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J H Peter

Publications and source records attributed to J H Peter.

At least 91 records · Page 5Linked to original sources

[Detecting blood pressure variation using spectral analysis in obstructive sleep apnea syndrome with and without nCPAP therapy].

The variation of blood pressure was investigated by power spectrum analysis in 12 patients with severe sleep apnea with and without nCPAP-therapy. In the baseline findings systolic and diastolic variation consisted of mainly two types of pressure oscillations: Swings of slow frequency (0-0.06 Hz) in tight association with the periodicity of breathing disorder and arousal and extensive respiratory pressure waves (0.2-0.5 Hz) due to the increased intrathoracic pressure changes during breathing efforts with partial or complete obstruction of the upper airway. In general systolic was higher than diastolic variation and the contribution of slow pressure oscillations was considerably bigger than that of respiratory waves. Sufficient nCPAP-therapy resulted in a decrease of the mean pressure and in a clear reduction of systolic and diastolic variation in which both types of pressure waves were diminished in a similar manner. At last there was a higher proportion of pressure waves in the frequency range of the Mayer-waves (0.06-0.2 Hz) with nCPAP-therapy.

Adult↗

[Nocturnal hypertension and sleep apnea: effect of the ACE inhibitor cilazapril on apnea-induced blood pressure increases during sleep].

The nocturnal increases in blood pressure in cases of obstructive sleep apnea are discussed as causes in connection with increased cardiovascular mortality in sleep apnea. Previous antihypertension therapy studies revealed the antihypertensive action of the ACE inhibitor cilazapril averaged over NREM (NR) and REM sleep (R). In the present study, the effect of this drug on the blood pressure increase within the stress segment of obstructive apnea in NR and R was investigated in a double-blind randomized study versus placebo. Data were collected in digital form with the help of cardiorespiratory polysomnography and intra-arterial blood pressure measurements; a total of 640 apnea in 16 patients were evaluated. Relevant increases in blood pressure occurred during the apnea which were, as expected, more pronounced in R (150/74 mmHg) than in NR (135/69 mmHg). The antihypertensive action of cilazapril was also stronger in R (systole--11.9/diastole--6.4 mmHg) than in NR (systolic--9.0 mmHg/diastolic--5.7 mmHg). Placebo caused significantly lower decreases in blood pressure (systolic--3.7 mmHg/diastolic--2.4 mmHg in R, systolic--2.8 mmHg/diastolic--1.8 mmHg in NR). Thus, evidence is provided for a clinically relevant blood pressure lowering effect of the drug cilazapril on the stress-induced blood pressure increases accompanying obstructive apnea both in NREM and in REM sleep.

Adult↗

[Surgical treatment of obstructive sleep apnea by osteotomy of the facial bones (results of 1 year)].

Surgical treatment of obstructive sleep apnea with abolition of obstructive apneas and hypopneas is possible by maxillomandibular advancement as our own results in 24 patients show. Maxilla and mandible must be advanced at least about 10 mm to secure success. Indication for maxillomandibular advancement should be restricted to patients with certain craniofacial disorders, which are of retrognathic dolichofacial type combined with pharyngeal narrowing. Before considering surgical treatment other possible contributing factors as for instance obesity should be eliminated, the more as nCPAP-therapy constitutes an effective conservative method. Despite our unchanged success rate after 1 year further polysomnographic follow-up control is essential to see what happens 5, 10 or 20 years after maxillomandibular advancement.

Adult↗

[Errors and risks in administration of nasal respiratory therapy of obstructive sleep apnea].

Over a period of 1 year we observed in our sleep laboratory in 502 patients with sleep related breathing disorders several side effects of positive airway pressure treatment, furthermore we observed in 5 patients unexpected dangerous complications due to the application of CPAP and BIPAP. We observed mask leakages which lead to insufficient positive airway pressure-therapy and an occurence of short central apnoeas during NREM sleep after arousal or wakefulness periods. Finally we observed in 5 patients during treatment with CPAP and BIPAP an unexpected appearance of long central apnoeas up to 110s and central hypoventilations up to 5 min accompanied by excessive hypoxaemia (SaO2 < 20%) and cardiac arrhythmias. We conclude that in the treatment of obstructive sleep apnoeas we have to expect in 1-2% complications of the positive airway pressure treatment itself. To avoid life endangered complications the first night application should be done only in conventional sleep laboratories.

