abelardo

    2015-09-01

    Introducción: la obesidad afecta a la función respiratoria e incrementa el riesgo de síndrome de apneas-hipopneas del sueño (SAHS). Objetivo: evaluar el efecto de la cirugía bariátrica, en mujeres con obesidad mórbida, sobre la función respiratoria y sobre el índice de apneas-hipopneas (IAH) tras dos años de seguimiento. Métodos: se incluyeron 15 mujeres (índice de masa corporal [IMC] medio 50,52 ± 12,71 kg.m-2, edad media 40,13 ± 10,06 años). Los enfermos fueron analizados en dos fases: previo a la cirugía bariátrica y tras dos años de la misma. En cada visita se valoraron las medidas antropométricas y se realizaron pruebas de función respiratoria consistentes en espirometría, pletismografía, medida de la presión inspiratoria máxima y del índice de tensión-tiempo de los músculos inspiratorios, así como análisis de gases arteriales. Por último, también se efectuó una poligrafía cardiorrespiratoria durante el sueño. Resultados: tras la cirugía bariátrica el IMC disminuyó en 44,07 kg.m-2 (IC 95% 38,32 – 49,81). De igual forma, se observaron incrementos significativos en el volumen espiratorio forzado al primer segundo (FEV1) (p < 0,01), la capacidad vital forzada (FVC) (p < 0,01), el volumen de reserva espiratorio (ERV) (p = 0,040), la capacidad funcional residual (FRC) (p = 0,009) y la resistencia de las vías aéreas (Raw) (p = 0,018). Por otra parte, el IAH (p = 0,001) y el índice de desaturación de oxígeno (p = 0,001) disminuyeron tras la cirugía. Se observó una correlación significativa entre el grado de pérdida de peso y el incremento del ERV (0,774, p = 0,024). Conclusiones: tras dos años desde la cirugía bariátrica se siguen observando mejorías significativas en la función respiratoria y en la gravedad del SAHS. La mejoría del ERV estaría en relación directa con los niveles de peso perdido.

  7. Left Ventricular Mass index and Pulmonary Artery Pressure in Patients with the Obstructive Sleep Apnea Syndrome

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    Seyed Hashem Sezavar

    2016-07-01

    Full Text Available Background: Sleep apnea is accompanied by some cardiovascular complications. It has even been hypothesized that sleep apnea, itself, can induce some of these complications. Given such controversies, we assessed the left ventricular mass index (LVMI and systolic pulmonary artery pressure in patients with sleep apnea.Methods: Through convenience sampling, 56 patients with the obstructive sleep apnea syndrome (OSAS were included in the present descriptive cross-sectional study. Patients with any past history of hypertension and diabetes mellitus were excluded. The apnea severity was assessed via the polysomnography-derived apnea-hypopnea index (AHI. All the patients underwent transthoracic echocardiography. In this cross-sectional study - data regarding age, gender, smoking, systolic and diastolic blood pressures, polysomnographic parameters (AHI, severity of disease, mean heart rate, mean oxygen saturation [SaO2], lowest SaO2, and duration of SaO2 below 90% [d.SaO2 < 90%], and  echocardiographic parameters (systolic pulmonary artery pressure and LVMI were accumulated and processed.Results: Fifty-two men and 14 women at a mean age of 49.29 ± 11.79 years participated in this study. Systolic and was significantly high in the severe group compared with the mild group (128.21 ± 9.73 mmHg vs. 119.23 ± 12.5 mmHg; p value = 0.007. The LVMI was increased parallel to an increase in the severity of the OSAS, but that increase was not statistically significant (p value = 0.161. The d.SaO2 < 90% was positively correlated with the LVMI, and this relationship remained true after adjustment for the body mass index (r = 0.27; p value = 0.042.Conclusion: Severe OSAS was accompanied by a higher blood pressure. The LVMI did not differ significantly between the patients with the OSAS and those who did not suffer from other risk factors of cardiac diseases.

  8. Apnea-hypopnea index use among intensive care patients: a case series

    Science.gov (United States)

    2014-01-01

    Introduction ApneaLink™ (RESMED-Munich, Germany) is a simple and inexpensive device that determines the apnea-hypopnea index. The sensitivity and specificity of the apnea-hypopnea index are 100 and 87.5%, respectively. Our hypothesis can be used to create a treatment plan using the apnea-hypopnea index for intensive care unit patients. Case presentation This treatment plan has been created by determining the apnea-hypopnea index of eight Caucasian patients with a variety of diagnoses. Case 1 is that of a 70-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 2 is that of a 65-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 3 is that of a 78-year-old woman diagnosed with chronic obstructive pulmonary disease-pneumonia. Case 4 is that of a 26-year-old man diagnosed with head trauma. Case 5 is that of an 80-year-old man diagnosed with cerebrovascular disease. Case 6 is that of a 79-year-old man diagnosed with cerebrovascular disease. Case 7 is that of an 8-year-old girl diagnosed with ventricular septal defect-epidural hemorragia. Case 8 is that of a 42-year-old man diagnosed with subarachnoid hemorrage. Conclusions The apnea-hypopnea index can be informative regarding prognosis and outcomes, and helps to take precautions and develop new treatment strategies among critical patients in intensive care. The integration of developments in sleep medicine to intensive care unit practices means that we can be more informed about critical patients. PMID:24906620

  9. Seasonal Timing of Infant Bronchiolitis, Apnea and Sudden Unexplained Infant Death.

    Directory of Open Access Journals (Sweden)

    Chantel D Sloan

    Full Text Available Rates of Sudden Unexplained Infant Death (SUID, bronchiolitis, and central apnea increase in winter in temperate climates. Though associations between these three conditions are suggested, more work is required to establish if there is a causal pathway linking bronchiolitis to SUID through inducing central apnea. Utilizing a large population-based cohort of infants studied over a 20-year period (n = 834,595, from birth years 1989-2009, we analyzed ecological associations between timing of SUID cases, bronchiolitis, and apnea healthcare visits. Data were analyzed between 2013 and 2015. We used a Cox Proportional Hazards model to analyze possible interactions between maternal smoking and maternal asthma with infant bronchiolitis on time to SUID. SUID and bronchiolitis both occurred more frequently in winter. An increase in bronchiolitis clinical visits occurred within a few days prior to apnea visits. We found a temporal relationship between infant bronchiolitis and apnea. In contrast, no peak in SUID cases was seen during peaks of bronchiolitis. Among those without any bronchiolitis visits, maternal smoking was associated with an increased risk of SUID: Hazard Ratio (HR of 2.38 (95% CI: 2.11, 2.67, p-value <0.001. Maternal asthma was associated with an increased risk of SUID among infants with at least one bronchiolitis visit: HR of 2.40 (95% CI: 1.04, 5.54, p-value = 0.04. Consistent trends between bronchiolitis, apnea, and SUID were not established due to small numbers of SUID cases. However, interaction analysis revealed potential differential associations of bronchiolitis and SUID by maternal smoking, maternal asthma status.

  10. Parasomnias: Common sleep disorders in children suffering from obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Alexander Torres Molina

    2010-12-01

    Full Text Available The sleep disorders have a tendency to chronic evolution in approximately the 30% of children and adolescents, what constitute the main parasomnias clinical expressions of these phenomena. The Obstructive Sleep Apnea Syndrome constitute a high prevailment ailment which affects the 2% of the childish population approximately it is considered an entity because of its cognitive and somatic resounding. Parasomnias are part of the complex symptomatic night cortege observed in OSAS, stablishing a direct physiopathology relationship between both of them. The reduction of the apnea episodes after the adenotonsillar hyperplasia surgical treatment is accompanied by diminishing of the sleep disorders modification in this patient.

  11. A systematic review on prevalence and risk factors associated with treatment- emergent central sleep apnea

    Directory of Open Access Journals (Sweden)

    Gaurav Nigam

    2016-01-01

    Conclusions: The aggregate point prevalence of TECSA is about 8% with the estimated range varying from 5% to 20% in patients with untreated OSA. The prevalence tends to be higher for split-night studies compared to full night titration studies. TECSA can occur at any CPAP setting although extremely high CPAP settings could increase the likelihood. Male gender, higher baseline apnea-hypopnea index, and central apnea index at the time of diagnostic study could be associated with the development of TECSA at a subsequent titration study.

  12. Fat, sleep, and Charles Dickens: literary and medical contributions to the understanding of sleep apnea.

    Science.gov (United States)

    Kryger, M H

    1985-12-01

    Although the relationship between breathing and sleep has only recently been "discovered" by the medical community, excellent literary descriptions of what we know to be the sleep apnea syndrome were made long ago. Although ancient Greek writings described probable sleep apnea, the most important literary contributions in this area are by Charles Dickens. His description of Joe the fat boy in the Pickwick Papers is an example of his brilliant skills of observation and description. It was not until about 140 years after Pickwick Papers was published that we understood what he was describing.

  13. Surgical History of Sleep Apnea in Pediatric Patients with Chiari Type 1 Malformation.

    Science.gov (United States)

    Pomeraniec, Isaac Jonathan; Ksendzovsky, Alexander; Yu, Pearl L; Jane, John A

    2015-10-01

    Sleep apnea represents a relative indication for posterior fossa decompression in pediatric patients with Chiari malformation type 1. Duraplasty was associated with improvement of sleep apnea in 100% of patients and dural splitting with improvement in 50% of patients. Duraplasty and dural splitting were associated with a similar reduction in tonsillar herniation on radiographic imaging of 58% (37% excluding tonsillectomy) and 35%, respectively. Longitudinal follow-up studies of patients with either neurologic deficits or severe symptoms will further elucidate the natural history of Chiari malformation type 1 and more appropriately gauge the risk-benefit tradeoff of surgical intervention.

  14. Life-Threatening Obstructive Sleep Apnea Caused by Adenoid Hypertrophy in an Infant with Noonan Syndrome

    Directory of Open Access Journals (Sweden)

    Sonia Khirani

    2012-01-01

    Full Text Available Adenoidectomy is a commonly performed surgery in children, even though its effectiveness is still under investigation. However, in children with risk factors such as age under 3 years old, associated comorbidities, or severe obstructive sleep apneas, a high postoperative respiratory morbidity is possible. We report the case of a 15-month-old boy with Noonan syndrome and a complex clinical history, who presented with a life-threatening obstructive sleep apnea due to hypertrophy of the adenoids which resolved completely after adenoidectomy.

  15. Obstructive sleep apnea alters sleep stage transition dynamics.

    Directory of Open Access Journals (Sweden)

    Matt T Bianchi

    Full Text Available INTRODUCTION: Enhanced characterization of sleep architecture, compared with routine polysomnographic metrics such as stage percentages and sleep efficiency, may improve the predictive phenotyping of fragmented sleep. One approach involves using stage transition analysis to characterize sleep continuity. METHODS AND PRINCIPAL FINDINGS: We analyzed hypnograms from Sleep Heart Health Study (SHHS participants using the following stage designations: wake after sleep onset (WASO, non-rapid eye movement (NREM sleep, and REM sleep. We show that individual patient hypnograms contain insufficient number of bouts to adequately describe the transition kinetics, necessitating pooling of data. We compared a control group of individuals free of medications, obstructive sleep apnea (OSA, medical co-morbidities, or sleepiness (n = 374 with mild (n = 496 or severe OSA (n = 338. WASO, REM sleep, and NREM sleep bout durations exhibited multi-exponential temporal dynamics. The presence of OSA accelerated the "decay" rate of NREM and REM sleep bouts, resulting in instability manifesting as shorter bouts and increased number of stage transitions. For WASO bouts, previously attributed to a power law process, a multi-exponential decay described the data well. Simulations demonstrated that a multi-exponential process can mimic a power law distribution. CONCLUSION AND SIGNIFICANCE: OSA alters sleep architecture dynamics by decreasing the temporal stability of NREM and REM sleep bouts. Multi-exponential fitting is superior to routine mono-exponential fitting, and may thus provide improved predictive metrics of sleep continuity. However, because a single night of sleep contains insufficient transitions to characterize these dynamics, extended monitoring of sleep, probably at home, would be necessary for individualized clinical application.

  16. COGNITIVE AND EMOTIONAL IMPAIRMENT IN OBSTRUCTIVE SLEEP APNEA SYNDROME

    Institute of Scientific and Technical Information of China (English)

    Bin Peng; Shun-wei Li; Hong Kang; Xi-zhen Huang

    2004-01-01

    Objective To evaluate the emotional and cognitive status in patients with obstructive sleep apnea syndrome (OSAS),using neuropsychological tests and evoked-related potential (P3).Methods Sixteen patients diagnosed of OSAS were tested by Hamilton rating scale for anxiety (HRSA) and Hamilton rating scale for depression (HRSD). Other three groups, OSAS patient group (n = 21), snoring group (n = 21), and control group (n = 21), were administered polysomnography (PSG), auditory evoked event-related potential (P3), and clinic memory test. The results were analyzed using general linear model (GLM) analysis and Post Hoc test.Results Twelve OSAS patients' scores of HRSA and HRSD were beyond the normal range, 26.42 ± 4.48 and 22.08 ±3.97 respectively. The auditory P3 latency in OSAS group was 363.1 ± 22.9 ms (Fz), 368.57 ± 28.03 ms (Cz), in snoring group 336.57 ± 31.08 ms (Fz), 339.81 ± 31.76 ms (Cz), in control group 340.8 ± 28.7 ms (Fz), 338.29 ± 29.21 ms (Cz).There were significant differences between OSAS group and snoring group, as well as control group (P < 0.05). No significant difference was seen between snoring group and control group. No significant difference was noted in P3 amplitude among three groups. Memory quotient (MQ) reduced in snoring group compared with control group.Conclusions Emotional disturbances are common clinical features in OSAS patients. Abnormal auditory P3 latency indicates the cognitive dysfunction in OSAS patients. Nocturnal hypoxaemia may play an important role on it. Snorers should be monitored because of the tendency to develop cognitive impairment.

  17. Cervical vertebral anomalies in patients with obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Saugat Ray

    2015-01-01

    Full Text Available Objective: The aim of this study was to find an association between the patients with obstructive sleep apnea (OSA and with cervical vertebral anomalies and any further correlation between various anomalies with varying severities of OSA. Materials and Methods: The sample consisted lateral cephalograms of 70 subjects who were diagnosed with OSA and 70 other orthodontic patients who were selected as a control group. The lateral radiographs of both cases and controls were traced and findings were recorded. Results: In total, 21.42% of subjects in the OSA group and 8.57% in the control group were affected with cervical vertebrae anomalies. The statistical analysis reveals that the number of subjects affected with cervical vertebrae anomalies in OSA group is highly significant. A number of cases of fusion were higher than posterior arch deficiency in OSA group and equal in the control group. However, in both the groups, the number of cases with two vertebrae fusion was higher. Further, the higher number of two vertebrae fusion cases in OSA group was found to be statistically significant. The findings of one-way ANOVA for OSA cases reveals the number of cases affected with cervical vertebrae anomalies were statistically highly significant (P < 0.01 in severe cases of OSA. Conclusion: Patients of cervical vertebral anomalies may be at higher risk of developing OSA, and the possibility of the presence of cervical vertebral anomalies may increase with the increase in the severity of OSA. The most common vertebral anomaly was found to be two vertebral fusions.

  18. Cardiac autonomic control in the obstructive sleep apnea

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    Nouha Gammoudi

    2015-04-01

    Full Text Available Introduction: The sympathetic activation is considered to be the main mechanism involved in the development of cardiovascular diseases in obstructive sleep apnea (OSA. The heart rate variability (HRV analysis represents a non-invasive tool allowing the study of the autonomic nervous system. The impairment of HRV parameters in OSA has been documented. However, only a few studies tackled the dynamics of the autonomic nervous system during sleep in patients having OSA. Aims: To analyze the HRV over sleep stages and across sleep periods in order to clarify the impact of OSA on cardiac autonomic modulation. The second objective is to examine the nocturnal HRV of OSA patients to find out which HRV parameter is the best to reflect the symptoms severity. Methods: The study was retrospective. We have included 30 patients undergoing overnight polysomnography. Subjects were categorized into two groups according to apnea–hypopnea index (AHI: mild-to-moderate OSAS group (AHI: 5–30 and severe OSAS group (AHI>30. The HRV measures for participants with low apnea–hypopnea indices were compared to those of patients with high rates of apnea–hypopnea across the sleep period and sleep stages. Results: HRV measures during sleep stages for the group with low rates of apnea–hypopnea have indicated a parasympathetic activation during non-rapid eye movement (NREM sleep. However, no significant difference has been observed in the high AHI group except for the mean of RR intervals (mean RR. The parasympathetic activity tended to increase across the night but without a statistical difference. After control of age and body mass index, the most significant correlation found was for the mean RR (p=0.0001, r=−0.248. Conclusion: OSA affects sympathovagal modulation during sleep, and this impact has been correlated to the severity of the disease. The mean RR seemed to be a better index allowing the sympathovagal balance appreciation during the night in OSA.

