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Pediatrics Nov 1988In an effort to characterize significant neonatal apnea and evaluate the nursing diagnosis of apnea, apnea type and frequency were determined in 27 infants by continuous...
In an effort to characterize significant neonatal apnea and evaluate the nursing diagnosis of apnea, apnea type and frequency were determined in 27 infants by continuous computer recording of heart rate, respiratory impedance, end-tidal CO2, and either or both transcutaneous oxygen and pulse oximetry. Of the 1,266 recorded apneas, 46% were central, 44% were mixed, and 10% were obstructive. Mixed apnea was associated with a longer mean duration and greater mean decrease in heart rate than central apnea. Apnea duration was positively correlated with both a decrease in heart rate and oxygen saturation (P less than .001), and a lower baseline saturation was associated with a greater decrease in oxygen saturation during apnea (P = .002). Theophylline therapy had no effect on apnea duration or oxygen desaturation but resulted in a decrease in the mean heart rate decrease associated with apnea. Overall, nurses diagnosed 54% of all apneic episodes and were significantly poorer at detecting mixed and obstructive events. Nursing detection of apnea improved with increasing apnea duration and was always associated with a greater decrease in heart rate. Nurses diagnosed significantly fewer mixed apnea following theophylline therapy. Improved monitoring techniques, particularly for mixed and obstructive apnea, are essential to increase apnea detection in the nursery.
Topics: Apnea; Computers; Heart Rate; Humans; Infant, Newborn; Monitoring, Physiologic; Nursing Assessment; Nursing Diagnosis; Sleep Apnea Syndromes; Theophylline
PubMed: 3186350
DOI: No ID Found -
Monatsschrift Kinderheilkunde : Organ... Jul 1993The pathogenesis of apnoea in preterm infants is poorly understood. Thus, it is yet unknown (1) whether the descriptive distinction between "central", "obstructive" and... (Review)
Review
The pathogenesis of apnoea in preterm infants is poorly understood. Thus, it is yet unknown (1) whether the descriptive distinction between "central", "obstructive" and "mixed" apnoeas is also reflected by differences in their respective pathogenesis, (2) how and where the airway closure occurs during the so-called "obstructive" apnoeas, (3) whether "central" apnoeas do indeed result from a disturbance in the central nervous control of breathing, as implied by their name, or whether they constitute a reflex response to a disturbance in the periphery of the lung, and (4) whether non-apnoeic mechanisms contribute to the hypoxaemia so frequently observed during these episodes. This paper summarises the present knowledge regarding the above issues. It also reviews the current definitions for apnoea, bradycardia and hypoxaemia in preterm infants, describes indications for intervention, and discusses some strategies aimed at preventing these episodes.
Topics: Apnea; Bradycardia; Brain Stem; Cross-Sectional Studies; Female; Germany; Humans; Hypoxia; Incidence; Infant, Newborn; Lung; Male; Pulmonary Ventilation; Respiratory Distress Syndrome, Newborn
PubMed: 8413332
DOI: No ID Found -
American Journal of Perinatology Apr 1997We tested the hypothesis that in preterm infants, prolonged apneas (apneas > or = 20 sec) are not random events but are preceded by frequent and progressively longer...
We tested the hypothesis that in preterm infants, prolonged apneas (apneas > or = 20 sec) are not random events but are preceded by frequent and progressively longer respiratory pauses associated with changes in ventilatory variables. We studied 36 preterm infants with apnea [birth weight 1190 +/- 60 g (mean +/- SEM), study weight 1300 +/- 60 g, gestational age 28 +/- 1 weeks, and postnatal age 23 +/- 2 days]. A nosepiece with a flow-through system was used to measure ventilation and alveolar gases. Throughout the monitoring period for each infant we established 10-min moving "window of observation" followed by a 1-min interval examined for the detection of a prolonged apnea. Within the 10-min window, three variables were defined: the number of apneic episodes, the maximum length of a single apneic episode, and the total duration of apneic time. During the following minute (eleventh) the presence or absence of a prolonged apnea was determined. Chi-square test for a linear-trend in the rate of prolonged apnea and multiple logistic regression analysis showed that the relative risk of a prolonged apnea increases significantly from preceding periods without apnea to preceding periods containing the potential predictors of prolonged apnea. The strongest predictor was total duration of apneic time in the previous 10 min. When the 1 min before prolonged apnea was compared with the 1 min of similar sleep state not having prolonged apnea, minute ventilation decreased, primarily due to a decrease in respiratory frequency. Oxygen saturation decreased and alveolar PCO2 did not change. These findings suggest that prolonged apnea is not a random event but is preceded by a disturbance of the respiratory control system characterized by (1) frequent apneas of progressive duration, (2) decrease in respiratory minute volume and frequency, and (3) decreased O2 saturation.
