Search PubMed⌕ Search

Biomedical subjects

A J Block

Publications and source records attributed to A J Block.

At least 109 records · Page 6Linked to original sources
PubMed1981

The effect of nasal packing on sleep-disordered breathing and nocturnal oxygen desaturation.

Nasal obstruction is known to cause abnormal ventilation during sleep in infants, but its effects on breathing and oxygenation during sleep in adults are unknown. However, in adults, obstruction of the nose by nasal packing has been shown to cause hypoxia, and on occasion, hypercarbia and sudden death. We have investigated the pattern of ventilation and the level of oxygenation during sleep in seven patients who had nasal packs after nasal polypectomy or septoplasty. Using standard polysomnographic techniques, we monitored chest wall motion, nasal and oral airflow, and arterial oxygen saturation and sleep stages. Nasal packing either caused or worsened sleep-disordered breathing in all patients and significantly increased the number, duration, and frequency of episodes for the group as a whole. Several patients also had a greatly increased number and severity of episodes of nocturnal oxygen desaturation. This study shows that obstruction of the nose by packing causes marked alterations in breathing during sleep in adults.

Airway Obstruction↗
PubMed1981

Sleep-disordered breathing and oxygen desaturation in obese patients.

Fourteen morbidly obese subjects, referred to our institution for bypass surgery for obesity, were studied with regard to pulmonary function and respiratory patterns during sleep. The seven female patients experienced no episodes of desaturation or disordered breathing during sleep. Six of the seven male patients experienced desaturation or disordered breathing. The one who did not had hypogonadism, suggesting that testosterone may have a role in the regulation of breathing during sleep. The two patients with the most frequent episodes of apnea and lowest oxygen saturation had a clinical picture consistent with the pickwickian syndrome. This supports the relationship previously noted between the degree of hypoxia and the presence of hypersomnolence.

Adult↗
PubMed1981

Oxygen desaturation during sleep as a determinant of the "Blue and Bloated" syndrome.

Certain patients with chronic obstructive pulmonary disease may be classified as blue bloaters or pink puffers. Recent studies suggest that physiologic changes during sleep contribute to the clinical expression of these syndromes. To investigate this, we monitored four blue bloaters and six pink puffers during one night's sleep to determine the incidence of sleep disordered breathing (SDB) and of arterial oxygen desaturation. There were no significant differences between the two groups for sleep period time, awake oxygen saturation, or the number of episodes of SDB. Blue bloaters had lower baseline oxygen saturations, more episodes of arterial oxygen desaturation, and larger falls in oxygen saturation and spent more time at low levels of oxygen saturation while asleep. We propose that the degree and the duration of sleep hypoxemia of blue bloaters but not of pink puffers may contribute to early pulmonary hypertension and cor pulmonale.

Adult↗
PubMed1981

Prospective evaluation for pneumonectomy using perfusion scanning: follow-up beyond one year.

Thirty-eight high-risk patients (forced expiratory volume in one second [FEV1] less than 2.0L or maximum voluntary ventilation [MVV] less than 50 per cent of predicted) were observed for a minimum of one year after pneumonectomy for carcinoma of the lung. Operability was assessed by calculating a predicted postoperative FEV1 (based on the right-left fractional perfusion estimated by a perfusion lung scan) and requiring this predicted postoperative value to exceed 800 ml. No other invasive physiologic studies were performed before surgery. At one year, 23 of 38 patients were still alive, and 13 of 38 patients survived to the end of the second year. At five years, two of 15 patients were alive with no evidence of metastatic disease. This simple physiologic approach involves widely available techniques and, in patients with lung cancer who have compromised pulmonary function, appears to result in acceptable survival over a longer period.

Carcinoma↗
PubMed1981

Transcutaneous noninvasive monitoring of carbon dioxide tension.

We evaluated the accuracy of a new device for continuous noninvasive measurement of cutaneous PCO2. The Hewlett-Packard capnometer (model 47210/HA) works by means of an infrared transducer applied to the forearm over an area of skin that has been stripped of the stratum corneum. Capnometer transcutaneous carbon dioxide pressure (CPCO2) was compared with arterial carbon dioxide pressure (PaCO2) during 60 simultaneously obtained measurements in 13 hemodynamically stable patients. Each patient was studied for 1 1/2 to 5 hours, and a wide range of PaCO2 values (21 to 82 mm Hg) was represented. The data show a clinically significant relationship whereby PaCO2 = CPCO2 - 4.13, with a SE of +/- 2.19 mm Hg. Clinical usefulness of noninvasive cutaneous CO2 monitoring can be foreseen in patients whose ventilatory support is being tapered, in those with respiratory depression caused by various neuromuscular disorders, and in patients with chronic obstructive pulmonary disease and acute respiratory failure. Our results indicate that continuous transcutaneous CPCO2 measurements are safe and accurate and strongly suggest that they can be of clinical usefulness in a select group of hemodynamically stable patients.

Adult↗
PubMed1981

Relationship between preoperative pulmonary function tests and complications after thoracotomy.

Simple spirometric testing remains useful for the preoperative assessment of patients being evaluated for thoracotomy. To routine spirometric testing, the maximal voluntary ventilation should be added. More specific tests do not seem to add predictive information. In addition, individual tests do not seem to correlate with specific complications. The amount of lung resected does not correlate with the occurrence of complications. Patients undergoing lobectomy as opposed to pneumonectomy often experience a stormy postoperative course and are prone to have atelectasis develop and to have an infection in the lung remaining on the operated upon side. Recent data would indicate that this remaining lung tissue is severely compromised during the immediate postoperative period. Those patients who undergo lobectomy may transiently lose considerably more function than would certainly be anticipated from the amount of tissue resected.

