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PubMed2005

Leukotriene modifier therapy for mild sleep-disordered breathing in children.

BACKGROUND: Children with mild sleep-disordered breathing (SDB), who may not be recommended for adenotonsillectomy, frequently exhibit neurocognitive and behavioral morbidity, and may benefit from alternative therapeutic interventions, such as leukotriene modifier therapy. METHODS: Twenty-four children with SDB completed an open-label intervention study for 16 weeks with daily montelukast therapy. Sleep studies and adenoid size estimates from lateral X-ray films of the neck were obtained before and after treatment. In a parallel study, adenoid and tonsillar tissues from children with obstructive sleep apnea or recurrent throat infections were subjected to quantitative polymerase chain reaction, immunohistochemistry, and Western blotting for gene and protein expression of leukotriene receptors LT1-R and LT2-R, and for concentrations of LTB4 and LTC4/D4/E4. RESULTS: Montelukast treatment induced significant reductions in adenoid size and respiratory-related sleep disturbances, which were absent in 16 children with SDB who did not receive treatment. LT1-R and LT2-R mRNA was similarly abundant in adenoid tissues, but increased LT1-R and LT2-R protein expression and higher levels of LTB4 and LTC4/D4/E4 emerged in children with obstructive sleep apnea. CONCLUSIONS: Oral therapy with a leukotriene modifier appears to be associated with improved breathing during sleep. Double-blind, placebo-controlled trials will be needed to corroborate current findings and solidly establish antiinflammatory strategies, such as leukotriene modifiers, as therapeutic alternatives in children with SDB too mild to justify referral for adenotonsillectomy.

Acetates↗
PubMed1990

Nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea in Hallermann-Streiff syndrome.

An 8-year-old girl with Hallermann-Streiff syndrome (oculomandibulofacial syndrome) was examined. She had a history of severe snoring, reported nocturnal apnea, excessive daytime hypersomnolence, nocturnal enuresis, and failure to thrive. Overnight polysomnography confirmed severe obstructive sleep apnea. Long-term nasal continuous positive airway pressure (CPAP) therapy completely relieved the obstructive sleep apnea and was associated with improved weight gain and growth.

Child↗
PubMed2002

Auto-CPAP therapy for obstructive sleep apnea: induction of microarousals by automatic variations of CPAP pressure?

STUDY OBJECTIVES: To investigate the frequency of microarousals (MA) associated with pressure changes during auto-CPAP therapy (APAP) for obstructive sleep apnea (OSA). DESIGN: Patients with OSA were studied by polysomnography during APAP therapy (Somnosmart). The MA were classified on the basis of concomitant changes in APAP pressure. SETTING: Sleep laboratory of a university hospital PARTICIPANTS: 30 patients with moderate to severe OSA. MEASUREMENTS AND RESULTS: The mean AHI during APAP was 4.7+/-4.7, the mean arousal index was 14.5+/-6.6 per hour. During epochs with a pressure variation greater than 0.5 mbar, significantly more MA occurred (0.30+/-0.17 MA per epoch) than in epochs with constant treatment pressure (0.10+/-0.054 MA per epoch; p<0.001). There were more MA during pressure-increase epochs than during pressure-decrease epochs (0.42+/-0.24 vs. 0.16+/-0.12 MA per epoch; p<0.001). 82.5 percent of the MA were not preceded by a significant change in pressure (at least 0.5 mbar within 30 sec.), 10.6% were associated with a significant prior increase and 6.9% with a significant prior decrease in pressure. The percentage of MA preceded by a significant pressure variation varied between 2.3% and 61%, with a mean of 18.9%. CONCLUSIONS: The overall frequency of MA was low, and in most individuals the relative amount of "pressure-associated MA" was not significant. However in some individuals it cannot be excluded that some additional MA may have been induced by pressure variations. Should it prove possible to prevent such "pressure-associated MA" by optimizing the regulation of APAP pressure, the overall clinical effect of APAP treatment may be improved.

Adult↗
PubMed2001

[A humidification system for CPAP therapy in obstructive sleep apnea--evaluation of the effectiveness in changing climatic environmental conditions].

