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Biomedical subjects

C Guilleminault

Publications and source records attributed to C Guilleminault.

At least 271 records · Page 15Linked to original sources
PubMed1989

Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure.

Nasal continuous positive airway pressure (CPAP) is an effective therapy for sleep apnea. We treated 144 patients with nasal CPAP and observed them for periods of as long as 25 months. No pneumothoraces occurred in any patient. Compliance rates were between 65% (90/139) and 83% (90/108), depending on the patient population considered. Demographic factors unrelated to discontinuing using CPAP included age, sex, and the presence of a housemate. Better-educated patients were less able to tolerate the equipment. Dry throat and nose and sore eyes were the most common side effects, but only sore eyes related to the amount of pressure. Side effects were unrelated to the number of months on the treatment, and obesity was related to higher pressures. Our study provides optimistic intermediate-term follow-up observations of patients on nasal CPAP therapy for sleep apnea. Whether adverse consequences occur over longer periods of time remains to be seen.

Adult↗
PubMed1989

Maxillo-mandibular surgery for obstructive sleep apnoea.

Many therapeutic approaches, including mandibular surgery, have been proposed for the treatment of obstructive sleep apnoea syndrome. In the largest study of its type yet reported, 54 patients (population A) underwent mandibular surgery: 36 had palato-pharyngoplasty and inferior sagittal osteotomy of the mandible with hyoid myotomy and resuspension, and 18 (population B) had maxillo-mandibular hyoid advancement, a procedure consisting of palato-pharyngoplasty, inferior sagittal osteotomy of the mandible with hyoid myotomy and, several months later, a maxillo-mandibular osteotomy. Criteria for procedure selection and for evaluation of results were pre-set, and clinical and polygraphic follow-up occurred 6-8 months after final surgery. In population A, 32 of the 36 patients had improved; but only 20 were evaluated as "satisfactory". In contrast, all of the population B patients were judged satisfactory. Four of the population B patients received nasal continuous positive airway pressure (CPAP) before any surgery, and both approaches gave similar good polygraphic results. The degree of skeletal cranio-facial deficiencies, particularly retrognathia, is crucial for procedure selection. We describe potential procedural risks and problems.

Adolescent↗
PubMed1988

Treatment of obstructive sleep apnea syndrome. A personal view based upon evaluation of over 4000 patients.

Obstructive sleep apnea syndrome (OSAS) is a common problem in middle-aged men. It is a syndrome often associated with upper airway anatomical abnormalities, but where the sleep disorder, part of the syndrome, impairs local upper airway reflexes involved in appropriate air exchange during sleep. We now have many possible treatments. It is better to associate them in a step-by-step approach. This implies development of appropriate services able to follow OSAS patients regularly. The immediate goal is to assure normal ventilation during sleep and maintenance of normal blood gases. This is obtained by use of nasal CPAP or nasal IPPV, less mutilating than tracheostomy. Weight loss and behavioral modification programs will improve some of the associated features of obesity, alcoholic intake, and smoking often associated with and worsening the sleep-related breathing disorders. Finally, an appropriate evaluation of the upper airway abnormalities will allow surgical approaches that, as a second step, will lead to an appropriate reconstruction of the upper airway and will allow discontinuation of mechanical devices, with a subsequent return to normal life for the patient. To offer only one of these services or to limit oneself to a single therapeutic approach is a long-term disservice to OSAS patients.

Behavior Therapy↗
PubMed1988

Effect of alpha 1-adrenoceptors blockade with prazosin in canine narcolepsy.

The role of central alpha 1-adrenergic receptors in cataplexy was investigated in 4 narcoleptic poodles and 6 genetically narcoleptic Doberman pinschers. Treatment of narcoleptic dogs with prazosin, a selective alpha 1-adrenergic receptor blocker, exacerbated cataplexy in both narcoleptic dog breeds. Control and heterozygous Dobermans were not affected by the drug. Binding studies using [3H]prazosin revealed an increase in alpha 1-receptor binding apparently limited to the amygdala. The present study suggests that central alpha 1-adrenoceptors, whose role is still mostly unknown, play a fundamental role in controlling mechanisms involved in cataplexy and REM sleep.