  19. Perioperative sleep apnea: a real problem or did we invent a new disease? [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sebastian Zaremba

    2016-01-01

    Full Text Available Depending on the subpopulation, obstructive sleep apnea (OSA can affect more than 75% of surgical patients. An increasing body of evidence supports the association between OSA  and perioperative complications, but some data indicate important perioperative outcomes do not differ between patients with and without OSA. In this review we will provide an overview of the pathophysiology of sleep apnea and the risk factors for perioperative complications related to sleep apnea. We also discuss a clinical algorithm for the identification and management of OSA patients facing surgery.

  20. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome

    NARCIS (Netherlands)

    Eijsvogel, Michiel M.; Ubbink, Rinse; Dekker, Janita; Oppersma, Eline; Jongh, de Frans H.; Palen, van der Job; Brusse-Keizer, Marjolein G.J.

    2015-01-01

    Study Objective Positional therapy (PT) is an effective therapy in positional obstructive sleep apnea syndrome (POSAS) when used, but the compliance of PT is low. The objective of this study was to investigate whether a new kind of PT is effective and can improve compliance. Methods 29 patients wer

  1. Validity and reliability of a protocol of orofacial myofunctional evaluation for patients with obstructive sleep apnea.

    Science.gov (United States)

    Folha, Gislaine A; Valera, Fabiana C P; de Felício, Cláudia M

    2015-06-01

    There is no standardized protocol for the clinical evaluation of orofacial components and functions in patients with obstructive sleep apnea. The aim of this study was to examine the validity, reliability, and psychometric properties of the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-expanded) in subjects with obstructive sleep apnea. Patients with obstructive sleep apnea and control subjects were evaluated, and the validity of OMES-expanded was tested by construct validity (i.e. the ability to discriminate orofacial status between apneic and control subjects) and criterion validity (i.e. correlation between OMES-expanded and a reference instrument). Construct validity was adequate; the apneic group showed significantly worse orofacial status than did control subjects. Criterion validity of OMES-expanded was good, as was its reliability. The OMES-expanded is valid and reliable for evaluating orofacial myofunctional disorders of patients with obstructive sleep apnea, with adequate psychometric properties. It may be useful to plan a therapeutic strategy and to determine whether the effects of therapy are related to improved muscle and orofacial functions.

  2. Sleep apnea in kidney transplant patients: Clinical correlates and comparison with pretransplant patients

    Directory of Open Access Journals (Sweden)

    Rasha Daabis

    2012-10-01

    Conclusion: SA is as highly prevalent in Tx as in WL patients. Moreover, this high prevalence in the transplant patients could be a consequence of declining renal function. In addition, we propose that sleep apnea is a new risk factor for hypertension and cardiovascular events in kidney-transplanted patients.

  3. Cardiovascular autonomic neuropathy contributes to sleep apnea in young and lean Type 1 Diabetes Mellitus patients

    Directory of Open Access Journals (Sweden)

    Carolina Castro Porto Silva Janovsky

    2014-08-01

    Full Text Available Sleep apnea in type 1 diabetes mellitus (T1DM is a crescent theme of discussion. In obese patient, it is explained by the excessive central adiposity, including large neck circumference. Its presence in nonobese patients, however, brings back its possible correlation with autonomic neuropathy. The aim of this study was to compare the prevalence of OSA in young and lean T1DM, with and without cardiovascular autonomic neuropathy (CAN. We studied 20 adult, nonobese, type 1 diabetic patients, divided in two groups according to the results of the cardiovascular autonomic reflex tests (CARTs. These two groups (9 with CAN and 11 without CAN were compared to a control group of 22 healthy individuals, matched by age and BMI. A polysomnography was performed and sleep was analyzed. The CAN+ group presented significantly higher prevalence of sleep apnea compared to the other groups (67% CAN+; 23% CAN-; 4,5% controls: CAN+ vs Control; p=0.00017 and CAN+ vs CAN-; p=0.02. As it was expected, the incidence of sleep apnea was correlated with more microarousals during sleep and excessive daytime sleepiness. The CAN- group showed a better sleep efficiency compared to the CAN+ group, demonstrating impaired sleep architecture in diabetics with this chronic complication. In conclusion, sleep apnea could not only be an indication of presence of CAN, but also a contributor to diabetic neuropathy impairment, causing both worse prognosis and reduced quality of life for these patients when not treated.

  4. Associations between craniofacial morphology, head posture, and cervical vertebral body fusions in men with sleep apnea

    DEFF Research Database (Denmark)

    Svanholt, Palle; Petri, Niels; Wildschiødtz, Gordon;

    2009-01-01

    INTRODUCTION: The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology. METHODS: Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies b...

  5. Neuropsychological functioning after CPAP treatment in obstructive sleep apnea: a meta-analysis

    NARCIS (Netherlands)

    W.A. Kylstra; J.A. Aaronson; W.F. Hofman; B.A. Schmand

    2012-01-01

    The generally held clinical view is that treatment with continuous positive airway pressure (CPAP) improves cognition in patients with obstructive sleep apnea (OSA). However, the cognitive domains in which recovery is found differ between studies. A meta-analysis was conducted to quantify the effect

  6. Neuropsychological functioning after CPAP treatment in obstructive sleep apnea: a meta-analysis

    NARCIS (Netherlands)

    W.A. Kylstra; J.A. Aaronson; W.F. Hofman; B.A. Schmand

    2013-01-01

    The generally held clinical view is that treatment with continuous positive airway pressure (CPAP) improves cognition in patients with obstructive sleep apnea (OSA). However, the cognitive domains in which recovery is found differ between studies. A meta-analysis was conducted to quantify the effect

  7. Effects of low humidity on small premature infants in servocontrol incubators. II. Increased severity of apnea.

    Science.gov (United States)

    Belgaumkar, T K; Scott, K E

    1975-01-01

    Apneic spells were recorded in 8 of 19 premature infants nursed in high and low humidity alternately in servocontrol incubators. A significantly greater proportion of severe apnea occurred in low than in high humidity. It is postulated that this frequency and severity was due to the increased (as well as widely fluctuating) ambient temperature during low humidity.

  8. An online sleep apnea detection method based on recurrence quantification analysis.

    Science.gov (United States)

    Nguyen, Hoa Dinh; Wilkins, Brek A; Cheng, Qi; Benjamin, Bruce Allen

    2014-07-01

    This paper introduces an online sleep apnea detection method based on heart rate complexity as measured by recurrence quantification analysis (RQA) statistics of heart rate variability (HRV) data. RQA statistics can capture nonlinear dynamics of a complex cardiorespiratory system during obstructive sleep apnea. In order to obtain a more robust measurement of the nonstationarity of the cardiorespiratory system, we use different fixed amount of neighbor thresholdings for recurrence plot calculation. We integrate a feature selection algorithm based on conditional mutual information to select the most informative RQA features for classification, and hence, to speed up the real-time classification process without degrading the performance of the system. Two types of binary classifiers, i.e., support vector machine and neural network, are used to differentiate apnea from normal sleep. A soft decision fusion rule is developed to combine the results of these classifiers in order to improve the classification performance of the whole system. Experimental results show that our proposed method achieves better classification results compared with the previous recurrence analysis-based approach. We also show that our method is flexible and a strong candidate for a real efficient sleep apnea detection system.

  9. Simulated Obstructive Sleep Apnea Increases P-Wave Duration and P-Wave Dispersion

    Science.gov (United States)

    Wons, Annette M.; Rossi, Valentina; Bratton, Daniel J.; Schlatzer, Christian; Schwarz, Esther I.; Camen, Giovanni; Kohler, Malcolm

    2016-01-01

    Background A high P-wave duration and dispersion (Pd) have been reported to be a prognostic factor for the occurrence of paroxysmal atrial fibrillation (PAF), a condition linked to obstructive sleep apnea (OSA). We tested the hypothesis of whether a short-term increase of P-wave duration and Pd can be induced by respiratory manoeuvres simulating OSA in healthy subjects and in patients with PAF. Methods 12-lead-electrocardiography (ECG) was recorded continuously in 24 healthy subjects and 33 patients with PAF, while simulating obstructive apnea (Mueller manoeuvre, MM), obstructive hypopnea (inspiration through a threshold load, ITH), central apnea (AP), and during normal breathing (BL) in randomized order. The P-wave duration and Pd was calculated by using dedicated software for ECG-analysis. Results P-wave duration and Pd significantly increased during MM and ITH compared to BL in all subjects (+13.1ms and +13.8ms during MM; +11.7ms and +12.9ms during ITH; p<0.001 for all comparisons). In MM, the increase was larger in healthy subjects when compared to patients with PAF (p<0.05). Conclusion Intrathoracic pressure swings through simulated obstructive sleep apnea increase P-wave duration and Pd in healthy subjects and in patients with PAF. Our findings imply that intrathoracic pressure swings prolong the intra-atrial and inter-atrial conduction time and therefore may represent an independent trigger factor for the development for PAF. PMID:27071039

  10. Apnea testing, a simple prognostic test for diagnosis of brain death

    Directory of Open Access Journals (Sweden)

    Nemat Bilan

    2014-05-01

    Full Text Available Introduction: Brain-death is the end stage of most illnesses that cause brain injury and decrease oxygenation and circulation of brain tissues. Early determination of brain-death isessential to the prevention of expensive modeling in the pediatric intensive care unit (PICUand reserving facilities for patients with good prognosis. Apnea test is one of the importantbrain-death determining methods in clinical evaluation that can be performed easier and fasterthan other methods. Methods: In a cross-sectional study, 75 patients with brain-death criteria were evaluated from2003-2011. Apnea testing was fulfilled through standard methods. Patients who did not develop spontaneous respiration at PaCo level of 60 mmHg or more were confirmed as brain-dead. Results: Mean age of patients was 40 months. All patients were comatose, without brainstemreflexes. Cause of coma was status epilepticus in most patients. All patients that had a positive apnea test died after a mean duration of 8 days.Conclusion: All other confirmative methods, irrespective of their accuracy, need complexinstruments and experienced manpower, and are expensive which makes their preparation impossible in most ICU centers. However, apnea test is a simple prognostic method in braindeathconfirmationwith100%accuracy.​

  11. An Empirical Continuous Positive Airway Pressure Trial for Suspected Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Robert P Skomro

    2007-01-01

    Full Text Available BACKGROUND: Standard practice in obstructive sleep apnea (OSA management requires that a positive diagnostic, overnight polysomnography (PSG test be obtained before initiating treatment. However, long waiting times due to lack of access to PSG testing facilities may delay the initiation of definitive treatment for OSA.

  12. Craniosynostosis: Obstructive sleep apnea in a unifying theory for intracranial hypertension.

    NARCIS (Netherlands)

    B. Spruijt (Bart)

    2016-01-01

    markdownabstractCraniosynostosis is a rare congenital disorder, characterized by the premature fusion of skull suture(s) resulting in an abnormal skull shape. These children are at risk for obstructive sleep apnea, but also for cranio-cerebral disproportion, hydrocephalus, venous hypertension and ab

  13. Available techniques for objective assessment of upper airway narrowing in snoring and sleep apnea

    DEFF Research Database (Denmark)

    Faber, Christian; Grymer, Luisa

    2003-01-01

    A number of techniques are available to determine the level of obstructive predominance in snoring and in the obstructive sleep apnea hypopnea syndrome (OSAHS): lateral cephalography, awake endoscopy, awake endoscopy with the Müller maneuver, endoscopy during sleep, endoscopy with nasal continuous...

  14. Correlation among obstructive sleep apnea syndrome, coronary atherosclerosis and coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    LU Gan; XU Zhuo-wen; ZHANG Yu-lin; YANG Zhi-jian; ZHANG Xi-long; YIN Kai-sheng

    2007-01-01

    @@ Epidemiologic investigations have shown that the morbidity of obstructive sleep apnea syndrome (OSAS) among adults is 2%-4%, among the population aged 30 years and over is 4.63%, and among patients with hypertension or coronary atherosclerostic disease (CAD) is as high as 30%-50%.

  15. Using the Pathophysiology of Obstructive Sleep Apnea to Teach Cardiopulmonary Integration

    Science.gov (United States)

    Levitzky, Michael G.

    2008-01-01

    Obstructive sleep apnea (OSA) is a common disorder of upper airway obstruction during sleep. The effects of intermittent upper airway obstruction include alveolar hypoventilation, altered arterial blood gases and acid-base status, and stimulation of the arterial chemoreceptors, which leads to frequent arousals. These arousals disturb sleep…

  16. Diagnostic accuracy of nocturnal oximetry for detection of sleep apnea syndrome in stroke rehabilitation

    NARCIS (Netherlands)

    J.A. Aaronson; T. van Bezeij; J.G. van den Aardweg; C.A.M. van Bennekom; W.F. Hofman

    2012-01-01

    Background and Purpose—Sleep apnea syndrome (SAS) is a common sleep disorder in stroke patients and is associated with decreased recovery and increased risk of recurrent stroke and mortality. The standard diagnostic test for SAS is poly(somno)graphy, but this is often not feasible in stroke rehabili

  17. Association of adiponectin genotype polymorphisms at positions 45 and 276 with obstructive sleep apnea hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    Mei Su; Xilong Zhang; Shicheng Su

    2009-01-01

    Objective: To investigate the relationship between adiponectin genotype polymorphisms and obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Using the TaqMan polymerase chain reaction(PCR) method, the single nucleotide polymorphisms(SNP)at positions 45 and 276 in the adiponectin gene were determined in Chinese of the Han nationality in the Nanjing district. The OSAHS group consisted of 78 patients, and the control group contained 40 subjects. The association of adiponectin genotype polymorphisms at positions 45 and 276 with obstructive sleep apnea hypopnea syndrome was analyzed. Results: No evidence of a direct association was found between OSAHS and adiponectin genotype SNP at positions 45 and 276(P> 0.05). However, compared with those OSAHS patients having G/T+T/T genotype at position 276, the OSAHS patients with the G/G genotype showed a greater neck circumference(NC), a prolonged duration of the longest apnea event, and elevated levels of blood cholesterol and low-density lipoprotein cholesterol(P < 0.05). Conclusion: No direct association was detected between OSAHS and adiponectin genotype distribution at positions 45 and 276 in Chinese of Han nationality in the Nanjing district. However, OSAHS patients with the adiponectin GIG genotype at position 276 had a larger NC and the longest apnea event compared to those having the adiponectin SNP276 G/T +T/T genotype. This may have an indirect influence on the development of OSAHS.

  18. Effects of One-Week Tongue-Task Training on Sleep Apnea Severity: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Eric Rousseau

    2015-01-01

    Full Text Available The aim of the present study was to assess the effects of one-week tongue-task training (TTT on sleep apnea severity in sleep apnea subjects. Ten patients with sleep apnea (seven men, mean [± SD] age 52±8 years; mean apnea-hypopnea [AHI] index 20.9±5.3 events/h underwent 1 h TTT in the authors’ laboratory on seven consecutive days. A complete or limited recording and tongue maximal protruding force were assessed before and after one-week TTT. One-week TTT was associated with a global AHI decrease (pre-TTT: 20.9±5.3 events/h; post-TTT: 16.1±5.1 events/h; P<0.001 and AHI decrease during rapid eye movement sleep (pre-TTT: 32.2±18.4 events/h; post-TTT: 16.7±6.6 events/h; P=0.03, while protruding force remained unchanged. The authors consider these results to be potentially clinically relevant and worthy of further investigation in a large randomized trial.

