Search PubMed⌕ Search

Biomedical subjects

J H Peter

Publications and source records attributed to J H Peter.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Long-term theophylline therapy in sleep apnea--follow-up over a period of 12 months].

Among all the sleep-related respiratory disorders, sleep apnoea is clinically the most important one because of its high incidence and potential cardiovascular sequelae. Treatment depends upon the risk profile of the individual patient; in severe cases or in risk patients nasal continuous superpressure ventilation is employed, whereas in milder cases theophylline has been successfully used alongside general measures. 103 patients were followed up during treatment on an outpatient basis for 2 to maximum 12 months. Initially a significant reduction of the apnoea index by a 50% average was achieved. This therapeutical effect remained largely constant with a slight average deterioration at the end of the observation period, whereas the subjective feeling tone also improved in most patients. The treatment course was prematurely discontinued in 34 patients. Good to very good success was achieved in a total of 43 patients, whereas 26 patients were non-responders either initially or as the treatment proceeded. Even though theophylline treatment is now well-tried in mild forms of sleep apnoea, predictors for its use in certain groups of patients must be determined before treatment is initiated.

Adult↗
PubMed1993

[Obstructive sleep apnea syndrome caused by craniofacial abnormalities].

Patients with obstructive sleep apnoea syndrome frequently present distinct changes in the craniofacial skeleton that result in a structural narrowing of the pharynx and promote pharyngeal collapse during sleep. The evaluation of the clinical data of patients with and without craniofacial dysmorphia reveals that mean age, mean Broca index and the number of additional diseases is decreased in patients with craniofacial dysmorphia. Young patients or patients with normal weight and OSAS usually present such skeletal changes. The number of sleep-related breathing disorders and the extent of nocturnal desaturation are also decreased in the group of patients with dysmorphia. The structure of sleep is similarly disturbed in both groups. In most cases patients with severe obstructive sleep apnoea have normal cephalometric data.

Adult↗
PubMed1993

[Sleep-related respiratory disorders: early detection and follow-up by close patient contact].

Sleep apnoea (SA) ist a challenge to clinical research, since it occurs in up to 10% of the male professionally active population. It is indeed a challenge in respect of diagnosis, clinical aspects and therapy. SA is not only responsible for mental handicaps during daytime caused by disturbed sleep (increased tendency to doze or fall asleep, proneness to accidents), it will also enhance morbidity and mortality in aspect of cardiopulmonary and cardiovascular diseases (hypertension, cardiac insufficiency, disturbances of cardiac rhythm). All kinds of secondary and/or subsequent damage are reversible, provided diagnosis and rigidly introduced and maintained treatment have been performed well in time. SA can be diagnosed, treated and followed up by means of methods that can be flexibly employed outside the hospital, i.e. on an outpatient basis, such as questionnaires, MESAM IV, behavioural counselling, drug therapy). Within the framework of the current three-year project a stepwise concept was developed for diagnosis and treatment that also includes outpatient examination procedures. This system integrates anamnesis, outpatient monitoring, sleep laboratory, therapy and therapy control into a comprehensive feedback system of patient care. The following standardised procedural steps are included in the outpatient part of this system: baseline examination, treatment that can be performed on an outpatient basis, short-term, medium-term and long-term therapy follow-up. If these steps do not yield satisfactory results or if there is a high acute risk, the patient is subjected to in-patient treatment. At present, 683 first examinations and 420 follow-ups have been recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Significance of a screening questionnaire for diagnosis of sleep apnea].