Topics: Apnea; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Pulmonary Ventilation; Regression Analysis; Respiration
PubMed: 9259927
DOI: 10.1055/s-2007-994126 -
American Journal of Otolaryngology 1985Four patients who were evaluated for hypersomnia-sleep apnea syndrome were found in all-night sleep studies to have obstructive or mixed apneas related to their sleeping...
Four patients who were evaluated for hypersomnia-sleep apnea syndrome were found in all-night sleep studies to have obstructive or mixed apneas related to their sleeping positions. All four were available for comprehensive follow-up and were subsequently restudied while avoiding the supine position. Supine, prone, and lateral decubitus apnea indices were calculated for each patient for each night. The supine sleeping position was associated with significantly more apneas than the non-supine positions. Keeping these patients off their backs when they slept was effective treatment. Additionally, when results of surgical or pharmacologic treatments of apnea are evaluated, positional apnea indices should be considered.
Topics: Follow-Up Studies; Humans; Male; Middle Aged; Posture; Sleep; Sleep Apnea Syndromes
PubMed: 4073378
DOI: 10.1016/s0196-0709(85)80015-6 -
Nederlands Tijdschrift Voor Geneeskunde Feb 1999Three neonates had diverse kinds of central apnoea. The first child, a girl aged 3 weeks, had an upper respiratory tract infection caused by the respiratory syncytial... (Review)
Review
Three neonates had diverse kinds of central apnoea. The first child, a girl aged 3 weeks, had an upper respiratory tract infection caused by the respiratory syncytial virus; she was intubated and needed ventilatory support for three days. The second patient, a boy of 17 days, had an Arnold-Chiari-malformation with apnoeas treated with a carbonic anhydrase inhibitor (acetazolamide). The third patient, a boy of 5 days, had central apnoeas of epileptic origin and was treated with phenobarbital. All three recovered well. If in an infant with apnoeas no paediatric explanation is found, and the child is neurologically at risk, it is advisable to make an EEG to determine if an epileptic substrate is present, even in the absence of motor phenomena.
Topics: Acetazolamide; Anticonvulsants; Apnea; Arnold-Chiari Malformation; DiGeorge Syndrome; Diagnosis, Differential; Electroencephalography; Epilepsy; Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Phenobarbital; Respiration, Artificial; Respiratory Syncytial Virus Infections; Syndrome; Treatment Outcome
PubMed: 10221119
DOI: No ID Found -
Undersea & Hyperbaric Medicine :... 1998We studied the effect of the human diving response, defined as bradycardia and reduced peripheral blood flow, on arterial hemoglobin desaturation. We induced a diving...
We studied the effect of the human diving response, defined as bradycardia and reduced peripheral blood flow, on arterial hemoglobin desaturation. We induced a diving response of different magnitudes by using apnea in air and apnea with face immersion. Each of 21 subjects performed five apneas in air and five apneas with face immersion in 10 degrees C water. Periods of apnea in both conditions were of the same duration in any individual subject (average: 126.4 s) and the order of air and water was equally distributed among subjects. Heart rate, skin capillary blood flow, arterial blood pressure, arterial hemoglobin oxygen saturation during apneas, and end-tidal fractions of CO2 after apneas were recorded with non-invasive methods. The bradycardia and capillary blood flow reduction during apnea in air (7.8 and 37.7% change from control, respectively) were significantly potentiated by face immersion (13.6 and 55.9%, respectively). Arterial hemoglobin desaturated more during apnea in air (2.7%) compared to during apnea with face immersion (1.4%). We conclude that the potentiation of the human diving response with face immersion in cold water leads to a smaller decrease in arterial hemoglobin saturation, which may reflect an oxygen-conserving effect.
