A total of 28 male patients objectively diagnosed with obstructive sleep apnea syndrome (OSAS) participated in specific drug trials involving naloxone (an opioid antagonist), theophylline and bromocriptine mesylate (a dopamine agonist). All subjects were between 15 and 40% overweight. The group median apnea-hypopnea (A + H) index was 58. None of the drugs had any significant beneficial effects on the number and duration of upper airway apneas and hypopneas or directly related oxygen desaturation. Theophylline increased the diaphragmatic activity during REM sleep-related mixed apnea but had no impact on upper airway apnea in the studied population.

Adult↗

PubMedDate not supplied

Need for multi-diagnostic approaches before considering treatment in obstructive sleep apnea.

To choose an appropriate therapeutic treatment for obstructive sleep apnea syndrome (OSAS) depends on accurately diagnosing the underlying problems that lead to the disease. Evaluating local anatomical problems is critical. New techniques, such as imaging, permit us to do this more effectively. Appreciating the involvement of the central nervous system (CNS) in a fully developed syndrome is also important. Abnormal stimulation of the autonomic nervous system can be evaluated easily with a Holter ECG. Recognizing that OSAS is a multi-faceted problem whose various symptoms interact and aggravate one another helps to explain why treatments may not be immediately effective.

Airway Resistance↗

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Palatopharyngoplasty and obstructive sleep apnea syndrome.

Thirty-five patients diagnosed with obstructive sleep apnea syndrome (OSAS) underwent palatopharyngoplasty (PPP) after an objective evaluation. They were all monitored polygraphically after surgery. The group's postsurgical results were positive, with significant improvement in the apnea-hypopnea index (A + H index) and oxygen desaturation. However, patients with hypopharyngeal or mandibular problems or massive obesity had poor postsurgical results. As no subject has been followed for longer than two years, the long-term prognosis for this surgical approach is unknown.

Follow-Up Studies↗

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Mandibular advancement and obstructive sleep apnea syndrome.

A surgical procedure performed to advance the mandible in patients with retrognathia and obstructive sleep apnea is described. The case history of an obese patient with severe sleep apnea problems who underwent a number of treatments, responding only to mandibular advancement, is presented.

Adult↗

PubMedDate not supplied

Chronic headaches and sleep disorders.

BACKGROUND: Headaches and sleep problems are common complaints in the daily practice of the general practitioner. Since the relationship between headaches and sleep complaints is complex, clear models of interaction are needed for adequate diagnosis and treatment. METHODS: All subjects, successively seen in a headache clinic during a defined period, were subdivided based on the time of onset of cephalalgia. Subjects who reported onset of headache on a long-term basis, during the nocturnal or early morning (before final awakening) period, were systematically studied by a headache clinic and a sleep disorders center. This subgroup represented 17% of the total headache group. RESULTS: Although the results of the headache clinic study did not differentiate this subgroup from the other patients, the sleep disorders center's interviews and questionnaires demonstrated a significant impact of the sleep disorders on headache and daytime function. Nocturnal monitoring during sleep identified specific sleep disorders in 55% of the subjects with onset of headache during the nocturnal sleep period. Follow-up after treatment of the sleep disorder showed that all subjects with an identifiable sleep disorder reported either an improvement or absence of their headache. The subjects identified with periodic limb movement syndrome were mostly those who reported only an improvement in their sleep and still needed treatment for their headaches. The question of the interaction and association of sleep-related headache and periodic limb movement syndrome is unresolved. CONCLUSION: Headaches occurring during the night or early morning are often related to a sleep disturbance.

Adult↗

PubMedDate not supplied

How sleep and mental disorders are related to complaints of daytime sleepiness.

BACKGROUND: Daytime sleepiness is widespread and has negative impacts on the public sector. OBJECTIVE: To ascertain the incidence and prevalence of daytime sleepiness and associated risk factors in the general population. METHOD: In 1994, a representative sample of the non-institutionalized British population aged 15 years or older was interviewed via telephone using an expert computer-assisted program designed to facilitate surveys of this type (Sleep-Eval, M. M. Ohayon, Montreal, Quebec). Subjects were classified into 3 groups based on the severity of their daytime sleepiness. We completed 4972 interviews (acceptance rate, 79.6%). RESULTS: Severe daytime sleepiness was reported in 5.5% (95% confidence interval, 4.9%-6.1%) of the sample, and moderate daytime sleepiness in another 15.2% (95% confidence interval, 14.2%-16.2%). Associated factors with severe daytime sleepiness included female sex, middle age, napping, insomnia symptoms, high daily caffeine consumption, breathing pauses or leg pain in sleep, depressive disorder (based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria), falling asleep while reading or watching television, and motor vehicle crashes or accidents involving use of machinery. Moderate daytime sleepiness was associated with female sex, napping, insomnia symptoms, arthritis or heart disease, and gross motor movements during sleep. CONCLUSIONS: It is likely that daytime sleepiness deleteriously affects work activities, social and/or marital life, and exhibits a negative socioeconomic impact. In addition, the risk of a motor vehicle crash appears to be higher in this specific population: twice as many subjects operating a motor vehicle or using machine tools reported having a crash or accident, respectively, in the previous year in the groups with severe daytime sleepiness or moderate daytime sleepiness than did the general population with no daytime sleepiness. The high prevalence rates of daytime sleepiness and multiplicity of related factors mandate further scrutiny by public health officials.

Adolescent↗