Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ACIDOSIS, RESPIRATORY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,315 records · Page 73Linked to original sources
PubMed2004

Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study.

OBJECTIVE: To evaluate the relationships between scalp-pH and CTG plus ST waveform analysis of the fetal ECG (STAN) clinical guidelines as indicators of intrapartum hypoxia in term fetuses born with cord artery acidemia. STUDY DESIGN: Data from 6999 term deliveries monitored by the STAN (R) S 21 as part of an EU multi-center study on clinical implementation of the STAN methodology for intrapartum fetal surveillance were analyzed. We identified 911 cases where a scalp-pH was obtained, including 53 cases with cord artery acidemia (pH < 7.06). Lag times between ST events and scalp-pH and time to delivery were related to cord artery metabolic and respiratory acidosis and neonatal outcome. RESULTS: 43 fetuses were identified by CTG plus ST as being in need of intervention 31 (25-46) minutes before delivery (median, 95% Cl). In five, no indications were given and in another five there were inadequate data. Fifteen cases with metabolic acidosis required special neonatal care, all 14 cases adequately monitored on STAN had indications to intervene for 19 minutes or more. In 30 adequately recorded cases, fetal blood sampling (FBS) was obtained within the last hour of labor. In 22 cases, FBS was obtained 13 (7-24) minutes after STAN guidelines had indicated abnormality and in eight no ST changes had occurred at time of FBS. The corresponding FBS data were pH 7.10 (7.01-7.15) and pH 7.21 (7.08-7.31), respectively, P = 0.01. In cases of metabolic acidosis, scalp-pH fell 0.01 units per minute after a baseline T/QRS rise was recorded during the second stage of labor. Apart from one newborn that died at 2 h from E. Coli septicemia, none of the neonates were affected neurologically. CONCLUSION: Cardiotocography plus ST analysis provides accurate information about intrapartum hypoxia similar to that obtained by scalp-pH.

Acidosis↗
PubMed1986

The concentration of bupivacaine in fetal organs during obstetrical epidural analgesia.

The concentration of bupivacaine in organs of non-viable human fetuses after obstetrical epidural analgesia in customary doses was investigated. The concentrations were determined with a gas chromatograph. The material consisted of a fetus who died following termination in the 24th week of pregnancy three minutes after birth without spontaneous respiration. The other fetus was born maturely in the 40th pregnancy week with anencephaly who lived 20 minutes following initial spontaneous respiration. Most noteworthy were the increased concentrations in the liver indicating the important metabolic function of the liver for the metabolism of bupivacaine in the fetus. Further a very high pulmonary concentration was found in the mature fetus. Even though blood gases analysis were not performed we conclude that: the lung is the best perfused organ after birth and onset of spontaneous respiration because of the closure of the ductus arteriosus; because of the increasing agonal respiratory acidosis, bupivacaine accumulates in the lung, the organ from which the acidosis originates. Also, the ionized form the bupivacaine is unable to leave the intracellular space. For the clinical use of epidural analgesia during delivery, these results constitute an important indication for avoiding fetal acidosis before and during the action of such analgesia. This mandates strict and continuous fetal monitoring. Our results in agreement with other authors show that during fetal acidosis and simultaneous administration of bupivacaine the fetal distress may be potentiated by an accelerated transfer of the anesthetic agent into the fetal placental space. Under normal conditions one may assume that this technique of analgesia has a positive effect on the fetus because of the improved placental perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed1990

Fetal ECG waveform analysis should improve fetal surveillance in labour.

Fetal heart rate (FHR) and fetal electrocardiogram (ECG) recordings were obtained from a scalp electrode with maternal thigh as reference and used for ST waveform analysis in 201 patients in labour. Nearly 45% had suspicious or abnormal FHR traces whilst only 27% had T/QRS ratio greater than 0.25 (mean +/- 2 SD). A normal T/QRS ratio identified 99.3% of fetuses with normal buffering capacity in cord artery blood. Of 13 infants with a cord artery blood pH less than 7.15, standard bicarbonate was less than 15.0 mmol/l in five who had an average T/QRS ratio less than 0.25 throughout labour. Of the eight with respiratory acidosis, five had an increase in T/QRS ratio greater than 0.25 for longer than 20 minutes prior to delivery, in two the ratio increased during the last few minutes and one had no change (pH 7.14). Persistent elevation of T/QRS in the first stage of labour identified those with decrease in buffer capacity in cord arterial blood (sensitivity of 94.1%). Acute hypoxia was recognized by the rapid rise in T/QRS. The specificity of T/QRS to identify fetuses at risk increased by combining the ST waveform analysis with FHR changes.