More and more patients present with nocturnal respiratory disorders, especially with sleep apnoea (SA). This makes it mandatory to develop methods for preselecting the patients. A symptom assessment questionnaire was developed according to the Marburg stepwise concept on sleep apnoea diagnostics. Every patient completes this questionnaire as a matter of routine before he is given an appointment for an examination. The procedure to be followed depends on the evaluation of this questionnaire. Questions asked: Weight, height, use of soporifics and sleeping pills, hypertension, snoring, involuntary falling asleep, respiratory standstills, tendency to fall asleep during car driving and accidents in which the tendency to fall asleep was also involved. Three categories result from the evaluation: presence of sleep apnoea improbable (negative), more accurate details of symptoms mandatory (checking required) sleep apnoea probable (positive), patient is given an appointment date. This method was tested on 124 patients (108 male, 16 female, average age 50 yrs., average body-mass index 29.1, average apnoea index (AI) 12.8) who completed the questionnaire and were examined as outpatients, independent of the evaluation of the questionnaire, using the MESAM-IV system (nocturnal long-term recording of respiratory noises, heart rate, oxygen saturation and posture sensor). Measurements according to MESAM-IV system yielded in 69 patients (55.6%) and AI < 6 (apnoea-negative). 12 patients (9.7%) had AI 6-10 (checking required), and 43 AI < 10 (positive). Basing on evaluation of the questionnaire, 42 of 43 apnoea-positive patients had been correctly classified (98%).(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1993

[Comparative use of MESAM IV and polysomnography in sleep-related respiratory disorders].

The high prevalence of sleep-related respiratory disturbances among the male population requires development of reliable outpatient measurement systems enabling the selection of patients to be admitted to the sleep laboratory. MESAM IV is such a system. It can record for up to 18 hours via four sensors a patient's snoring sounds, heart rate, oxygen saturation and posture. To test the reliability of the instrument we compared parallel night measurements by MESAM IV and polysomnography (PSG) via the respective Respiratory Disturbance Indices (RDI = number of apnoeas plus hypopnoeas per hour). The group of subjects studied numbered 68 patients of the sleep laboratory suspected of having sleep-related respiratory disturbances (age 18-78 years, average 50.8 yrs.; height 164-192 cm, av. 175.2 cm; weight 40-160 kg, av. 99.3 kg; body mass index 13.8-49.5, av. 32.3). Assessment of the MESAM measurements was effected on the one hand by means of a computer programme (version 1.2) that is part of the system, and on the other hand by 3 independent evaluators, two of whom were already experienced in MESAM evaluation. Each evaluator was unaware of all personal and clinical data of the patients and of the results obtained by the other evaluators. Visual assessment was performed according to fixed criteria with the inclusion of all four measurement signals of the system, whereas two mutually independent respiratory disturbance indices (RDI) were calculated by computer evaluation. The results of the various MESAM IV evaluations were compared with those of polysomnography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Validation study of the 10-channel Sidas 2010 registration unit for diagnosis of sleep-related respiratory disorders].

UNLABELLED: We developed in cooperation with F. D. Stott, Oxford, the Mobile 10-Channel Unit SIDAS 10, a recording instrument for diagnosing sleep-related breathing disorders, to cope with the large number of patients requiring to be diagnosed. Studies that have already been published prove the clinical worth of this instrument that has been conceived as a mobile unit for the diagnosis of sleep-related breathing disorders outside a conventional sleep laboratory. To test the validity of this unit the present study was designed as a comparative study of conventional polygraphs versus SIDAS recordings. METHOD: 20 unselected patients (18 men, 2 women), average age 54.8 (34-65) years, body mass index (BMI) 29.8 (20.2-46.2) kg/m2, were examined parallel for one night in the sleep laboratory. We compared the breathing a) recorded with nasal airflow, oesophageal pressure, oxygen saturation and b) with induction plethysmography, ITP (a non-invasive recording of intrathoracic pressure variations), nasal airflow and pulse oxymetry via SIDAS 2010. The writeouts were evaluated visually according to internationally valid criteria. RESULTS: We found 10 patients with an apnoea index (AI) > 10/h (mean AI 53.2), 4 patients with AI between 5 and 10/h (mean AI 6.4) and 6 patients with an AI < 5/h (mean AI 3.4). 5835 apnoeas and hypopnoeas were evaluated. The statistical analyses yielded the following results: equal classification of central apnoeas in 87%, of obstructive apnoeas in 90% and of mixed apnoeas in 92% of the cases; on the whole, 10% more hypopnoeas were classified in the SIDAS recordings.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Sleep analysis computer in diagnosis of sleep-related respiratory disorders].