OBJECTIVE: Upper airway dryness is a frequent side-effect of nasal continuous positive airway pressure (nCPAP) therapy in obstructive sleep apnoea syndrome (OSA). In this situation, heated humidification is often used. Therefore, the present study aimed to investigate the humidification performance--defined as the maximum achievable humidity in the tube system of the CPAP device--of a heated humidifier (HH) offered as CPAP accessories, as a function of ambient air conditions (humidity and temperature). PATIENTS AND METHODS: In 30 patients (22 male, 8 female, mean age 56.4 +/- 11.7 years) with OSA undergoing CPAP treatment, temperature (T) and relative humidity (RH) in the CPAP tube system were measured, with and without the HH Somnowave, until a steady state was achieved. At the same time, ambient T and RH in the examination room were recorded. T and RH were used to calculate the absolute humidity (AH). RESULTS: The conditions of the examination room during the examination nights were as follows: T = 21.9 +/- 2.8 degrees C (15.2-26.9), RH 46.5 +/- 11.9% (21.7-69.1) and AH 9.2 +/- 3.2 g/m3 (3.7-16.7). The steady state AH without HH was 9.6 +/- 3.0 g/m3 (4.1-15.4), that with HH (humidification performance) 23.2 +/- 2.8 g/m3 (19.1-29.9) (p < 0.001). CONCLUSION: Under the ambient conditions of humidity and temperature, commonly found in European bedrooms, the HH demonstrate a high humidification performance. Thus, it would appear that the HH is suitable for the treatment of dry upper airways under nCPAP therapy.

Adult↗
PubMed1994

Center-based vs patient-based diagnosis and therapy of sleep-related respiratory disorders and the role of the respiratory care practitioner.

Unlike center-based laboratories that follow prescribed technical standards, patient-based studies lack technical standardization. Whereas center-based studies are usually performed by technicians who have met certain professional criteria, patient-based studies can be performed by anyone, even those without clinical training. Although guidelines are currently being developed to direct the use of unattended monitoring in the home, a need exists for specific guidelines that delineate professional qualifications for those who initiate and titrate therapy for patients with sleep-related respiratory disorders. The opportunity exists for respiratory care practitioners to become involved with creating guidelines for patient monitoring and therapeutic intervention, in both center-based and patient-based settings. A need exists for multicenter, peer-reviewed, controlled studies to establish standard recording variables and machine specifications for unattended monitoring devices. Also, the role and cost-benefit ratio of unattended monitoring in healthcare delivery need to be defined. Therefore, with the demand for technology-oriented research, clinical outcome studies, and professional standards, more respiratory care practitioners have the opportunity to expand their practice into the field of sleep medicine.

Allied Health Personnel↗
PubMed1989

[Indications for home oxygen therapy in cases of sleep oxygen desaturation].

Home oxygen therapy is now considered indicated in cases of severe sleep oxygen desaturation. To explore whether we could choose cases with severe sleep desaturation by measurement of waking physiological parameters, we examined the relationship between arterial blood gases, lung functions and pulmonary artery pressure while awake and the degree of sleep oxygen desaturation in 21 patients with chronic obstructive pulmonary disease and 22 cases with a past history of pulmonary tuberculosis. There were significant correlations between waking PaO2, PaCO2 and pulmonary artery mean pressure and sleep lowest SaO2, respectively, whereas no significant relation was found between %VC or FEV1.0% and sleep lowest SaO2. However, we found wide ranges of PaO2 and PaCO2 in cases who had 10 min or more with SaO2 below 85% during sleep. This was also true in the patients who underwent 60 min or more with SaO2 below 85% while a sleep. These results suggest that it may be difficult to find out the indications for cases with severe sleep desaturation by evaluation of arterial blood gases while awake.

Aged↗
PubMed2006

Sudden onset of sleep and dopaminergic therapy in patients with restless legs syndrome.