Electrocardiography↗
PubMed1993

Infant neurodevelopmental outcome in pregnancies complicated by gestational hypertension and intra-uterine growth retardation.

The neonatal outcome of 78 consecutive singleton pregnancies complicated by intrauterine growth retardation (IUGR) and gestational hypertension were compared with the outcome of 78 adequately matched pregnancies complicated by idiopathic IUGR. The rate of low (< 5) 1-minute Apgar scores was higher in infants born to hypertensive mothers (12.8% vs 2.6% p = .035). No differences in the prevalence of other perinatal factors such as acidosis, respiratory distress syndrome, hypoglycemia, pneumothorax, bronchopulmonary dysplasia, intracranial hemorrhage, requirement for assisted ventilation or survival were found between cases and controls. After two years' follow-up, the rate of major neurological neonatal handicaps, was 2.8% in the cases and 1.4% in the controls (p = 0.56). Mild neurodevelopmental abnormalities were more frequent in infants born to hypertensive mothers (14.3% vs 2.9% p = .025). After adjustment by multiple logistic regression, to eliminate the effect of confounding factors, the probability of normal neurodevelopmental outcome was reduced by 82% in infants born to hypertensive mothers as compared to controls (Odds Ratio = 0.18; 95% confidence interval 0.05 to 0.82 p = .028). These findings suggest that pregnancies complicated by IUGR and gestational hypertension are associated with a high prevalence of subsequent neurodevelopmental problems among infants.

Adult↗
PubMed2001

Carfentanil citrate used as an oral anesthetic agent for brown bears (Ursus arctos).

Carfentanil citrate was given orally to five adult brown bears (Ursus arctos) on 14 separate occasions during the winter and summer to determine effective anesthetic dosages and how season may alter these dosages. Lower blood urea nitrogen:creatinine ratios, depressed appetite, and decreased activity levels in the winter versus summer were reflective of different metabolic states, even though bears were not hibernating in the winter. Doses of carfentanil citrate between 6.0 and 15.2 microg/kg were mixed with 5-10 ml of honey, which the bears licked voluntarily from a spoon. During each anesthetization, respiratory and heart rates, hemoglobin saturation, temperature, electrocardiogram, blood gas values, and level of consciousness were monitored and utilized to determine effective dosages. Mean (+/- SE) dose requirements in the winter were 7.6 +/- 0.4 microg/kg, whereas a greater mean dose of 12.7 +/- 0.5 microg/kg was required in the summer (P < 0.05). After ingestion began, sternal recumbency occurred in an average of 7.5 min (range: 4-11 min), and full restraint and safe handling was achieved in 21 min (range: 8-40 min). At the end of each procedure, naltrexone was given as the reversal agent at a ratio of 100 mg naltrexone per 1 mg carfentanil, with 25% of the dose given i.v. or i.m. and 75% given s.c. Mean reversal time was 6 min after injection of naltrexone (range: 4-9 min). Rapid induction and recovery times and ease of oral administration make carfentanil citrate an effective anesthetic agent for use in brown bears. However, hypoventilation and respiratory acidosis were noted in all bears, and oxygen insufflation is recommended.

Administration, Oral↗
PubMedDate not supplied

Passive transfer of colostral immunoglobulins in calves.

Passive transfer of colostral immunoglobulins has long been accepted as imperative to optimal calf health. Many factors, including timing of colostrum ingestion, the method and volume of colostrum administration, the immunoglobulin concentration of the colostrum ingested, and the age of the dam have been implicated in affecting the optimization of absorption. The practice of colostrum pooling, the breed and presence of the dam, and the presence of respiratory acidosis in the calf also may affect passive transfer. Various tests have been reported to accurately measure passive transfer status in neonatal calves. The radial immunodiffusion and the enzyme-linked immunosorbent assay (ELISA) are the only tests that directly measure serum IgG concentration. All other available tests including serum total solids by refractometry, sodium sulfite turbidity test, zinc sulfate turbidity test, serum gamma-glutamyl transferase activity, and whole blood glutaraldehyde gelation estimate serum IgG concentration based on concentration of total globulins or other proteins whose passive transfer is statistically associated with that of IgG. This paper presents a comprehensive review of the literature of passive transfer in calves including factors that affect passive transfer status, testing modalities, effects of failure of passive transfer on baseline mortality, consequences of failure of passive transfer, and some treatment options. Many previously accepted truisms regarding passive transfer in calves should be rejected based on the results of recent research.