  19. Amyotrophic lateral sclerosis presenting with orthopnea in a patient with COPD and obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    T.L.N. Swamy

    2011-01-01

    Full Text Available Amyotrophic lateral sclerosis (ALS, also known as motor neuron disease (MND is a relentlessly progressive neurological disorder causing peripheral muscular weakness and resultant respiratory failure. In this article, we report a case of ALS with chronic obstructive pulmonary disease (COPD and obstructive sleep apnea (OSA with orthopnea as initial symptoms.

  20. Oral-appliance therapy obstructive sleep apnea-hypopnea syndrome : a clinical study on therapeutic outcome

    NARCIS (Netherlands)

    Hoekema, Aarnoud

    2007-01-01

    The obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related breathing disorder characterized by disruptive snoring and repetitive upper airway obstructions. Its neurobehavioral consequences include excessive sleepiness, an increased risk of accidents, and an impaired quality of l

  1. Is there a place for teaching obstructive sleep apnea and snoring in the predoctoral dental curriculum?

    Science.gov (United States)

    Ivanoff, Chris S; Hottel, Timothy L; Pancratz, Frank

    2012-12-01

    The widespread prevalence of obstructive sleep apnea and apneic snoring is both alarming and well documented. Sleep disorders affect one out of five Americans. Yet, during an attempt to study the prevalence of obstructive sleep apnea and snoring among patients at the University of Tennessee Health Science Center College of Dentistry, a search through the entire school's database for the terms "sleep apnea" and "snoring" found only ninety-two patients who admitted to snoring. Currently, the condition "sleep apnea" is not even on the school's list of health/medical questions. These figures not only are inconsistent with national statistics, but confirm that more needs to be done to make dental students aware of these disorders, include them in patient medical histories, and ultimately educate patients about therapies that can help. Considering the health concerns related to this sleep disorder, the economic impact of insomnia and daytime sleepiness, as well as the fact that the dentist is well poised to reduce symptoms and increase the quality of life among sufferers, mandibular advancement devices should become an educational standard in the predoctoral clinical curriculum of dental schools. Predoctoral clinical curricula need to reflect this current health trend and train dentists to care for these patients comprehensively.

  2. MRI findings and sleep apnea in children with Chiari I malformation.

    Science.gov (United States)

    Khatwa, Umakanth; Ramgopal, Sriram; Mylavarapu, Alexander; Prabhu, Sanjay P; Smith, Edward; Proctor, Mark; Scott, Michael; Pai, Vidya; Zarowski, Marcin; Kothare, Sanjeev V

    2013-04-01

    Chiari I malformation is characterized by downward herniation of the cerebellar tonsils through the foramen magnum. Scant data are available on the clinical course, relationship to the extent of herniation on magnetic resonance imaging in Chiari I malformation and the presence of sleep-disordered breathing on polysomnography. Retrospective analysis was performed looking at polysomnographic findings of children diagnosed with Chiari I malformation. Details on how Chiari I malformation was diagnosed, brainstem magnetic resonance imaging findings, and indications for obtaining the polysomnogram in these patients were reviewed. We also reviewed available data on children who had decompression surgery followed by postoperative polysomnography findings. Twenty-two children were identified in our study (11 males, median age 10 years, range 1 to 18). Three had central sleep apnea, five had obstructive sleep apnea, and one had both obstructive and central sleep apnea. Children with sleep-disordered breathing had excessive crowding of the brainstem structures at the foramen magnum and were more likely to have a greater length of herniation compared with those children without sleep-disordered breathing (P = 0.046). Patients with central sleep apneas received surgical decompression, and their conditions were significantly improved on follow-up polysomnography. These data suggest that imaging parameters may correlate with the presence of sleep-disordered breathing in children with Chiari I malformation.

  3. Detection of cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome using mismatch negativity

    Institute of Scientific and Technical Information of China (English)

    Xiaohui Wen; Ningyu Wang; Jinfeng Liu; Zhanfeng Yan; Zhonghai Xin

    2012-01-01

    In this experiment, 97 patients with obstructive sleep apnea hypopnea syndrome were divided into three groups (mild, moderate, severe) according to minimum oxygen saturation, and 35 healthy subjects were examined as controls. Cognitive function was determined using the mismatch negativity paradigm and the Montreal Cognitive Assessment. The results revealed that as the disease worsened, the mismatch negativity latency was gradually extended, and the amplitude gradually declined in patients with obstructive sleep apnea hypopnea syndrome. Importantly, mismatch negativity latency in severe patients with a persistent time of minimum oxygen saturation 60 seconds. Correlation analysis revealed a negative correlation between minimum oxygen saturation latency and Montreal Cognitive Assessment scores. These findings indicate that intermittent night-time hypoxemia affects mismatch negativity waveforms and Montreal Cognitive Assessment scores. As indicators for detecting the cognitive functional status of obstructive sleep apnea hypopnea syndrome patients, the sensitivity of mismatch negativity is 82.93%, the specificity is 73.33%, the accuracy rate is 81.52%, the positive predictive value is 85.00%, the negative predictive value is 70.21%, the positive likelihood ratio is 3, and the negative likelihood ratio is 0.23. These results indicate that mismatch negativity can be used as an effective tool for diagnosis of cognitive dysfunction in obstructive sleep apnea hypopnea syndrome patients.

  4. Sleep structure in patients with periodic limb movements and obstructive sleep apnea syndrome.

    Science.gov (United States)

    Iriarte, Jorge; Murie-Fernandez, Manuel; Toledo, Estefania; Urrestarazu, Elena; Alegre, Manuel; Viteri, Cesar; Salvador, Javier; Baptista, Peter; Alcaide, Belen; Artieda, Julio

    2009-08-01

    Periodic limb movements (PLM) and obstructive sleep apnea syndrome (OSAS) are two frequent sleep disorders which often occur in the same patient. The goal of this study was to know the influence of the presence of PLM in the sleep architecture in patients with and without OSAS. Two hundred twenty consecutive patients (69 women and 151 men) participated in this transversal study. They were patients with clinical suspicion of dysomnia, including snoring, OSAS, and PLM. All of them underwent a full polysomnography and were interviewed using questionnaires about the sleep quality. The sleep parameters (percentage of sleep stages, rapid eye movement latency, sleep efficiency, awakenings, PLM presence, apnea-hypopnea index) were calculated and compared between groups. Descriptive statistics and nonparametric distribution techniques were used for the analysis. Patients with PLM when compared with patients with OSAS had lower sleep efficiency and less rapid eye movement percentage. The presence of PLM in patients with sleep apnea was less relevant being responsible only for an increase in the rapid eye movement latency and a decrease in the duration of the three to four sleep stages. However, the presence of OSAS was related to a better sleep efficiency (patients with PLM plus OSAS had a better sleep efficiency than patients with only PLM). PLM alters the structure of sleep. In patients with sleep apnea, the presence of PLM is less relevant.

  5. Craniofacial, craniocervical, and pharyngeal morphology in bilateral cleft lip and palate and obstructive sleep apnea patients

    NARCIS (Netherlands)

    Oosterkamp, B.C.M.; Remmelink, H.J.; Pruim, G.J.; Hoekema, A.; Dijkstra, P.U.

    2007-01-01

    Objective: The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men. Subjects and methods: Lateral cephalograms were obt

  6. Simulating Sleep Apnea by Exposure to Intermittent Hypoxia Induces Inflammation in the Lung and Liver

    Directory of Open Access Journals (Sweden)

    Darlan Pase da Rosa

    2012-01-01

    Full Text Available Sleep apnea is a breathing disorder that results from momentary and cyclic collapse of the upper airway, leading to intermittent hypoxia (IH. IH can lead to the formation of free radicals that increase oxidative stress, and this mechanism may explain the association between central sleep apnea and nonalcoholic steatohepatitis. We assessed the level of inflammation in the lung and liver tissue from animals subjected to intermittent hypoxia and simulated sleep apnea. A total of 12 C57BL/6 mice were divided into two groups and then exposed to IH (n=6 or a simulated IH (SIH (n=6 for 35 days. We observed an increase in oxidative damage and other changes to endogenous antioxidant enzymes in mice exposed to IH. Specifically, the expression of multiple transcription factors, including hypoxia inducible factor (HIF-1α, nuclear factor kappa B (NF-κB, and tumor necrosis factor (TNF-α, inducible NO synthase (iNOS, vascular endothelial growth factor (VEGF, and cleaved caspase 3 were shown to be increased in the IH group. Overall, we found that exposure to intermittent hypoxia for 35 days by simulating sleep apnea leads to oxidative stress, inflammation, and increased activity of caspase 3 in the liver and lung.

  7. [Implementation of respiratory rehabilitation in the municipalities of Valparaíso, Viña del Mar, Quilpué and Villa Alemana in 2013].

    Science.gov (United States)

    Manriquez Villarroel, Pablo; Colines Rodríguez, Yasna; Poblete Vega, Felipe; Otárola Bravo, Jaime; Paredes Barrera, Cristhian; Acuña Cabrera, Ana María

    2014-10-03

    Introducción: La rehabilitación respiratoria es un pilar fundamental en el tratamiento del paciente con Enfermedad Pulmonar Obstructiva Crónica. Reduce importantemente los costos para el sistema de salud, el uso de recursos sanitarios, disminuyendo la estadía hospitalaria y las consultas a servicios de urgencia. Objetivo: Describir la condición actual de la rehabilitación respiratoria en los centros de atención primaria ubicados en la región de Valparaíso. Método: Se aplicó una encuesta cerrada a cada profesional a cargo del área respiratoria en los centros de atención primaria de salud. La muestra estuvo conformada por 32 centros de salud correspondientes a las comunas de Valparaíso, Viña del Mar, Quilpué y Villa Alemana. Resultados: 9 centros (28%) del total de la muestra realizan rehabilitación respiratoria y el mismo número tiene un programa de rehabilitación estructurado. En 15 (47%) de los centros existe un Nutricionista dentro del equipo de salud. En el 100% de los centros se evalúa a los pacientes mediante espirometría y escalas de disnea. La mayoría de los centros (89%) realiza entrenamiento de extremidades superiores e inferiores. Dentro de los factores que limitan la realización de la rehabilitación respiratoria, 20 (63%) centros refieren que el horario de atención es uno de los factores más limitantes, mientras que 23 (72%) centros refieren que no cuentan con espacio físico adecuado y 22 (69%) centros relatan no contar con los implementos mínimos necesarios. Discusión: Los datos obtenidos indican que en la mayoría de los centros encuestados no se realiza rehabilitación respiratoria como parte del tratamiento del paciente con Enfermedad Pulmonar Obstructiva Crónica, principalmente por problemas de recursos humanos, materiales e infraestructura.

  8. Aspectos psicológicos de la rehabilitación pulmonar en el paciente con enfermedad pulmonar obstructiva crónica Psychological aspects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    PAULA REPETTO L

    2011-06-01

    Full Text Available Se realiza una revisión de la literatura sobre los aspectos psicológicos de la rehabilitación pulmonar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC. La revisión está organizada en cuatro temas centrales. Primero, se presentan las manifestaciones psicológicas más habituales descritas en pacientes con EPOC, en particular trastornos depresivos y ansiosos. Segundo, se discuten algunos factores psicosociales que pueden influir en el tratamiento y curso de la enfermedad, incluyendo las siguientes: apoyo social, creencias de enfermedad, autoeficacia y autogestión en salud. Tercero, se presentan los tratamientos y las intervenciones que se consideran son más efectivas para el manejo de estos trastornos psicológicos en pacientes con EPOC y se discute su evidencia. El capítulo termina con una discusión sobre la influencia de la rehabilitación pulmonar en la sintomatología psicológica y psiquiátrica de estos pacientes.We present a review of the literature available on the psychological issues of the rehabilitation of patients with chronic obstructive pulmonary disease (COPD. The review is organized around four main themes. First, we present the more commonly psychological manifestations described among patients with COPD, in particular depression and anxiety. Second, we discuss some psychosocial factors that may influence the treatment and course of the disease, including the following: social support, illness beliefs, self-efficacy and self- management (human agency. Third, we present treatments and interventions that are considered to be effective for the management of these psychological disorders in patients with COPD and discuss the evidence. The chapter ends with a discussion about the influence of the pulmonary rehabilitation on the psychological and psychiatric symptoms that these patients present.

  9. Maxillomandibular Advancement in Obstructive Sleep Apnea Syndrome Patients: a Restrospective Study on the Sagittal Cephalometric Variables

    Directory of Open Access Journals (Sweden)

    Paolo Ronchi

    2013-06-01

    Full Text Available Objectives: The present retrospective study analyzes sagittal cephalometric changes in patients affected by obstructive sleep apnea syndrome submitted to maxillomandubular advancement. Material and Methods: 15 adult sleep apnea syndrome (OSAS patients diagnosed by polysomnography (PSG and treated with maxillomandubular advancement (MMA were included in this study. Pre- (T1 and postsurgical (T2 PSG studies assessing the apnea/hypopnea index (AHI and the lowest oxygen saturation (LSAT level were compared. Lateral cephalometric radiographs at T1 and T2 measuring sagittal cephalometric variables (SNA, SNB, and ANB were analyzed, as were the amount of maxillary and mandibular advancement (Co-A and Co-Pog, the distance from the mandibular plane to the most anterior point of the hyoid bone (Mp-H, and the posterior airway space (PAS.Results: Postoperatively, the overall mean AHI dropped from 58.7 ± 16 to 8.1 ± 7.8 events per hour (P < 0.001. The mean preoperative LSAT increased from 71% preoperatively to 90% after surgery (P < 0.001. All the patients in our study were successfully treated (AHI < 20 or reduced by 50%. Cephalometric analysis performed after surgery showed a statistically significant correlation between the mean SNA variation and the decrease in the AHI (P = 0.01. The overall mean SNA increase was 6°.Conclusions: Our findings suggest that the improvement observed in the respiratory symptoms, namely the apnea/hypopnea episodes, is correlated with the SNA increase after surgery. This finding may help maxillofacial surgeons to establish selective criteria for the surgical approach to sleep apnea syndrome patients.

  10. Distraction osteogenesis as a treatment of obstructive sleep apnea syndrome

    Science.gov (United States)

    Tsui, Wai Kin; Yang, Yanqi; Cheung, Lim Kwong; Leung, Yiu Yan

    2016-01-01

    Abstract Background: To conduct a systematic review to answer the clinical question “What are the effectiveness of mandibular distraction osteogenesis (MDO) and its complications to treat patients with obstructive sleep apnea syndrome (OSAS)?”. Methods: A systematic search including a computer search with specific keywords, reference list search, and manual search were done. Relevant articles on MDO were assessed and selected in 3 rounds for final review based on 5 predefined inclusion criteria and followed by a round of critical appraisal. Different types of distraction and their treatment outcomes of OSAS were recorded with standardized form and analyzed. Results: Twelve articles were included in the final review. A total of 256 patients aged 7 days to 60 years were treated with either external or internal MDO, with a mean follow-up period of 6 to 37 months. The average distraction distance of 12 to 29 mm was achieved with various distraction protocols. The success rate for adult patients was 100%, and cure rates were ranged from 82% to 100%. The definition of success or cure for OSAS in children or infants was not defined. Therefore, there were no clearly reported success or cure rates for children/infants in the included studies. However, all studies reported that these patients showed significant improvement in OSAS, with many of them who avoided tracheostomy or had the tracheostomy decannulated. The complication rates were ranged from 0% to 21.4%, with most being from local wound infections or neurosensory disturbances. Conclusion: This systematic review showed that MDO was effective in resolving OSAS in adults with retrognathic mandible. MDO also showed promising results in infants or children with OSAS. From the results of this systematic review, we recommend to define the criteria of success or cure for OSAS surgery in children and infants. We also recommend setting up randomized controlled trials to compare MDO with traditional maxillomandibular

  11. Heart rate responses to autonomic challenges in obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Paul M Macey

    Full Text Available Obstructive sleep apnea (OSA is accompanied by structural alterations and dysfunction in central autonomic regulatory regions, which may impair dynamic and static cardiovascular regulation, and contribute to other syndrome pathologies. Characterizing cardiovascular responses to autonomic challenges may provide insights into central nervous system impairments, including contributions by sex, since structural alterations are enhanced in OSA females over males. The objective was to assess heart rate responses in OSA versus healthy control subjects to autonomic challenges, and, separately, characterize female and male patterns. We studied 94 subjects, including 37 newly-diagnosed, untreated OSA patients (6 female, age mean ± std: 52.1 ± 8.1 years; 31 male aged 54.3 ± 8.4 years, and 57 healthy control subjects (20 female, 50.5 ± 8.1 years; 37 male, 45.6 ± 9.2 years. We measured instantaneous heart rate with pulse oximetry during cold pressor, hand grip, and Valsalva maneuver challenges. All challenges elicited significant heart rate differences between OSA and control groups during and after challenges (repeated measures ANOVA, p<0.05. In post-hoc analyses, OSA females showed greater impairments than OSA males, which included: for cold pressor, lower initial increase (OSA vs. control: 9.5 vs. 7.3 bpm in females, 7.6 vs. 3.7 bpm in males, OSA delay to initial peak (2.5 s females/0.9 s males, slower mid-challenge rate-of-increase (OSA vs. control: -0.11 vs. 0.09 bpm/s in females, 0.03 vs. 0.06 bpm/s in males; for hand grip, lower initial peak (OSA vs. control: 2.6 vs. 4.6 bpm in females, 5.3 vs. 6.0 bpm in males; for Valsalva maneuver, lower Valsalva ratio (OSA vs. control: 1.14 vs. 1.30 in females, 1.29 vs. 1.34 in males, and OSA delay during phase II (0.68 s females/1.31 s males. Heart rate responses showed lower amplitude, delayed onset, and slower rate changes in OSA patients over healthy controls, and impairments may be more pronounced in

  12. A study on correlation of obstructive sleep apnea-hypopnea syndrome and perihematoma edema of hypertensive cerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    高晓刚

    2013-01-01

    Objective To analyse the correlation of obstructive sleep apnea-hypopnea syndrome (OSAHS) and perihematoma edema of hypertensive cerebral hemorrhage.Methods One hundred and forty-four patients with hypertensive cerebral hemorrhage were collected and 78 of

  13. Role of continuous positive airway pressure in patients with combined sleep apnea syndrome without congestive heart failure

    Directory of Open Access Journals (Sweden)

    Shereen Farghaly

    2016-07-01

    Conclusion: CPAP can be effective in combined obstructive and central apnea patients without heart failure with consideration of individual variability. A trial of CPAP titration should be done in those patients.

