Biomedical subjects

K Sonka

Publications and source records attributed to K Sonka.

At least 19 recordsLinked to original sources

PubMed2002

Continuous versus non-nightly use of zolpidem in chronic insomnia: results of a large-scale, double-blind, randomized, outpatient study.

New treatment strategies are encouraged in insomnia and, in particular, discontinuous treatment. The aim of this double-blind study was to compare, in a large primary care population of chronic insomniacs (> 4 weeks duration) the efficacy and safety of zolpidem 10 mg 5 nights/week and placebo 2 nights/week, to that of nightly zolpidem. Seven hundred and eighty-nine drug-free insomniacs, with a Total Sleep Time (TST) of 3-6 h/night were enrolled in seven European countries. After a placebo run-in period, treatment lasted 14 days. The primary criterion was the Clinical Global Impression improvement score (CGI-II) which showed that 65.2% of patients in the continuous and 58.6% in the discontinuous groups were rated 'much' or 'very much' improved. Even though the non-inferiority test did not show the equivalence of both regimens, the difference of 7% in responder rates does not appear to be clinically relevant. Other sleep parameters such as TST, number of nocturnal awakenings and Quality of Life scales showed marked, not significantly different, improvements in both groups. Both regimens were well tolerated and no adverse event which could be related to non-treatment nights was reported in the discontinuous group. Non-nightly zolpidem appears to be a feasible and safe additional option for the management of chronic insomnia.

Adolescent↗

PubMed2001

Increased REM density in narcolepsy-cataplexy and the polysymptomatic form of idiopathic hypersomnia.

The present work is focused on REM sleep density in patients with primary hypersomnia in comparison with non-hypersomnia subjects. 28 unmedicated patients with narcolepsy-cataplexy (NC) and 10 unmedicated patients suffering from the polysymptomatic form of idiopathic hypersomnia (IH) and their age- and sex-matched controls were included in the study. The clinical diagnosis was confirmed by MSLT and nocturnal PSG, HLA typing was performed in a respective group of narcoleptic patients. Polygraphical recordings were visually scored with particular regard to the two most characteristic phasic features of REM sleep: the number of rapid eye movements (REMs) and chin muscle twitches (Tws) per minute. These events were evaluated according to recognized criteria; a closer look was taken at both their frequency and their distribution across all the nocturnal REM periods (REMPs). The following main differences between hypersomniac patients (of both groups examined) and healthy controls were found in terms of phasic activity: (I) REM density (expressed in REMs/min and Tws/min in each REM period) was significantly increased in the hypersomniac patients in comparison with the controls. (p>0.05).(II) The intra-night phasic activity distribution was found rising more conspicuously in the hypersomniacs than in the controls.

Adult↗

PubMed2001

Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly.

OBJECTIVE: To explain the effect of craniofacial relations on the development of the sleep apnoea syndrome (SAS) in acromegaly, and to elucidate how the activity of acromegaly affects the severity of SAS. DESIGN: Prospective observational study. METHODS: Cephalometry and sleep ventilation measurements were performed in 26 acromegalic men and in 96 men with SAS. RESULTS: SAS was found in 20 acromegalic men. Compared with non-acromegalic men with SAS, patients with acromegaly and SAS were found to have: enlargement of almost all linear dimensions; increased angle indicating mandibular protrusion; increased difference between maxillary and mandibular protrusion; articular angle decrease; soft palate lengthening; and pharyngeal airway space (PAS) enlargement in the palatal and uvular-tip planes. A comparison of acromegalic men with and without SAS revealed no significant difference in the craniofacial skeleton, although there was a narrowing of the minimal PAS (MinPAS) and of PAS in the uvular-tip plane in patients with SAS. SAS was more frequent in the patients with active acromegaly. MinPAS in the patients with active acromegaly was narrower than in those without disease activity. CONCLUSION: Skeletal abnormalities in acromegalic men with SAS were different from those in SAS patients without acromegaly. Upper airway narrowing due to changes in pharyngeal soft tissues takes a more relevant share in the development of SAS in acromegalic men than skeletal anomalies.

Acromegaly↗

PubMed2001

Electromagnetic field of mobile phones affects visual event related potential in patients with narcolepsy.