Acidosis↗
PubMedDate not supplied

Toxic effects of nonsteroidal anti-inflammatory drugs in overdose. An overview of recent evidence on clinical effects and dose-response relationships.

Nonsalicylate, nonsteroidal anti-inflammatory drugs (NSAIDs) can be divided into 4 chemical classes: acetic acids, fenamic acids, oxicams and propionic acids. Most NSAID overdoses result in a benign outcome. Of 50,614 exposures reported to poison centres in the United States in a 2-year period, 131 (0.26%) had a major outcome, with 10 deaths. Despite the generally mild effects reported in large patient series, isolated case reports have documented serious toxicity, such as seizures, hypotension, apnoea, coma and renal failure. The majority of these consequences occur after ingestion of substantial quantities by adults attempting suicide. Rarely, with ibuprofen and piroxicam, children who ingest small amounts in accidental exposure develop serious toxicity. Typical signs and symptoms of NSAID overdose include nausea, vomiting, headache, drowsiness, blurred vision and dizziness. Seizures are rarely documented across all NSAID classes, with the exception of mefenamic acid (where seizures occur in over one-third of cases), or following massive ingestion of other agents. Drugs in the propionic acid group have produced metabolic acidosis, respiratory depression and coma in severe cases. Ibuprofen is the agent with the most published data on overdose, probably because it is available without a prescription in many countries. Symptoms are unlikely after ingestion of 100 mg/kg or less, and are usually not life-threatening unless more than 400 mg/kg is ingested. There is some relationship between plasma concentrations and the potential for development of symptoms, but plasma concentrations have no impact on treatment decisions. Treatment of NSAID overdose is entirely supportive. Recent trends in emergency department procedures regarding gastric decontamination are evolving towards the recommended administration of activated charcoal without gastric emptying in patients presenting more than 1 hour after ingestion, although gastric lavage, followed by administration of activated charcoal, may be advisable in patients who present earlier. Home administration of syrup of ipecac is still recommended if treatment is given shortly after ingestion, with a few exceptions: for example, ipecac is contraindicated after ingestion of mefenamic acid or ibuprofen in amounts greater than 400 mg/kg. Urine alkalinisation and diuresis have been recommended to enhance the elimination of NSAIDs, based on a pKa in the range of 3 to 5. However, because the drugs are universally highly protein bound, with little unchanged renal excretion, this technique is not likely to be beneficial. Haemodialysis is also unlikely to enhance elimination, but may be required if oliguric renal failure develops. Multiple dose activated charcoal may be useful in enhancing elimination of NSAIDs with long half-lives, such as piroxicam and sulindac.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

Difference in the mode of acute cold-induced hypothermia between rat and hamster.

The present work was undertaken to elucidate the underlying causative factors limiting survival in hypothermic rats (non-hibernator) and hamsters (hibernator). A variety of physiological and biochemical parameters were measured for 28 male Wistar rats (205-286 g) and 26 male golden hamsters (85-118 g) before and during induction of hypothermia to colonic temperature (Tco) of 18 degrees C. With progressive decreases in Tco, parallel falls in VO2, VCO2, and heart rate were observed. In rats, plasma pH (pHp) in arterial blood was significantly lowered from 7.453 at Tco of 38 degrees C to 7.327 at Tco of 18 degrees C (p less than 0.001). From the observations of increased arterial PCO2 and bound CO2 (bicarbonate ion) concentration, together with the unchanged blood lactate, respiratory acidosis caused by hypoventilation was suggested to be responsible for the decrease in pHp. In contrast to rats, in hamsters pHp was almost unchanged during the induction of hypothermia, while nearly complete depletion of blood glucose (-84.6%) and liver glycogen (-99.5%) were observed when Tco of 38 degrees C was lowered to 18 degrees C. It is concluded that the decrease in pHp is a limiting factor for rats to survive the deep hypothermia at Tco of 18 degrees C and the exhaustion of carbohydrates as an energy supply for hamsters.