Sleep related breathing disorders influence the structure of sleep by considerably modifying the ratios of the individual sleep stages. The sleep analyses carried out by polysomnography in the diagnosis of sleep related breathing disorders have so far been evaluated manually according to the criteria of Rechtschaffen and Kales, since automatic systems do not permit standardised evaluation as yet. Automatic sleep analyses via SAC, however, has been developed further in recent years and has widened its scope and efficiency. It is now possible to perform a comprehensive sleep analysis via SAC by means of modified criteria after Rechtschaffen and Kales. The SAC determines individual curves in the EEG and EOG and includes in addition to the EEG parameters an automatic apnoea detection as well as detailed breathing and oxygen saturation analyses. The Sleep Analysis Computer (SAC) records 15 parameters (2 EEG, 2 EOG, 2 EMG, ECG, NAF, thoracic and abdominal breathing curves, oxygen saturation, body posture, optionally blood pressure = RR, CPAP etc.). This means that all the parameters required for diagnosing sleep related breathing disorders as well as their differential diagnosis can be determined. Within the framework of a blood pressure study, 16 patients (average 45.5 SD 4.6 years) were subjected to SAC measurement in addition to conventional PSG. The computer recordings were evaluated according to apnoea index, the form of the apnoea and the oxygen saturation desaturations. The evaluation yielded the following pattern: 4 patients with AI < 10, 8 patients with AI between 10 and 20, 4 patients with AI > 20. Obstructive apnoeas were seen in 6 patients, mixed apnoeas in 8 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebral Cortex↗
PubMed1993

[Effect of obstructive sleep apnea on preload of the right heart].

Obstructive sleep apnea (OSA) is characterized by a total inspiratory occlusion of the extrathoracic airways with persisting respiratory effort. During obstructive breathing efforts the intrathoracic pressure (ITP) falls below-20 Torr. This should augment venous return by depleting the blood from the extrathoracic veins into the thoracic veins, thus pre- and afterload of the right heart rises. Until now preload of the right heart during OSA was not measured. This study shows the filling pressures (tmPRA) of the right heart during OSA. In five patients the in- and expiratory right atrial pressure and the intrathoracic pressure were measured, beat by beat, during the non REM hour in which the most apnea episodes occurred. The tmPRA values were calculated as follows: tmPRA = PRA-ITP. The rising tmPRA with falling ITP shows that the venous return, during apnea episodes, rises mostly unhampered. Only in one patient did a cut-off of the increasing tmPRA occur. This patient showed a flow limitation of venous return. Two more patients developed different trends. One part of the measurements led to a linear increase of tmPRA, the other part shows a plateau up from a certain ITP. In two patients tmPRA increases linearly, in the extreme, with decreasing ITP. This indicates no flow limitation of venous return. The results of this investigation suggest that the protective mechanism of the limitation of venous return, occurring under artificial conditions, does not regularly appear in patients with OSA. This leads to repetitive volume overloads of the right heart.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Long-term registration of arterial blood pressure in sleep with noninvasive methods].

Sleep related breathing disorders and essential hypertension are highly interrelated. Many different studies proved a casual relationship between the two disorders (1,2). In a clinical sleep laboratory diagnostics of hypertension has to be non-invasive. There are two completely different methodologies to record blood pressure noninvasively. Continuous methods using fingerphotoplethysmography can record apnea related cyclical variations of blood pressure beat to beat. Unfortunately the absolute value of the pressure readings is sensitive to the position of the finger sensor. Noncontinuous methods using arm cuff inflation preserve appropriate blood pressure values but these are only spot measures during the night. To make use of these it is necessary to record other sleep and respiration related signals in parallel. Both methods were applied in our sleep laboratory and results are presented.

Blood Pressure↗
PubMed1993

[Nocturnal hypoxia--its relevance with reference to sleep structure in patients with coronary heart disease].