Adult↗
PubMed1980

Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women.

Twenty postmenopausal women were monitored for disordered breathing (apnea and hypopnea) and oxygen desaturation during one night's sleep. These women were compared with 18 premenopausal women previously reported to have a low incidence of sleep-disordered breathing and nocturnal oxygen desaturation. Twelve of the 20 postmenopausal women had 102 episodes of sleep-disordered breathing and 118 episodes of oxygen desaturation, compared with only six episodes of apnea in two premenopausal women (P less than 0.01). Premenopausal women did not become desaturated. Of the postmenopausal women, 11 became desaturated; and in five of them saturation decreased to less than 85 per cent. Duration of sleep, and increased age and weight: height ratios, correlated significantly with the incidence of desaturation (P less than 0.01--P less than 0.05). Postmenopausal women resemble men with respect to disordered breathing during sleep and nocturnal oxygen desaturation. Protection from these sleep events in premenopausal women might be afforded by the respiratory stimulant effects of circulating progesterone.

Adult↗
PubMed1980

The effect of low flow oxygen on sleep-disordered breathing and oxygen desaturation. A study of patients with chronic obstructive lung disease.

Oxygen desaturation occurs during sleep in many patients with chronic obstructive lung disease (COLD) and is often caused by sleep-disordered breathing (SDB). Nocturnal oxygen therapy should improve nighttime hypoxemia, but might also worsen SDB. Using standard polysomnographic techniques, we evaluated the frequency and duration of oxygen desaturation and SDB during sleep in 11 patients with stable COLD. During half of the night the patients breathed air through a nasal cannula and during the other half of the night they breathed oxygen at 2 liters per minute. Five patients had arterial lines inserted for determination of arterial blood gas levels during periods of SDB or desaturation. The ten men and one woman slept 70 minutes (52 percent of time in bed) while on air and 111 minutes (80 percent of time in bed) while on oxygen (p < 0.001). Oxygen therapy reduced the number of episodes of desaturation per hour and the time spent in desaturation. However, there was no difference between air and oxygen in episodes of SDB per hour, the duration of episodes of SDB, baseline sleeping PaCO2 or PaCO2 during episodes of desaturation or SDB. Therefore, in most patients with stable COLD, administration of oxygen at 2 liters per minute improves oxygenation, prolongs sleep, but does not adversely affect SDB.

Adult↗
PubMed1979

Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance.

Thirty asymptomatic men and 19 asymptomatic women were monitored during one night's sleep to determine the incidence of breathing abnormalities and oxygen desaturation in normal subjects. Twenty men accounted for 264 episodes of nocturnal oxygen desaturation or abnormal breathing. Women never experienced oxygen desaturation, and only three had a total of nine episodes of apnea. These sex differences were highly significant (P less than 0.003). In men, increasing age and obesity correlated positively with the incidence of nocturnal oxygen desaturation and abnormal breathing. Four asymptomatic men weighing more than 90 kg dropped their saturation to very low levels (68 to 72 per cent). Abnormal breathing and oxygen desaturation during sleep in subjects with chronic obstructive lung disease of the syndrome of hypersomnolence with periodic breathing may represent the superimposition of smoking or obesity on a normal tendency to snoring and oxygen desaturation in men.

Adult↗
PubMed1979

Disordered breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease (COLD).

Seven patients with chronic obstructive lung disease (COLD) were monitored during their overnight sleep to determine the occurrence of disordered breathing and oxygen desaturation. Nasal and oral airflows were sensed by thermistor probes, chest wall movement by impedance pneumography and arterial oxygen saturation by ear oximetry. These variables were correlated with electroencephalographic and electrooculographic tracings. The subjects had a mean base line oxygen saturation of 89.2 per cent and slept an average of 218 minutes. Six of these seven subjects had one to 30 episodes of oxygen desaturation (decrease more than 4 per cent), 4 seconds to 30 minutes in duration, with declines in saturation as great as 36 per cent. In two subjects, saturation dropped to less than 50 per cent. Breathing was disordered in five of the seven subjects and included apnea and hypopnea. Subjects experienced from nine to 37 episodes of disordered breathing. Disordered breathing caused 42 per cent of the episodes of desaturation, all of which were less than 1 minute in duration. The mean maximum decline in saturation was 7.6 per cent. All episodes of desaturation lasting longer than 5 minutes occurred in rapid eye movement (REM) sleep and were not caused by disordered breathing. The mean maximal decrease in saturation was 22 per cent. This study reveals that disordered breathing is common in subjects with COLD and often causes desaturation but that it cannot explain all episodes of sleep desaturation.

Adult↗
PubMed1979

Nocturnal vs diurnal cardiac arrhythmias in patients with chronic obstructive pulmonary disease.

Continuous electrocardiograms were recorded from ten patients with chronic obstructive pulmonary disease. During 24 hours of recording, the patients breathed air; and for 24 hours, they breathed oxygen at 2 L/min by nasal cannula. Oxygenation, as monitored by ear oximetric studies and by periodic analysis of arterial blood, showed frequent nocturnal desaturation. Nine patients demonstrated arrhythmias during the monitoring period, and the frequency of premature ventricular contractions was significantly greater at night. Therapy with supplemental oxygen dramatically reduced the frequency of premature ventricular contractions in four patients, but the reduction in frequency of arrhythmias in the total group did not reach statistical significance. These results show that cardiac arrhythmias occur commonly at night during sleep in patients with chronic obstructive pulmonary disease. The data suggest that arterial desaturation may be responsible for some of these arrhythmias.

Aged↗