Animals↗
PubMed1993

Augmented arterial to end-tidal PCO2 difference during laparoscopic CO2 insufflation in man.

Acid-base status of the blood and tissue fluids and pulmonary gas exchange were continuously observed during intra-abdominal CO2 insufflation for 2 h in 8 paralyzed and artificially ventilated patients who underwent laparoscopic cholecystectomy or resection of the sigmoid colon. Carbon dioxide pressure in the arterial and mixed venous blood as well as in end-tidal air started to increase already at 5 min CO2 insufflation. On the other hand, appreciable elevation in VCO2 and tissue PCO2 (PTCO2) was noted only after 15 min. In vivo buffer value (beta) was well within the normal physiological range at 5 min and gradually declined up to 2 h. These observations indicated that chemical buffering to CO2 and redistribution of buffer base among the blood and tissue fluids were slowly developed during entire period of observation. In reflecting these experimental findings, arterial to end-tidal PCO2 difference (a-ADCO2) and respiratory gas exchange ratio (R) were promptly and significantly increased at 5 min and maintained slow increment up to 2 h. We conclude that these profiles of a-ADCO2 and R can be explained by initially rapid and subsequently slow augmentation in ventilation-perfusion ratio (VA/Q) during the specific type of respiratory acidosis elicited in this study.

Acid-Base Equilibrium↗
PubMed2007

Bacteraemia in neonatal foals: clinicopathological differences between Gram-positive and Gram-negative infections, and single organism and mixed infections.

REASONS FOR PERFORMING STUDY: Treatment for bacteraemia in foals must be started before the identity of the causative organism is known. Information aiding selection of effective antimicrobials should improve outcome. OBJECTIVES: To describe differences in clinical and clinicopathological data and outcome in foals with bacteraemia due to different classes of bacteria. METHODS: Records of foals with a positive blood culture, age < 10 days and presenting to a university hospital 1995-2004, were reviewed. Bacterial culture results, subject details, historical information, physical examination findings at admission and clinicopathological data generated during the first 48 h of hospitalisation were analysed. Results from foals with Gram-positive or Gram-negative organisms, single or mixed organism bacteraemias, and with bacteraemia due to 3 commonly isolated organisms were compared. RESULTS: Eighty-five foals met the inclusion criteria. Gram-negative organisms (n = 59) Gram-positive organisms (n = 13) or multiple organisms (n = 19) were cultured from individual foals. Foals with Gram-negative bacteraemia had lower total white blood cell and lymphocyte counts at admission than did those from which only Gram-positive bacteria were cultured. Mixed organism bacteraemia was associated with tachycardia, increased serum concentrations of sodium, chloride and urea nitrogen, acidosis, respiratory distress, recumbency on admission and nonsurvival. Actinobacillus spp. infections were associated with leucopenia, neutropenia, lymphopenia and depression on hospital admission. CONCLUSIONS AND POTENTIAL RELEVANCE: Recognising particular patterns of clinical and clinicopathological findings associated with infection with specific groups of bacteria may, in the future, aid antimicrobial selection and influence prognosis in bacteraemic foals.

Animals↗
PubMed1998

Assessment of the oxygen transport capacity of NRCs with a 70% blood exchange in rats.

Neo red cells (NRCs) are a blood substitute representing stroma free hemolysate (SFHL) encapsulated in liposomes and containing NAD, glucose, adenine, and inosine, etc. as substrates or coenzymes of the Embden-Meyerhof pathway in RBCs and inositol hexaphosphate (IHP) as an allosteric effector. The oxygen transport efficiency (OTE) of NRCs was increased to > 45% when the oxygen partial pressure in arterial blood increased. We carried out exchange transfusion with NRCs in rats, monitored their functioning as a blood substitute in vivo, and demonstrated that NRCs worked sufficiently. First, we confirmed that the OTE of NRCs was augmented by increasing the oxygen supply to the rats by using oxygen masks. Second, we carried out 70% blood exchange with NRCs (with hemoglobin concentrations of 4, 5, 6, or 7 g/dl), and compared these experimental groups with control groups (RBC and saline). Each sample was contained bovine albumin (final volume of 5% (w/v)). As a result, the NRC groups with hemoglobin concentrations of 5, 6, and 7 g/dl showed stability after the exchange transfusion. On the other hand, the NRC group with hemoglobin concentration of 4 g/dl and the saline group showed respiratory acidosis and a drop of blood pressure and heart rate, and thus did not maintain an adequate oxygen supply. We concluded that a hemoglobin concentration of > 5 g/dl was sufficient in the NRC solution, and demonstrated in an experiment on animals that the OTE of NRCs was increased by using oxygen masks.

