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Biomedical subjects

C Guilleminault

Publications and source records attributed to C Guilleminault.

At least 199 records · Page 11Linked to original sources
PubMed1993

Obstructive sleep apnea syndrome: a surgical protocol for dynamic upper airway reconstruction.

A surgical protocol for dynamic upper airway reconstruction in the treatment of obstructive sleep apnea syndrome is presented. Two hundred thirty-nine consecutively treated patients were evaluated. All patients underwent a presurgical evaluation that included a physical examination, fiberoptic pharyngoscopy, cephalometric analysis, and polygraphic monitoring. The goal of the presurgical evaluation was to document sleep apnea and isolate the area of obstruction. The treatment was then directed to the obstructive site. The surgical protocol included two phases. Phase 1 was a conservative approach and included uvulopalatopharyngoplasty and/or mandibular osteotomy with genioglossus advancement-hyoid myotomy and suspension. Polysomnography was repeated at 6 months and patients with unsuccessful surgical results were offered maxillary-mandibular advancement osteotomy. Results were based on the postoperative polysomnograms, and included assessing changes in both sleep architecture and sleep-disordered breathing. The surgical results were compared with results in patients who were using nasal continuous positive airway pressure. The surgical success rate for the 239 patients entered into phase 1 therapy was 61% (145 patients). Twenty-four patients who failed phase 1 treatment elected phase 2 treatment. The surgical success rate of this phase was 100%.

Cephalometry↗
PubMed1993

Daytime somnolence: therapeutic approaches.

Excessive daytime somnolence is a major neurological problem involving about 4% of the general population. Its treatment is based on accurate etiological dissection. Sleep-disordered breathing is a major cause of EDS. Stimulant medication is helpful in many other instances.

Disorders of Excessive Somnolence↗
PubMed1993

Pseudo-hypersomnia and pre-sleep behaviour with bilateral paramedian thalamic lesions.

The sleep/wake status of three patients with bilateral lesions involving the paramedian thalamic regions was investigated. Long-term monitoring with infrared video camera and polygraphy were performed. In spite of presenting a behavioural aspect of sleep with sleep posture, eyes closed and lack of activity for 15-17 h per day, these subjects did not develop the normal non-rapid eye movement (NREM) and rapid eye movement (REM) sleep states during the daytime. The EEG indicated presence of a mixture of low amplitude, irregular, diffuse theta and alpha range frequencies during hours associated with this 'sleep-like' behaviour. Multiple sleep latency tests performed some time after the acute insult gave varying results, but while stage 1 NREM sleep might have been noted for three to four epochs, other states of sleep never appeared. Patients were apathetic and 'drowsy' but could develop sleep only during the normal circadian period for sleep, i.e. during the night. Even several years later, in one of the subjects in whom follow-up recordings were obtained, apathetic behaviour and sleep 'posturing' were present during much of the day, even though the subject, if requested, could perform tasks adequately all day long. Subjects with such lesions do not present a 'hypersomnia' but a 'de-arousal' or 'subwakefulness' with inability to develop sleep outside the normal circadian boundaries for its appearance. However, these subjects, at least initially, also lacked full wakefulness. They have a behavioural impairment with a compulsive sleep posture and are left in the transition between wakefulness and sleep.

Adult↗
PubMed1993

Multiple sleep latency test (MSLT) and sleep apnea in aged women.

Sleep disturbance and the tendency to sleep during the day were assessed polysomnographically in 31 elderly women (mean age = 76.7 +/- 3.6 SD) recruited from a senior citizen's living facility without reference to sleep-wake complaints. The data showed that the level of sleepiness during the day in each subject depended in part on the severity of her respiratory disturbance. It was found that the group (n = 7) of elderly females with apnea and hypopnea index (AHI) higher than 20 was more sleepy [multiple sleep latency test (MSLT) = 7.9 +/- 2) than the group (n = 10) with AHI > 5 but less than 20 (MSLT = 12.7 +/- 5). Nevertheless, the presence and severity of respiratory disturbance were not the only factors that influenced the level of sleepiness during the day in the studied sample. A subgroup of four elderly females showed a marked sleepiness during the four tested periods (MSLT = 5.2 +/- 0.6) with a very low respiratory disturbance index (AHI = 5.5 +/- 0.8).

Aged↗
PubMed1993

Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients.