BACKGROUND AND PURPOSE: Sudden onset of sleep (SOS) was recently reported in patients with Parkinson's disease (PD) under dopaminergic treatment. Here, we investigated as to what extent SOS is found in patients with restless legs syndrome (RLS), who are frequently treated with dopaminergic drugs, and controls. PATIENTS AND METHODS: A questionnaire survey on SOS was administered to 156 RLS patients and 126 controls. RESULTS: While no significant difference between RLS patients and controls was detected in Epworth sleepiness scale (ESS) scores (P=0.76), the prevalence of SOS was higher in RLS patients (32.7%) than in controls (19.8%) (P=0.02). Significant predictors of SOS in RLS were ESS score (odds ratio (OR) 16.4), male sex (OR 4.6), duration of night-time sleep (OR 3.0), and age (OR 2.9), while no association was observed for duration or severity of the disease. Patients on dopaminergic therapy usually featured a lower risk of SOS than untreated patients. Falling asleep while driving was reported by 14.6% of all RLS patients with a driver's license and associated with increased risk of accident (OR 7.1). CONCLUSIONS: RLS patients who are untreated, male, and elderly should be assessed for the presence of SOS. In contrast to PD, dopaminergic drugs may reduce the risk of SOS in RLS. The possible benefit of the drugs should be investigated particularly in male patients.

Accidents, Traffic↗
PubMed2004

Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure.

OBJECTIVES: We studied the effects of cardiac resynchronization therapy (CRT) on heart failure (HF) patients with central sleep apnea (CSA). BACKGROUND: Patients with advanced HF often suffer from CSA with Cheyne-Stokes respiration. Cardiac resynchronization therapy improves myocardial function and exercise capacity in HF patients with conduction disturbances. The relationship between CRT and CSA is currently unknown. METHODS: Twenty-four patients (7 females; 62 +/- 11 years) with HF, a reduced left ventricular ejection fraction (24 +/- 6%), and left bundle branch block (QRS duration 173 +/- 22 ms) received a CRT device. The number of apneas and hypopneas per hour (apnea-hypopnea index [AHI]) and minimal oxygen saturation (SaO2min) were quantified by cardiorespiratory polygraphy. Fourteen patients showed CSA (AHI >5/h), and 10 patients had an AHI <5/h without CSA. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were evaluated before and after 17 +/- 7 weeks of CRT. RESULTS: In patients with CSA, CRT led to a significant decrease in AHI (19.2 +/- 10.3 to 4.6 +/- 4.4, p < 0.001) and PSQI (10.4 +/- 1.6 to 3.9 +/- 2.4, p < 0.001) without Cheyne-Stokes respiration and to a significant increase in SaO2min (84 +/- 5% to 89 +/- 2%, p < 0.001). There was no significant change in AHI (1.7 +/- 0.7 to 1.5 +/- 1.6), PSQI (2.4 +/- 0.5 to 2.6 +/- 0.9), and SaO2min (90 +/- 2% to 91 +/- 1%) in patients without CSA. CONCLUSIONS: Cardiac resynchronization therapy leads to a reduction of CSA and to increased sleep quality in patients with HF and sleep-related breathing disorders. This may have prognostic implications in patients receiving CRT.

Aged↗
PubMed2001

[Sleep disorders. Differential diagnosis and therapy in general practice].

Sleep Disorders are one of the most common complaints of patients seen by general practitioners. Prevalences vary considerably--depending on the kind of research and the definition of sleep disorders--between 4 and 40%. In 2000 the first grand nationwide survey was carried out in primary care settings [1]. 12.3% of the 17,928 questioned stated sleep disorders as the main reason for their consultation, the prevalence of all kinds of sleep disorders being 29%. Like seen in other studies sleep complaints increased with age and predominated significantly in women. In one-third of the sample the differential diagnosis was primary or non-organic insomnia [1] while treatment was mainly conducted by the general practitioner. In two-thirds of the patients sleep disorders existed for more than 12 months while 41%--by their own account--took sleep agents at least once a week. This article gives an overview of the causes and treatment of sleep disorders, particularly therapy of non-organic insomnia.

Central Nervous System Agents↗
PubMed1995

Adequacy of prescribing nasal continuous positive airway pressure therapy for the sleep apnoea/hypopnoea syndrome on the basis of night time respiratory recording variables.