A disorder in the physiological structure of the sleep cycles (macrostructure) is known to occur both in patients with sleep apnoea (SA) and coronary heart disease (CHD). The study presented here was concerned with the problem whether the sleep structure in patients suffering from CHD and apnoea-conditioned hypoxia is greatly disturbed e.g. by myocardial ischaemia. Polysomnographic recordings including EEG, EOG, EMG and 6-channel ECG were performed for 6 nights in 30 patients suffering from sleep apnoea (AI > 10/h) and/without CHD. The average age of the patients was 57.9 years (range 47-68 yrs). The 2nd, 4th and 6th nights were subjected to fine analysis. In 6 patients it was possible to detect a total of 144 episodes with nocturnal myocardial ischaemia, 123 of these during cumulative apnoea and oxygen desaturation. The 30 patients spent on the average 67.1% in sleep stages I and II, 14.9% in deep sleep (stages III and IV) and 18% in REM sleep. 77.8% of the ischemie, episodes occurred during REM sleep and only 1.4% during the deep sleep stages. Sleep during myocardial ischaemia showed significantly more arousals than to control periods without ischaemia. There was furthermore a dependence of the degree of arousal on the degree of oxygen desakivations during apnoea. I. Patients suffering from CHD and sleep apnoea are endangered by nocturnal hypoxia-conditioned myocardial ischaemia which in turn can lead to increased electrical instability. II. The macrostructure of the sleep of patients suffering from CHD and sleep apnoea is comparatively as disturbed as that of patients with apnoea without CHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Therapy control of theophylline evening dosage in patients with sleep-related respiratory disorders--follow-up study].

We conducted a prospective study to perform classification according to responder types and follow-up during theophyllin treatment (500 mg/d) in a group of (up to now) 65 patients suffering from sleep apnoea. Changes in the apnoea index (AI) and clinical symptoms were taken as response criteria. A significant AI reduction was seen during a follow-up period of 3 months. At the last control measurement after 6 months no significant change has been detected so far. 10 patients were classified as Type I responders (improvement in initial AI 60%, over the total period at least 25%). No patient had a responder type II profile. 13 patients were nonresponders (improvement in initial AI and over the whole period not more than 25%, no improvement in the pattern of clinical symptoms). 13 patients dropped out of the trial due to non-compliance. Side effects typical of theophyllin leading to discontinuation of the treatment course occurred in 5 patients. 22 patients have not yet completed the course at the time of writing. Standardised questioning of patients showed a definite improvement in feeling tone, especially with regard to the tendency to fall asleep during the day and refreshed feeling in the morning. Nocturnal complaints occurred in only a few isolated cases. Hence, administration of theophyllin retard preparations in evening doses of 500 mg/d remains a meaningful therapeutic approach to sleep apnoea.

Adult↗
PubMed1993

[Measuring circadian core temperature periodicity without masking in obstructive sleep apnea].

Although close interactions between sleep respectively sleep disturbances and the circadian system are known, chronobiological aspects have not been taken into account sufficiently in investigation and therapy of obstructive sleep apnea (OSA). We carried out a 24-hours lasting constant routine. Considering the circadian course of core temperature, patients with OSA show an impairment of the circadian system, which improves after three nights with nCPAP-treatment.

Adult↗
PubMed1993

[Hemodynamics and sleep structure in attempted weaning after nCPAP ventilation therapy of obstructive sleep apnea syndrome].

nCPAP (continuous positive airway pressure) treatment is presently the standard therapy in marked obstructive sleep apnoea syndrome. Fundamentally, this is a long-term treatment. Various authors have been making different recommendations in respect of the frequency of application, based partly only on the patient's individual pattern of complaints and symptoms. Our study aimed at examining the short-term nocturnal effects of discontinuing the treatment course in 12 patients, using polysomnography as a diagnostic tool. Results showed that directly after discontinuation of therapy the sleep structure, respiration during sleep and the nocturnal blood pressure pattern returned to baseline findings. It is concluded from this that nCPAP treatment should be strictly adhered to every night to minimise the risk of cardiovascular complications in the patients concerned.

Adult↗
PubMed1993

[Indications and application of BiPaP therapy].

