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Results for “Sleep Apnea, Obstructive”

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At least 19 recordsLinked to original sources
PubMed1987

Reversibility of deficient sleep entrained growth hormone secretion in a boy with achondroplasia and obstructive sleep apnea.

Obstructive sleep apnea may lead to disordered sleep architecture and impair the physiologic slow wave sleep related growth hormone release. Obstructive sleep apnea occurs with craniofacial syndromes and in children with airway narrowing, pharyngeal hypoplasia, tonsillar adenoidal hypertrophy, micrognathia and achondroplasia. To examine the relationship between disordered sleep and growth hormone release we studied a 9 year old male with achondroplasia, growth failure (3 cm/year) and obstructive sleep apnea. Polysomnography data and a 20 min sampling for sleep entrained growth hormone showed before therapeutic tracheostomy numerous apneic episodes, absent slow wave sleep and abnormal low growth hormone secretion during sleep. Normalized slow wave sleep entrained growth hormone secretion after tracheostomy led to a sustained increase in growth rate. Normal growth rate (greater than 5 cm/year) continues 2 years after tracheostomy. We conclude that obstructive sleep apnea may impair sleep related growth hormone release. Obstructive sleep apnea may be a useful model for other diseases in which growth failure and sleep disturbances are linked.

Achondroplasia↗
PubMed2005

Medical devices for the diagnosis and treatment of obstructive sleep apnea.

Obstructive sleep apnea is increasingly being recognized as a serious public health problem, and is characterized by repetitive, complete or partial closure of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation. The key symptoms of obstructive sleep apnea are snoring, witnessed apneas, excessive daytime sleepiness and deficits in neurocognitive function, adversely impacting on quality of life. The last 10 years have seen a steady increase in evidence linking obstructive sleep apnea to long-term cardiovascular morbidity, including hypertension, myocardial infarction and stroke, and an increased risk of motor vehicle accidents. The discovery of continuous positive airway pressure treatment, and the resultant recognition of the high prevalence of snoring and obstructive sleep apnea, and their impact on health, has spawned a new and rapidly growing global industry. Whilst diagnostic technologic advancements have evolved relatively rapidly, many questions relating to the use of such devices in clinical practice remain unresolved. Similarly, on the therapeutic front, advances in continuous positive airway pressure technology have broadened the use of such treatment, although compliance remains an important impediment to widespread treatment of this common disorder. This has prompted a search for simpler treatment alternatives, ranging from surgical, medical and dental therapies, although none have matched the efficacy of continuous positive airway pressure. Advances in our understanding of the neurobiology of sleep and respiration herald the prospect of pharmacologic treatment in the longer term.

Continuous Positive Airway Pressure↗
PubMed1999

Obstructive sleep apnea.

Obstructive sleep apnea is a significant medical problem affecting up to 4 percent of middle-aged adults. The most common complaints are loud snoring, disrupted sleep and excessive daytime sleepiness. Patients with apnea suffer from fragmented sleep and may develop cardiovascular abnormalities because of the repetitive cycles of snoring, airway collapse and arousal. Although most patients are overweight and have a short, thick neck, some are of normal weight but have a small, receding jaw. Because many patients are not aware of their heavy snoring and nocturnal arousals, obstructive sleep apnea may remain undiagnosed; therefore, it is helpful to question the bedroom partner of a patient with chronic sleepiness and fatigue. Polysomnography in a sleep laboratory is the gold standard for confirming the diagnosis of obstructive sleep apnea; however, the test is expensive and not widely available. Home sleep studies are less costly but not as diagnostically accurate. Treatments include weight loss, nasal continuous positive airway pressure and dental devices that modify the position of the tongue or jaw. Upper airway and jaw surgical procedures may also be appropriate in selected patients, but invasiveness and expense restrict their use.

Adult↗
PubMed2003

Obstructive sleep apnea.