  14. Validation of the MediByte® Type 3 Portable Monitor Compared with Polysomnography for Screening of Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Helen S Driver

    2011-01-01

    Full Text Available BACKGROUND: Portable monitors are increasingly being used as a diagnostic screening tool for obstructive sleep apnea (OSA, and in-laboratory validation of these devices with polysomnography (PSG is required.

  15. Treatment of obstructive sleep apnea syndrome with a Kampo-formula, San'o-shashin-to: a case report.

    Science.gov (United States)

    Hisanaga, A; Saitoh, O; Fukuda, H; Kurokawa, K; Okabe, A; Tachibana, H; Hagino, H; Mita, T; Yamashita, I; Tsutsumi, M; Kurachi, M; Itoh, T

    1999-04-01

    The following describes a 76-year-old male with obstructive sleep apnea syndrome successfully treated with a Kampo-formula, San'o-shashin-to (Formula medicamentorum tres ad dispellendi cordis). Polysomnography, performed before and after administration of San'o-shashin-to, revealed that the apnea index decreased from 11.1 events/hour to 4.1 events/hour, and that the apnea plus hypopnea index decreased from 18.4 events/hour to 10.7 events/hour. The patient was normo-weight (body mass index: 20.4 kg/m2), and events of sleep apnea and hypopnea were mostly noted during a non-rapid eye movement sleep. It is possible that San'o-shashin-to has some alleviating effects on the upper airway resistance during sleep.

  16. Obstructive sleep apnea in a Danish population of men and women aged 60-80 years with nocturia

    DEFF Research Database (Denmark)

    Bing, Mette Hornum; Jennum, Poul; Moller, Lars Alling;

    2012-01-01

    The aim of the present study was in a case-control design to evaluate the association between nocturia and obstructive sleep apnea, in men and women who had nocturia ≥ 2 per night (nocturics) compared to those without nocturia (controls).......The aim of the present study was in a case-control design to evaluate the association between nocturia and obstructive sleep apnea, in men and women who had nocturia ≥ 2 per night (nocturics) compared to those without nocturia (controls)....

  17. [Influence of a program of physical activity in children and obese adolescents with sleep apnea; study protocol].

    Science.gov (United States)

    Aguilar Cordero, M J; Sánchez López, A M; Mur Villar, N; Sánchez Marenco, A; Guisado Barrilao, R

    2013-01-01

    Recent studies show an alarming increase in the rate of overweight / obesity among the infant - juvenile population. Obesity in childhood is associated with a significant number of complications, such as sleep apnea syndrome, insulin resistance and type 2 diabetes, hypertension, cardiovascular disease and some cancers. It is estimated that the prevalence of sleep apnea in children is 2-3% in the general population, while in obese adolescents, varies between 13% and 66%, according to various studies. It is associated with impairment of neurocognitive function, behavior, cardiovascular system, metabolic disorders and growth. Sleep apnea is a serious public health problem that increases when children and adolescents are overweight or obese. We hypothesize that aerobic endurance exercise can be an effective treatment for obesity and apnea at the same time. The aim of this study was to determine the influence of physical activity in children and adolescents with overweight / obesity in sleep apnea. An observational, descriptive, prospective, longitudinal study will be carried out in children with sleep apnea and obesity. The universe will be made up of 60 children and adolescents aged between 10 and 18 years, attending the endocrinology service for suffering of obesity in the Hospital Clinico San Cecilio of Granada during the period September 2012-September 2013. The smple will consist of children and adolescents that meet these characteristics and to whom their parents/tutors have authorized through the informed consent. Sleep apnea in children wil be measured by polysomnography and sleep quality questionnaire. There will also be a nutritional assessment by a food frequency questionnaire and an anthropometric assessment. Among the expected results are the lower overweight and obesity in children through the physical activity program. To reduce apnea and to improve sleep quality.

  18. Quality of life impairment in patients of obstructive sleep apnea and its relation with the severity of disease

    OpenAIRE

    Naveen Dutt; Ashok Kumar Janmeja; Prasanta Raghab Mohapatra; Anup Kumar Singh

    2013-01-01

    Background: Several studies have demonstrated considerable impairment of quality of life (QOL) in obstructive sleep apnea (OSA) patients, but its relation with severity of OSA is yet unclear. Study Objectives: To investigate the effects of OSA on the QOL and its association with the disease severity. Design and Setting: Observational, prospective case-control study. Materials and Methods: QOL of 69 OSA patients and 41 healthy controls were assessed using the Calgary sleep apnea quality of lif...

  19. Colloidal cyst of the third ventricle. Case presentation Quiste coloide del tercer ventrículo. Presentación de un caso

    Directory of Open Access Journals (Sweden)

    Joan O Rojas Fuentes

    2009-09-01

    Full Text Available

    Colloidal cysts are congenital intracranial benign lesions of the anterior superior portion of the third ventricle. They represent between the 0,2 and 2 % of all the intracranial tumours and represent the 15 or 20 % of all the intraventricular masses. They become symptomatic during the adolescence or early adulthood and start normally with migraine or symptoms of intracranial hypertension causing obstructive hydrocephaly. We present the case of a teenager of 18 years of age with history of migraine after two years and the symptoms worsened in intensity and frequency including vomiting and bilateral paresthesia; the diagnosis was obstructive hydrocephaly with colloidal cyst of the third ventricle. An appropriate practice was adopted due to the uncertain diagnosis in order to avoid neurological damage and death. We discussed the main characteristics of the colloidal cyst, its clinical presentation and radiological characteristics and we performed.

    Los quistes coloides son lesiones intracraneales congénitas benignas, de la porción antero-superior del tercer ventrículo. Suponen del 0,2 al 2 % de todos los tumores intracraneales y representan del 15 al 20 % de todas las masas intraventriculares. Comienzan a ser sintomáticos en la adolescencia o edad adulta temprana, generalmente con manifestaciones de cefalea o síntomas de hipertensión intracraneal al provocar hidrocefalia obstructiva. Se presenta una adolescente de 18 años con historia de cefalea de 2 años de evolución, cuyos síntomas fueron empeorando en intensidad y frecuencia, acompañados de vómitos y parestesias bilaterales; se le diagnosticó hidrocefalia obstructiva con quiste coloide del tercer ventrículo. Ante la sospecha del diagnóstico se tomó una conducta adecuada, para evitar el deterioro neurológico y la muerte. Se discutieron las principales características del quiste coloide, su cuadro clínico y radiológico.

  20. A Robust Apnea Period Detection Method in Changing Sleep Posture by Average Mutual Information of Heartbeat and Respiration

    Science.gov (United States)

    Kurihara, Yosuke; Watanabe, Kajiro; Kobayashi, Kazuyuki; Tanaka, Tanaka

    Sleep disorders disturb the recovery from mental and physical fatigues, one of the functions of the sleep. The majority of those who with the disorders are suffering from Sleep Apnea Syndrome (SAS). Continuous Hypoxia during sleep due to SAS cause Circulatory Disturbances, such as hypertension and ischemic heart disease, and Malfunction of Autonomic Nervous System, and other severe complications, often times bringing the suffers to death. In order to prevent these from happening, it is important to detect the SAS in its early stage by monitoring the daily respirations during sleep, and to provide appropriate treatments at medical institutions. In this paper, the Pneumatic Method to detect the Apnea period during sleep is proposed. Pneumatic method can measure heartbeat and respiration signal. Respiration signal can be considered as noise against heartbeat signal, and the decrease in the respiration signal due to Apnea increases the Average Mutual Information of heartbeat. The result of scaling analysis of the average mutual information is defined as threshold to detect the apnea period. The root mean square error between the lengths of Apnea measured by Strain Gauge using for reference and those measured by using the proposed method was 3.1 seconds. And, error of the number of apnea times judged by doctor and proposal method in OSAS patients was 3.3 times.

  1. Correlation between chronic obstructive pulmonary disease and obstructive sleep apnea syndrome in a general population in Iran

    Directory of Open Access Journals (Sweden)

    Babak Amra

    2011-01-01

    Full Text Available Background: The aim of this study was to evaluate epidemiological relationship between chronic obstructive pulmonary disease and sleep apnea syndrome in a sample of Persian population. Methods: As a part of a population-based cross-sectional study, 3900 randomly selected individuals aged 15 years or older were invited to take part in the survey; 3770 individuals (96.6% agreed to fill out the respiratory and sleep questionnaire. Those subjects suspected to have either chronic obstructive pulmonary disease and/or obstructive sleep apnea underwent spirometry and polysomnography test if indicated. Spirometric measurements were performed on 420 invited responders. Polysomnography measurements were performed on 25 of the responders. Results: Prevalence rates for sleep apnea, chronic obstructive pulmonary disease and current asthma were 4.98%, 5.7% and 3.1%, respectively. Logistic regression showed independent associations between sleep apnea and chronic obstructive pulmonary disease. There was no significant independent association between sleep apnea symptoms and current asthma and wheeze ever. Conclusions: These observations indicated relationship between chronic obstructive pulmonary disease and obstructive sleep apnea. These observations indicated the necessity of further studies to explain the possible common pathogenic mechanisms involved in two disease entities.

  2. Variation of the anal resting pressure induced by postexpiratory apnea effort in patients with constipation

    Directory of Open Access Journals (Sweden)

    Thaís Helena Benetti

    2011-03-01

    Full Text Available CONTEXT: Intestinal constipation - a common symptom among the general population - is more frequent in women. It may be secondary to an improper diet or organic or functional disturbances, such as dyskinesia of the pelvic floor. This is basically characterized by the absence of relaxation or paradoxical contraction of the pelvic floor and anal sphincter during evacuation. OBJECTIVE: To analyze, by manometric data, the anal pressure variation at rest, during evacuation effort by using the Valsalva maneuver and forced post-expiratory apnea in subjects with secondary constipation. METHODS: Twenty-one patients (19 females - 90.4% with a mean age of 47.5 years old (23-72 were studied. The diagnosis was performed using anorectal manometry, with a catheter containing eight channels disposed at the axial axis, measuring the proximal (1 and distal (2 portions of the anal orifice. The elevation of the pressure values in relation to the resting with the evacuation effort was present in all patients. The Agachan score was used for clinical evaluation of constipation. The variables studied were: mean anal pressure of the anal orifice for 20 seconds at rest, the effort of evacuation using Valsalva maneuver and the effort of evacuation during apnea after forced expiration, as well as the area under the curve of the manometric tracing at moments Valsalva and apnea. RESULTS: The analysis of the mean values of the anal pressure variation at rest evidenced difference between proximal and distal channels (P = 0.007, independent of the moment and tendency to differ during moments Valsalva and apnea (P = 0.06. The mean of values of the area under the manometric tracing curve showed differences between moments Valsalva and apnea (P = 0.0008, either at the proximal portion or at the distal portion of the anal orifice. CONCLUSION: The effort of evacuation associated with postexpiratory apnea, when compared with the effort associated with the Valsalva maneuver, provides

  3. Veloplastia funcional secundaria: Una alternativa no obstructiva en el tratamiento de la insuficiencia velofaríngea Secondary functional veloplasty: a non-obstructive approach to valopharyngeal insufficiency

    Directory of Open Access Journals (Sweden)

    J. Cortés Araya

    2004-04-01

    Full Text Available Introducción. La insuficiencia velofaríngea es quizá la secuela más común de las técnicas de veloplastia realizadas para la corrección de las fisuras palatinas. A menudo la terapia fonoaudiológica se encuentra limitada, obteniéndose generalmente sólo resultados parciales. En estos casos la faringoplastia se presenta como el tratamiento de elección, existiendo diversas técnicas publicadas. Éstas, cualesquiera que sean, tienen en común la utilización de colgajos faríngeos que determinan una reducción del diámetro de la vía aérea superior con el consiguiente riesgo de generar un trastorno obstructivo del sueño. Objetivos. En el ánimo de obviar esta situación y simultáneamente alargar y dar competencia velopalatina, se ha diseñado una técnica quirúrgica que tiene por objetivo la reconstrucción morfofuncional velar o veloplastia funcional secundaria, inspirada en los principios de Delaire. Material y técnica quirúrgica. Presentamos nuestra experiencia basada en una serie de 15 casos tratados de esta nueva manera: se divide completamente el paladar blando, incindiendo sobre la línea media y exponiendo ambos hemivelos hasta la región retrouvular. En ese momento se busca e identifican las estructuras musculares remanentes, se separan del borde óseo palatino y de las mucosa nasal y bucal y se unen en una posición más posterior con las contralaterales en la línea media. Resultados. En nuestra experiencia se ha logrado el alargamiento velopalatino y la corrección o mejoramiento de rinolalias. En la evaluación de resultados hemos utilizado tanto el examen clínico fonoaudiológico como la aerofonoscopía con muy buenos resultados comparativos.Introduction: Velopharyngeal insufficiency could be produced by a partial or inappropriate veloplasty performed to correct palate clefts. Phonoaudiologic therapy is often limited, and generally only obtains partial results. In these cases, pharyngoplasty seems to be the procedure

  4. [Upper airway's 3D analysis of patients with obstructive sleep apnea using tomographic cone beam].

    Science.gov (United States)

    Bruwier, A; Poirrier, A L; Limme, M; Poirrier, R

    2014-12-01

    The progress of medical imaging over the last decades has led to a better understanding of the upper airway structure in sleep-disordered patients. The Obstructive Sleep Apnea Syndrome (OSA) is attributed to a functional narrowing of the upper airway, particularly of the oropharynx, during sleep. This narrowing is multifactorial. We have shown that in 60% cases, the maxilla (nasal pyramid) seems too narrow. A mandible retroposition may also play a dominant role in 30% of the cases. Both scenarios can be combined. Cone Beam Computed Tomography (CBCT) is a new medical imaging technique that permits to visualize the upper airway with less ionizing radiation than the conventional scanner. To date, only five authors have performed an upper airway's 3D analysis of sleep apnea patients with cone beam. A better understanding of the affected segment of the upper airway should help refine treatment options.