Administration, Inhalation↗
PubMed1992

Effect of acid-base management with or without carbon dioxide on plasma phosphate concentration during and after hypothermic cardiopulmonary bypass.

Variations of the phosphate concentration in plasma were studied in two groups of 12 patients undergoing cardiac surgery with hypothermic cardiopulmonary bypass (CPB). Management of the acid-base status differed between the groups, according to whether or not carbon dioxide was added to the anesthetic gas mixture during hypothermia ('pH-stat' vs. 'alpha-stat' mode) following correction vs. no correction of pCO2 and pH for body temperature. Phosphate variations throughout the study were mostly within normal limits. From the start to the end of CPB, the mean rise in phosphate levels was 70% in the pH-stat group and 37% in the alpha-stat group (p < 0.001). During 3 hours after CPB, the phosphate values continued to rise by a mean of 25% in the alpha-stat patients, but fell by a mean of 3% in the pH-stat patients (p < 0.001). Such different phosphate patterns during and immediately after CPB may reflect profound metabolic disturbances and may be related to the altering effects of CO2 addition and respiratory acidosis on intracellular metabolic activity and phosphate homeostasis.

Acid-Base Equilibrium↗
PubMed1998

Nutrient and immunity transfer from cow to calf pre- and postcalving.

Nutritional and management strategies for dairy cattle are designed to prepare the cow for lactation and to minimize the incidence of metabolic diseases around calving. However, strategies initiated during the dry period should also consider the potential effects on the calf prior to and after calving. Fetal requirements for energy and protein are significant, particularly during the last trimester of gestation. Energy requirements increase to 1.3 to 1.5 times maintenance in late pregnancy; therefore, the formulation of rations for dry cows must contain sufficient energy to support fetal growth plus maintenance. Protein requirements during pregnancy increase, particularly during the last 2 mo. Colostrum is a source of immune components and nutrients to the neonate and contains more protein, immunoglobulins (Ig), nonprotein nitrogen, fat, ash, vitamins, and minerals than does milk. Because some vitamins do not cross the placental barrier, colostrum is the primary source of these nutrients for the calf after birth. Colostrum from cows that are not supplemented with vitamin E during the dry period may provide inadequate vitamin E to calves after birth. The Ig concentration in colostrum is not markedly affected by prepartum protein nutrition; diets containing high crude protein (CP) generally increase the nonprotein fraction of colostrum, but low CP diets do not affect the CP or Ig concentration of colostrum. However, data from beef calves suggest that absorption of IgG may be impaired when low protein diets are fed during the dry period. Diets for dry cows may be balanced to reduce the cation to anion ratio, which may reduce the incidence of parturient paresis. Recent research also suggests that these diets might increase the incidence of calves born in respiratory acidosis, which may impair the acquisition of passive immunity.

Animal Nutritional Physiological Phenomena↗
PubMed1996

pHi in piglet cerebral microvascular endothelial cells: recovery from an acid load.

Cerebral microvascular endothelial cells form a barrier between the blood and brain, which is critical for normal neuronal functions. These endothelial cells can be challenged by metabolic and respiratory acidosis, especially in newborn babies. We investigated mechanism(s) by which cerebral endothelial cells recover intracellular pH (pHi) when challenged with an intracellular acid load. pHi in piglet cerebral microvascular endothelial cells in primary culture was monitored using the pH-sensitive fluorescent dye BCECF (2',7'-bis-2-carboxyethyl-5(6)-carboxy-fluorescein acetoxymethyl ester), with dual wavelength fluorescence spectroscopy. Endothelial cells attached to coverslips and continuously superfused with HCO3-/CO2 containing medium (25 mM HCO3-, 5% CO2; pH 7.40) have a steady state of pHi of 7.18 +/- 0.02. Under basal conditions, amiloride (100 microMol) and H2DIDS (0.5 mM) decreased pHi 0.12 +/- 0.01 and 0.05 +/- 0.01 pH units, respectively. Removal of external Na+ lowered pHi 0.18 +/- 0.02pH units, while Cl- free medium decreased pHi 0.16 +/- 0.03pH units. These data suggest the presence of an amiloride-sensitive Na+-H+ exchanger and a Na+-dependent HCO3- -Cl- anion exchanger in endothelial cells. Propionate and high PCO2 cause rapid intracellular acidification at constant pH. The cells recover to control pHi over 10 min. Recovery from propionate was largely inhibited by amiloride, slightly inhibited by H2DIDS, and completely prevented by the combination. pHi recovery during elevated PCO2 was blocked by amiloride, H2DIDS, or Na+-free media. These results indicate that recovery from intracellular acidosis can involve amiloride-sensitive Na+-H+ exchange and a Na+-dependent HCO3-/Cl- anion exchange. Relative contributions of pumps and their independence appears to depend on the nature of the acid load.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed2000