Obstructive sleep apnea is an increasingly well-recognized disease characterized by periodic collapse of the upper airway during sleep. This leads to either complete or partial obstruction of the airway, resulting in apneas, hypopneas, or both. This disorder causes daytime somnolence, neurocognitive defects, and depression. It affects almost every system in the body, resulting in an increased incidence of hypertension, cardiovascular disease, stroke, pulmonary hypertension, cardiac arrhythmias, and altered immune function. It also increases the risk of having an accident, presumably as a result of associated somnolence. The gold standard for the diagnosis of sleep apnea is an overnight polysomnogram. Split-night studies are becoming increasingly common and allow for quicker implementation of therapy at a reduced cost. Treatment options for sleep apnea include weight loss, positional therapy, oral devices, continuous positive airway pressure (CPAP), and upper airway surgery. CPAP is the most efficacious and widely used therapy. Its complications include nasal congestion or dryness, mask discomfort, and claustrophobia. Heated humidifiers, newer types of masks, and nasal steroids have improved tolerance of this therapy. Bilevel positive-pressure therapy can be considered for patients who find it difficult to exhale against the consistently increased pressure of CPAP. The disease requires aggressive treatment to improve quality of life and prevent its complications.

Cardiovascular Diseases↗
PubMed2005

Insomnia complaints in patients evaluated for obstructive sleep apnea.

Obstructive sleep apnea (OSA) and insomnia are among the most common sleep diagnoses encountered in the sleep clinic population, however little is known about potential interactions or associations between the two disorders. This retrospective, cross-sectional study was designed to determine the prevalence of insomnia complaints in patients undergoing evaluation for OSA and to ascertain which clinical and polysomnographic features are associated with insomnia. Of 255 consecutive patients who underwent polysomnography for clinically suspected OSA, 54.9% reported a complaint of insomnia: 33.4% reported difficulty initiating sleep, 38.8% difficulty maintaining sleep, and 31.4% early morning awakenings. Insomnia complaints were noted more commonly in patients without significant sleep-disordered breathing [apnea hypopnea index (AHI)<10; 81.5%] vs those with sleep-disordered breathing (AHI> or =10; 51.8%); p=0.01. Clinical factors associated with insomnia included female gender, psychiatric diagnoses, chronic pain, the absence of regular alcohol use, restless leg symptoms, and reports of nocturnal kicking. Polysomnographic factors associated with insomnia included lower AHI and lower desaturation index (DI). In the subgroup of patients with significant sleep-disordered breathing (AHI> or =10, n=228), there was no association between insomnia complaints and AHI or DI. These results suggest that insomnia is a common complaint in patients being evaluated for OSA, but it is not strongly associated with sleep-disordered breathing and may instead reflect other coexisting factors.

Adult↗
PubMed1999

An overview of nasal CPAP therapy in the management of obstructive sleep apnea.

Obstructive sleep apnea is readily reversible with nasally administered continuous positive airway pressure, although its effectiveness can be limited by poor patient compliance with therapy. With recent developments in technology, the ability to both diagnose and manage this disorder is dramatically improving. Assessment and therapeutic intervention can now be carried out not only in attended settings, such as sophisticated sleep laboratories, but in semiattended and unattended situations, including the home. What impact these advances will have on improving patient tolerance to therapy and reducing long-term clinical consequences of obstructive sleep apnea remains to be seen. However, there is no doubt that sleep-trained professionals now have many more tools at their disposal to diagnose and treat this disorder.

Humans↗
PubMed2004

Comprehensive reconstructive surgery for obstructive sleep apnea.

Obstructive sleep apnea (OSA) is commonly treated by continuous positive airway pressure (CPAP). Patients can be intolerant, noncompliant, or avoidant of CPAP therapy but incur increased risk of cardiopulmonary disease, stroke, and shortened life span without treatment. Comprehensive hard and soft tissue surgical therapy directed at the nasal, retro-palatal, and retro-lingual airway has been shown to optimize surgical outcomes compared with isolated soft tissue procedures. Outcome information from postoperative sleep studies shows that staged surgical procedures of hard and soft tissues are comparable to CPAP studies. While CPAP is the "gold standard" therapy for obstructive sleep apnea, combined soft tissue and maxillofacial surgical techniques can provide a treatment alternative for patients that are unable or unwilling to use CPAP treatment.

Adult↗
PubMed1995

[Right ventricular function in patients with obstructive sleep apnea].

Obstructive sleep apnea often affects the cardiovascular system. So far, only few data are available on its influence on the function of the right ventricle that can be evaluated by gated radionuclide ventriculography. This technique was performed on 68 patients with polysomnographically verified obstructive sleep apnea. 27.9% of the patients showed an impairment of right ventricular function. There was no correlation between right ventricular function and degree of obstructive sleep apnea or pulmonary artery pressures--as evaluated by right heart catheterization. Gated radionuclide ventriculography thus seems to be suitable for early detection of pathological effects of obstructive sleep apnea on the function of the right ventricle.