  5. Surgical management of maxillomandibular advancement in sleep apnea patients: specific technical considerations.

    Science.gov (United States)

    Gilon, Y; Raskin, S; Heymans, O; Poirrier, R

    2001-01-01

    Maxillomandibular advancement is an integral part of the surgical treatment of patients suffering from obstructive sleep apnea. A number of publications report its efficacy and have attempted to define predictive success criteria. However, few authors have shown an interest in the surgical specificity of this intervention and in the difficulties that can be encountered, which differ from those seen in conventional orthognathic surgery. In this article, a series of patients treated with maxillomandibular osteotomy to correct obstructive sleep apnea syndrome (n = 17) are compared with patients who underwent surgery for the correction of dentofacial disharmonies (n = 33). Observations emphasized the importance of respecting a strict surgical and postsurgical protocol to avoid any technical traps linked to maxillomandibular advancement, both in preoperative simulations and during and after surgery. Results concerning sleep parameters will be the subject of a future publication.

  6. [Effect of positive pressure respiration on diurnal catecholamine excretion by patients with obstructive sleep apnea].

    Science.gov (United States)

    Cieślicki, J; Wocial, B; Koziej, M; Pałasiewicz, G; Zieliński, J

    1996-02-01

    The aim of the study was to investigate effects of CPAP treatment on diurnal catecholamine excretion in urine in patients with obstructive sleep apnea (OSA). 12 males with severe OSA (mean AHI = 63) were measured in 3 separate 8 hour samples by fluorimetric method. NA levels were higher in OSA patients in all urine samples than in obese, mildly hypertensive males (control group = C). In C group patients NA levels were significantly lower at night than during the day contrary to OSA patients in whom NA levels dropped insignificantly during sleep. In OSA patients NA levels during sleep correlated with severity of apneas (r = 0.42) and night hypoxaemia (r = -0.46). CPAP treatment resulted in significant fall in NA levels during sleep (p sleep in OSA patients may be related to sleep fragmentation and hypoxia. CPAP treatment restores normal circadian rhythm of NA excretion.

  7. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea.

    Science.gov (United States)

    Suratt, P M; McTier, R F; Findley, L J; Pohl, S L; Wilhoit, S C

    1987-10-01

    The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea (OSA). We therefore prospectively studied eight patients before and after dietary-induced weight loss. Mean weight loss was 20.6 kg +/- 12.8 SD. After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness, and in the number of desaturation episodes per hour of sleep, average desaturation per episode, and number of movement arousals. The number of apneas and hypopneas significantly decreased in six of eight patients. There was a significant correlation between body mass index and number of disordered breathing events. Nasopharyngeal collapsibility and pulse flow resistance decreased in awake patients after weight loss. We conclude that moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness, decreases the number of disordered breathing events in many patients, decreases the collapsibility of the nasopharyngeal airway.

  8. Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea.

    Science.gov (United States)

    McEntire, Dan M; Kirkpatrick, Daniel R; Kerfeld, Mitchell J; Hambsch, Zakary J; Reisbig, Mark D; Agrawal, Devendra K; Youngblood, Charles F

    2014-11-01

    The perioperative care of obstructive sleep apnea (OSA) patients is currently receiving much attention due to an increased risk for complications. It is established that postoperative changes in sleep architecture occur and this may have pathophysiological implications for OSA patients. Upper airway muscle activity decreases during rapid eye movement sleep (REMS). Severe OSA patients exhibit exaggerated chemoreceptor-driven ventilation during non-rapid eye movement sleep (NREMS), which leads to central and obstructive apnea. This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients. In particular, we addressed three questions in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA. Indeed, these classes of drugs alter sleep architecture, which likely significantly contributes to abnormal postoperative sleep architecture, exacerbation of OSA and postoperative complications.

  9. Age-related outcomes of sleep apnea surgery in infants and children.

    Science.gov (United States)

    Januszkiewicz, J S; Cohen, S R; Burstein, F D; Simms, C

    1997-05-01

    This study was designed to determine whether age at the time of surgery is an important influencing factor on outcomes following surgical correction of severe refractory obstructive sleep apnea (OSA) in infants and children. Data were collected prospectively on 55 children, all with severe OSA refractory to conservative medical and surgical measures, who underwent combinations of soft-tissue and skeletal procedures aimed at relieving their airway obstruction. The study population was subdivided for analysis into three groups based on age at the time of surgery (> 36 months, > 12 to 36 months group demonstrated a significant improvement in respiratory disturbance index (RDI), apnea index, and lowest overnight oxygen saturation postoperatively. Only RDI improved significantly in the > 12 to 36 months group. Surgical management of severe refractory OSA in children age < or = 12 months is more difficult and less likely to succeed. The reasons for this are discussed and recommendations for management are given.

  10. Sleep apnea termination decreases cerebral blood volume: a near-infrared spectroscopy case study

    Science.gov (United States)

    Virtanen, Jaakko; Noponen, Tommi; Salmi, Tapani; Toppila, Jussi; Meriläinen, Pekka

    2009-07-01

    Medical near-infrared spectroscopy (NIRS) can be used to estimate cerebral haemodynamic changes non-invasively. Sleep apnea is a common sleep disorder where repetitive pauses in breathing decrease the quality of sleep and exposes the individual to various health problems. We have measured oxygenated and deoxygenated haemoglobin concentration changes during apneic events in sleep from the forehead of one subject using NIRS and used principal component analysis to extract extracerebral and cortical haemodynamic changes from NIRS signals. Comparison of NIRS signals with EEG, bioimpedance, and pulse oximetry data suggests that termination of apnea leads to decreases in cerebral blood volume and flow that may be related to neurological arousal via neurovascular coupling.

  11. Circulating Endocannabinoids and Insulin Resistance in Patients with Obstructive Sleep Apnea.

    Science.gov (United States)

    Wang, Xiaoya; Yu, Qin; Yue, Hongmei; Zhang, Jiabin; Zeng, Shuang; Cui, Fenfen

    2016-01-01

    Objectives. The purpose of this study is to investigate the relationship between plasma endocannabinoids and insulin resistance (IR) in patients with obstructive sleep apnea (OSA). Methods. A population of 64 with OSA and 24 control subjects was recruited. Body mass index (BMI), waist circumference, lipids, blood glucose and insulin, homeostasis model of assessment for insulin resistance index (HOMA-IR), anandamide (AEA), 1/2-arachidonoylglycerol (1/2-AG), and apnea-hypopnea index (AHI) were analyzed. Results. Fasting blood insulin (22.9 ± 7.8 mIU/L versus 18.5 ± 7.2 mIU/L, P endocannabinoids levels, especially AEA, were associated with IR and AHI in patients with OSA.

  12. Application of lingual tonsillectomy to sleep apnea syndrome involving lingual tonsils.

    Science.gov (United States)

    Suzuki, Kenji; Kawakatsu, Kenji; Hattori, Chikaya; Hattori, Hirokazu; Nishimura, Yoichi; Yonekura, Arata; Yagisawa, Mikio; Nishimura, Tadao

    2003-01-01

    In sleep apnea syndrome, surgical treatment is applied in obstructive-type cases and some mixed-type cases. If the obstructive part is in the root of the tongue, forward transfer of the tongue, lingual tonsillectomy and laser midline glossectomy are applied. In this study, we demonstrate the surgical technique of lingual tonsillectomy using an ultrasonic coagulating dissector (SonoSurg) with a blade tip shape developed in our department. We conclude that lingual tonsillectomy using SonoSurg, which we have frequently used, should be the first choice of treatment for snoring and sleep apnea caused by hypertrophy of the lingual tonsils from the viewpoints of effectiveness, prevention of hemorrhage, safety and handling.

  13. Continuous positive airway pressure ameliorated severe pulmonary hypertension associated with obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Ogawa,Aiko

    2006-06-01

    Full Text Available

    A 52-year-old obese woman was admitted to our institution for evaluation of dyspnea and pulmonary hypertension (PH. Polysomnography revealed severe obstructive sleep apnea (OSA with an apnea hypopnea index of 99.8. Treatment with nocturnal continuous positive airway pressure (CPAP resulted in correction of daytime hypoxemia, hypercapnia, and near-normalization of pulmonary artery pressure. To our knowledge, this is the most severe case of OSA-associated PH (approximately70 mmHg reported to date, and it was successfully treated with nocturnal CPAP. This case demonstrates that OSA should be considered and polysomnography performed in all patients with PH, irrespective of severity, and that nocturnal CPAP has therapeutic effects on both OSA and daytime PH.

  14. [Obstructive sleep apnea-hypopnea syndrome in children: beyond adenotonsillar hypertrophy].

    Science.gov (United States)

    Esteller, Eduard

    2015-01-01

    The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner.

  15. COMPARISON OF CBCT PARAMETERS AND SLEEP QUESTIONNAIRES IN SLEEP APNEA PATIENTS AND CONTROLS

    Science.gov (United States)

    Enciso, Reyes; Nguyen, Manuel; Shigeta, Yuko; Ogawa, Takumi; Clark, Glenn T.

    2009-01-01

    Objective To compare the Cone-Beam Computerized Tomography (CBCT) scan measurements between patients with Obstructive Sleep Apnea (OSA) and snorers to develop a prediction model for OSA based on CBCT imaging and the Berlin Questionnaire. Materials and methods 80 subjects (46 OSA patients with Apnea-Hypoapnea Index [AHI]≥ 10 and 34 snorers AHI57 years, male gender, a “high risk” Berlin Questionnaire and narrow upper airway lateral dimension (<17mm) were identified as significant risk factors for OSA. The results of this study indicate that 3-dimensional CBCT airway analysis could be used as a tool to assess the presence and severity of OSA. The presence and severity (as measured by the RDI) of OSA is associated with a narrow lateral dimension of the airway, increasing age, male gender, and the Berlin questionnaire. PMID:20123412

  16. Hipercoagulabilidad y daño endotelial en pacientes con enfermedad pulmonar obstructiva crónica en fase estable Hypercoagulability state and endotelial injury in stable chronic obstructive pulmonary disease patients

    Directory of Open Access Journals (Sweden)

    M. A. Aibar

    2010-04-01

    Full Text Available La enfermedad pulmonar obstructiva crónica es en la actualidad la cuarta causa de muerte en nuestro país. El principal agente causal de la enfermedad es el tabaco, cuyos efectos sobre el árbol bronquial no se limitan al parénquima pulmonar sino que además lesionan la pared endotelial, lo que podría contribuir a la aparición de trombosis, isquemia o hipertensión pulmonar. En nuestro trabajo se estudia la existencia de un estado protrombótico en estos pacientes caracterizado por la activación de la coagulación y por el daño endotelial y, para ello, se comparan las cifras de marcadores bioquímicos en enfermos con EPOC y en sujetos sanos. Se seleccionaron 51 pacientes con EPOC y un grupo de 30 voluntarios sanos de edades similares y se compararon las cifras de fibrinógeno, D-dímero, factor VIII y factor von Willebrand (FvW:Ag y FvW:Rico. Se observó un aumento de todos los marcadores en el grupo de pacientes con respecto al grupo de controles sanos. Las diferencias encontradas fueron estadísticamente significativas en todos los casos (pCOPD is currently the fourth cause of death in our country; the main causal agent of the disease is tobacco whose effects on the bronchial tree are not limited to the lung parenchyma. The action of tobacco injures the endothelial wall, which could contribute to lung thrombosis, ischemic events or secondary pulmonary hypertension. Our work investigates the existence of a prothombotic state in these patients, characterized by the activation of clotting and endothelial injury, comparing the values of biochemical markers between COPD patients and healthy volunteers. Fifty-one patients with COPD and a group of 30 healthy volunteers of similar ages were selected and fibrinogen, D-dimer, factor VIII and von Willebrand factor (FvW:Ag and FvW:Rico levels were compared. We found an increase of all markers in the patient group compared to the healthy control group. The differences found were statistically

  17. Added value of a mandible movement automated analysis in the screening of obstructive sleep apnea.

    Science.gov (United States)

    Maury, Gisele; Cambron, Laurent; Jamart, Jacques; Marchand, Eric; Senny, Frédéric; Poirrier, Robert

    2013-02-01

    In-laboratory polysomnography is the 'gold standard' for diagnosing obstructive sleep apnea syndrome, but is time consuming and costly, with long waiting lists in many sleep laboratories. Therefore, the search for alternative methods to detect respiratory events is growing. In this prospective study, we compared attended polysomnography with two other methods, with or without mandible movement automated analysis provided by a distance-meter and added to airflow and oxygen saturation analysis for the detection of respiratory events. The mandible movement automated analysis allows for the detection of salient mandible movement, which is a surrogate for arousal. All parameters were recorded simultaneously in 570 consecutive patients (M/F: 381/189; age: 50±14 years; body mass index: 29±7 kg m(-2) ) visiting a sleep laboratory. The most frequent main diagnoses were: obstructive sleep apnea (344; 60%); insomnia/anxiety/depression (75; 13%); and upper airway resistance syndrome (25; 4%). The correlation between polysomnography and the method with mandible movement automated analysis was excellent (r: 0.95; P<0.001). Accuracy characteristics of the methods showed a statistical improvement in sensitivity and negative predictive value with the addition of mandible movement automated analysis. This was true for different diagnostic thresholds of obstructive sleep severity, with an excellent efficiency for moderate to severe index (apnea-hypopnea index ≥15h(-1) ). A Bland & Altman plot corroborated the analysis. The addition of mandible movement automated analysis significantly improves the respiratory index calculation accuracy compared with an airflow and oxygen saturation analysis. This is an attractive method for the screening of obstructive sleep apnea syndrome, increasing the ability to detect hypopnea thanks to the salient mandible movement as a marker of arousals.

  18. [The role of maxillofacial surgery in obstructive sleep hypopnea and apnea syndrome].

    Science.gov (United States)

    Gilon, Yves; Raskin, Sylviane; Heymans, Olivier; Poirrier, Robert

    2002-01-01

    One of the most common symptoms of obstructive sleep apnea syndrome (OSAS) is daytime drowsiness. It is associated with a high cardiovascular morbidity and mortality, and an elevated incidence of car crashes. In general, young patients don't want conservative treatment because symptomatic and to prevent secondary effects. In this article, we briefly define sleep disorders and the interest of cephalometric examination. We describe the different treatment possibilities and stress the important role of orthognathic surgery in this syndrome.

  19. Parasomnias: Common sleep disorders in children suffering from obstructive sleep apnea syndrome

    OpenAIRE

    Alexander Torres Molina

    2010-01-01

    The sleep disorders have a tendency to chronic evolution in approximately the 30% of children and adolescents, what constitute the main parasomnias clinical expressions of these phenomena. The Obstructive Sleep Apnea Syndrome constitute a high prevailment ailment which affects the 2% of the childish population approximately it is considered an entity because of its cognitive and somatic resounding. Parasomnias are part of the complex symptomatic night cortege observed in OSAS, stablishing a d...

  20. Incidence of hypothyroidism and its correlation with polysomnography findings in obstructive sleep apnea.

    Science.gov (United States)

    Ozcan, K Murat; Selcuk, Adin; Ozcan, Ibrahim; Ozdas, Talih; Ozdogan, Fatih; Acar, Mustafa; Dere, Huseyin

    2014-11-01

    The aim of this study is to investigate the thyroid functions and its correlation with polysomnography findings in obstructive sleep apnea patients. This study was conducted on 203 patients evaluated with the complaints of snoring, witnessed apnea and daytime sleepiness and established polysomnography (PSG) indication between May 2008 and August 2011. All patients' nocturnal PSG recordings were carried out. The thyroid function was classified as euthyroid, subclinical hypothyroidism and clinical hypothyroidism after analyzing serum TSH and free T4 values. The correlation between the data obtained from PSG records and thyroid function values was statistically compared. Apnea hypopnea index obtained from PSG was in the range of 5.4-132.9/h, and mean value was 32.7/h. The lowest oxygen saturation level was in the range of 20-92 %, and the mean value was 76.4 %. According to PSG results, 55 patients (27.09 %) had mild obstructive sleep apnea syndrome (OSAS), 48 patients (23.65 %) had moderate OSAS and 100 patients (49.26 %) had severe OSAS. On evaluation of the thyroid function test results, 10.8 % (n = 22) of the patients were defined to have subclinical hypothyroidism and 1.97 % (n = 4) clinical hypothyroidism. We found a total of 12.77 % subclinical and clinical hypothyroidism in patients with OSAS. Though the incidence of hypothyroidism was pretty high in patients with OSA, there was no statistically significant correlation between thyroid functions and polysomnography findings. We suggest that evaluation of the thyroid functions is important and necessary in patients with OSAS. Polysomnography findings do not correlate statistically with thyroid function tests, addressing the need for thyroid screening for all OSAS patients.