Topics: Adolescent; Adult; Apnea; Blood Pressure; Diving; Heart Rate; Humans; Immersion; Male; Oxygen Consumption; Vasoconstriction
PubMed: 9566083
DOI: No ID Found -
The Laryngoscope Mar 2023
Topics: Humans; Sleep Apnea, Central; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Adenoidectomy; Tonsillectomy
PubMed: 35642620
DOI: 10.1002/lary.30220 -
Emerging Topics in Life Sciences Dec 2023Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a common disorder characterised by repetitive episodes of the complete or partial collapse of the pharyngeal...
Obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is a common disorder characterised by repetitive episodes of the complete or partial collapse of the pharyngeal airway during sleep. This results in cessation (apnoea) or reduction (hypopnoea) of airflow, leading to oxygen desaturation and sleep fragmentation. An individual's disposition to develop OSAHS depends on the collapsibility of a segment of the upper airway. The degree of collapsibility can be quantified by the balance between occluding or extraluminal pressures of the surrounding tissues. Patients can experience snoring, unrefreshing sleep, witnessed apnoeas, waking with a choking sensation and excessive daytime sleepiness. OSAHS has a broad range of consequences, including cardiovascular, metabolic, and neurocognitive sequelae. Treatment options include lifestyle measures, in particular weight loss, and strategies to maintain upper airway patency overnight, including continuous positive airway pressure, mandibular advancement devices and positional modifiers.
Topics: Humans; Sleep Apnea, Obstructive; Syndrome; Lung; Snoring; Continuous Positive Airway Pressure
PubMed: 38130167
DOI: 10.1042/ETLS20180939 -
The Indian Journal of Medical Research Feb 2010Central sleep apnoea (CSA) is characterized by the cessation of breathing during sleep due to absent ventilatory drive and may be associated with symptoms of insomnia,... (Review)
Review
Central sleep apnoea (CSA) is characterized by the cessation of breathing during sleep due to absent ventilatory drive and may be associated with symptoms of insomnia, excessive daytime sleepiness or frequent arousals. Central apnoeas occur through two pathophysiologic patterns, either post- hyperventilation or post-hypoventilation. The prevalence of CSA is dependent on the population being studied, the predominant risk factors being elderly age group and co-morbid conditions.Data regarding the racial distribution of this disorder are very limited. CSA may be a clinical marker of underlying medical disorders, including cardiac or neurological disease, with resultant significant morbidity and mortality. Given that the underlying pathogenesis remains poorly understood, therapeutic options are currently limited to empiric treatment with PAP devices and rudimentary attempts at pharmacologic therapy with respiratory stimulant drugs and/or oxygen/carbon dioxide gas supplementation as well as treating the underlying cause. The long-term impact of CSA on health and mortality needs further clarification. Future research should be aimed at elucidating the physiologic determinants and consequences of central breathing instability in populations of different age groups, gender and racial descent, as a prerequisite to the development of novel therapeutic interventions in the different populations.
Topics: Age Factors; Aged; Comorbidity; Disorders of Excessive Somnolence; Female; Humans; Male; Middle Aged; Prevalence; Regression Analysis; Risk Factors; Sleep Apnea Syndromes; Sleep Initiation and Maintenance Disorders
PubMed: 20308740
DOI: No ID Found -
Archives of Disease in Childhood. Fetal... Jul 2016Apnoea of prematurity (AOP) affects almost all infants born at <28 weeks gestation or with birth weight <1000 g. When untreated, AOP may be associated with negative... (Review)
Review
Apnoea of prematurity (AOP) affects almost all infants born at <28 weeks gestation or with birth weight <1000 g. When untreated, AOP may be associated with negative outcomes. Because of these negative outcomes, effective treatment for AOP is an important part of optimising care of preterm infants. Standard treatment usually involves xanthine therapy and respiratory support. Cutting-edge work with stochastic vibrotactile stimulation and new pharmaceutical agents continues to expand therapeutic options. In this article, we review the pathophysiology of AOP, associated conditions and treatment options.
Topics: Apnea; Disease Management; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases
PubMed: 27010019
DOI: 10.1136/archdischild-2015-310228