Adult↗
PubMedDate not supplied

The potential for neurostimulation in obstructive sleep apnea.

Obstructive sleep apnea affects millions of individuals. It usually is due to pharyngeal collapse during sleep, resulting in daytime somnolence. This can have grave consequences on everyday life and in the long term can lead to pulmonary and systemic hypertension, myocardial disease, and stroke. Non-structural obstructive sleep apnea can be relieved by tracheostomy and continuous positive airway pressure, two methods that bypass the overly compliant pharyngeal musculature during inspiration. It may well be desirable to exchange a dynamic and more physiologic approach to obstructive sleep apnea for these purely static solutions. This approach should restore disturbed cyclical stiffening of the upper airway by electronically stimulating the appropriate muscles, timed by information originating during the inspiratory effort. The open-loop systems proposed here are based upon principles pioneered by us for the rehabilitation of the paralyzed larynx that are now well within practical reach of current technologies.

Electric Stimulation↗
PubMed1990

Respiratory muscle function during obstructive sleep apnea.

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep. Inspiratory muscles may be subjected to potentially fatiguing loads during an obstructive apnea and this may be related to the termination of obstructive apnea. We have measured transdiaphragmatic pressure (Pdi) and breathing patterns in six male patients with OSA during sleep to characterize respiratory muscle function in OSA and determine whether apnea termination is consistently related to a pressure time index of the diaphragm (PTI) associated with respiratory muscle fatigue. There was a large intersubject variability in Pdi generation during apnea. No consistent level of PTI was associated with apnea termination. During prolonged apneas, the respiratory duty cycle plateaued, which is suggestive of an inhibitory reflex possibly mediated by chest wall afferents. There were intersubject differences in both inspiratory and expiratory muscle recruitment during apnea. In the majority of patients, the diaphragm appeared to be the primary inspiratory muscle during apnea, but in some it appeared to be the intercostal/accessory muscles. The majority of patients demonstrated an increase in gastric pressure and inward abdominal movement during the expiratory phases of an apnea, consistent with abdominal muscle recruitment stimulated by increased ventilatory drive.

Diaphragm↗
PubMed1990

Posterior airway changes associated with mandibular advancement surgery: implications for patients with obstructive sleep apnea.

Obstructive sleep apnea syndrome is caused by loss of tone in the pharyngeal muscles. Bilateral sagittal ramus osteotomy has occasionally been used to treat this syndrome. To determine if postsurgical changes in posterior airway space are predictable, the posterior airway space in 25 patients who did not have obstructive sleep apnea was measured before and after surgery. Analysis revealed that the posterior airway space usually increased after advancement of the mandible, but the changes were varied. Therefore, the procedure may be helpful in some patients with obstructive sleep apnea syndrome and may obviate the need for tracheostomy, but success cannot be guaranteed.

Adolescent↗
PubMed2003

Hypertension and obstructive sleep apnea.

Obstructive sleep apnea is a common disorder that is often unrecognized and underappreciated. Emerging evidence suggests that there is a causal link between obstructive sleep apnea and hypertension. This relationship appears to be independent of other comorbidities that have been previously linked to hypertension, such as obesity. The majority of studies support the contention that alleviation of sleep disordered breathing has a clinically significant beneficial impact on decreasing both nighttime and daytime blood pressure. A pathophysiologic basis for patients with sleep apnea having an increased risk for hypertension is not fully elucidated. However, there is consistent evidence that autonomic mechanisms are implicated. Sympathetic activation along with humoral responses to repetitive episodes of hypoxemia and apnea over the longer term may cause vasoconstriction, endothelial dysfunction, and possibly hypertension. Patients with sleep apnea are often obese and may be predisposed to weight gain. Hence, obesity may further contribute to hypertension in this patient population.

Blood Pressure↗
PubMed1998

Surgical approaches to obstructive sleep apnea.