  1. Acoustic-integrated dynamic MR imaging for a patient with obstructive sleep apnea.

    Science.gov (United States)

    Chen, Yunn-Jy; Shih, Tiffany Ting-Fang; Chang, Yi-Chung; Hsu, Ying-Chieh; Huon, Leh-Kiong; Lo, Men-Tzung; Pham, Van-Truong; Lin, Chen; Wang, Pa-Chun

    2015-12-01

    Obstructive sleep apnea syndrome (OSAS) is caused by multi-level upper airway obstruction. Anatomic changes at the sites of obstruction may modify the physical or acoustic properties of snores. The surgical success of OSA depends upon precise localization of obstructed levels. We present a case of OSAS who received simultaneous dynamic MRI and snore acoustic recordings. The synchronized image and acoustic information successfully characterize the sites of temporal obstruction during sleep-disordered breathing events.

  2. Time-on-task decrements in "steer clear" performance of patients with sleep apnea and narcolepsy

    Science.gov (United States)

    Findley, L. J.; Suratt, P. M.; Dinges, D. F.

    1999-01-01

    Loss of attention with time-on-task reflects the increasing instability of the waking state during performance in experimentally induced sleepiness. To determine whether patients with disorders of excessive sleepiness also displayed time-on-task decrements indicative of wake state instability, visual sustained attention performance on "Steer Clear," a computerized simple RT driving simulation task, was compared among 31 patients with untreated sleep apnea, 16 patients with narcolepsy, and 14 healthy control subjects. Vigilance decrement functions were generated by analyzing the number of collisions in each of six four-minute periods of Steer Clear task performance in a mixed-model analysis of variance and linear regression equations. As expected, patients had more Steer Clear collisions than control subjects (p=0.006). However, the inter-subject variability in errors among the narcoleptic patients was four-fold that of the apnea patients, and 100-fold that of the controls volunteers; the variance in errors among untreated apnea patients was 27-times that of controls. The results of transformed collision data revealed main effects for group (p=0.006), time-on-task (p=0.001), and a significant interaction (p=0.022). Control subjects showed no clear evidence of increasing collision errors with time-on-task (adjusted R2=0.22), while apnea patients showed a trend toward vigilance decrement (adjusted R2=0.42, p=0.097), and narcolepsy patients evidenced a robust linear vigilance decrement (adjusted R2=0.87, p=0.004). The association of disorders of excessive somnolence with escalating time-on-task decrements makes it imperative that when assessment of neurobehavioral performance is conducted in patients, it involves task durations and analyses that will evaluate the underlying vulnerability of potentially sleepy patients to decrements over time in tasks that require sustained attention and timely responses, both of which are key components in safe driving performance.

  3. Caffeine intake is independently associated with neuropsychological performance in patients with obstructive sleep apnea

    OpenAIRE

    Norman, Daniel; Bardwell, Wayne A; Loredo, Jose S.; Ancoli-Israel, Sonia; Heaton, Robert K; Dimsdale, Joel E.

    2008-01-01

    In healthy individuals, caffeine intake may improve performance on cognitive tests. Obstructive sleep apnea (OSA) is a disorder that has been associated with impaired cognitive function. In this study, we investigated whether increased caffeine intake in untreated patients with OSA is linked to better cognitive performance. Forty-five untreated OSA patients underwent baseline polysomnography after completing a survey of 24-h caffeine intake. Participants completed a battery of neuropsychologi...

  4. Accelerated Echo Planer J-resolved Spectroscopic Imaging of Putamen and Thalamus in Obstructive Sleep Apnea

    OpenAIRE

    Manoj K. Sarma; Macey, Paul M.; Rajakumar Nagarajan; Ravi Aysola; Ronald M Harper; M. Albert Thomas

    2016-01-01

    Obstructive sleep apnea syndrome (OSAS) leads to neurocognitive and autonomic deficits that are partially mediated by thalamic and putamen pathology. We examined the underlying neurochemistry of those structures using compressed sensing-based 4D echo-planar J-resolved spectroscopic imaging (JRESI), and quantified values with prior knowledge fitting. Bilaterally increased thalamic mI/Cr, putamen Glx/Cr, and Glu/Cr, and bilaterally decreased thalamic and putamen tCho/Cr and GABA/Cr occurred in ...

  5. Obstructive Sleep Apnea and the Subsequent Risk of Chronic Rhinosinusitis: A Population-Based Study

    OpenAIRE

    Li-Ting Kao; Shih-Han Hung; Herng-Ching Lin; Chih-Kuang Liu; Hung-Meng Huang; Chuan-Song Wu

    2016-01-01

    The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) still remains unclear. This retrospective cohort study aimed to investigate the relationship between OSA and subsequent CRS using a population-based dataset. The study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 971 patients with OSA for the study cohort and 4855 patients without OSA for the comparison cohort. Each patient was tracked for 5 years to determine those wh...

  6. Treatment of Insomnia, Insomnia Symptoms, and Obstructive Sleep Apnea During and After Menopause: Therapeutic Approaches

    OpenAIRE

    Tal, Joshua Z.; Suh, Sooyeon A.; Dowdle, Claire L.; Nowakowski, Sara

    2015-01-01

    Understanding sleep complaints among menopausal women is an emerging area of clinical and research interest. Several recent reviews have focused on mechanisms of menopausal insomnia and symptoms. In this review, we present a discussion on the most relevant and recent publications on the treatment of sleep disorders for menopausal women, with a focus on menopause-related insomnia, insomnia symptoms, and obstructive sleep apnea. We discuss both nonpharmacological and pharmacological treatments,...

  7. Apnea-Induced Rapid Eye Movement Sleep Disruption Impairs Human Spatial Navigational Memory

    OpenAIRE

    Varga, Andrew W.; Kishi, Akifumi; Mantua, Janna; Lim, Jason; Koushyk, Viachaslau; Leibert, David P.; Osorio, Ricardo S.; David M. Rapoport; Ayappa, Indu

    2014-01-01

    Hippocampal electrophysiology and behavioral evidence support a role for sleep in spatial navigational memory, but the role of particular sleep stages is less clear. Although rodent models suggest the importance of rapid eye movement (REM) sleep in spatial navigational memory, a similar role for REM sleep has never been examined in humans. We recruited subjects with severe obstructive sleep apnea (OSA) who were well treated and adherent with continuous positive airway pressure (CPAP). Restric...

  8. Laser midline glossectomy and lingual tonsillectomy as treatments for sleep apnea syndrome.

    Science.gov (United States)

    Yonekura, Arata; Kawakatsu, Kenji; Suzuki, Kenji; Nishimura, Tadao

    2003-01-01

    Preservation treatments for sleep respiratory disorders, such as the use of a dental device and the technique of nasal continuous positive air pressure, cause discomfort to the patient and are not radical treatments. Therefore, we performed operative therapy instead. Laser midline glossectomy was performed to treat constriction at the root of the tongue in 16 patients diagnosed with sleep apnea syndrome. We also tried lingual tonsil excision using the Harmonic Scalpel in three patients with stenosis at the base of the tongue.

  9. Relationship between the quality of life and the severity of obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    C. Lopes

    2008-10-01

    Full Text Available The effects of sleep disorders on the quality of life (QOL have been documented in the literature. Excessive sleepiness and altered circadian rhythms may negatively affect ability to learn, employment, and interpersonal relations, and directly degrade QOL. The objective of the present study was to evaluate the impact of obstructive sleep apnea syndrome of varying severity on QOL. The study was conducted on 1892 patients aged 18 years or older referred by a physician to the Sleep Institute, São Paulo, with complaints related to apnea (snoring, excessive daytime sleepiness, hyperarousal, and fatigue. They were submitted to overnight polysomnography for the diagnosis of sleep disorders from August 2005 through April 2006. The patients completed the Epworth Sleepiness Scale and QOL SF-36 sleep questionnaires. They were classified as non-physically active and physically active and not-sleepy and sleepy and the results of polysomnography were analyzed on the basis of the apnea hypopnea index (AHI. The apneic subjects showed a reduction in QOL which was proportional to severity. There was a significant decrease in all domains (physical functioning, role physical problems, bodily pain, general health perceptions, vitality, social functioning, emotional problems, general mental health for apneics with AHI >30, who generally were sleepy and did not participate in physical activities (P < 0.05. The present study provides evidence that the impact of sleep disorders on QOL in apneics is not limited to excessive daytime sleepiness and that physical activity can contribute to reducing the symptoms. Thus, exercise should be considered as an adjunct interventional strategy in the management of obstructive sleep apnea syndrome.

  10. Obstructive sleep apnea syndrome and fatty liver: Association or causal link?

    Institute of Scientific and Technical Information of China (English)

    Mohamed; H; Ahmed; Christopher; D; Byrne

    2010-01-01

    Obstructive sleep apnea (OSA) is a complex disorder that consists of upper airway obstruction, chronic intermittent hypoxia and sleep fragmentation. OSA is well known to be associated with hypoxia, insulin resistance and glucose intolerance, and these factors can occur in the presence or absence of obesity and metabolic syndrome. Although it is well established that insulin resistance, glucose intolerance and obesity occur frequently with non-alcoholic fatty liver disease (NAFLD), it is now becoming apparen...

  11. The predictive value of Muller maneuver in REM-dependent obstructive sleep apnea.

    Science.gov (United States)

    Ozcan, Kursat Murat; Ozcan, Muge; Ozdogan, Fatih; Hizli, Omer; Dere, Huseyin; Unal, Adnan

    2013-09-01

    To our knowledge, no studies up to date have investigated the correlation of rapid eye movement (REM) dependent obstructive sleep apnea syndrome (OSAS) and Muller maneuver. The aim of this study is to investigate whether REM-dependent OSAS is predicted by the findings of the Muller maneuver. The study was conducted on 149 patients with witnessed apnea and daytime sleepiness. Muller maneuver was performed to all patients and the obstruction site was determined using a five-point scale. Then, polysomnography of the patient was obtained and the apnea-hypopnea indexes were determined in total sleep time, REM-dependent sleep and non-REM-dependent sleep. The correlations between the Muller maneuver findings and polysomnographic data were analyzed. The ages of the patients included in the study ranged between 25 and 73 years with a mean age of 49.3 ± 10.1 years. Their mean body mass index was 30.8 ± 5.1 kg/m(2) (range 21.9-55.4 kg/m(2)). The patients' mean apnea-hypopnea indexes in total sleep time was 28.1 and ranged between 5.4 and 124.3. REM-dependent OSAS was determined in 49 patients. When the data were analyzed, it was determined that there were no statistically significant correlations between tongue base or lateral pharyngeal band obstruction at the level of hypopharynx and the REM-dependent OSAS. At the level of the soft palate, the obstruction caused by the lateral pharyngeal bands or soft palate and REM dependency did not show any statistically significant correlation (p > 0.05). In conclusion, Muller maneuver does not provide useful data to predict REM dependency of OSAS.

  12. The influence of upper airways diameter on the intensity of obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Jolanta Szymańska

    2014-03-01

    Full Text Available Introduction and Objective. Obstructive sleep apnea (OSA is characterized by at least 5 ten-second-long episodes of apnea or hypopnea, per hour of sleep. This disease may lead to severe, life-threatening complications. Therefore, risk analysis and its influence on disease intensity is crucial for proper implementation of preventive treatments. Objective. To determine the relation between the intensity of OSA expressed in Apnea-Hypopnea Index (AHI, and the anterior-posterior diameter of upper airways at the levels of soft palate and tongue base. Material and Method. Medical records of 41 patients with sleep apnea (AHI>4 diagnosed through polysomnographic examination obstructive were used for the study. The data consisted of: age and gender, polysomnographic examination results (AHI, lateral cephalogram with cephalomertic analysis, together with measurements of the upper and lower pharyngeal depth according to McNamara. Statistical analysis was carried out in accordance with Pearson’s r correlation coefficient test (Statistica 8.0 software package. Results. Analysis of the influence of upper airways diameter on the intensity of OSA showed that the value of upper Airways diameter at the tongue base level had no statistically significant impact on the value of AHI (p=0.795. However, a statistically significant impact of the value of upper airways diameter on the AHI value (p=0.008 at the soft palate level was observed. Patients with OSA have narrowed upper airways diameter. The value of AHI increases with the decrease of upper diameter and is not dependent on a lower diameter value. Patients with a decreased upper airways diameter should be informed about potential breathing disorders during sleep.

  13. High risk for obstructive sleep apnea in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Carla Renata Silva Andrechuk

    2015-10-01

    Full Text Available Objectives: to stratify the risk for obstructive sleep apnea in patients with acute myocardial infarction, treated at a public, tertiary, teaching hospital of the state of São Paulo, Brazil, and to identify related sociodemographic and clinical factors.Method: cross-sectional analytical study with 113 patients (mean age 59.57 years, 70.8% male. A specific questionnaire was used for the sociodemographic and clinical characterization and the Berlin Questionnaire for the stratification of the risk of obstructive sleep apnea syndrome.Results: the prevalence of high risk was 60.2% and the outcome of clinical worsening during hospitalization was more frequent among these patients. The factors related to high risk were body mass index over 30 kg/m2, arterial hypertension and waist circumference indicative of cardiovascular risk, while older age (60 years and over constituted a protective factor.Conclusion: considering the high prevalence of obstructive sleep apnea and its relation to clinical worsening, it is suggested that nurses should monitor, in their clinical practice, people at high risk for this syndrome, guiding control measures of modifiable factors and aiming to prevent the associated complications, including worsening of cardiovascular diseases.

  14. Oxygen desaturation during night sleep affects decision-making in patients with obstructive sleep apnea.

    Science.gov (United States)

    Delazer, Margarete; Zamarian, Laura; Frauscher, Birgit; Mitterling, Thomas; Stefani, Ambra; Heidbreder, Anna; Högl, Birgit

    2016-08-01

    This study assessed decision-making and its associations with executive functions and sleep-related factors in patients with obstructive sleep apnea. Thirty patients with untreated obstructive sleep apnea and 20 healthy age- and education-matched controls performed the Iowa Gambling Task, a decision-making task under initial ambiguity, as well as an extensive neuropsychological test battery. Patients, but not controls, also underwent a detailed polysomnographic assessment. Results of group analyses showed that patients performed at the same level of controls on the Iowa Gambling Task. However, the proportion of risky performers was significantly higher in the patient group than in the control group. Decision-making did not correlate with executive functions and subjective ratings of sleepiness, whereas there was a significant positive correlation between advantageous performance on the Iowa Gambling Task and percentage of N2 sleep, minimal oxygen saturation, average oxygen saturation and time spent below 90% oxygen saturation level. Also, the minimal oxygen saturation accounted for 27% of variance in decision-making. In conclusion, this study shows that a subgroup of patients with obstructive sleep apnea may be at risk of disadvantageous decision-making under ambiguity. Among the sleep-related factors, oxygen saturation is a significant predictor of advantageous decision-making.

  15. Switching Kalman filter based methods for apnea bradycardia detection from ECG signals.

    Science.gov (United States)

    Montazeri Ghahjaverestan, Nasim; Shamsollahi, Mohammad B; Ge, Di; Hernández, Alfredo I

    2015-09-01

    Apnea bradycardia (AB) is an outcome of apnea occurrence in preterm infants and is an observable phenomenon in cardiovascular signals. Early detection of apnea in infants under monitoring is a critical challenge for the early intervention of nurses. In this paper, we introduce two switching Kalman filter (SKF) based methods for AB detection using electrocardiogram (ECG) signal.The first SKF model uses McSharry's ECG dynamical model integrated in two Kalman filter (KF) models trained for normal and AB intervals. Whereas the second SKF model is established by using only the RR sequence extracted from ECG and two AR models to be fitted in normal and AB intervals. In both SKF approaches, a discrete state variable called a switch is considered that chooses one of the models (corresponding to normal and AB) during the inference phase. According to the probability of each model indicated by this switch, the model with larger probability determines the observation label at each time instant.It is shown that the method based on ECG dynamical model can be effectively used for AB detection. The detection performance is evaluated by comparing statistical metrics and the amount of time taken to detect AB compared with the annotated onset. The results demonstrate the superiority of this method, with sensitivity and specificity 94.74[Formula: see text] and 94.17[Formula: see text], respectively. The presented approaches may therefore serve as an effective algorithm for monitoring neonates suffering from AB.