The effects of the mobile phone (MP) electromagnetic fields on electroencephalography (EEG) and event-related potentials (ERP) were examined. With regard to the reported effects of MP on sleep, 22 patients with narcolepsy-cataplexy were exposed or sham exposed for 45 min to the MP (900 MHz, specific absorption rate 0.06 W/kg) placed close to the right ear in a double blind study. There were no changes of the EEG recorded after the MP exposure. A subgroup of 17 patients was studied on visual ERP recorded during the MP exposure. Using an adapted "odd-ball" paradigm, each patient was instructed to strike a key whenever rare target stimuli were presented. There were three variants of target stimuli (horizontal stripes in (i) left, (ii) right hemifields or (iii) whole field of the screen). The exposure enhanced the positivity of the ERP endogenous complex solely in response to target stimuli in the right hemifield of the screen (P < 0.01). The reaction time was shortened by 20 ms in response to all target stimuli (P < 0.05). In conclusion, the electromagnetic field of MP may suppress the excessive sleepiness and improve performance while solving a monotonous cognitive task requiring sustained attention and vigilance.

Brain Mapping↗

PubMed2001

[Sleep disorders in hemodialysis patients].

BACKGROUND: Many hemodialyzed patients complain about bad sleep. The aim of this study was to learn the subjective view of patients on their sleep and its influence by hemodialysis treatment. METHODS AND RESULTS: A simple questionnary containing 20 questions concerning sleep was prepared and given to regularly hemodialyzed patients in two hemodialysis centres. Uncorperating as well as severely ill patients were excluded. The questionnary was responded by 103 patients (mean age 60.4 years)--61 men (mean age 56.7 years) and 42 women (mean age 65.7 years). 34% of patient regard their sleep as bad. 45.6% of dialyzed patients feel restlessness of legs during the night and 32% snore or have some breath problems. 38% of patients considered their sleep as better before starting the hemodialysis treatment, in 14.6% the sleep became better after starting the dialysis treatment. CONCLUSIONS: Sleep disorders in hemodialysed patients worsen the quality of life of these patients. Moreover, sleep disorders represent a serious problem as they can increase the mortality.

Aged↗

PubMed2000

[Prevalence of obesity, hypertension and smoking in patients with the sleep apnea syndrome--comparison with the Czech population].

BACKGROUND: Sleep apnoea syndrome (SAS) is an serious disease increasing morbidity and mortality. SAS is often associated with cardiovascular diseases. This retrospective study is focused on the prevalence of selected risk factors of ischemic heart disease. METHODS AND RESULTS: The comparison of BMI, prevalence of obesity, hypertension and smoking was performed in 356 patients with SAS (287 men, 69 women, age 25-64 years) and 2353 persons--representing 1% of Czech population (WHO project MONICA). T-test was used for statistical analysis of BMI and chi-square test for obesity, hypertension and smoking prevalence. Groups of patients and the MONICA group were stratified by age into 4 subgroups. Statistical significant difference was found in BMI and obesity prevalence in men in all age subgroups. Men aged 35-64 years differed in systemic hypertension prevalence (p < 0.001) and in age subgroups of 45-64 years in smoking prevalence (p < 0.001). Females aged subgroups of 35-54 years differed significantly in BMI (p < 0.001) and in age subgroups of 45-54 years in hypertension (p < 0.01). CONCLUSIONS: Higher prevalence of obesity, hypertension, and smoking were found in patients with SAS compared to non-selected Czech population.

Adult↗

PubMed2000

[Comparison of cephalometric parameters in patients with sleep apnea syndrome and normal individuals].

BACKGROUND: Craniofacial abnormalities which predispose to pharyngeal obstruction can be detected by cephalometry. The aim of the present study was to compare cephalometric findings of the patients with sleep apnoea syndrome (SAS) with those of healthy population. METHODS AND RESULTS: The SAS patients (23 females, 96 males) and normal population (36 females, 50 males) were examined by cephalometry. In the group of females with SAS following significant differences were observed: elongation of the soft palate (p < 0.001), narrowing pharyngeal airway space (p < 0.001), mandibular retrognathism (p < 0.05), micrognathism of the mandible (p < 0.001), dorsocaudal rotation of the mandible (p < 0.01), increased lower gonion angle (p < 0.001) and the articular angle (p < 0.05), increased anterior facial height (p < 0.05), narrowing the depth of bony framework of the nasopharynx (p < 0.001), decreased depth of the upper face (p < 0.01) and decreased length of the cranial base (p < 0.01). In the group of males with SAS, following significant differences were observed: elongation of the soft palate (p < 0.001), narrowing pharyngeal airway space (p < 0.001), decreased depth of the maxilla (p < 0.001), decreased angle of the cranial base (p < 0.01), decrease saddle angle (p < 0.01), decreased depth of the upper face (p < 0.01), increased lower gonion angle (p < 0.01), increased articular angle (p < 0.001) and increased anterior and posterior facial height (p < 0.001). CONCLUSIONS: There are important differences in orofacial skeleton and soft tissue of the nasopharynx measured by cephalometry in the patients with sleep apnoea compared to normal population.