Effects of xylazine on acid-base balance and arterial blood-gas tensions in goats under different environmental temperature and humidity conditions.

The effects of acute exposure to 3 different temperature and humidity conditions on arterial blood-gas and acid-base balance in goats were investigated after intravenous bolus administration of xylazine at a dose of 0.1 mg/kg. Significant (P<0.05) changes in the variables occurred under all 3 environmental conditions. Decreases in pH, partial pressure of oxygen and oxyhaemoglobin saturation were observed, and the minimum values for oxygen tension and oxyhaemoglobin saturation were observed within 5 min of xylazine administration. The pH decreased to its minimum values between 5 and 15 min. Thereafter, the variables started to return towards baseline, but did not reach baseline values at the end of the 60 min observation period. Increases in the partial pressure of carbon dioxide, total carbon dioxide content, bicarbonate ion concentration, and the actual base excess were observed. The maximum increase in the carbon dioxide tension occurred within 5 min of xylazine administration. The increase in the actual base excess only became significant after 30 min in all 3 environments, and maximal increases were observed at 60 min. There were no significant differences between the variables in the 3 different environments. It was concluded that intravenous xylazine administration in goats resulted in significant changes in arterial blood-gas and acid-base balance that were associated with hypoxaemia and respiratory acidosis, followed by metabolic alkalosis that continued for the duration of the observation period. Acute exposure to different environmental temperature and humidity conditions after xylazine administration did not influence the changes in arterial blood-gas and acid-base balance.

Acid-Base Equilibrium↗
PubMed1976

Periodic apnea, exercise hypoventilation, and hypothalamic dysfunction.

Periodic apnea and exercise hypoventilation were observed in a 14-year-old boy. Hyperphagia, obesity, serum hyperosmolality without diabetes insipidus or appropriate thirst, and retardation of growth and sexual development indicated a hypothalamic disorder. Neurologic evaluation was normal except for electroencephalographic changes induced by apnea. Pulmonary function tests, resting arterial blood gases in the wakeful state, and ventilatory response to inhaled CO2 were also normal. Acute hypoxemia and respiratory acidosis occurred with apnea during sleep and with insufficient ventilation during exercise. The central origin of sleep apneas was shown by esophageal pressure monitoring. The hypothalamic dysfunction and exercise hypoventilation distinguish this patient from others with obesity and periodic apnea.

Adolescent↗
PubMed1976

Hemodynamics in sleep-induced apnea. Studies during wakefulness and sleep.

Twelve patients with predominantly obstructive type sleep apnea underwent cardiac catheterization, hemodynamic monitoring, and arterial blood gas analysis during wakefulness and sleep. Abnormalities during wakefulness included systemic hypertension in four of 12, exercise-induced mild pulmonary hypertension in five of 12, and alveolar hypoventilation in one. During sleep nine patients had cyclic elevations of arterial pressure with each apneic episode, exceeding 200 mm Hg systolic in three of 12. Pulmonary artery pressures increased in 10 of 12, exceeding 60 mm Hg systolic in five. Marked degrees of hypoxemia (arterial P02, less than 50 mm Hg in eight of 12) and moderate hypercapnia with respiratory acidosis were associated with these hemodynamic changes. Cyclic upper airway obstruction during sleep may result in hypercapnia, acidosis, and pronounced hypoxemia, which can lead to hemodynamic abnormalities during sleep. Sustained pulmonary hypertension and possibly systemic hypertension may follow. Tracheostomy is an effective therapy and is recommended to symptomatic patients who have predominantly obstructive apnea but no relievable anatomic cause of upper airway obstruction.

Adult↗