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Biomedical subjects

C Guilleminault

Publications and source records attributed to C Guilleminault.

At least 343 records · Page 19Linked to original sources
PubMed1984

Five cases of near-miss sudden infant death syndrome and development of obstructive sleep apnea syndrome.

Five full-term infants were referred for "near miss" sudden infant death syndrome events, which occurred between 3 and 12 weeks of age. After a complete pediatric evaluation and 24-hour polygraphic monitoring, each infant was monitored at home with a cardiorespiratory monitor. Each was followed regularly (with repeat polygraphic recordings) up to 4 years of age. All five infants developed heavy snoring at night and symptoms of obstructive sleep apnea syndrome. The diagnosis of obstructive sleep apnea syndrome was confirmed by polygraphic recordings; surgery was recommended. Four of the five children underwent adenoidectomies between 3 and 4 years of age, and this significantly improved their condition. These five cases are the first polygraphically documented histories of the development of obstructive sleep apnea syndrome.

Adenoidectomy↗
PubMed1984

A surgical treatment for snoring and obstructive sleep apnea.

Snoring caused by oropharyngeal obstruction and some cases of obstructive sleep apnea syndrome can be cured or considerably lessened by resecting redundant tissue from patients' oropharynx and soft palate. Preoperative, and in some instances postoperative, sleep monitoring is a necessary part of evaluating these conditions.

Humans↗
PubMed1983

Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome.

This report presents the first study of cardiac arrhythmias and conduction disturbance in a large group (400 patients) with sleep apnea syndrome studied between 1974 and 1979 with 24-hour Holter electrocardiography and a simultaneously recorded polygraph during late afternoon or nocturnal sleep. Of the 400, 193 patients (48%) had cardiac arrhythmias during the recorded night. The mean number of apneic events, age, weight and lowest oxygen saturation during sleep were not significantly different in those with arrhythmias. The most significant abnormalities were unsustained ventricular tachycardia in 8 patients, sinus arrest that lasted for 2.5 to 13 seconds in 43 patients, and second-degree atrioventricular conduction block in 31. Seventy-five had frequent (greater than 2 beats/min) premature ventricular contractions during sleep. Fifty patients with significant arrhythmias had a tracheostomy and were monitored again after surgery. No arrhythmia was present in these patients except for premature ventricular contractions.

Adult↗
PubMed1983

Snoring, and some obstructive sleep apnea, can be cured by oropharyngeal surgery.

Surgical resection of physiologically unneeded palate and oropharyngeal tissue can completely stop a large part of social snoring problems and benefit at least 50% of persons with the obstructive sleep apnea syndrome. We report detailed results of the conditions of 28 patients who underwent 50 palatopharyn-goplasty (PPD) operations done by us since the concept was introduced two years ago. The results clearly prove that the social snoring problem of most patients can be fixed. The results are inconclusive as to just how PPP surgery fits into predictive management of sleep apnea. For some patients it is an effective alternative to tracheotomy.

Humans↗
PubMed1983

Cerebrospinal fluid monoamine metabolites in narcolepsy and hypersomnia.

Two groups of patients with the common complaint of excessive daytime sleepiness were examined. One group fulfilled the criteria for narcolepsy. The other had the sole symptom of excessive daytime sleepiness, confirmed by sleep latency tests, which was unaccompanied by systemic illness. Spinal fluid examinations for homovanillic acid, 3,4-dihydroxyphenylacetic acid, 3-methoxy-4-hydroxyphenylethylene glycol, and 5-hydroxyindoleacetic acid were carried out before and after administration of probenecid on the 20 patients and 40 controls. Probenecid-corrected accumulation of the dopamine metabolites was significantly increased in each of the patient groups, suggesting an association between pathological sleepiness and elevated dopamine turnover in the central nervous system.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1983

Cephalometric analyses and flow-volume loops in obstructive sleep apnea patients.