Animals↗
PubMed1988

Role of central alpha-1 adrenoceptors in canine narcolepsy.

The role of central alpha-1 adrenergic receptors in cataplexy was investigated in genetically narcoleptic Doberman pinschers. Treatment of narcoleptic dogs with 25-600 micrograms/kg prazosin, a selective alpha-1 adrenergic receptor blocker, exacerbated cataplexy, whereas treatment with the alpha-1 agonist, methoxamine, ameliorated it. Subsequent studies showed that the beneficial effects of classical treatments of human narcolepsy (amphetamines and tricyclic antidepressants) are antagonized by prazosin, suggesting that these drugs are active through an indirect alpha-1 stimulation (via an increase of norepinephrine in the synaptic cleft). Other studies confirmed that the observed effects were not due to peripheral alpha-1 cardiovascular involvement. Atropine, a central anticholinergic agent, but not methylatropine, a peripheral one, completely suppressed the prazosin effect, which suggests that adrenergic and cholinergic systems act sequentially and not independently to generate cataplexy. Little is known about the physiological role of central alpha-1 adrenoceptors. This series of experiments implicates these receptors in narcolepsy-cataplexy.

Animals↗
PubMed1988

Obstructive sleep apnea, continuous positive airway pressure, and surgery.

Patients with obstructive sleep apnea (OSA) who have undergone upper airway surgery could be expected to improve if surgery alleviated some or all of the anatomic obstructions, or continue to desaturate at preoperative levels if the surgery was not corrective. Factors such as morbid obesity, general anesthesia recovery, and operative edema can potentially cause desaturations below preoperative levels. Because of this risk, patients with severe OSA have been considered for protective tracheostomy. The findings of our study suggest that selected patients who would have been past candidates for protective tracheostomy while undergoing surgery for severe OSA can, as an alternative, be considered for immediate postoperative use of nasal continuous positive airway pressure (CPAP). Ten surgical patients with severe OSA who elected surgical treatment were successfully treated with CPAP immediately after extubation and postoperatively to assist with airway patency and hemoglobin saturation. Postoperative followup included monitoring of continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases. Preoperatively, all ten patients had marked decrease in oxygen desaturation levels during sleep, with a mean nadir oxygen saturation (SaO2) to 51.5%. After surgery, all patients in this group maintained SaO2 levels to no lower than 90%, with a mean SaO2 level of 93% while using CPAP on room air (F10(2) 21%) only.

Adult↗
PubMed1988

Effect of maturation on heart rate response to ocular compression test during rapid eye movement sleep in human infants.

Thirty-three premature and full-term infants (31.5-50 wk postconceptional age) free from neurologic and cardiopulmonary disease at time of testing, underwent a standardized ocular compression test during polygraphically controlled rapid eye movement sleep. RR intervals were measured on the ECG before and during ocular compression. RR interval changes during ocular compression were compared to the preceding 60-s mean RR interval in each infant. Results were analyzed relative to gestational age, postnatal age, and postconceptional age. Baseline heart rate during REM sleep decreased with postconceptional age. During ocular compression, there was a significant negative correlation between the longest RR interval or the "latency" variable with postconceptional age. Latency is defined as the time, in milliseconds, from beginning of eyelid pressure to the first measurable RR increase compared to mean control RR + 1 SD. Our results indicate that during rapid eye movement sleep, "baseline heart rate" decreases with maturation, an effect supposedly related to increased vagal activity, whereas the heart rate response on ocular pressure stimulus, a vagally mediated reflex, is significantly influenced and blunted with maturation.

Autonomic Nervous System↗
PubMed1988

Women and the obstructive sleep apnea syndrome.

