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Biomedical subjects

J H Peter

Publications and source records attributed to J H Peter.

At least 163 records · Page 9Linked to original sources
PubMed1989

[Long-term acceptance of nasal continuous positive airway pressure therapy in 70 patients with sleep apnea over a 6-month treatment period].

NCPAP therapy is considered to be an effective method of treatment in cases of obstructive and mixed sleep apnea (SA). We investigated its effectiveness during initiation of therapy, and the acceptance of the ambulatory long-term treatment. Here we present the first 70 patients (68 m, 2f) treated with nCPAP for at least six to a maximum of 20 months (on average: eleven months). Sixty-seven of the 70 patients were effectively treated with a nCPAP pressure of 5-15 mbar. The apnea index was reduced from 49 apnea episodes per hour (range 12-125) to 2 episodes per hour (range 0-8) on average. Therapy failed in one case (anatomical defect of the nasopharynx) and had to be abandoned in two cases (claustrophobia, acute rhinitis). Sixty-three patients, decided in favour of ambulatory long-term therapy. These patients were asked to complete a questionnaire about their experience with nCPAP. Four patients abandoned therapy (all within the first four weeks because of intolerance towards the apparatus), and one patient died 10 days after terminating treatment of an infection of the upper airway. Fifty-eight patients (82% of all) are still undergoing treatment. Eighty-eight per cent of these are using nCPAP for 5-7 nights a week throughout the entire sleep period, or at least for five hours. All patients report a marked reduction in or elimination of subjective symptoms. Mild local side effects occur quite frequently, but can be greatly reduced or eliminated in most cases. In individual cases they lead to a shortening of the nocturnal duration of application.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Does determination of atrial natriuretic factor have significance in the assessment of cardiac stress in apnea in sleep apnea patients?].

It has long been known that the heart is involved volume regulation. This fact took on new importance when, in 1981, de Bold discovered the existence of ANF. Apnea-associated cardiovascular changes make the treatment of apnea necessary to prevent the occurrence of cardiovascular sequelae. What is needed, however, is a parameter which, non-invasively, reflects both the cardiac loading during apnea and effects of treatment. Krieger succeeded in demonstrating that the commonly observed nycturia regresses under nasal cPAP therapy. This prompted us to consider whether the ANF factor might not be involved. In an attempt to find an answer, we have, up to now, investigated six patients prior to and during nCPAP therapy. On the basis of the results we obtained, the following conclusions may be drawn: 1. During apnea, the patients show sometimes dramatic increases in ANF plasma levels. 2. Under nasal CPAP treatment, these elevated levels decrease again, in some cases by as much as 50%. 3. The ANF plasma level correlates with pulmonary arterial pressure. This suggests to us that ANF determination is of importance for the assessment of cardiac loading during apnea, and represents a parameter that reflects the effects of therapy.

Atrial Natriuretic Factor↗
PubMed1989

[How frequent are pathologic ENT findings in patients with obstructive sleep apnea syndrome?].

Several studies have been reported suggesting a relationship between pharyngeal obstruction due to ENT pathology and the sleep apnea syndrome (SAS). To determine the incidence of pathological ENT findings that may present symptoms similar to SAS, we performed ENT examination, fiberoptic nasopharyngoscopy, rhinomanometry and partial audiometry and electronystagmography in 431 patients who had undergone polysomnography for clinically suspected SAS. 336 patients were referred for ENT examination; 95 patients had some kind of ENT disease and therapy before polysomnography. In the first group 31% showed one or more pathological ENT finding (ears 9%, nasopharynx 2%, nose 19%, oropharynx 5%, larynx 5%, neck 1%); 10.5% had pathology in two regions and 0.7% in three regions. An ENT operation was indicated in 23%, usually for nasal obstruction. ENT findings included chronic otitis media, adenoids, enlargement of lingual tonsil and vocal cord pathology, but no patient had a malignant tumor or severe pharyngeal obstruction. We conclude that severe anatomical abnormalities or dysplastic syndromes are rare; only 2 SAS patients had acromegaly due to hypophyseal adenoma and 1 patient without SAS had craniofacial dysplasia. However, ENT examination frequently revealed severe nasal obstruction due to septal deviation, polyposis or adenoids. These findings emphasize the need for ENT examination and therapy before application of CPAP (continuous positive air pressure) therapy.