We investigated the way in which nasal continuous positive airway pressure (CPAP) affects the circadian profiles of blood pressure (BP) and heart rate (HR) in obstructive sleep apnea syndrome (OSAS) patients. Nine patients with OSAS, confirmed by nocturnal polysomnography, were studied with ambulatory blood pressure monitoring (Colin ABPM-630) during two 48-hour periods, before and during nasal CPAP treatment, at the Stanford University Sleep Disorders Clinic. During each 48-hour monitoring period, blood pressure measurements were taken by the ambulatory device every 30 minutes. During the ambulatory blood pressure recordings, nocturnal sleep time was defined as the period between 0000 hours to 0600 hours and active daytime was defined as the period between 1000 hours and 2000 hours. An average systolic blood pressure > 135 mm Hg during the 48-hour baseline recording was defined as hypertensive. Using these criteria, we selected four hypertensive and five normotensive patients. Average BP (systolic/diastolic) and HR during the 48-hour periods decreased significantly from 148.6/88.2 mm Hg to 138.7/81.4 mm Hg, and from 77.9 beats per minute (bpm) to 67.2 bpm in hypertensives during CPAP treatment (p = 0.04), but there were no significant changes observed in normotensives. Average BP, during the day and at night, decreased from 152.3/91.8 mm Hg to 141.2/85.1 mm Hg and from 133.9/76.8 mm Hg to 125.9/73.7 mm Hg, respectively, in the hypertensives during CPAP, but such changes were not observed in normotensives. Average HR during the day and at night decreased significantly from 85.2 bpm to 72.6 bpm and from 69.8 bpm to 56.5 bpm in the hypertensives (p = 0.04), but not in normotensives.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Excessive daytime somnolence in women with abnormal respiratory efforts during sleep.

An abnormal level of respiratory efforts, indicated by significant increase in peak negative esophageal pressure (Pes), can be associated with daytime somnolence in snoring pre-menopausal women. No drop in oxygen saturation (SaO2) or visual evidence of transient electroencephalographic (EEG) arousals can be found at repeat polysomnography. Nasal continuous positive airway pressure (CPAP) titrated on Pes measurements eliminates somnolence.

Adult↗
PubMed1993

Dream-disturbed sleep in insomnia and narcolepsy.

Both patients with narcolepsy and insomnia frequently present clinically with nocturnal sleep disrupted by disturbing dreams. Polysomnographic correlates of these reports are unclear. In this study, 24 patients with psychophysiological insomnia and 16 patients with narcolepsy were compared on selected polysomnographic and self-reported typical dream characteristics. As a group, patients with narcolepsy showed more frightening, recurrent dreams and shorter rapid eye movement (REM) segments when compared with patients with insomnia. However, within the narcolepsy group, there were few correlations between typical dream characteristics and any measure of REM segment length or REM density. In the insomnia group, shorter REM segments and higher REM density were related to typically more vivid, frightening, and disrupted dreaming. We speculate that the mechanisms of disturbed dream recall may be different in insomnia and narcolepsy.

Adult↗
PubMed1993

Obstructed breathing in children during sleep monitored by echocardiography.

Six 3 to 14-year-old boys with snoring and obstructive sleep apnea syndrome were monitored polygraphically during sleep with and without nasal continuous positive airway pressure with simultaneous recording of esophageal pressure (Pes) and M-mode and two-dimensional echocardiograms. Continuous non-invasive blood pressure monitoring was performed in two older children. Three of the six children demonstrated a diastolic leftward shift of the interventricular septum related to the negativity of Pes. Progressively more negative Pes correlated significantly with an increase in right ventricular internal end-diastolic dimension and a decrease in left ventricular internal end-diastolic dimension, with at times left ventricular "collapse". One of the subjects with blood pressure monitoring demonstrated pulsus paradoxus with leftward shift of the interventricular septum. Nasal continuous positive airway pressure normalized all changes. Pulsus paradoxus and leftward shift of the interventricular septum are related to the mechanical changes associated with heavy snoring during sleep, regardless of the amount of oxygen desaturation.

Adolescent↗
PubMed1993

Obstructive sleep apnea syndrome: a review of 306 consecutively treated surgical patients.

Three hundred six consecutively treated surgical patients with obstructive sleep apnea syndrome were evaluated from a group of 415 patients. One hundred nine patients were excluded because they failed to obtain a postoperative polysomnogram or were lost to followup. All patients received a physical examination, cephalometric analysis, fiberoptic examination, and polysomnography before treatment to document OSAS and determine the areas of obstruction. A two-phase surgical protocol was used for the reconstruction of the upper airway. Phase I surgery consisted of a uvulopalatopharyngoplasty (UPPP) for palatal obstruction and genioglossus advancement with hyoid myotomy-suspension for base of tongue obstruction. Failures of phase I were offered phase 2 reconstruction, which consisted of maxillary-mandibular advancement osteotomy. One hundred twenty-one patients were treated with nasal continuous positive airway pressure (CPAP) before surgery and this was the primary method of evaluating surgical success. Results were reported on the polysomnogram performed a minimum of 6 months after surgery and compared to the preoperative polysomnogram and the second night nasal CPAP study. The polysomnographic results included respiratory disturbance index (RDI), lowest oxyhemoglobin saturation (LSAT), and sleep architecture parameters. Surgery was considered a success if it was equivalent to nasal CPAP or the postoperative RDI was less than 20 with normal oxygenation. The overall success rate, which included patients that dropped from the protocol, was 76.5%, with a mean followup of 9.3 months (SD, 6.7). The preoperative RDI, nasal CPAP RDI, and postoperative RDI were 55.8 (SD, 26.7), 7.2 (SD, 5.4), and 9.2 (SD, 7.5), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The positive diagnosis of narcolepsy and narcolepsy's borderland.