Twenty-seven women referred to a sleep disorders clinic for symptoms of obstructive sleep apnea syndrome (OSAS) during one year were systematically analyzed after polygraphic monitoring of sleep and cephalometric x-ray examination. Our subjects, one-third of whom were premenopausal, comprised approximately 12 percent of the total OSAS population seen. Women with OSAS were compared with 110 OSAS men and with a group of 16 women without OSAS but referred to orthodontists for mild dental malocclusion. Women with OSAS were massively obese, much more so than their male counterparts. There was no significant difference between pre- and postmenopausal women, with the exception of the respiratory disturbance index (RDI), which was lower in the postmenopausal group despite similar morbid obesity (seemingly better tolerated by women with OSAS than by men with the same syndrome) and long mandibular plane-hyoid bone distance. The significantly higher RDI noted in premenopausal women, despite equally massive obesity and upper airway abnormalities, is thought to be related to hormonal status and better arousal response. Chronic obstructive lung disease (COLD) seen in a subgroup of women with OSAS did not differentiate this subgroup from the other OSAS patients when oxygen saturation during sleep, frequency of abnormal respiratory events and sleep variables were considered. Massive obesity is the dominant factor for the appearance of OSAS in women.

Adolescent↗
PubMed1988

Obstructive sleep apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep.

In a six-month period, 157 obstructive sleep apnea syndrome (OSAS) patients seen consecutively in clinic had standardized cephalometric roentgenograms and underwent polygraphic monitoring during sleep. Different variables, including cephalometric landmarks, body mass index (BMI), and polygraphic results (particularly degree of O2 saturation and number of abnormal breathing events), were statistically analyzed. As a rule, OSAS patients had upper airway anatomic abnormalities and an elevated BMI: massive obesity was associated with less anatomic abnormality, less nocturnal sleep disruption, and longer total sleep time (TST). Patients having a high respiratory disturbance index (RDI) were more likely to have upper airway anatomic abnormalities; they slept for a shorter time and had increased stage 1 non-rapid eye movement (NREM) sleep but decreased stage 3 and 4 and REM sleep. Long mandibular plane to hyoid bone (MP-H) distance and width of the posterior airway space (PAS) (space behind the base of the tongue) were statistically significant predictors of elevated RDI. The cephalometric variables were much less useful for predicting frequency of O2 saturation drops below 80 percent. The patient population can be subdivided into (a) patients with clear anatomic abnormalities and low BMI, (b) patients with morbid obesity with few abnormal cephalometric measurements, and (c) patients who have variably increased BMI and abnormal cephalometric measurements. This is the largest group. We concluded that standardized cephalometric roentgenograms can be useful in determining the appropriate treatment for OSAS patients.

Adult↗
PubMed1988

Determinants of daytime sleepiness in obstructive sleep apnea.

To investigate determinants of daytime sleepiness in obstructive sleep apnea syndrome (OSAS), we studied 100 unselected OSAS patients by nocturnal polygraphic recording and the Multiple Sleep Latency Test (MSLT). Data obtained were submitted to three types of analysis. Respiratory disturbance index, oxygen saturation indices, body mass index, and total nocturnal sleep time did not significantly correlate with daytime sleepiness, as measured by the MSLT. Analysis of subgroups based on weight and degree of alertness also showed a nonsignificant correlation with daytime sleepiness. The best predictor of the excessive daytime sleepiness (EDS) frequently found in OSAS patients was the nocturnal polygraphic recording of the sleep disturbances and sleep structure anomalies that reflect the brain's overall dysfunction in OSAS. Understanding why an electroencephalogram arousal response occurs during sleep in association with abnormal breathing and how this response can become blunted may help us to better predict the development of EDS.

Body Weight↗
PubMed1988

Long-term outcome for obstructive sleep apnea syndrome patients. Mortality.

