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Biomedical subjects

K Sonka

Publications and source records attributed to K Sonka.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1997

Familial aspects of narcolepsy-cataplexy in the Czech Republic.

A group of 153 probands with narcolepsy included 38 subjects (24.8%) with a familial incidence of excessive daytime sleepiness (EDS). In 15 cases (9.8%), at least one additional family member suffered from narcolepsy-cataplexy; only EDS was present in the remaining 23 cases (15.0%). One thousand eighty-two relatives were evaluated. The percentage of first degree relatives affected with narcolepsy-cataplexy was 2.28% (1.20% if only clinically confirmed cases were accounted); the adequate value for second degree relatives was 1.49%. The occurrence of EDS exceeded these values several times (4.28% in first degree relatives, 6.57% in second degree relatives). The vertical mode of transmission was found in most families. Human leukocyte antigen (HLA) typing was performed in six families with multiple-case incidence of narcolepsy. Forty-one blood samples were analyzed (12 patients with narcolepsy, 7 with only EDS, 2 with sleep apnea syndrome, and 20 healthy relatives). HLA DR2+ and DQB1*0602+ were found in only 8 out of 12 narcoleptic patients with cataplexy and in six out of seven patients with isolated attacks of sleepiness. These findings support the hypothesis that there is a common genetic basis for narcolepsy associated with cataplexy and "monosymptomatic" forms of narcolepsy and suggest the existence of non-major histocompatibility complex (MHC) susceptibility factors for narcolepsy.

Adolescent↗
PubMed1997

[Disappearance of the sleep apnea syndrome in a female patient after surgery of a hypophyseal adenoma with acromegaly].

The association of the syndrome of sleep apnoea and acromegaly was described in the literature. However, so far no satisfactory explanation was given of the more frequent concomitant incidence of these diseases. The authors describe the disappearance of the sleep apnoea syndrome in a female patient after removal of an intrasellar microadenoma of the pituitary with overproduction of growth hormone.

Acromegaly↗
PubMed1996

[Computed tomography of the upper respiratory tract in patients with apnea].

BACKGROUND: When deciding on the therapeutic procedure in sleep apnoea syndrome (SAS) it is important to know the anatomical conditions of the upper airways. METHODS AND RESULTS: We examined on account of SAS, verified by all night monitoring, using the MESAM4 method a total of 60 patients by means of computed tomography (CT). SAS without associated disease was diagnosed in 48 patients. To facilitate comparison of results of (CT) and MESAM4 we defined the MESAM4 score (M4) as the number of desaturations per hour multiplied by their depth (difference between mean minimal and basic saturation). Axial sections, 5mm thick at 5mm intervals were made from the level of the hard palate to the upper trachea in a vertical position to the longitudinal axis of the pharynx in the patient awake at the peak of the inspirium. The air-filled area, sagittal and coronary sections were measured at five levels (nasopharyngeal, velopharyngeal, retrobasilingual, at the level of the hyoid bone and trachea). The results differed significantly from the normal population examined by the same protocol (foreign standards). Macroglossia as a factor promoting SAS was also examined. CONCLUSIONS: The frontal and sagittal reformation reflected, on account of numerous inaccuracies, the actual state only partly. When the borderline between mild and more severe apnoea was set at M4 = 300, the correlation with the retrobasilingual section and coronary and velopharyngeal section was best. The authors suggest a simpler CT examination protocol which improves further the prediction of severity of SAS. The correlation with the body mass index (BMI) and the neck circumference (p < 0.001) confirmed the asset of CT parameters.

Adult↗
PubMed1996

MESAM4 evaluated nocturnal respiration disturbances in myasthenia gravis.

Twenty-eight treated patients with myasthenia gravis (MG) (Osserman's scale: ocular form-12 cases, mild generalized form-5 cases, medium generalized form-10 cases, free of symptoms after thymectomy-1 case) were examined with MESAM4. Typical sleep apnea syndrome (SAS) patterns were observed in 12 subjects, mild saturation undulation without respiratory noises and without heart rate changes in 7 (3 of them also produced the SAS pattern) and irregular nonspecific changes in 3. The average vital capacity in SAS patients was 2556 (SD = 1166) ml, and in patients without MESAM4 abnormality 1629 (559) ml, P < 0.05. The average of oxygen saturation minima in SAS patients was 87.6 (3.6) %, in patients without MESAM4 abnormality 91.5 (1.8), P < 0.01. We conclude that there is no relation between any clinical parameter of MG and the occurrence of nocturnal respiratory disturbances. The risk factors of the occurrence of sleep respiratory disturbances in MG are similar to those of the non-myasthenia population although the incidence of this condition in MG is higher.

Adult↗
PubMed1996

[Treatment of excessive daytime sleepiness].

Excessive day-time sleepiness (EDS) is in more than 80% of the subjects caused by the sleep apnoe syndrome (SAS), narcolepsy and idiopathic hypersomnia. SAS is treated by continuous positive airway pressure or by uvulopalatopharyngoplasty. Narcolepsy is manifested by imperative sleepiness which may be preceded by a period of non-imperative EDS. In the treatment of narcolepsy "preventive" day-time naps and administration of stimulants are used. EDS cannot be completely eliminated in some narcoleptics. EDS in idiopathic hypersomnia can be usually influenced only by stimulants. The author gives an account of the medication used in 57 patients with narcolepsy (mean age 51.7 years, range 16-75) and experience with this therapy. Ephedrine was used by 45.6% patients (usually combined with phenmetrazine) amphetamines in 26.3%, phenmetrazine in 82.5% and mazindol in 19.3%. Significant phenmetrazine dependence was developed by one patient from a group of more than 200 narcoleptics. Other causes of EDS are illnesses and circumstances which interfere with nocturnal sleep. There it is important to influence at the first place the quality of the nocturnal sleep. Diseases of circadian rhythmicity elicit EDS teo and can be treated using special therapeutical approaches. EDS may be the manifestation of psychiatric diseases.

Adolescent↗
PubMed1995

[Insomnia. A short review of the most important etiopathogenic factors].

The etiology of insomnia remains usually in practice unknown. This article represents basic features of diseases expressed frequently or regularly by disturbances of sleep. Emphasis was layed on psychophysiologic insomnia, narcolepsy, sleep apnea syndrome, periodic legs movements in sleep, restless legs syndrome and on insomnia within circadian dysregulation. Most important neurologic and psychiatric diseases, which can be accompanied by insomnia, are listed.

Humans↗