BiPAP allows the independent adjustment of in- and expiratory pressure. BiPAP may thus be used as a "physiologic" CPAP if high expiratory pressure values are not tolerated or as a pressure limited ventilator in pts. suffering from central sleep related breathing disorders (SRBD). 12 pts with SRBD were treated with nBiPAP: 7 did not tolerate the expiration against the elevated pressure, 4 pts suffering from MSA who still presented relevant CSA or central Hypoventilation during nCPAP and 1 pt. with CSA who did not respond to nCPAP. Mean age was 52.3 y (range 33-70) and mean broca index was 149.6 (range 115-254). RDI before therapy ranged between 33-152/h (mean value 79/h); in the five pts. who tolerated nCPAP, the reduction of the RDI obtained was considered insufficient (RDI during nCPAP: 16-71/h). During BiPAP mean RDI was 6.8/h (range 1-17) at pressure levels of 10/7 to 16/13 cm H2O (inspiratory/expiratory pressure) in those pts. that had not tolerated CPAP and 7.9/h (range 2-16.5) in the pts. suffering from central SRBD: in one pt. BiPAP could successfully replace a combined treatment with CPAP and IPPV. 11 pts. are using BiPAP for 10 to 25 months (mean value 13.5) now at home. If CPAP proves ineffective (central SRBD, high expiratory pressure) BiPAP constitutes an effective alternative therapy.

Adult↗
PubMed1993

[Hypertension at awakening in sleep apnea].

There is an increased mortality among patients with sleep related breathing disorders. This fact is largely ascribed to arterial hypertension and its associated cardiovascular risk with which sleep apnoea is interlinked, as is known from epidemiological and clinical studies. The present study was based on 20 males suffering from arterial hypertension and sleep apnoea, measuring the blood pressure changes 4 hours before and 4 hours after waking up, in each case without therapy and after 8 weeks' treatment with a combination preparation made up from verapamil and a potassium-saving diuretic. Besides the usual polysomnographic measurements in the sleep laboratory blood pressure was measured intra-arterially and continually, each time on two consecutive days. The average age was 53 (39-70) years, and the average of Broca's index was 129 (109-158). It was found that blood pressure values rise already 2-3 hours before waking up and maximum is attained subsequent to waking. Under therapy the minimal systolic values before waking dropped from 132.8 mmHg (+/- 22.8) to 119.4 mmHg (+/- 11.9) (p < 0.01) and the maximal values after awakening were reduced with 149.8 mmHg (+/- 27.7) vs 132.7 mmHg (+/- 25.4) (p < 0.01) without dropping to hypotensive levels. Under therapy there was a less marked and also slower rise in blood pressure with time. Besides pointing to the fact that endogenous mechanisms also influence blood pressure patterns in addition to the well-known exogenous influences, the study proved the favourable therapeutic action of treatment with an antihypertensive drug that is effective for a period of 24 hours.

Adult↗
PubMed1992

Ambulatory diagnosis of sleep-related breathing disorders.

Ambulatory diagnosis of sleep-related breathing disorders (SRBD) is necessary due to their high prevalence and to the limited capacities of sleep centers. Categories of SRBD which must be diagnosed and differentiated are defined. Indications for ambulatory diagnosis are given. A selection of systems on the market in Europe are given and described in terms of their parameters. The correct system for diagnosis in a specific patient must be selected according to the specific question. The issue of ambulatory diagnosis of SRBD has gained importance in Germany because beginning in spring 1992 physicians will be reimbursed if they continuously record respiratory signals, heart rate, oxygen saturation and movement in their patients and if they qualify by attending a one-week training course.

Airway Obstruction↗
PubMed1992

[Analysis of long-term blood pressure measurements during sleep].

Fifty patients with sleep-related breathing disorders and arterial hypertension underwent diagnostic polysomnography for two nights; EEG, EOG, EMG, and respiratory signals were recorded in parallel with invasive blood pressure. Computerized evaluation was performed to calculate systolic and diastolic blood pressure values, as well as heart rate beat-to-beat. All signals were stored once per second for further evaluation. These time series were analyzed in respect of underlying periodicities by means of spectral analysis. It was possible to distinguish four different groups of patients according to the compressed spectral arrays. Pronounced peaks of different extents were found that reflected both periodicities of respiration (3-5 s) and periodicities of sleep apnea (30-60 s). A comparison of spectral analysis of blood pressure and heart rate showed that systolic blood pressure is suited best to recognize periodicities related to respiration and apneas.

Adult↗