As the actual mortality and morbidity of obstructive sleep apnea syndrome (OSAS) have been unknown heretofore, we undertook a follow-up study of 198 OSAS patients seen at the Stanford Sleep Disorders Clinic between 1972 and 1980, for whom either tracheostomy (71 patients) or weight loss (127 patients) had been recommended. At five-year follow-up, all of the deaths (14) had occurred among those conservatively treated with weight-loss (a mortality rate of 11 per 100 patients per five years). These patents also had a higher five-year crude vascular mortality rate: 6.3 per 100 patients per five years, with an age-standardized vascular mortality rate of 5.9 per 100 patients per five years (95 percent confidence interval [CI] 2.5-11.6) vs 0 per 100 for the surgically treated population; this despite a lower mean apnea index (43 versus 69) and a lower mean body mass index (31 versus 34 kg/m2) in the conservatively treated group. With the fictional adjunction of one possible death at five-year follow-up in the surgically treated group, the age-adjusted odds of vascular mortality at five years for the conservatively treated group was 4.7. Our data therefore encourage "aggressive" treatment for patients with OSAS.

Adolescent↗
PubMed1988

Nocturnal asthma: snoring, small pharynx and nasal CPAP.

We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Müller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.

Adolescent↗
PubMed1988

Determinants of respiratory disturbance and oxygen saturation drop indices in obstructive sleep apnoea syndrome.

Although chronic sleep fragmentation and oxygen saturation (Sao2) drops alone do not induce obstructive sleep apnoea (OSA), both are part of the feedback loop leading to obstructive sleep apnoea syndrome (OSAS). To determine factors in respiratory disturbance and Sao2 drops, we used polysomnographic and cephalometric data from 120 OSAS patients to construct a model which we then applied prospectively to 25 new OSAS patients, calculating the correlation between observed and predicted values. We found body mass index and the amount of stage 1 non-rapid eye movement sleep to be significant variables when considering both the respiratory disturbance index (RDI) and Sao2 drops. Posterior airway space was also a significant variable for RDI. Forced expiratory volume in one second, expressed as the percentage of forced vital capacity (FEV1/FVC), was significant when considering Sao2 drops. Upper airway abnormalities were also significant variables in the models and must be considered when treating OSAS patients.

Female↗
PubMed1988

The QT interval during wake and sleep in patients with ventricular arrhythmias.

Eight patients with frequent ventricular ectopy underwent continuous electrocardiographic (ECG) and polygraphic monitoring for 4 days. A complex protocol consisted of normal day-night, activity-nonactivity, cycles for 48 h (nine patients); followed by a 24-h awake bedrest; and finally by a very delayed sleep and inactivity phase in the morning before returning to a normal day-night cycle (eight patients only). ECG tracings showed that the QT intervals during rapid eye movement sleep and nonrapid eye movement sleep increased significantly when compared with active wakefulness. The Bazett's corrected QT (QTc) interval also increased from active wakefulness to rapid eye movement sleep and nonrapid eye movement sleep. Adjusted mean QT intervals computed using the RR [corrected] interval as a covariate were significantly longer during non-rapid-eye-movement (407 ms) and rapid-eye-movement (408 ms) sleep than during active wakefulness (386 ms). The RR-adjusted mean QT intervals during inactive wake were also longer (400 ms) but this clear trend did not reach statistical significance (p = 0.08). Although prolongation of the QT interval during sleep reflects inactivity that may be related to withdrawal of sympathetic tone, we postulate that sleep per se also has an effect on the interval.

Adult↗
PubMed1988

Periodic leg movement, sleep fragmentation and central sleep apnoea in two cases: reduction with Clonazepam.

Two subjects presented with periodic leg movement (PLM) syndrome during sleep that was characterized by marked sleep fragmentation and repetitive short central apnoeas. Treatment of PLM using Clonazepam, a benzodiazepine with hypnotic properties, markedly reduced the sleep fragmentation due to PLM and, despite its depressant properties on the central nervous system, controlled the repetitive central apnoeas. These two observations, although rare, give insight into the role of non-ventilatory variables in the development of sleep apnoea. Significant sleep fragmentation should be considered when assessing factors leading to respiratory instability during sleep and/or the pathophysiology of sleep apnoea syndromes.

Adult↗