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Biomedical subjects

A Kales

Publications and source records attributed to A Kales.

At least 91 records · Page 5Linked to original sources
PubMed1985

Severe obstructive sleep apnea--I: Onset, clinical course, and characteristics.

The clinical course and characteristics of severe obstructive sleep apnea are described for 50 adults whose condition warranted recommendation for tracheostomy. All patients had a history of snoring, excessive daytime sleepiness and sleep attacks, nocturnal snorting and gasping sounds and observer-noted nocturnal breath cessations. Generally, these symptoms became manifest before age 40, their appearance tended to cluster together within only a few years and, invariably, they were chronic. Aside from snoring, excessive daytime sleepiness was on average often the first symptom and began at a mean age of 36 years. However, in half of the patients either hypertension or overweight preceded excessive daytime sleepiness by at least 1 year. Physicians in the office setting should suspect severe obstructive sleep apnea in patients who have loud snoring and either excessive daytime sleepiness, hypertension, or obesity. Further evidence of apnea can be obtained by determining the presence of the additional signs of loud nocturnal snorting and gasping sounds and nocturnal breath cessations.

Adult↗
PubMed1985

Severe obstructive sleep apnea--II: Associated psychopathology and psychosocial consequences.

Personality patterns, signs of mental impairment, mental health correlates, and psychosocial consequences were assessed in 50 patients who had obstructive sleep apnea of sufficient severity to warrant recommendation for tracheostomy. The personality patterns of sleep apnea patients were consistently those of a somatic-neurotic type, similar to typical patterns for medical outpatients. The high level of psychologic distress demonstrated was clearly a consequence rather than a cause of the disorder. Most patients showed cognitive impairment; 76% had suspected or mild to severe deficits in terms of thinking, perception, memory, communication, or the ability to learn new information, resulting in a greater potential for being distractible, confused, and irritable. Finally, another striking finding was the high incidence of patients' reports of frequent, severe psychosocial disruption in their lives--involving the family, social interactions and work situations.

Adult↗
PubMed1985

Sleep apneic activity in older healthy subjects.

The percentage of subjects with sleep apneic activity was significantly greater in a group of 60 healthy subjects who were 50 yr and older compared with a control group of 69 subjects who were younger than 50 yr. Sixteen of the older subjects (26.7%) and six of the younger subjects (8.7%) met the criteria for sleep apneic activity, i.e., 3-29 episodes per night. However, only one of the older subjects (1.7%) had enough sleep apneic activity (30 or more episodes in a night) to meet the definition of the condition of sleep apnea. In both age groups, sleep apneic activity (SAA) was slightly more prevalent in males than females. Older subjects with SAA were not significantly heavier than those without SAA but were so when compared with the younger subjects with SAA. In the 29 older subjects for whom hemoglobin O2 saturation (Sao2) was recorded, those with SAA had a significantly lower mean minimum Sao2 value (87%) than those without (92%).

Aged↗
PubMed1985

The effects of nasal anesthesia on breathing during sleep.

Inability to breathe through the nose is an increasingly recognized cause of disordered breathing during sleep. To test the hypothesis that this respiratory dysrhythmia could result from loss of neuronal input to respiration from receptors located in the nose, we anesthetized the nasal passages of 10 normal men during sleep. Each subject spent 4 consecutive nights in the sleep laboratory while sleep stages, breathing patterns, respiratory effort, and arterial oxygen saturation were monitored. Night 1 was for acclimatization with Nights 3 and 4 being randomized to nasal spraying with either 4% lidocaine or placebo. On the lidocaine and placebo nights (Nights 3 and 4) the nasal passages were also sprayed with a decongestant to prevent increased nasal air-flow resistance resulting from mucosal swelling. To control for the possible effects of this decongestant, an additional night (Night 2) was included during which the nasal passages were sprayed with room air. Parallel studies conducted during wakefulness demonstrated low nasal resistance during the lidocaine-decongestant regimen. Because of the short duration of anesthesia with lidocaine, spraying was done at lights out and 2.5 and 5 h later. On the placebo night (decongestant plus saline) there were 6.4 +/- 1.8 (SEM) disordered breathing events (apneas plus hypopneas) per subject, whereas with lidocaine (plus decongestant) this increased fourfold to 25.8 +/- 7.8 events per subject (p less than 0.05). The majority of the disordered breathing events were apneas and were fairly evenly distributed between central and obstructive events. The magnitude of these changes is similar to that previously reported with complete nasal obstruction. These results suggest that nasal receptors sensitive to air flow may be important in maintaining breathing rhythmicity during sleep.