Obstructive sleep apnea results from a combination of a structurally small upper airway and loss of upper airway muscle tone. Surgical therapy is effective by enlarging the upper airway and decreasing collapsibility. Limited palatal surgery has been demonstrated successful for the treatment of snoring but less for the treatment of obstructive sleep apnea. More aggressive multilevel surgeries addressing several airway segments demonstrate improved success rates. Multilevel surgeries and combined with bimaxillary advancement surgery have demonstrated success rates of 90%. New surgical procedures, eg, radiofrequency volume reduction, offer the potential of altering the upper airway with low morbidity. Hypoglossal nerve stimulation is a potential innovative technique.

Female↗
PubMed2005

Cerebral structural changes in severe obstructive sleep apnea.

Obstructive sleep apnea is associated with abnormalities in neuropsychologic function, and defects in respiratory control may contribute to pathogenesis. Abnormalities may be reflected in structural brain changes. Twenty-seven male untreated patients with severe sleep apnea without comorbidities, and 24 age-matched control subjects, had T1-weighted brain imaging in a high-resolution magnetic resonance scanner. Twenty-three patients with sleep apnea had repeat imaging after 6 months of continuous positive airways pressure treatment. No areas of gray matter volume change were found in patients using an optimized voxel-based morphometry technique, at p < 0.05 adjusted for multiple comparisons (despite the method being sensitive to changes in gray matter fraction of 0.17 or less in all voxels). Furthermore, no differences were seen in bilateral hippocampal, temporal lobe, or whole brain volumes, assessed by manual tracing of anatomical borders. No longitudinal changes were seen in gray matter density or regional volumes after treatment, but whole brain volume decreased slightly. We have found no gray matter volume deficits nor focal structural changes in severe obstructive sleep apnea. Whole brain volume decreases without focal changes after 6 months of continuous positive airways pressure treatment.

Adult↗
PubMed2003

The Great Leap Forward: the anatomic basis for the acquisition of speech and obstructive sleep apnea.

Obstructive sleep apnea is an anatomic illness caused by evolutionary changes in the human upper respiratory tract. These changes include shortening of the maxillary, ethmoid, palatal and mandibular bones, acute oral cavity-skull base angulation, pharyngeal collapse with anterior migration of the foramen magnum, posterior migration of the tongue into the pharynx, descent of the larynx and shortening of the soft palate with loss of the epiglottic-soft palate lock-up. While it is commonly believed that some of these changes had positive selection pressures for bipedalism, binocular vision and locomotion, development of voice, speech and language ultimately became a substantial contributing factor. Here it is shown that these changes are the anatomic basis of obstructive sleep apnea.

Animals↗
PubMed1996

Motor control of the pharyngeal musculature and implications for the pathogenesis of obstructive sleep apnea.

Obstructive sleep apnea is a common breathing problem that results in recurrent episodes of nighttime hypoxemia, hypercapnia, bradytachycardia, and hypertension, as well as sleep disturbance and daytime hypersomnolence. The obstruction is located in the oropharynx and is caused by hypotonia of the pharyngeal dilator muscles. In this paper, the various mechanisms affecting motor output to the upper airway muscles are reviewed. In particular, the respiratory function of the pharyngeal dilator muscles, the various reflex mechanisms underlying their control, and the effects of sleep on these mechanisms are discussed. The literature relevant to the central neuronal circuits and neurotransmitters that may be involved in the state-dependent activity of the pharyngeal dilator muscles is also reviewed. In addition to an examination of these basic mechanisms, consideration is given throughout this review as to how these mechanisms may relate to the normal control of pharyngeal patency awake and asleep and how they may be involved in the pathogenesis of obstructive sleep apnea.

Carbachol↗
PubMed1991

Obstructive sleep apnea.

Obstructive sleep apnea is diagnosed with the use of polysomnography by documenting repetitive periods of upper airway closure during sleep. Apneic episodes can compromise gas exchange and disrupt the sleep pattern. The challenge to the clinician is to suspect this diagnosis when evaluating the awake patient. The history of loud snoring plus daytime hypersomnolence or multiple awakenings during sleep justifies ordering a polysomnogram. The importance of diagnosing obstructive sleep apnea is underscored by the resolution of its sequelae with effective medical or surgical treatment.

Airway Obstruction↗
PubMed1992

Obstructive sleep apnea.

Obstructive sleep apnea represents a common disorder with potentially high morbidity and mortality. Its clinical significance and treatment options have not been fully defined. Excessive daytime sleepiness and the cardiovascular complications of obstructive sleep apnea constitute a significant public health problem. Clinical features and treatment are discussed.

Female↗