Equipment Failure↗

[Parameters for determining the effective treatment pressure in nCPAP therapy of sleep apnea].

We evaluated the accuracy of single parameters from the polysomnography in establishing the effective nCPAP treatment pressure in order to possibly economize pressure adjustment. In four patients (pts) a standard polysomnography was performed. 67 segments of 30-60s in duration, showing different typical types of breathing disturbances or normal breathing were selected. The segments were divided into 5 horizontal parts consisting of only one of the following signals: SaO2, snoring, mask pressure, esophageal pressure (Poes) and respiratory movements (RC + Abd). A second investigator then classified these 335 one lead recordings without knowing the complete segment. The classification based on the complete segment compared to that based on only one parameter gave an identical result in 44.8% (SaO2), 61.2% (Poes), 64.2% (RC + Abd), 80.6% (sonoring) and 82.1% (mask pressure) respectively. 97% of the complete segments were classified identically by both investigators. Each of the studied parameters alone was not adequate in establishing the correct pressure level. SaO2 corresponds least, mask pressure and snoring best to the classification based on all parameters.

Air Pressure↗

[Machine-assisted detection of individually effective minimal CPAP pressure using the Vitalog HMS 5000 monitor].

UNLABELLED: Continuous positive airway pressure ventilation (CPAP) has been proven to be highly effective in the elimination of sleep-related breathing disorders (SRBD) in the last couple of years. The titration of the effective airway pressure should be carried out under continuous polysomnographic supervision in the sleep laboratory. The CPAP ventilation may result in potential hazards through the positive airway pressure and each patient needs an individually adjusted pressure for therapy. In a prospective study we investigated under polysomnographic supervision the effectivity and the hazards of a machine-controlled CPAP calibration in 22 male patients (pts) (age: 53.6 +/- 8.9 years, BMI: 29.9 +/- 5.0 kg/m2) with obstructive SRBD (RDI: 50.6 +/- 1/h). Automatic CPAP-calibrations were carried out using the Vitalog HMS-5000 monitor and the Respironics BiPAP-STD ventilator. An algorithm determined the cyclical changes of the airway pressure. The following night we controlled the assessed pressure through manual adjustment during conventional polysomnography. RESULTS: The CPAP-levels assessed through the automatic calibrations (8.36 +/- 2.36 cmH2O) showed in 19 pts a good agreement with the CPAP-levels of the control nights (8.15 +/- 2.36 cmH2O), the difference was statistically nonsignificant (p < 0.5). The CPAP-levels of the automatic titrations and the control nights agreed exactly in 12 pts (63%). 3 pts of the 22 failed the automatic CPAP-titration process because of functional or psychical reasons. 14 pts (64% of 22 pts) showed a good functional tolerance to the cyclical changes of the airway pressure. 3 pts were unable to fall asleep under the increasing airway pressure, but after falling asleep at a constant pressure of 2 or 4 cmH2O they could tolerate the automatic pressure titration. A reset of the actual pressure to the baseline was necessary in 13 pts to enable them falling asleep, in 2 pts because of increase of the airway pressure due to movement artifacts, in 2 pts because of central apneas and in one patient because of ventricular extrasystoles. 35 increases of the baseline level (48% of altogether 73 increases) occurred due to clinically irrelevant desaturations. We found a direct hazardous effect of the machine-controlled CPAP-titration (central apneas, secondary alveolar hypoventilation, ventricular extrasystole) in 7 pts with chronic obstructive pulmonary disease and/or cardiovascular disorder. CONCLUSION: The machine-controlled CPAP-titration should be carried out only in a selected group of patients. Nevertheless, despite of the good agreement of the assessed pressure levels with the polysomnographic controls, this method seems to be not suitable for the clinical routine because of its potential hazards and contraindications in high risk patients.

Adult↗

Manifestations and consequences of obstructive sleep apnoea.