Adult↗
PubMed1985

Pharmacologic and psychotherapeutic issues in coexistent paranoid schizophrenia and narcolepsy: case report.

The case of a 32-year-old man with schizophrenia and narcolepsy, two seemingly unrelated disorders, is discussed from the perspective of the diagnostic and therapeutic challenges raised by their coexistence. In addition, the development of tardive dyskinesia and its subsequent amelioration with a depot form of a high-potency neuroleptic are discussed in relation to these disorders. Consistent and supportive psychotherapy for such patients is recommended for maintaining compliance, for pharmacotherapy, and an optimal level of personal, occupational, and interpersonal functioning.

Adaptation, Psychological↗
PubMed1984

Sleep apnoea in a hypertensive population.

50 hypertensive patients and 50 normal controls were evaluated in the sleep laboratory for the presence of sleep apnoea or sleep apnoeic activity. Hypertensive patients were at high risk of sleep apnoea; 15 hypertensive patients (30%) had sleep apnoea and another 17 (34%) had sleep apnoeic activity. In contrast, none of the age-matched and sex-matched control subjects had sleep apnoea, and 24% had sleep apnoeic activity. The degree of oxygen desaturation was correlated with the duration as well as the number of apnoeic events. Presence of sleep apnoea in the patients was significantly correlated with higher blood pressure levels when they were initially seen in the clinic. Patients with the most severe sleep apnoea had the highest initial blood-pressure levels and were more refractory to treatment.

Adolescent↗
PubMed1984

Sleep in the Prader-Willi syndrome. Clinical and polygraphic findings.

Nine patients with the Prader-Willi syndrome, ranging in age from 3 to 21 years, were examined clinically as well as studied in the sleep laboratory. They had striking disturbances of sleep-wakefulness patterns. All patients except one had the symptom of excessive daytime sleepiness. The most striking finding was the presence in five patients of rapid-eye-movement (REM) sleep occurring at sleep onset (SOREM). None of the patients had the condition of sleep apnea. One patient, however, demonstrated severe hypoventilation during REM sleep; the lowest value recorded for O2 saturation was 40%, with a consistent value below 50% for as long as ten to 15 minutes. Previous findings have indicated that the Prader-Willi syndrome is of hypothalamic origin. We hypothesize that both the SOREM and O2 desaturation findings in our patients with the Prader-Willi syndrome are also a result of hypothalamic changes.

Adolescent↗
PubMed1984

Sleep apnea precipitated by pharyngeal surgery in a patient with myotonic dystrophy.

A patient was seen for evaluation of excessive daytime sleepiness, which was exacerbated following complications secondary to surgical reconstruction of the pharynx for a submucous cleft palate. She underwent recordings in the sleep laboratory and was found to have sleep apnea. Also, a thorough clinical and laboratory assessment established the diagnosis of myotonic dystrophy. Following tracheostomy, both the patient's sleep apnea and daytime hypersomnia were eliminated. Our case demonstrates that surgical procedures involving the upper airway should be approached with considerable caution in patients with myotonic dystrophy and only after the presence of associated sleep apnea has been carefully excluded. An original finding is the suggestion of a decrease in the number of T-cell lymphocytes in a patient with myotonic dystrophy.

Adult↗
PubMed1984

Biopsychobehavioral correlates of insomnia, V: Clinical characteristics and behavioral correlates.