BACKGROUND: The increased demand of full polysomnographic studies, not only for diagnostic purposes but also for continuous positive airway pressure (CPAP) titration, has produced long waiting lists. Simpler methods are therefore needed to avoid having to refer all patients for full polysomnography. The hypothesis that CPAP therapy for the sleep apnoea/hypopnoea syndrome (SAHS) can be performed exclusively on the basis of recording night time respiratory variables was tested. METHODS: The level of CPAP in a group of 41 patients (three women) of mean (SD) age 52 (10) years, body mass index 31.5 (4.4) kg/m2, and apnoea/hypopnoea index (AHI) 53(16) events/hour was measured. During a two week period CPAP titration was performed in a random order in two settings: (1) in the sleep laboratory using full polysomnography; and (2) in the respiratory ward using equipment which continuously recorded and displayed pulse oximetry, airflow, chest and abdominal motion, and body position. The level of CPAP was increased progressively until apnoea, hypopnoea, snoring, and thoraco-abdominal paradox disappeared. RESULTS: No differences in CPAP levels (9.34(2.2) versus 9.68 (2.1) cm H2O) were found between full polysomnography and night time respiratory recordings. The accuracy of the measurement of both procedures showed good agreement. Only one patient showed a significant difference in CPAP level requirements between the two methods. CONCLUSIONS: Night time respiratory recording is sufficient to permit a reasonable choice of CPAP levels to abolish all the respiratory disturbances in most of the patients studied.

Female↗
PubMed2004

Nasal dilator strip therapy for chronic sleep maintenance insomnia: a case series.

Sleep-disordered breathing (SDB) is a salient factor in chronic sleep maintenance insomnia. However, many insomnia patients with comorbid SDB may not be interested initially in receiving treatment with continuous positive airway pressure or oral appliance therapy. As an interim pathway, we used Breathe Right nasal dilator strip (NDS) therapy to introduce these patients to the relationship between insomnia and SDB. We hypothesized that NDS-associated improvements might motivate patients to pursue comprehensive SDB therapies. In this open label trial, three men with chronic sleep maintenance insomnia were treated with an educational session about SDB coupled with nightly NDS therapy. At 4-week follow-up, global insomnia severity, difficulty staying asleep, difficulty falling back asleep when awakened, total number of awakenings, and wake time after sleep onset systematically improved. Following NDS therapy, all three insomnia patients elected to pursue comprehensive SDB treatment at local sleep centers.

Case-Control Studies↗
PubMed2006

Sleep deprivation and hormone therapy in postmenopausal women.

BACKGROUND AND PURPOSE: Sleep complaints increase after menopause, but literature on the effect of postmenopausal hormone therapy (HT) on sleep is controversial. The purpose of this study was to determine the effect of ageing and HT on sleep quality, assessed using polysomnography, and on the accuracy of the subjective estimation of sleep quality in women before and after sleep deprivation. PATIENTS AND METHODS: Twenty postmenopausal women (aged 58-72 years) were recruited: 10 HT-users and 10 non-HT-users. Eleven young women (aged 20-26 years) served as controls. Polysomnography and subjective sleep quality were measured on four consecutive nights: adaptation, baseline, 40-h sleep deprivation and recovery. RESULTS: Although the postmenopausal women slept worse than the controls at baseline, and in particular during the recovery night, their recovery response to sleep deprivation was well preserved. At baseline, HT-users had a shorter latency to rapid eye movement (REM) (P=0.043), with fewer awakenings from slow wave sleep (SWS) (P=0.029) but more from REM (P=0.033) than non-HT-users. During recovery, the HT-users had more stage 2 sleep (P=0.048) and less slow wave activity (SWA) in the first non-rapid eye movement (NREM) sleep episode (P=0.021) than the non-HT-users. The poor correlation between subjective and objective sleep quality at baseline became significant during recovery. CONCLUSIONS: Although sleep in postmenopausal women was worse than in young controls, the recovery response following sleep deprivation was relatively well preserved. HT offered no significant advantage to sleep at baseline and slightly weakened the recovery response to prolonged wakefulness.

Adult↗
PubMed1997

[The effect of long-term therapy of obstructive sleep apnea syndrome with CPAP for symptoms of daytime sleepiness].

The study was undertaken to investigate whether a long-term CPAP therapy improves the symptoms of daytime sleepiness in patients with the obstructive sleep apnoea syndrome. Seventy six patients (72 men and 4 women) with AHI = 53(+/- SE = 3), BMI 35 (+/- SE = 0.8), mean age 46.3 (+/- SE = 11.4) have undergone CPAP therapy for at least one year (mean: 2.48 +/- SE = 0.33). The aggravation of alterations of the daytime sleepiness was estimated using the questionnaire from Sleep Laboratory at the Marburg University and the Epworth Sleepiness Scale (ESS). After the CPAP therapy, we have observed the decrease of the symptoms of the excessive daytime sleepiness (p < 0.001). Negative correlation between CPAP compliance and ESS outcome was observed (r = 0.4; p < 0.001). There was not correlation between the term of using CPAP and the degree of the complaints decrease.