Over the last two decades the diagnostic tools used in sleep medicine have developed enormously, making it possible to study the interaction of sleep-related breathing disorders (SRBD) with cardiovascular function and the autonomic nervous system, as well as the effects of SRBD on a variety of physiological processes during wakefulness. Different modes of nasal ventilation are now available, allowing all forms of SRBD to be treated. If early diagnosis and treatment are provided, the acute and long-term sequelae of SRBD can be prevented. In addition to the care and treatment of patients with severe obstructive sleep apnoea syndrome (OSAS), future patient management will need to focus on patients with milder forms of obstructive sleep apnoea (OSA). In particular, the consequences of SRBD on cardiac arrhythmias, arterial hypertension and hypersomnolence are discussed, considering epidemiological, clinical, diagnostic and therapeutic aspects. Some economical issues arising from SRBD are also discussed, and the authors conclude that a Europewide programme for early detection, treatment and prevention of SRBD is required. This could make a large contribution to the reduction of cardiovascular morbidity and mortality and also reduce the incidence of "human error catastrophes" due to hypersomnolence.

Arrhythmias, Cardiac↗

[Morbidity and mortality in sleep apnea and nocturnal bradyarrhythmia].

The as yet unanswered question, whether patients with sleep apnoea and apnoea-associated bradyarrhythmias have a higher morbidity and mortality rate, was retrospectively investigated in 132 men with sleep apnoea (apnoea index > 10/h). Sleep-associated bradycardic arrhythmias were recorded in 71 (mean age 50.1 years; group 1). For comparison served 61 men with sleep apnoea but no bradyarrhythmias (mean age 51.4 years; group 2), matched for age and weight. There was no significant difference between the two groups as to diagnosis and initial findings on ergometry, lung function tests and blood gas analysis. The apnoea index of 48.1 +/- 23.9/h in group 1 was significantly higher than that of 31.9 +/- 20.1/h in group 2 (P < 0.001). During a follow-up period of a mean of 41.1 (19-66) months, two patients in group 1 died (of myocardial infarction), while one died (of bronchial carcinoma) in group 2 (follow-up period of 29.6 [18-54] months). The two deaths in group 1 were in a subgroup of 16 patients who had declined treatment or had used it irregularly. There was no death among those who had been treated (n = 54), by nasal continuous positive airway pressure, operation or pacemaker implantation. However, no causal relationship could be established from these data between increased mortality rate and apnoea-associated arrhythmias.

Adult↗

Surgical treatment of obstructive sleep apnea by maxillomandibular advancement.

In recent years obstructive sleep apnea syndrome has gained increasing interest. Treatment of choice is nasal continuous positive airway pressure ventilation during sleep for upper airway patency, which does not cure sleep apnea and has to be applied throughout a patient's lifetime. In respect to various underlying pathomechanisms, in certain cases with craniofacial disorders, causal therapy by craniofacial osteotomies seems possible. A series of 21 consecutive patients with maxillary and mandibular deficiency were treated primarily with a 10-mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort-I osteotomy, respectively. Obstructive sleep apnea syndrome was considerably improved in all patients. In 20 of 21 patients, the postoperative respiratory disturbance index (RDI) was reduced clearly to under 10, oxygen saturation rose and sleep quality improved. This was achieved by a maxillomandibular advancement of 10 mm without secondary refinements. In one patient the RDI could only be reduced to 20, probably due to insufficient maxillary advancement; oxygen desaturations still existed despite secondary corrections. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space.

Adult↗

Twenty-four-hour blood pressure control: effect of cilazapril on continuous arterial blood pressure during sleep, and physical and mental load in patients with arterial hypertension and sleep apnea.

To assess the effectiveness of cilazapril in regulating blood pressure (BP) in patients with sleep-related breathing disorders, 23 male patients (mean age, 50 years; mean body mass index, 32.7 kg/m2) with a mean apnea/hypopnea index of 49.7 and arterial hypertension (163/104 mm Hg) participated in a placebo-controlled, randomized, double-blind study. They received either cilazapril, 2.5 mg/day (n = 12) or placebo (n = 11). The effects of treatment were studied under different conditions of sleep and physical and mental load before and after 8 days of treatment. Measurements by night included cardiorespiratory polysomnography, inductive plethysmography, pulse oximetry and nasal air flow, electroencephalography, (EEG), electrooculography and electromyography, (ECG), and blood pressure (BP). Measurements by day (ECG, heart rate, and BP) were performed at rest and under physical and mental load. Systolic, diastolic, and mean BP (5 min at night; 1 s during the day), heart rate, apnea and hypopnea index, EEG data, and test reaction times were compared in both groups. The systolic and diastolic BP of patients receiving cilazapril was lower compared to baseline for all physical and mental loads. Mean BP reductions over all standardized loads was greater with cilazapril than placebo (-10 vs. -4.3 mm Hg, p < 0.05). These results show that BP is influenced similarly by mental and physical loads, and that behavior [i.e., awake state and non-rapid eye movement and rapid eye movement (NREM and REM) sleep determines BP regulation. Cilazapril is effective in reducing BP in all situations, especially during REM sleep hypertension.