Fifteen patients with obstructive sleep apnea syndrome (OSAS) and 10 controls were studied. Polygraphic monitoring during sleep confirmed the presence or absence of OSAS. Ten OSAS patients and five controls had cephalometric analysis and 12 OSAS patients and five controls had a flow-volume loop study during wakefulness. Seven OSAS patients were submitted to both analyses. Flow-volume loops were unable to detect extrathoracic airway obstruction in six out of 12 OSAS patients. One control was found with positive results. Six out of seven subjects with positive flow-volume loops were overweight (greater than or equal to 30% ideal weight). Cephalograms were very useful in demonstrating mandibular deficiencies in OSAS patients. The length of the soft palate and the position of the hyoid bone, together with the measurement of the posterior airway space, are criteria of great interest in OSAS patients. Cephalometric analysis is recommended in all OSAS patients scheduled for surgical procedure. None of these tests, however, whether alone or in combination, is capable of identifying all cases of OSAS.

Adolescent↗
PubMed1983

Posttraumatic excessive daytime sleepiness: a review of 20 patients.

Twenty patients complaining of excessive daytime somnolence (EDS) secondary to significant head trauma were studied objectively. Several polygraphic recording protocols were performed over the 12-year study period. Eighteen of the 20 patients were objectively sleepy, 8 of them presented mixed sleep apnea syndrome that fragmented their sleep, 5 patients' sleep-related breathing problems improved over time, 9 patients presented daytime somnolence, and 1 reported abrupt bouts of muscle weakness and had two sleep onset rapid eye movement (REM) periods during daytime testing. Cerebrospinal fluid analysis for specific neurotransmitter metabolites' evaluation, pre- and postprobenecid, did not differentiate posttraumatic EDS patients from narcoleptics or other patients with EDS. Two patients (one with organic brain syndrome, the other depressed) reported subjective sleepiness, not confirmed by objective data. Objective testing in posttraumatic sleepiness is recommended because of the plurality of problems and medicolegal implications.

Adolescent↗
PubMed1983

The effects of flurazepam on sleep studies in patients with chronic obstructive pulmonary disease.

We studied five male nonobese patients (mean age, 61 years) who had moderate chronic obstructive pulmonary disease (COPD). Each patient underwent three successive nights of systematic monitoring of sleep variables. On nights 2 and 3, patients received placebo and flurazepam (30 mg). Patients were also given flurazepam (15 mg) for seven consecutive nights and underwent sleep monitoring on nights 1 and 7. Two patients exhibited oxygen desaturation during rapid-eye-movement (REM) sleep, both spontaneously and after administration of flurazepam. The three other patients had no nocturnal oxygen desaturation, either spontaneously or after ingestion of flurazepam. We concluded that sleep-induced respiratory abnormalities are not systematically worsened by flurazepam. Flurazepam (15 mg) had no effect on the sleep disturbances of our patients with COPD after seven nights of administration.

Aged↗
PubMed1983

'Near-miss' for sudden infant death syndrome infants: a clinical problem.

Three hundred six infants were referred for evaluation of "near-miss" sudden infant death syndrome (SIDS) from 1973 to 1980. Following the hospitalization and medical evaluation, there were 156 infants (115 term and 41 preterm) for whom there was no explanation for the presenting event and who were considered near-miss infants; 88% of these infants were seen during the first 3 months of life. A repeat near-miss event was reported in 63% (term) and 83% (preterm) infants. Twelve percent of term infants and 17% of the preterm infants had ten or more repeat events. A home apnea/cardiac monitor was prescribed for 88% of the infants for an average duration of 5.6 months in term infants and 3.5 months in preterm infants. Monitoring had been discontinued in 69% of the infants by 7 months of age. One full-term infant was later a SIDS victim. The risk of a repeat near-miss event is concluded to be sufficiently great to demand immediate hospitalization, medical evaluation, home monitoring when there is no specific treatment, and close clinical follow-up. Follow-up studies are needed to determine whether there is any long-term morbidity for infants who have had near miss events.

Age Factors↗
PubMed1982

Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning.