Adult↗
PubMed2006

Drug therapy for obstructive sleep apnoea in adults.

BACKGROUND: The treatment of choice for moderate to severe obstructive sleep apnoea (OSA) is continuous positive airways pressure (CPAP) via a mask during sleep. However this is not tolerated by all patients and its role in mild OSA is not proven. Drug therapy has been proposed as an alternative to CPAP in some patients with mild to moderate sleep apnoea and could be of value in patients intolerant of CPAP. A number of mechanisms have been proposed by which drugs could reduce the severity of OSA. These include an increase in tone in the upper airway dilator muscles, an increase in ventilatory drive, a reduction in the proportion of REM sleep, an increase in cholinergic tone during sleep, a reduction in airway resistance and a reduction in surface tension in the upper airway. OBJECTIVES: To determine the efficacy of drug therapies in the treatment of sleep apnoea. SEARCH STRATEGY: We carried out searches on the Cochrane Airways Group Specialised Register of trials. Searches were current as of July 2005. SELECTION CRITERIA: Randomised, placebo controlled trials involving adult patients with confirmed OSA . We excluded trials if continuous positive airways pressure, mandibular devices or oxygen therapy were used. No restriction was placed upon publication language or trial duration. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies for inclusion, undertook data extraction according to pre-specified entry criteria, and quality assessment of studies. No response for further information was forthcoming from study authors. Results were expressed as mean differences and 95% Confidence Intervals (CI). MAIN RESULTS: Twenty-six trials of 21 drugs, involving 394 participants contributed data to the review. Most of the studies were small and many trials had methodological limitations. Each of the studies states that the subjects had OSA but diagnostic criteria were not always explicit and it is possible that some patients with central apnoeas may have been recruited. Six drugs had some impact on OSA severity and two altered daytime symptoms. One study reported that apnoea hypopnea index (AHI) was lower following treatment with intranasal fluticasone compared with placebo (23.3 versus 30.3) in 24 participants with sleep apnoea and rhinitis. Subjective alertness in the daytime also improved. Physostigmine gave an AHI of 41 compared to 54 on placebo (10 participants) and in a similar study Mirtazipine 15 mg produced an AHI of 13 compared to 23.7 for placebo (10 participants). Topical nasal lubricant given twice overnight resulted in an AHI of 14 compared to 24 with placebo (10 participants). These three latter studies were of single night crossover design and so there are no data on the acceptability of these treatments or their effect on symptoms. Paroxetine was shown to reduce AHI to 23.3 compared to 30.3 for placebo, most of the 20 participants tolerated the treatment but there was no improvement in daytime symptoms. Acetazolamide also reduced the AHI (one crossover trial of nine patients, mean difference 24 (95% CI 4 to 44). However there was no symptomatic benefit from the drug and it was poorly tolerated in the long term. Protriptyline led to a symptomatic improvement (improved versus not improved) in two out of three crossover trials (13 participants, Peto Odds Ratio 29.2 (95% CI 2.8 to 301.1) but there was no change in the apnoea frequency. In one trial naltrexone did reduce AHI, but total sleep time favoured placebo. No significant beneficial effects were found for medroxy progesterone, clonidine, mibefradil, cilazapril, buspirone, aminophylline, theophylline doxapram, ondansetron or sabeluzole. AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend the use of drug therapy in the treatment of OSA. Small studies have reported positive effects of certain agents on short-term outcome. Certain agents have been shown to reduce the AHI in largely unselected populations with OSA by between 24 and 45%. For fluticasone, mirtazipine, physostigmine and nasal lubricant, studies of longer duration are required to establish whether this has an impact on daytime symptoms. Individual patients had more complete responses to particular drugs. It is likely that better matching of drugs to patients according to the dominant mechanism of their OSA will lead to better results and this also needs further study.

Humans↗
PubMed2005

Surgical therapy for adult obstructive sleep apnea.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review will present the current state of art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiograph, formulation of a surgical plan through a selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

Adult↗