  16. Assessment of the sleep parameters in patients with obstructive sleep apnea syndrome with a

    Directory of Open Access Journals (Sweden)

    Özlem Abakay

    2013-06-01

    Full Text Available Objective: In this study, traffic accident with a history ofobstructive sleep apnea syndrome (OSAS in patientswith polysomnographic parameters was investigated.Methods: A total of 77 OSAS patients were included inthe study. All-night polysomnographic recordings obtainedfrom patients with enuresis parameters and thepresence of traffic accidents recorded in standard form.Results: The mean age of patients was 45.15 ± 11.53years. 53% of the patients were male and 47% female.The mean apnea hypopnea index (AHI in patients was13.54 events/h. History of traffic accidents was found in12% patients. Apnea hypopnea index, supine AHI, arousalindex and oxygen desaturation index were found significantlydifferent parameters between history of trafficaccidents group and non-history of traffic accidents group(p <0.05.Conclusion: In this study, patients with OSAS severity ofthe disease with a history of traffic accidents were associatedthe relationship between the parameters. This relationshipwith the severity of the disease might be due tothe negative effects on attention. J Clin Exp Invest 2013;4 (2: 204-207Key words: OSAS, traffic accident, AHI

  17. Radiologic evaluation of adenoids and tonsils in children with obstructive sleep apnea: Plain films and fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kreplick Fernbach, S.; Brouillette, T.; Riggs, T.W.; Hunt, C.E.

    1983-07-01

    Twenty-six children with obstructive sleep apnea were evaluated by lateral neck radiographs during wakefulness, and by polygraphic monitoring and upper airway fluoreoscopy during natural sleep. Children with craniofacial abnormalities, palatal surgery, and central nervous system disease were excluded from the study. Moderate or marked enlargement of tonsils and adenoids was noted on lateral neck radiographs of 18 of 26 patients. An objective measure of adenoidal enlargement, the adenoidal-nasopharyngeal ratio, correlated well with subjective judgment of adenoidal size but was not generally more useful than subjective estimation. Upper airway fluroescopy demonstrated the site and mechanism of obstruction in all patients. Because all children with moderate to marked adenotonsillar enlargement demonstrated obstruction at the adenoidal or tonsillar level on fluoroscopy, we now screen children with suspected sleep apnea with lateral airway radiographs and polysomnography. Fluoroscopy is reserved for children with mild adenotosillar enlargement, craniofacial dysplasia, prior cleft palate repair, or neuromuscular disorders. These results suggest that the pathogenesis of obstuctive sleep apnea in children involve anatomic factors which narrow the upper airway, sleep-related hypotonia of pharyngeal dilator musculature, and compensatory mechanisms to prevent or alleviate asphyxia.

  18. Upper airway finding on CT scan with and without nasal CPAP in obstructive sleep apnea patients

    Energy Technology Data Exchange (ETDEWEB)

    Akashiba, Tsuneto; Sasaki, Iwao; Kurashina, Keiji; Yoshizawa, Takayuki; Otsuka, Kenzo; Horie, Takashi (Nihon Univ., Tokyo (Japan). School of Medicine)

    1991-04-01

    The area of upper airway (from the nasopharynx to the hypopharynx) was measured by means of computed tomography (CT) scan in 15 confirmed cases of obstructive sleep apnea (OSA) and in 4 normal controls while they were awake. The minimum cross-sectional area (MA) of the upper airway was 14.7+-20.0 mm{sup 2} in OSA patients and 80.0+-33.1 mm{sup 2} in normal controls and the difference was statistically significant (p<0.01). In OSA patients, MA did not correlate with age, body weight, apnea index, desaturation index, mean nadir-SO{sub 2} and lowest SO{sub 2}. MA was also measured with OSA patients while nasal continuous positive airway pressure (NCPAP) of 10 cmH{sub 2}O was applied and it was found that MA was significantly widened when NCPAP therapy was performed. We conclude that upper airway narrowing is consistent finding in OSA patients but the degree of narrowing does not correlate with parameters of apnea and gas exchange during sleep, and NCPAP is effective to widen the area of upper airway in OSA patients. (author).

  19. Toward numerical simulations of fluid-structure interactions for investigation of obstructive sleep apnea

    Science.gov (United States)

    Huang, Chien-Jung; Huang, Shao-Ching; White, Susan M.; Mallya, Sanjay M.; Eldredge, Jeff D.

    2016-04-01

    Obstructive sleep apnea (OSA) is a medical condition characterized by repetitive partial or complete occlusion of the airway during sleep. The soft tissues in the airway of OSA patients are prone to collapse under the low-pressure loads incurred during breathing. This paper describes efforts toward the development of a numerical tool for simulation of air-tissue interactions in the upper airway of patients with sleep apnea. A procedure by which patient-specific airway geometries are segmented and processed from dental cone-beam CT scans into signed distance fields is presented. A sharp-interface embedded boundary method based on the signed distance field is used on Cartesian grids for resolving the airflow in the airway geometries. For simulation of structure mechanics with large expected displacements, a cut-cell finite element method with nonlinear Green strains is used. The fluid and structure solvers are strongly coupled with a partitioned iterative algorithm. Preliminary results are shown for flow simulation inside the three-dimensional rigid upper airway of patients with obstructive sleep apnea. Two validation cases for the fluid-structure coupling problem are also presented.

  20. The Tongue Muscle Training (ZMT® in nCPAP Patients with Obstructive Sleep Apnea Syndrome (OSAS

    Directory of Open Access Journals (Sweden)

    Gessmann H.-W.

    2013-06-01

    Full Text Available Obstructive Sleep Apnea Syndrome is treated not only with the help of nCPAP but by other means which help to support the sufficient level of pharyngeal airways. In course of our experiment we investigated changes in parameters of breath during night sleep in patients with high indices of obstructive Sleep Apnea Syndrome after the tongue muscle training. 40 patients with OSAS treated only with the help of nCPAP underwent a 5-week course of electrical stimulation of upper pharyngeal muscles. This type of treatment was supposed to result in dilatation of pharyngeal airways and cure of occlusion and obstruction. Parameters of breath during the night sleep before- and after the treatment were detected with the help of somno-poligraphic investigations and compared. Indices of apnea and hypopnea decreased in 26 of 40 patients, which is more than half of the probands. We recommended the patients with a diagnosed OSAS without a risk of recurrence to add tongue muscle training to nCPAP. In case the course of nCPAP therapy is launched it helped achieve sufficient improvement of parameters affecting breath during the night sleep and in many cases decrease respiratory pressure of nCPAP therapy or its complete cessation.

  1. Correlation between hippocampal sulcus width and severity of obstructive sleep apnea syndrome.

    Science.gov (United States)

    Akhan, Galip; Songu, Murat; Ayik, Sibel Oktem; Altay, Canan; Kalemci, Serdar

    2015-12-01

    The aim of the present study was to evaluate the relationship between obstructive sleep apnea syndrome (OSAS) severity and the hippocampal sulcus width in a cohort of subjects with OSAS and controls. A total of 149 OSAS patients and 60 nonapneic controls were included in the study. Overnight polysomnograpy was performed in all patients. Hippocampal sulcus width of the patients was measured by a radiologist blinded to the diagnosis of the patients. Other variables noted for each patient were as follows: gender, age, body mass index, apnea hypopnea index, Epworth sleepiness scale, sleep efficacy, mean saturation, lowest O2 saturation, longest apnea duration, neck circumference, waist circumference, hip circumference. A total of 149 OSAS patients were divided into three groups: mild OSAS (n = 54), moderate OSAS (n = 40), severe OSAS (n = 55) groups. The control group consisted of patients with AHI sulcus width was 1.6 ± 0.83 mm in the control group; while 1.9 ± 0.81 mm in mild OSAS, 2.1 ± 0.60 mm in moderate OSAS, and 2.9 ± 0.58 mm in severe OSAS groups (p sulcus width. Our findings demonstrated that severity of OSAS might be associated with various pathologic mechanisms including increased hippocampal sulcus width.

  2. Accurate method for home-based diagnosis of obstructive sleep apnea: a review

    Directory of Open Access Journals (Sweden)

    Hosna Ghandeharioun

    2016-12-01

    Full Text Available Overnight polysomnography is the gold standard for the detection of obstructive sleep apnea-hypopnea syndrome (OSAS. However, it is expensive and needs attending personnel. The study of simplified sleep apnea monitoring is one of the recent trends for sleep medicine research. The proposed clinical prediction rules employ the vital and social statistics, symptoms, craniofacial traits, and obesity-related measures for initial screening of OSAS in an ambulatory setting. However, most of them are partially or completely clinical and not home-based. One disadvantage of this sort of screening methods is their inability to asses OSAS severity. Another approach of initial OSAS screening is a usage of just one or two physiological signals such as electrocardiography (ECG, pulse oximetry, snoring, nasal airflow, or even speech sound. In this study, we aimed to review the different strategies and to compare their performances, reported by means of their sensitivity–specificity and accuracy for OSAS incidence and severity. OSAS severity is determined by apnea-hypopnea index (AHI value. Based on the data obtained from the related articles, the most accurate methods of AHI estimation exploit ECG and pulse oximetry signals.

  3. Caffeine intake is independently associated with neuropsychological performance in patients with obstructive sleep apnea.

    Science.gov (United States)

    Norman, Daniel; Bardwell, Wayne A; Loredo, Jose S; Ancoli-Israel, Sonia; Heaton, Robert K; Dimsdale, Joel E

    2008-08-01

    In healthy individuals, caffeine intake may improve performance on cognitive tests. Obstructive sleep apnea (OSA) is a disorder that has been associated with impaired cognitive function. In this study, we investigated whether increased caffeine intake in untreated patients with OSA is linked to better cognitive performance. Forty-five untreated OSA patients underwent baseline polysomnography after completing a survey of 24-h caffeine intake. Participants completed a battery of neuropsychological tests, then demographically corrected T scores and a global deficit score (GDS) were calculated on these tests. Partial correlation analysis was performed to compare daily caffeine intake with GDS, after controlling for body mass index (BMI) and sleep apnea severity. Analysis of covariance was done to examine differences in daily caffeine intake between cognitively impaired (GDS >or= 0.5) and non-impaired (GDS or= 0.5) for cognitive impairment. There was a significant inverse association between caffeine intake and the GDS, both when controlling for BMI (r =or -0.331, p = 0.04) and when controlling for BMI and apnea severity (r =or-0.500, p = 0.002); those with less impairment consumed more caffeine. Analysis of covariance demonstrated that cognitively impaired individuals consumed one-sixth as much caffeine as non-impaired individuals (p caffeine intake was associated with less cognitive impairment.

  4. Patients with Obstructive Sleep Apnea Display Increased Carotid Intima Media: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Rashid Nadeem

    2013-01-01

    Full Text Available Background. Obstructive sleep apnea (OSA is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT. Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from −0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, (P<0.0001. Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process.

  5. Apnea testing during brain death assessment: a review of clinical practice and published literature.

    Science.gov (United States)

    Scott, J Brady; Gentile, Michael A; Bennett, Stacey N; Couture, MaryAnn; MacIntyre, Neil R

    2013-03-01

    The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and Paco2 levels are allowed to rise. A "positive" test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidence-based safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.

  6. Assessing severity of obstructive sleep apnea by fractal dimension sequence analysis of sleep EEG

    Science.gov (United States)

    Zhang, J.; Yang, X. C.; Luo, L.; Shao, J.; Zhang, C.; Ma, J.; Wang, G. F.; Liu, Y.; Peng, C.-K.; Fang, J.

    2009-10-01

    Different sleep stages are associated with distinct dynamical patterns in EEG signals. In this article, we explored the relationship between the sleep architecture and fractal dimension (FD) of sleep EEG. In particular, we applied the FD analysis to the sleep EEG of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), which is characterized by recurrent oxyhemoglobin desaturation and arousals from sleep, a disease which received increasing public attention due to its significant potential impact on health. We showed that the variation of FD reflects the macrostructure of sleep. Furthermore, the fast fluctuation of FD, as measured by the zero-crossing rate of detrended FD (zDFD), is a useful indicator of sleep disturbance, and therefore, correlates with apnea-hypopnea index (AHI), and hourly number of blood oxygen saturation (SpO 2) decreases greater than 4%, as obstructive apnea/hypopnea disturbs sleep architecture. For practical purpose, a modified index combining zDFD of EEG and body mass index (BMI) may be useful for evaluating the severity of OSAHS symptoms.

  7. Quantitative Analysis of Periodic Breathing and Very Long Apnea in Preterm Infants

    Science.gov (United States)

    Mohr, Mary A.

    Electronic signals from bedside monitors in University of Virginia's Neonatal Intensive Care Unit (NICU) are routinely collected and stored. The overall goal of our research is predictive monitoring: we seek patterns in signals that give early warning of impending pathology. This work focuses on apnea (pauses in regular respiration), and on periodic breathing (regular cycles of breathing and apnea). Our examination of apnea events revealed a disturbing number of cases in which the cessation of breathing lasted at least 60 seconds. These observations were validated, clinical correlations of these events were identified, and a theory was developed that partially explains how they occur. Periodic breathing in neonates is a normal developmental phenomenon. It arises when there is instability in the respiratory control system. A mathematical model of periodic breathing was developed to analyze the stability of the control system in infants. Periodic breathing has long been thought to be benign, however, exaggerated durations of periodic breathing may be an indicator of pathology. Characterization of periodic breathing has previously been limited to short monitoring times in small numbers of infants. An automated system for measurement and characterization of periodic breathing was developed and applied to 5 years of data from the NICU. The amount of periodic breathing that infants had was found to increase with gestational age (up to 32 weeks). Also, times of excessive periodic breathing were recorded and clinical correlations were sought. A significant increase in periodic breathing in the 24 hours before diagnosis of necrotizing enterocolitis was found.

  8. Do Mandibular Advancement Devices Influence Patients' Snoring and Obstructive Sleep Apnea?

    DEFF Research Database (Denmark)

    Marcussen, Lillian; Henriksen, Jan Erik; Thygesen, Torben

    2015-01-01

    PURPOSE: The upper airway volume is central to the development and treatment of snoring and obstructive sleep apnea, and mandibular advancement devices (MADs) have increasingly been used as an effective alternative to continuous positive airway pressure for these 2 conditions. We investigated...... Student's t test and the Wilcoxon signed rank test, and mixed-model analyses were performed adjusting for sleep apnea severity, type 2 diabetes, body mass index, gender, and age. RESULTS: A total of 44 patients (31 men and 13 women, age 50 ± 13 years, body mass index 31 ± 5.6 kg/m(2)) completed the trial....... MAD therapy was associated with an increase in the total upper airway volume from 22.9 ± 8.7 cm(3) before treatment to 26.7 ± 10.7 cm(3) after treatment (P apnea-hypopnea index (AHI) from 15.8 ± 17.4 events/hour before treatment to 6.2 ± 9.8 events/hour after treatment...

  9. Lingua-epiglottis position predicts glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome.

    Science.gov (United States)

    Li, Shuhua; Wu, Dahai; Jie, Qin; Bao, Jimin; Shi, Hongjin

    2014-10-01

    The objective of the study was to investigate the relationship between lingua-epiglottis position and glossopharyngeal obstruction in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). One hundred and four patients with OSAHS diagnosed by polysomnography (PSG) were enrolled. Lingua-epiglottis position was visualized using endoscopy and classified into three types. Spiral CT imaging of the upper respiratory tract was performed to measure the cross-sectional area and inner diameter of the glossopharyngeal airway. The PSG was repeated after nasopharyngeal tube insertion (NPT-PSG). The NPT-PSG results, CT-measured data and incidence of stenosis were compared among the different lingua-epiglottis position groups. Obstructive sleep apnea hypopnea syndrome patients with different lingua-epiglottis positions had similar demographics. As lingua-epiglottis position type varied from type I to type III, cross-sectional area and inner diameter of the glossopharyngeal area decreased, glossopharyngeal airway stenosis rate increased, and apnea hypopnea index measured by NPT-PSG increased. The lowest oxygen saturation decreased. Lingua-epiglottis position was significantly related to glossopharyngeal obstruction. Lingua-epiglottis position should be used in clinical practice for the preliminary assessment of glossopharyngeal obstruction.