Twenty-five children, age range 2 to 14 years (mean age = 7), were referred to the Stanford University Sleep Disorders Clinic for various clinical symptoms, including excessive daytime somnolence, heavy nocturnal snoring, and abnormal daytime behavior. All children (10 girls and 15 boys) were polygraphically monitored during sleep. No sleep apnea syndrome or oxygen desaturation was revealed. However, each child presented significant respiratory resistive load during sleep associated with electrocardiographic R-R interval and endoesophageal pressure swings. The most laborious breathing occurred during REM sleep. Second degree atrioventricular blocks were also noted. Tonsillectomy and/or adenoidectomy was performed in every case and resulted in a complete disappearance or substantial amelioration of the reported symptoms. Objective evaluation by Multiple Sleep Latency Test and Wilkinson Addition Test confirmed the beneficial effect of surgery.

Adenoidectomy↗
PubMed1982

Aging, drugs and sleep.

Elderly subjects are infrequently selected as subjects to evaluate the effects of medication. In combination with increasing age and sleep, certain drugs may lead to unsuspected and undesirable secondary effects which may be life-threatening or at least very disturbing to the well-being of the elderly subject. Medications administered during the daytime may affect sleep or lead to sleep-related pathology. Administration of cardiovascular medications, corticosteroids, tricyclic antidepressants, and antiparkinsonian drugs have been found to induce significant problems during sleep in patients, leading to investigation and polygraphic testing in our clinic at Stanford. Benzodiazepines are frequently prescribed in elderly subjects to control nocturnal sleep disturbances. However, long-lasting benzodiazepines, such as flurazepam, may induce confusion, disorientation, daytime sleepiness, or may impact on breathing and its control during sleep.

Adrenal Cortex Hormones↗
PubMed1982

Movement and gastroesophageal reflux in awake term infants with "near miss" SIDS, unrelated to apnea.

Forty-five term infants who had a "near miss" for SIDS were studied with a continuous overnight polygraphic recording of endoesophageal pH, respiration, and ECG. Recordings were examined for occurrences of GER and for central apnea of 10 seconds or greater duration. There were 341 apneic events greater than or equal to 10 seconds recorded in 46 studies, with a mean of 7 +/- 7. In 91% of the infants, no apneas exceeded 15 seconds. Only 31 episodes of apnea greater than or equal to 10 seconds occurred during GER: in two of these episodes the apneic event was greater than or equal to 15 seconds. Twenty-four of the 31 apneas greater than or equal to 10 seconds during periods of pH less than 4 occurred in one infant. A total of 356 precipitous pH drops was recorded (mean 8.7 +/- 7.4). The pH drops occurred most frequently when the patient appeared to be awake (73%), and in 84% of events there was movement before and during the pH change. We conclude that the majority of these near miss SIDS infants had GER associated with movement during awake periods, without any temporal relationship to apnea. Although reflex apnea following GER may be seen in some term infants, this problem may be more significant for the immature infant.

Apnea↗
PubMed1982

Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome.

In order to determine whether reversible alterations in ventilatory control are found in obstructive sleep apnea syndromes, 5 male patients 31 to 57 yr of age presenting with the syndrome were polygraphically monitored before and several times during the 6 months after tracheostomy. They also had a hypercapnic ventilatory response study before surgery and again 3 months after surgery during the daytime. A dramatic decrease in overall apnea index was seen immediately after surgery, but the number of central apneas and the central apnea index did not reach low values until several months after tracheostomy. Ventilatory response to CO2 improved in all cases after surgery.

Adult↗
PubMed1982

The detection and quantification of sleep apnea by tracheal sound recordings.

Tracheal sound recordings and O2 saturation were compared with conventional recordings of respiratory events (thermistors, strain gauges, and O2 saturation) in 14 patients referred for assessment of sleep apnea syndrome. There was no significant difference in the number of respiratory events associated with desaturation recorded during the sleep by the two methods. Tracheal sound recordings were more useful in analyzing the cause of the respiratory event. Hypopnea without desaturation was seen more often with tracheal sound recordings than with the conventional methods. The durations of apneic and hypopneic events were significantly longer when recorded by thermistors and strain gauges than by breath sounds.

Adult↗