The authors compared two large samples of insomniac patients with a group of control subjects. Sleep difficulty usually began before the age of 40 and generally persisted for many years (average duration, 14 years). Several characteristic behaviors were correlated with the symptom of insomnia. During the day and at bedtime, patients reported difficulty relaxing and frequently described themselves as tense, anxious, overly preoccupied, worried, and depressed. Reports of poor mental and physical health were far more prevalent in the insomniac patients than in control subjects. These results indicate that psychiatric factors need to be a primary focus in the multidimensional treatment of chronic insomnia.

Adult↗
PubMed1984

Biopsychobehavioral correlates of insomnia. IV: Diagnosis based on DSM-III.

DSM-III diagnoses were established for 100 patients with chronic insomnia. Principal and additional diagnoses on axis I and II (psychiatric and personality disorders) were extremely prevalent. Only five patients had a principal diagnosis on axis III (physical disorders). The most common diagnoses on axis I were dysthymic, anxiety, somatoform, and substance use disorders. Compulsive personality disorder or trait was the most common axis II diagnosis. Ninety-five patients had multiple diagnoses. This study confirms that patients with chronic insomnia have a high prevalence of psychopathology and characteristic internalizing patterns of anxiety, depression, obsessive-compulsiveness, phobia, and excessive somatic concerns.

Adjustment Disorders↗
PubMed1984

Clinical experience with the silicone tracheal cannula in obstructive sleep apnea.

The surgical and postoperative course was evaluated in 20 patients with severe obstructive sleep apnea who underwent tracheostomy in which a silicone tracheal cannula was used. The cannula has been introduced recently by Dr. William Montgomery for use in a variety of clinical settings. Our findings indicate that the silicone tracheal cannula is a simple and reliable method of maintaining the tracheal airway in patients with severe sleep apnea. There were infrequent complications and a high degree of patient acceptance with this surgical procedure. Advantages of the silicone tracheal cannula include ease of insertion (especially in the often obese neck of the patient with sleep apnea), the inconspicuous nature of the cannula itself, the ease of care, and the maintenance of speech. Thus our clinical experience with this new tracheal cannula in the treatment of certain types of sleep-related breathing disorders indicates that it has a number of advantages as well as infrequent complications.

Adult↗
PubMed1984

Nocturnal sleep and wakefulness: effects of age and sex in normal sleepers.

Sleep patterns were evaluated in 100 normal men and women who did not have any complaints of a sleep disorder and who were divided into three broad age groups: 19-29, 30-49, and 50-80 years. Total laboratory recording time was held constant across all four study nights. The amount of nightly wakefulness was positively correlated with age; total wake time for the oldest age group was about two times that of the youngest group, due primarily to an increase in wake time after sleep onset, because sleep latency did not change with age. Within each of the three age groups, especially the two oldest groups, the greatest amount of wakefulness following sleep onset occurred in the final hours of the recording period. Sleep in men was characterized by a higher number of nocturnal awakenings, and in elderly men by a longer final awakening; however, other parameters of sleep efficiency did not differ considerably between the sexes.

Adult↗
PubMed1984

Biopsychobehavioral correlates of insomnia, III: Polygraphic findings of sleep difficulty and their relationship to psychopathology.

The effects of age and sex on sleep-wakefulness patterns and the relationship between these patterns and psychopathology are described in 150 adults with a primary complaint of insomnia and 100 controls who did not have any complaints of sleep difficulty. Within the insomniac subjects, the degree of difficulty in staying asleep was positively correlated with age. The primary difference between the insomniacs and controls was the insomniacs' greater difficulty in initially falling asleep or returning to sleep once having awakened during the night. Also, in terms of the distribution of wakefulness, insomniacs had significantly greater mean values for wakefulness during each of the first three to four hours of the night. In insomniacs the severity of sleep difficulty and the degree of psychopathology were positively related. Finally, various sleep difficulty and MMPI variables reliably discriminated insomniacs from controls.

Adolescent↗