We studied the validity of cataplexy and number of sleep-onset rapid-eye-movement periods (SOREMPs) during one Multiple Sleep Latency Test (MSLT) as determinants of narcolepsy in 306 subjects with excessive daytime sleepiness not related to obstructive sleep apnea or other known syndromes. The subgroup defined by a history of cataplexy was the most homogeneous in clinical and polygraphic variables. However, only 83% of these subjects had two or more SOREMPs in one MSLT. The subgroup defined by two or more SOREMPs included many patients without cataplexy. A disproportionate number of these subjects were older women whose chances of developing cataplexy are remote. This group of older women had a higher number of periodic leg movements during sleep than the other groups. Patients with both cataplexy and two or more SOREMPs have the greatest chance of being DR2 DQw1 positive. Thus, the combination of history of cataplexy and two or more SOREMPs is the best clinical determinant of narcolepsy. However, two or more SOREMPs is a poorer discriminant of narcolepsy than history of cataplexy.

Adolescent↗
PubMed1993

Flow velocity paradoxus and pulsus paradoxus in obstructive sleep apnea syndrome.

Echo-Doppler monitoring was performed simultaneously with two-dimensional and M-mode echocardiography, polysomnography and blood pressure recording in an obstructive sleep apnea patient. Increase in tricuspid flow and decrease of mitral flow velocity was demonstrated during each diastole prior to pulsus paradoxus, while aortic flow velocity decreased with pulsus paradoxus during obstructed breathing during sleep.

Adolescent↗
PubMed1993

A cause of excessive daytime sleepiness. The upper airway resistance syndrome.

Subjects with isolated complaints of chronic daytime sleepiness are usually classified as "idiopathic hypersomniacs" and treated symptomatically. A group of these subjects was investigated during nocturnal sleep and daytime naps. In a subgroup of them, sleep was fragmented by very short alpha EEG arousals throughout the sleeping period. These short arousals are usually ignored in sleep analyses, but their impact is significant (in the 15 subjects identified with the syndrome, the mean sleep latency in multiple sleep latency tests was 5.1 +/- 1 min). These arousals are directly related to an abnormal increase in respiratory efforts during sleep (the mean peak inspiratory esophageal pressure measured in our subjects in the respiratory cycle just preceding a transient arousal was -33 +/- 7 cm H2O). Typically, an arousal occurs within one to three breaths of flow limitation associated with abrupt but limited reduction in tidal volume (ie, abnormal increase in upper airway resistance during sleep). The arousal restores normal breathing. Snoring was noted in association with these transient arousals in 10 of the 15 subjects; however, snoring was neither sufficient nor necessary for the identification of the clinical syndrome. Both sexes were equally represented in the affected group. All studied subjects had upper airway anatomy that was mildly abnormal. Nasal continuous positive airway pressure, used as an experimental tool, eliminated the daytime sleepiness (multiple sleep latency mean score = 13.5 min), the transient arousals (mean alpha EEG arousal index decreased from 31.3 +/- 12.4 to 8 +/- 2 per hour of sleep), and the abnormal upper airway resistance. Chronic daytime sleepiness is a major cause of social, economic, and medical impairment. Recognition of this syndrome and its cause is important, as specific treatments can be developed to eliminate the problem.

Adult↗
PubMed1993

Further characterization of the alpha-1 receptor subtype involved in the control of cataplexy in canine narcolepsy.

We have demonstrated previously that central noradrenergic mechanisms, especially postsynaptic alpha-1 receptors, are critically involved in the regulation of cataplexy, a pathological manifestation of rapid eye movement sleep atonia in narcolepsy. However, it has been shown recently that alpha-1 receptors constitute a heterogeneous population of binding sites, which is encoded by several distinct genes. In light of these findings, we investigated the possibility that the effect of alpha-1 compounds on cataplexy found in our previous study is mediated more specifically by certain alpha-1 receptor subtypes than by other subtypes. We therefore examined the effects of eight selective alpha-1 antagonists and five agonists on canine cataplexy and compared these with the affinities of the same compounds for the canine central alpha-1a and alpha-1b subtypes. The affinities of the compounds for the alpha-1 receptor subtypes were assessed by using [3H]prazosin receptor binding in combination with a 5-methylurapidil (an alpha-1a selective ligand) mask. Six of the eight alpha-1 antagonists tested exacerbated canine cataplexy, whereas all five agonists tested suppressed cataplexy. Furthermore, the potency (ED50 values) of the compounds on cataplexy significantly correlated with the affinity of the compounds for the alpha-1b binding site. These results are consistent with our earlier implication of the alpha-1 receptor mechanisms in the control of cataplexy and further suggest a specific involvement of the alpha-1b receptor subtype in these mechanisms.

Adrenergic alpha-Agonists↗