Airway Obstruction↗
PubMed1989

[Results of left heart catheterization study in 64 patients with nocturnal disorders of respiratory control (sleep apnea)].

Sleep apnea (SA) is associated with increased morbidity of the cardiovascular system, the interaction between the disordering of respiratory coordination and cardiovascular regulation being largely unknown. In 64 patients (age: mean = 54.1; range: 35-67 years) with an increased apnea index (AI greater than 10), a cardiac catheterisation investigation was performed to exclude coronary heart disease (CHD) or cardiomyopathy. CHD was excluded in 39 patients, 6 patients had coronary single-vessel disease, 9 patients coronary two-vessel, and 10 three vessel disease. In 10 patients, cardiomyopathy was detected, while high-grade impairment of the left ventricular ejection fraction (greater than 30%) was observed in five patients. With the exception of a single patient, CHD was observed only in patients in the over-fifty age group. Arterial hypertension was seen in 84% of the patients with, and in 69% of the patients without, CHD. The patient groups with and without coronary heart disease did not differ with respect to apnea index, ten minute index, or the average duration of the 30 longest apneic episodes. Anginal complaints, observed in a total of 72% of the patients, were one of the major indications for coronary angiography. These results do not support the assumption that SA is primarily a consequence of underlying cardiac disease, but do indicate that SA must be considered a cardiac risk factor, especially in view of the fact that pronounced nocturnal changes in blood gases and haemodynamics, together with malignant arrhythmias, are found in conjunction with this disturbance of breathing.

Adult↗
PubMed1989

[Diagnosis of sleep apnea: required equipment for staged diagnosis].

In view of the high prevalence of sleep apnoea (SA) a stepped concept for diagnosis and therapy is needed. Such a concept requires appropriate instrumentation. The apparative requirement for a five-stage concept, and the experience gained with it, are presented, in particular these newly introduced stages: screening instrument, based on an analysis of heart rate and breathing sounds, and a mobile sleep laboratory based on oxygen saturation measurement combined with inductive plethysmography and four further parameters. Experience obtained with such a stepped concept demonstrates its efficiency and necessity in the diagnosis of sleep-related breathing disturbances.

Electrocardiography, Ambulatory↗
PubMed1989

[Psychological aspects of sleep related disorders of respiratory control].

An impaired ability to concentrate, loss of intellectual performance, and changes in personality are frequently-mentioned psychological symptoms of sleep apnoea. Apnea-associated disturbances of sleep structure as well as nocturnal cerebral hypoxia are possible causes. Twenty men and two women with an average age of 51.5 years underwent psychological testing. The average apnea index was 36 (range 11 to 92). The following psychodiagnostic procedures were used for screening; attention-strain test (d2) to measure short term concentration ability, numbers-connecting test (ZVT) for the evaluation of cognitive processing speed as an indication of intellectual performance, the Freiburg Personality Inventory FPI-R for assessing personality traits. As compared with the standard random sample of the d2, our patients' ability to concentrate over a period of five minutes does not seem to be impaired. Deficits in patients with sleep apnea are more likely to be found in the care of long-term concentration, especially in monotonous situations. The mean IQ score of our sample (93) is rather low as compared with the mean value of the age-matched sample (100). Patients with an Apnea index greater than 30 tended to have lower IQ-values (87.4) than those with less severe sleep apnea (97). Older patients had significantly lower age-corrected figures (87.2) than younger patients (98). Younger patients with high apnea activity (greater than median) had significantly (ANOVA: interaction alpha = 0.01) lower IQ scores (84.8) than younger patients with less severe sleep apnea (107). Sleep apnea seems to impair cognitive processing speed. Our sample turned out to be normal with respect to the twelve personality traits measured by means of the FPI-R.(ABSTRACT TRUNCATED AT 250 WORDS)

Arousal↗
PubMed1989

[Diagnosis of sleep apnea: initial experiences with a staged procedure].