Adult↗

PubMed2000

Prevalence of the sleep apnea syndrome in acromegaly population.

The prevalence of sleep apnea syndrome (SAS) in acromegaly is high. Consequences of SAS are serious and are associated with increased morbidity and mortality. The aim of this study was to assess the relative frequency and predictive factors for SAS in a group of patients with acromegaly (n=55). The presence of SAS was evaluated using the Polymesam device. Hormonal and clinical examination consisted of assessment of growth hormone, insulin-like growth factor I plasma levels, body mass index (BMI), neck circumference, age, sex, treatment modes of acromegaly and ear, nose and throat (ENT) examination. The relative frequency of SAS in our group of patients with acromegaly was 75%. Independent predictors of SAS were: increased activity of acromegaly, higher age and neck circumference. No association between SAS and BMI and ENT findings was observed. The role of gender was controversial.

Acromegaly↗

PubMed2000

Seizures in sleep apnea patients: occurrence and time distribution.

A retrospective survey of consecutive 480 adult patients (394 men, 96 women, mean age 50.3, SD +/- 10.4 years) with sleep apnea syndrome (SAS) was made in attempt to find out among them the patients with epilepsy. In total 19 subjects (17 men, 2 women, average age 55.8 +/- 8.7 years) representing 4.0% experienced at least two seizures in adult age. The average age at the first seizure was 48.4 +/- 16.1 years. Ten subjects suffered from primarily generalized tonic-clonic seizures, seven from secondarily generalized tonic-clonic seizures, one had complex partial seizures and one simple partial seizures. In 15 subjects (78.9%) the seizures occurred exclusively during sleep. Two patients (11.1%) had seizures exclusively during vigilance and in remaining two subjects the seizures occurred during sleep and vigilance. The findings of high proportion of subjects with epilepsy among SAS subjects, of late seizure onset and of predominantly sleep occurrence of seizures suggest that sleep apnea and hypopnea can facilitate epileptic seizures.

Epilepsy↗

PubMed2000

[Sleep disorders and the 24-hour profile of melatonin and cortisol].

The aim of our study was to assess the prevalence of the specific disorders of the circadian rhythm of cortisol and melatonin in the patients with sleep disorders. The group of our patients consisted of 93 persons (25 men, 68 women), from 4-72 years (mean age 38.3 years) with a sleep disorders. These patients were studied on Department of Neurology of 1st Medical Faculty of Charles University in Prague during years 1997-1999. Patients were divided by the clinical diagnosis into many subgroups: idiopathic hypersomnia (IH) 24 patients and other hypersomnias 8, narcolepsy 22, degenerative disorders 9, delay sleep phase syndrome (DSPS) 7, periodic leg movements syndrome (PLMS) 6, insomnia 7 and Parkinson's disease 10 patients. Twelve salivary samples were taken from each patient during a period of 24 hours in order to investigate the circadian secretion pattern of melatonin and cortisol. Salivary melatonin and cortisol levels were estimated by radioimmunoassay in the Department of Physiology of the Academy of Science, Czech Republic. Significant differences were found between our patients and the control group in idiopathic hypersomnia--acrophase of melatonin was delayed and secretion was prolonged. Patients suffered from narcolepsy often displayed multiple peak of melatonin secretion. The peak of the melatonin concentration occurred later in DSPS (non significantly). Low level of melatonin and prolonged signal of melatonin was in Parkinson's disease patients.

Adolescent↗

PubMed2000

[Manifestations of abnormal behavior during REM sleep in all-night polysomnography in patients with Parkinson disease].

REM sleep behaviour disorder (RBD) is characterized by savage extremities movements and by vocalizations associated with vivid dreams in REM sleep and by insufficient muscle atonia in REM sleep. Videopolysomnography was performed in nine patients (six men and three women, average age 59.8, SD +/- 7.2 years) suffering from Parkinson's disease (PD). The insufficient muscle atonia was found in the records of four subjects. No behavioural symptoms of RBD were observed. The authors stress on the disposition to RBD in great number of patients with RBD and on the necessity to look for RBD by detailed disease history.

Female↗

PubMed2000

[Hypocretin (orexin) deficiency in narcolepsy-cataplexy].