Adult↗

Nocturnal hypertension and cardiovascular risk: consequences for diagnosis and treatment.

General use of ambulatory noninvasive 24-h blood pressure monitoring in many patients has shown that new criteria for arterial hypertension are useful. A classification of circadian blood pressure in "dippers" and "nondippers" (no physiologic drop of blood pressure) needs to be specified. An altered circadian blood pressure profile, like that in nondippers, was used as a diagnostic criterion for secondary hypertension. Recent epidemiologic studies in patients with essential hypertension have shown that nondippers are at higher risk for cardiovascular complications such as myocardial infarction and cerebrovascular insult. The studies also revealed that sleep-related breathing disorders (SRBD) are characterized by increased cardiovascular risk. Increases in blood pressure caused by SRBD could be documented, with the highest amount occurring during REM sleep. A study performed in a general practice showed a high incidence (40/112) of nondippers in a group of snoring middle-aged men with obesity and daytime fatigue. This indicates diagnostic and therapeutic consequences for the control of 24-h blood pressure, including nocturnal breathing pattern and daytime symptoms due to SRBD. The goal of antihypertensive drug therapy is to reduce blood pressure significantly during the day and during the night in different stages of wakefulness and sleep. A new protocol was designed to investigate blood pressure over 24 h under a standardized load, including nocturnal hypertension. The angiotensin-converting enzyme (ACE) inhibitor cilazapril was used in this test procedure and showed a significant and clinically relevant mean blood pressure reduction of 10.0 mm Hg (versus placebo 4.3 mm Hg) over 24 h.

Adult↗

A new method to study blood pressure, heart rate and EEG as a function of reaction time.

A new method is presented to study the relationship between reaction time and blood pressure, heart rate and EEG. The method consists of a simultaneous recording of continuous invasive or non-invasive arterial blood pressure, ECG, EEG, EMG and EOG in a sound-isolated chamber while a monotonous visual reaction time test is running for about 90 minutes. The signals are A/D-converted and analyzed digitally after recording. One second average amplitudes are computed. Systolic, mean and diastolic blood pressure values are calculated, and the EEG is divided into the delta, theta, alpha, sigma and beta frequency bands. The signal amplitudes are averaged in three different reaction time categories, i.e., when the reaction is normal, delayed or missing. Preliminary tests suggest that interesting differences can be observed in the studied variables in different reaction time classes. This method can also be applied to the investigation of autonomic control and to treatment studies.

Blood Pressure↗

Lipoprotein (a), low-density, intermediate-density lipoprotein, and blood pressure in a young male population.

Both hypercholesterolemia and hypertension are risk factors for atherosclerotic vascular disease, and elevated cholesterol levels occur more frequently than expected in patients with hypertension. Elevated levels of intermediate-density lipoproteins (IDL) and low-density lipoproteins (LDL) were shown to be atherogenic, and LDL, comprising the major cholesterol-carrying fraction in human plasma, are structurally related to lipoprotein (a)[Lp(a)], a further risk factor for atherosclerosis. In the present study we investigated 200 male employees (mean age 26 +/- 7 years) to determine whether the relationship of IDL and Lp(a) to systemic blood pressure is similar to the reported correlations between total and LDL cholesterol and systemic blood pressure. To this end blood pressure was measured several times in each individual, and lipids, lipoprotein-cholesterol, apolipoprotein B (apo B), and Lp(a) were determined in fasting serum. IDL cholesterol and apo B, the main protein component of IDL and LDL correlated with blood pressure. However, levels of Lp(a) correlated neither with systolic or diastolic blood pressure nor with lipoprotein cholesterol, body weight, or age. Although IDL and Lp(a) are considered lipoprotein risk factors for atherosclerosis, levels of Lp(a), unlike IDL, are not related to blood pressure, body weight, or age. Our data suggest different metabolic and pathophysiological mechanisms of the risk factors, IDL, LDL, and Lp(a).