  10. Treatment of obstructive sleep apnea syndrome using radiofrequency-assisted uvulopalatoplasty with tonsillectomy.

    Science.gov (United States)

    Lim, Dae Jun; Kang, Sung-Ho; Kim, Bo-Hyeng; Hong, Seok-Chan; Yu, Myeong Sang; Kim, Young-Hyun; Choi, Jeong-Seok; Jin, Kwang Ho

    2013-02-01

    Radiofrequency surgery was introduced to minimize thermal damage to the tissue. A radiofrequency electrode can be used to make cuts in the free edge of the soft palate like those done in laser-assisted uvulopalatoplasty [radiofrequency-assisted uvulopalatoplasty (RAUP)]. Tonsillectomy can enlarge the lateral diameter of the pharynx. The aim of our study was to evaluate the efficacy of RAUP with tonsillectomy in treatment of obstructive sleep apnea syndrome (OSAS). Ninety-two patients with obstructive sleep apnea were included in this study. Patients were categorized according to disease severity and Friedman's staging system. Patients were assessed with the preoperative visual analog scale (VAS) for snoring, Epworth Sleepiness Scale (ESS) and apnea-hypopnea index (AHI) at baseline and repeated at 6 months postoperatively. The intensity of postoperative pain, speech deficits and dysphagia were also recorded. There was a significant improvement in the VAS score for snoring, ESS and AHI before and after surgery. Overall, the results of the present study indicated a surgery success rate (a 50 % decrease in AHI and AHI tonsillectomy is an effective treatment for patients with OSAS.

  11. Is Perioperative Fluid and Salt Balance a Contributing Factor in Postoperative Worsening of Obstructive Sleep Apnea?

    Science.gov (United States)

    Lam, Thach; Singh, Mandeep; Yadollahi, Azadeh; Chung, Frances

    2016-05-01

    An understanding of the potential mechanisms underlying recurrent upper airway collapse may help anesthesiologists better manage patients in the postoperative period. There is convincing evidence in the sleep medicine literature to suggest that a positive fluid and salt balance can worsen upper airway collapse in patients with obstructive sleep apnea through the redistribution of fluid from the legs into the neck and upper airway while supine, in a process known as "rostral fluid shift." According to this theory, during the day the volume from a fluid bolus or from fluid overload states (i.e., heart failure and chronic kidney disease) accumulates in the legs due to gravity, and when a person lies supine at night, the fluid shifts rostrally to the neck, also owing to gravity. The fluid in the neck can increase the extraluminal pressure around the upper airways, causing the upper airways to narrow and predisposing to upper airway collapse. Similarly, surgical patients also incur large fluid and salt balance shifts, and when recovered supine, this may promote fluid redistribution to the neck and upper airways. In this commentary, we summarize the sleep medicine literature on the impact of fluid and salt balance on obstructive sleep apnea severity and discuss the potential anesthetic implications of excessive fluid and salt volume on worsening sleep apnea.

  12. Melatonin secretion and excretion in patients with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Wikner, J; Svanborg, E; Wetterberg, L; Röjdmark, S

    1997-11-01

    Melatonin (MT) secretion and excretion were investigated in patients with obstructive sleep apnea syndrome (OSAS). Nine men, mean age 55.1 years, mean body mass index 31.2, with a previously confirmed diagnosis of moderate to severe OSAS, were tested on two occasions: immediately before initiation of continuous positive airway pressure (CPAP) treatment and again after at least 4 weeks of continuous nocturnal use of CPAP. Serum MT concentrations were determined every second hour between 2000 and 0800 hours. Urine was collected between 2200 and 0700 hours for determination of urinary MT excretion. Sleep apnea recordings included ear oximetry, respiration and body movements, body position, and breathing sounds. Nine healthy male controls were tested on one occasion. We found that the MT secretion, as reflected by the area under the curve (AUC), among the OSAS patients did not differ from that found in healthy controls (MT AUC 1.68 vs. 1.92 nmol/l x h). Sleep apnea recordings were normalized during CPAP treatment. Moreover, the excessive daytime sleepiness disappeared in all patients. Neither MT secretion (MT AUC 1.68 vs. 1.56 nmol/l x h) nor urinary excretion of MT (0.122 vs. 0.108 nmol/9 h) changed significantly as a result of the CPAP treatment.

  13. Correlation between the oropharyngo-laryngoscopic findings and the severity of obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Priscila Sequeira Dias

    2015-10-01

    Full Text Available Objective: To correlate anatomical and functional changes of the oral cavity, pharynx and larynx to the severity of obstructive sleep apnea syndrome (OSAS. Methods : We conducted a cross-sectional study of 66 patients of both genders, aged between 21 and 59 years old with complaints of snoring and / or apnea. All underwent full clinical evaluation, including physical examination, nasolarybgoscopy and polisonography. We classified individuals into groups by the value of the apnea-hypopnea index (AHI, calculated measures of association and analyzed differences by the Kruskal-Wallis and chi-square tests. Results : all patients with obesity type 2 had OSAS. We found a relationship between the uvula projection during nasoendoscopy and OSAS (OR: 4.9; p-value: 0.008; CI: 1.25-22.9. In addition, there was a major strength of association between the circular shape of the pharynx and the presence of moderate or severe OSAS (OR: 9.4, p-value: 0.002, although the CI was wide (1.80-53.13. The septal deviation and lower turbinate hypertrophy were the most frequent nasal alterations, however unrelated to gravity. Nasal obstruction was four times more common in patients without daytime sleepiness. The other craniofacial anatomical changes were not predictors for the occurrence of OSAS. Conclusion : oral, pharyngeal and laryngeal disorders participate in the pathophysiology of OSAS. The completion of the endoscopic examination is of great value to the evaluation of these patients.

  14. Effectiveness of Home Single-Channel Nasal Pressure for Sleep Apnea Diagnosis

    Science.gov (United States)

    Masa, Juan F.; Duran-Cantolla, Joaquin; Capote, Francisco; Cabello, Marta; Abad, Jorge; Garcia-Rio, Francisco; Ferrer, Antoni; Mayos, Merche; Gonzalez-Mangado, Nicolas; de la Peña, Monica; Aizpuru, Felipe; Barbe, Ferran; Montserrat, Jose M.; Larrateguy, Luis D.; de Castro, Jorge Rey; Garcia-Ledesma, Estefania; Utrabo, Isabel; Corral, Jaime; Martinez-Null, Cristina; Egea, Carlos; Cancelo, Laura; García-Díaz, Emilio; Carmona-Bernal, Carmen; Sánchez-Armengol, Ángeles; Fortuna, Ana M.; Miralda, Rosa M.; Troncoso, Maria F.; Gonzalez, Monica; Martinez-Martinez, Marian; Cantalejo, Olga; Piérola, Javier; Vigil, Laura; Embid, Cristina; del Mar Centelles, Mireia; Prieto, Teresa Ramírez; Rojo, Blas; Lores, Vanesa

    2014-01-01

    Introduction: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring. Objectives: To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points. Methods: We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives. Results: Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI Ferrer A, Mayos M, Gonzalez-Mangado N, de la Peña M, Aizpuru F, Barbe F, Montserrat JM, Spanish Sleep Network. Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis. SLEEP 2014;37(12):1953-1961. PMID:25325484

  15. [Perioperative management in children with sleep apnea syndrome (SAS) undergoing adenoidotonsillectomy].

    Science.gov (United States)

    Mizuno, Ju; Nemoto, Mikiko; Sato, Tomoko; Yokoyama, Takeshi; Hanaoka, Kazuo

    2013-02-01

    We should take care of the occurrences of apnea and hypopnea after emergence from general anesthesia in the children with sleep apnea syndrome (SAS) due to an increase in sensitivity to opioid agonists given for previous recurrent hypoxia. Preoperative assessment for SAS with apnea hypopnea index (AHI), oxygen desaturation index (ODI), and minimum artery oxygen saturation by pulse oxymetry (lowest SpO2) obtained from polysomnography (PSG) test could help to predict the postoperative respiratory depression. In perioperative management in the children with SAS who are candidates for adenotonsillectomy, the dose of opioid agonists during anesthesia maintenance for purpose of postoperative analgesia and sedation should be reduced; postoperative respiratory and circulatory management with monitoring of respiratory movement of the thoracoabdominal part, and electrographic (ECG) and SpO2 monitoring should be continued intensively under long-term oxygen administration; and airway management, nasal continuous positive airway pressure (nCPAP), and artificial ventilation should be prepared for the occurrence of postoperative respiratory depression.

  16. Serum Level of Vascular Endothelial Growth Factor in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

    Institute of Scientific and Technical Information of China (English)

    MA Jing; XU Yongjian; ZHANG Zhenxiang; LIU Huiguo; XIONG Weining; XU Shuyun

    2007-01-01

    To explore the relationship between the serum vascular endothelial growth factor (VEGF)level and the severity of obstructive sleep apnea hypopnea syndrome (OSAHS), the concentrations of serum VEGF in 40 OSAHS patients and 9 healthy controls were measured by using ELISA method.Meanwhile the correlation between the concentration of VEGF and parameters of polysomnography (PSG) was examined. Our results showed that the concentrations of VEGF were significantly higher in OSAHS patients with severe hypoxia (536.8±334.7 pg/mL) than in those with mild hypoxia (329.2±174.7 pg/mL) and healthy controls (272. 8±211.0 pg/mL) (P<0.05 for both). The concentrations of VEGF were also significantly higher in OSAHS patients with hypertension (484.5±261.4 pg/mL) than in those without hypertension (311.0±158.4 pg/mL) and healthy controls (272. 8±211.0 pg/mL) (P<0.05 for both). There was a positive correlation between the concentration of VEGF and the apnea hypopnea index (AHI) (γ=0.34, P<0.05). It is concluded that the concentration of the serum VEGF is positively related to the severity of OSAHS. The elevated serum VEGF level may be involved in the pathogenesis of the complications of obstructive sleep apnea hypopnea syndrome.

  17. Influence of premedication with alprazolam on the occurence of obstructive apneas. A prospective randomized double-blind study.

    Science.gov (United States)

    Deflandre, E; Bonhomme, V; Courtois, A-C; Degey, S; Poirrier, R; Brichant, J-F

    2016-08-01

    Postoperative development or worsening of obstructive sleep apnea is a potential complication of anesthesia. The objective of this study was to study the effects of a premedication with alprazolam on the occurrence of apneas during the immediate postoperative period. Fifty ASA 1 - 2 patients undergoing a colonoscopy were recruited. Patients with a history of obstructive sleep apnea (OSA) were excluded. Recruited patients were randomly assigned to one of two groups: in Group A, they received 0.5 mg of alprazolam orally one hour before the procedure; and in Group C, they received placebo. Anesthesia technique was identical in both groups. Patients were monitored during the first two postoperative hours to establish their AHI (apnea hypopnea index, the number of apneas and hypopneas per hour). Nine patients were excluded (4 in group A and 5 in group C) due to technical problems or refusal. Interestingly, premedication by alprazolam did not change intra-operative propofol requirements. During the first two postoperative hours, the AHI was significantly higher in group A than in group C (Group A: 20.33 ± 10.97 h(-1), C: 9.63 ± 4.67 h(-1)). These apneas did not induce significant arterial oxygen desaturation, or mandibular instability. Our study demonstrates that a premedication with 0.5 mg of alprazolam doesn't modify intra-operative anesthetic requirements during colonoscopy, but is associated with a higher rate of obstructive apneas during at least three and a half hours after ingestion. No severe side effects were observed in our non-obese population. Our results must be confirmed on a larger scale.

  18. The role of physical exercise in obstructive sleep apnea.

    Science.gov (United States)

    Andrade, Flávio Maciel Dias de; Pedrosa, Rodrigo Pinto

    2016-01-01

    Obstructive sleep apnea (OSA) is a common clinical condition, with a variable and underestimated prevalence. OSA is the main condition associated with secondary systemic arterial hypertension, as well as with atrial fibrillation, stroke, and coronary artery disease, greatly increasing cardiovascular morbidity and mortality. Treatment with continuous positive airway pressure is not tolerated by all OSA patients and is often not suitable in cases of mild OSA. Hence, alternative methods to treat OSA and its cardiovascular consequences are needed. In OSA patients, regular physical exercise has beneficial effects other than weight loss, although the mechanisms of those effects remain unclear. In this population, physiological adaptations due to physical exercise include increases in upper airway dilator muscle tone and in slow-wave sleep time; and decreases in fluid accumulation in the neck, systemic inflammatory response, and body weight. The major benefits of exercise programs for OSA patients include reducing the severity of the condition and daytime sleepiness, as well as increasing sleep efficiency and maximum oxygen consumption. There are few studies that evaluated the role of physical exercise alone for OSA treatment, and their protocols are quite diverse. However, aerobic exercise, alone or combined with resistance training, is a common point among the studies. In this review, the major studies and mechanisms involved in OSA treatment by means of physical exercise are presented. In addition to systemic clinical benefits provided by physical exercise, OSA patients involved in a regular, predominantly aerobic, exercise program have shown a reduction in disease severity and in daytime sleepiness, as well as an increase in sleep efficiency and in peak oxygen consumption, regardless of weight loss. RESUMO A apneia obstrutiva do sono (AOS) é uma condição clínica comum, possuindo prevalência variável e subestimada. Principal condição associada à hipertens

  19. Inhibition of central Na+/H+ exchanger type 3 can alleviate sleep apnea in Sprague-Dawley rats

    Institute of Scientific and Technical Information of China (English)

    Wang Qimin; Zhou Rong; Zhang Cheng; Dong Hui; Ma Jing; Wang Guangfa

    2014-01-01

    Background Recent studies showed the central Na+/H+ exchanger type 3 (NHE3) has a close relationship with ventilation control.The objective of the study is to investigate the role of NHE3 in sleep apnea in Sprague-Dawley (SD) rats.Methods A sleep study was performed on 20 male SD rats to analyze the correlation between the sleep apneic events and total NHE3 protein content and inactive NHE3(pS552) in the brainstem measured by Western blotting.Another 20 adult male SD rats received 3 days of sleep and respiration monitoring for 6 hours a day,with adaption on the first day,0.5% DMSO microinjection into the fourth ventricle on the second day,and AVE0657 (specific inhibitor of NHE3) microinjection on the third day.Rats were divided into two groups with injection of 5 μmol/L or 8 μmol/L AVE0657 before the sleep study.The effects of AVE0657 on sleep apnea and sleep structure of rats were analyzed through self-control.Results The total post-sigh apnea index (TPSAI) and post-sigh apnea index in non-rapid eye movement (NREM) sleep (NPSAI) and total apnea index (AI) in NREM sleep (NAI) were negatively correlated with NHE3(pS552) protein contents in the brainstem (r=-0.534,-0.547 and-0.505,respectively,P<0.05).The spontaneous apnea index in REM sleep (RSPAI) was positively correlated with the level of NHE3(pS552) protein expression in the brainstem (r=0.556,P<0.05).However,the sleep AI had no relationship with total NHE3 protein.Compared with the blank control and microinjection of 0.5% DMSO,5 μmol/L AVE0657 significantly reduced the total AI and NPSAI (both P<0.05) without a significant effect on sleep architecture.In contrast to blank control and microinjection of 0.5% DMSO,injection of 8 μmol/L AVE0657 significantly reduced the AI and PSAI in NREM and REM sleep (all P<0.05).Conclusions The severity of sleep apnea was negatively correlated with central inactive NHE3.A specific inhibitor of NHE3 decreased the sleep AI.Thus,our results indicate that central

  20. Validity and Predictive Value of a Portable Two-Channel Sleep-Screening Tool in the Identification of Sleep Apnea in Patients With Heart Failure

    NARCIS (Netherlands)

    de Vries, Grietje E.; van der Wal, Haye H.; Kerstjens, Huib A. M.; van Deursen, Vincent M.; Stegenga, Boudewijn; van Veldhuisen, Dirk J.; van der Hoeven, Johannes H.; van der Meer, Peter; Wijkstra, Peter J.

    2015-01-01

    Background: Sleep apnea is an important comorbidity in heart failure (HF) and is associated with an adverse outcome. Diagnosing sleep apnea is difficult, and polysomnography, considered to be the criterion standard, is not widely available. We assessed the validity of a portable 2-channel sleep-scre