A mutation in the HCRT locus was proved in 18-yrs old male suffering from narcolepsy-cataplexy. He has demonstrated cataplectic attacks (brief spells of head dropping provoked by laughter) as well as imperative sleep in spells of several minutes up to one hour since the age of six months. He has suffered from severe bulimia since five years; later hypnagogic hallucinations, sleep paralysis and unquiet nocturnal sleep accompanied by periodic limb movements appeared. Symptoms are partially controlled with methylphenidate and either imipramine, clomipramine or fluoxetine. Periodic leg movements poorly responded to L-DOPA and clonazepam treatment. He is HLA-DQB1*0602 negative. Repeated MSLT (over 16 years followed-up period) showed extremely short latency with predominant SOREMPs and also nocturnal PSG recordings revealed fragmented sleep with SOREMPs. This case report demonstrates that hypocretin (orexin) mutations in human can produce the full narcolepsy phenotype and validates data recently reported in dog and mouse models suggesting a role for hypocretin (orexin) in the pathophysiology of narcolepsy and the regulation of REM sleep.

Adolescent↗

PubMed2000

[The sleep apnea syndrome in hypophyseal disorders with the exception of acromegaly].

The aim of the study was to ascertain the occurrence of the sleep apnoea syndrome (SAS) in patients after pituitary afunctional adenoma operation or in patients with other affection in sella turcica region except acromegaly patients. Eighty-one patients were addressed. Sixteen patients (eight men, eight women) underwent the examination; the rest of them had no interest to be explored. Afunctional pituitary adenoma was diagnosed in twelve patients, afunctional pituitary adenoma and subsequently optic glioma in one patient, craniopharyngioma in one patient, prolactinoma in one patient and undifferentiated cystic pituitary tumour in one patient. Neurological examination was done in all patients (standardized sleep questionnaire was included). SAS was quantified using PolyMESAM. Severity of SAS were set up from the value of M index (M = ODI.delta saturation; ODI--oxygen desaturation index). Mild SAS: 40 < M < 100; middle SAS: 100 < M < 210; severe SAS: M > 210. SAS was diagnosed in 13 patients: mild SAS in three of them (average value of M index: 81.0 +/- 12.7), moderate SAS in seven patients (average value of M index: 129.0 +/- 18.7) and severe SAS in three patients (average value of M index: 790.0 +/- 563.0). Therapy by continuous positive airway pressure (CPAP) was recommended in six patients. Five of them continue in using of CPAP--four patients with good compliance. The occurrence of SAS was 16.05% in measured group, higher than in normal population.

Acromegaly↗

PubMed2000

[Genioglossal advancement in the surgical treatment of obstructive sleep apnea syndrome in adults].

A 68-year-old female referred for excessive daytime sleepiness, strong morning headaches, snoring and suspected chronic fatigue syndrome. The polyMESAM examination was performed with following results: Respiratory Disturbances Index--RDI (average number of apnoeas and hypopnoeas in one hour of registration) 26, Oxygen Desaturation Index--ODI (average number of oxygen haemoglobin saturation drops in one hour) 51, basal oxygen haemoglobin saturation 90% and average oxygen haemoglobin saturation minimas 82%. Her condition was rated as grave OSAS. CPAP therapy was, however, impeded by anxiety state caused by claustrophobia. Analysis of lateral cephalogram proved significant constriction of the retrolingual posterior airway space to 6 mm (the bottom standard limit for women is 12 mm), with a relatively good position of the hyoid bone. The genioglossus advancement surgery was therefore performed on the patient as the only causational therapy. Then the patient referred improvement of sleepiness, snoring, fatigue and morning headache. PolyMESAM recorded two months after the surgery showed a strong improvement of OSAS: RDI 11, ODI 14, basal oxygen haemoglobin saturation 93% and average oxygen haemoglobin saturation minimas 89%.

Aged↗

PubMed2000

[Care of patients with the sleep apnea syndrome in the Czech Republic].

In the Czech Republic, for ten million inhabitants there are eight sleep laboratories (two neurological, one otorhinolaryngological and five pneumological), equipped with twelve units monitoring four or eight parameters. The first OSAS laboratory was established in 1991. In 1994, health insurance began providing patients with CPAP and doctors began publicising sleep syndromes. Since 1994, 3,860 patients were examined. Patients were referred: by general practitioners (34%), by otorhinolaryngologists (16%), by pneumologists (15%) or by neurologists (12%) and 24% came voluntarily. The ratio was eight men to one woman. Nearly all came because partners requested it. Of the 3,860 examined, 740 (around 19%) began using CPAP. The criteria for using CPAP are following: an oxygen saturation in the blood below 90% for more than 20% of the sleeping period. In very serious cases BiPAP was used (27 patients--0.7%). 185 patients (4.8%) underwent surgery on soft palate.