Adult↗

Theophylline therapy in sleep apnoea syndrome.

There is evidence that theophylline improves obstructive sleep apnoea, although the existing studies are not comparable because of different patient groups, methods and treatment regimes and therefore may give partly conflicting results. In our opinion, patients with mild or moderate sleep apnoea syndrome, who do not need nasal ventilation therapy urgently, or who are not at a high cardiovascular risk, are the favourite group for theophylline therapy and an attempt in oral treatment in this group of patients is recommendable, since all other drugs have failed. Serum theophylline level should be lower than in anti-obstructive therapy, because of its otherwise deleterious effect in sleep structure. The improvement in apnoea index, when responding is not only a short-term effect, but lasts over a long-term treatment period, although patients should still be monitored, because of the possibility of worsening in some cases. The reason for responding and not responding in different patients remains unclear, and further studies are needed to investigate the precise mechanisms of action of theophylline in sleep apnoea, which include central and peripheral effects, to establish predictors for treatment in different groups of sleep apnoea patients.

Humans↗

[Influence of nCPAP therapy on bradycardic arrhythmias in sleep apnea].

In 5-10% of patients with sleep apnoea, AV conduction block or sinus arrest up to several seconds can be demonstrated. We studied the effect of nCPAP treatment on apnoea-associated heart blocks. 10 consecutive patients (9 m, 1 f) between 28-56 years of age (mean value 43.4 y) were studied. The diagnosis of sleep apnoea and nocturnal heart blocks during the first visit at the outpatient department were the only selection criteria. A standard polysomnography before and during nCPAP was performed. Mean pretreatment RDI was 91/h. Repetitive II degrees and III degrees AV conduction blocks were diagnosed in 2 patients (pts) and sinus arrest of 2 to 11 s in 8 pts at the study without therapy. 89.2% of heart blocks occurred during REM-sleep. In 8 pts a complete reversal of heart blocks could be demonstrated during nCPAP. In 2 pts heart blocks persisted at a reduced number during REM-sleep, mainly during ineffective nCPAP. In 80% of our pts nCPAP leads to a complete reversal of heart blocks. The indication for pacemaker implantation must be established on an individual basis.

Adult↗

[Spectral analysis of long-term blood pressure measurements in patients with sleep-related respiratory disorders].

Spectral analysis of long-term recordings of blood pressure is a convenient method to recognise and reveal the amplitude and periodicity of changes in blood pressure during sleep. The increased variability of nocturnal blood pressure in patients with sleep apnoea is mainly determined by two types of oscillating variations in blood pressure: 1. Oscillations in a low frequency range of 0.0-0.06 Hz associated with breathing disorders and consecutive arousals. 2. Oscillations in a higher frequency range of 0.2-0.5 Hz associated with three different patterns of breathing. Normal undisturbed breathing, regular snoring and ineffective breathing efforts during obstruction of the upper airways. Furthermore, the interaction between breathing or breathing disorder and arterial blood pressure is determined by the influence of the sleep stages.

Adult↗

[Non-invasive, continuous, portable blood pressure recording in the sleep laboratory].

The importance of cardiovascular consequences of sleep related breathing disorders implies the need for continuous recording of blood pressure in any cardiorespiratory polysomnography. Invasive techniques, which are the gold standard, are limited to special indications and studies. Non-invasive, continuous methods opened new possibilities for sleep laboratory investigations. The existing Finapres system proved to be a valuable method if parallel video recording was applied. The size of the system restricts its application to stationary settings only. Therefore the methodology was improved and integrated in a portable recorder. A prototype of this recorder, the Portapres, was validated against invasive pressure in 9 one-hour tests during the day and 12 polysomnographic recordings of 8 hours duration. The Portapres has now two finger cuffs and an automatic hydrostatic height compensation to overcome limitations of the Finapres. The technical implementation of the recorder needs more improvements. The correlation of mean blood pressure was 0.81 and mean pressure of the Portapres was 6.8 mmHg lower than invasive values.

Blood Pressure↗