The high prevalence of sleep-related breathing disturbances (SRBD), in association with cardiopulmonary disease, and the impairment by such disorders of the quality of the patients life, together with the good response of SRBD to therapy when diagnosed early on, point up the importance of incorporating the diagnostic evaluation of SRBD into the routine medical and pneumological diagnostic work-up. Since classical polysomnography requires a considerable effort, a stepwise diagnostic procedure was needed for use in practice. This includes a narrowing down of the indications, a brief questionnaire and a detailed questionnaire. For positive demonstration of a respiratory disturbance or differential diagnostic purposes, the following measures are employed on an outpatient basis in the following order: High-resolution 24-hour (Holter) ECG; analysis of heart rate and respiratory sounds, including, in particular snoring, with the MESAM system; induction plethysmography and continuous oxygen partial pressure measurement (pO2tc). Only after exhaustive use has been made of the ambulatory work-up, are the following diagnostic inhospital measures employed in the order indicated: 10-channel recording using the SIDAS system (respiration 3 channels, oxygen saturation, EOG, actogram, heart rate, intrathoracic pressure fluctuations), complete polysomnography. Once SRBD has been established, the patient is sent to the sleep laboratory to establish a baseline. Baseline measurement is accompanied by the determination of a marker, that is, a readily determined parameter capable of providing information about the success of therapy, is established. This permits complete polysomnography to be concentrated on differential-diagnostic and treatment-refractory problem cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

[Video-endoscopic recording of the pharynx before and following nasal continuous positive airway pressure therapy in patients with obstructive sleep apnea].

The action mechanism of nCPAP in the treatment of obstructive sleep apnea is not adequately known. We took video endoscopic pictures (chip video camera manufactured by Videotronik) of the pharynx in five patients with SA in the awake state, during apnea during sleep, and under nCPAP treatment during sleep. The patients were all in the supine position. Simultaneously with video-endoscopy, polysomnography was performed. Qualitatively good pictures were obtained in 3 patients. In the awake state, a relatively narrow pharynx was observed which, however, was completely patent during the entire respiratory cycle. During apnea and hypopnoea, a concentric collapse of the oropharynx was observed, with involvement of the lateral and posterior walls of the pharynx and the tongue, together with the soft palate over a length of several centimetres to above the epiglottis. During the hyperventilation phase following apnea, the occlusion opened up again, the diameter of the pharynx then being appreciably greater than that seen in the awake state. Under increasing CPAP pressure, occlusion became progressively less complete; when the effective pressure had been attained, the diameter of the pharynx was roughly comparable to that seen in the hyperventilation phase, that is, appreciably wider than in the awake state. During inspiration, however, even under effective nCPAP pressure, a discrete decrease in pharyngeal diameter occurred. On the basis of the visual impression, we believe that the effect of CPAP is based on a passive "pneumatic splinting" of the pharyngeal musculature.

Adult↗
PubMed1988

[Cardiovascular diseases in nocturnal disorders of respiratory regulation].

Sleep related disorders of respiratory regulation can result, through various mechanisms, in impairment of the hemodynamics of the heart and the systemic and pulmonary circulations. The group of patients with sleep apnea has been most thoroughly investigated thus far. The patients frequently develop essential and/or pulmonary hypertension. In sleep all forms of cardiac arrhythmia may occur, and thus the patients are at high risk for nocturnal sudden cardiac death. Responsibility for most hemodynamic alterations is attributed to apnea-induced hypoxia and hypercapnia and the intrathoracic pressure fluctuations observed in obstructive apnea. However, we are still short of detailed knowledge regarding the individual pathologic mechanisms. The hemodynamic changes observed in patients with sleep related disorders of respiratory regulation lead in the long run to cardiac failure. Early diagnosis and care of these patients is therefore urgently necessary to render timely therapeutic action possible.

Arrhythmias, Cardiac↗