Czech Republic↗

PubMed1999

[Sleep apnea syndrome in acromegaly. Treatment and development-- retrospective analysis].

In total 56 subjects with acromegaly (37 men and 19 females) were examined in attempt to find sleep apnoea syndrome (SAS). The examination consisted of clinical examination and of all-night monitoring MESAM4 or polyMESAM. The diagnosis of SAS was established in 76.4% of subjects: 31 men and 11 females, average age 51.8 (SD +/- 9.6) years. The average ODI (oxygen desaturation index--number of oxygen saturation drops per 1 hour of sleep) of SAS patients was 29.2 (+/- 20.7). The therapy of SAS was recommended to 27 patients: sleeping position on the side (3 patients), reduction of the weight (8 patients), change of hypnotic drug (1 patient) and CPAP--continuous positive airway pressure (24 patients). CPAP titration was performed in 18 patients (in one subject the titration was repeated 4 years later). CPAP was titrated within all-night polysomnography in 10 subjects and in 9 subjects using self adjusting CPAP. Primary acceptance of CPAP was 94.4%. The average CPAP pressure was 7.8 (+/- 2.1) mbar. The theoretical duration of CPAP use was 546.6 (+/- 533.7) days. Long term compliance was considered as sufficient (weekly 25 hours or more) in 66.7% of patients. Ten patients underwent important acromegaly therapy or its change during the follow up and the improvement or the disappearance of SAS symptoms occurred in 6 of them.

Acromegaly↗

PubMed1998

Craniofacial abnormalities in sleep apnoea syndrome.

One hundred and four men with the suspected diagnosis of sleep apnoea syndrome (SAS) not suffering from neuromuscular diseases or acromegaly were examined by X-ray cephalometry. Subjects suffering from bronchial obstruction, laryngeal carcinoma, suspected Treacher Collins syndrome as well as subjects in whom SAS was not verified were excluded. The remaining 81 men were divided into two groups depending upon disease severity as expressed by the mean index of oxygen desaturations per hour (less than 30-group A; more than 30-group B). In group B, the following parameters were significantly altered as compared with group A: dorsocaudal rotation of the mandible, elongation of the soft palate, and an increase of the saddle angle, increase of the angle of the cranial base, the lower gonion angle and the angle of the inclination of the mandible. Differences in the size of the soft palate, the rotation of the mandible and the size of the lower gonion angle can be found not only between healthy and subjects with SAS but also between subjects with mild and severe apnoea.

Cephalometry↗

PubMed1997

[Compliance in treatment of the sleep apnea syndrome using continuous positive pressure respiration].

BACKGROUND: Continuous positive airway pressure (CPAP) is the therapeutic method of choice in sleep apnoea syndrome (SAS) but involves at first discomfort for the patients. The correct indication, correct setting of the overpressure and good adaptation influence the application and therapeutic asset of CPAP. METHODS AND RESULTS: From a total number of 41 patients with SAS treated by CPAP 24 were examined (incl. three women), who had CPAP in domiciliary treatment for more than two months. The mean period of use was 288.2 days (range 52-824). 84% of the patients used CPAP daily, the mean number of applications per week was 6.26 (range 2-7). For the whole period of sleep CPAP was used by 75% patients and the mean sleep period with CPAP was 6 hours (range 2.5-8). None of the patients discontinued treatment completely. Four patients used CPAP inadequately (less than 25 hours per week) - one because of intolerance associated with severe CHOCHB, the second one for intolerance of overpressure of 15 mbar, the third one because of poor motivation and the fourth one because of dehydration of mucous membranes. All patients recorded the therapeutic effect of CPAP. Rhonchopathy disappeared in 87.5% patients, excessive somnolence improved in 91.7%, fatigue declined in 88.5%. The functional capacity and work performance improved in 95.8% patients. Undesirable effects were not serious nor frequent: escape of air from the mask (29.2%), dry mucosae (20.8%), pressure sores caused by the mask (20.8%), serous rhinitis (12.5%), burning sensation of the mucosae of the upper airways (8.3%) and conjunctivitis (4.2%) CONCLUSIONS: Adequate compliance with CPAP was recorded in 83.3% patients and a favourable effect of treatment was proved.

Female↗