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The European Respiratory Journal Jul 1995The pathophysiology of obstructive sleep apnoea (OSA) is complex and incompletely understood. A narrowed upper airway is very common among OSA patients, and is usually... (Review)
Review
The pathophysiology of obstructive sleep apnoea (OSA) is complex and incompletely understood. A narrowed upper airway is very common among OSA patients, and is usually in adults due to nonspecific factors such as fat deposition in the neck, or abnormal bony morphology of the upper airway. Functional impairment of the upper airway dilating muscles is particularly important in the development of OSA, and patients have a reduction both in tonic and phasic contraction of these muscles during sleep when compared to normals. A variety of defective respiratory control mechanisms are found in OSA, including impaired chemical drive, defective inspiratory load responses, and abnormal upper airway protective reflexes. These defects may play an important role in the abnormal upper airway muscle responses found among patients with OSA. Local upper airway reflexes mediated by surface receptors sensitive to intrapharyngeal pressure changes appear to be important in this respect. Arousal plays an important role in the termination of each apnoea, but may also contribute to the development of further apnoea, because of reduction in respiratory drive related to the hypocapnia which results from postapnoeic hyperventilation. A cyclical pattern of repetitive obstructive apnoeas may result. A better understanding of the integrated pathophysiology of OSA should help in the development of new therapeutic techniques.
Topics: Adult; Airway Resistance; Arousal; Female; Humans; Male; Middle Aged; Obesity; Posture; Respiratory Center; Respiratory Muscles; Risk Factors; Sleep Apnea Syndromes
PubMed: 7589402
DOI: 10.1183/09031936.95.08071161 -
Scientific Reports Feb 2018Obstructive sleep apnea (OSA) occurs when the upper airway narrows or collapses due to the loss of upper airway muscle activation at sleep onset. This study investigated...
Obstructive sleep apnea (OSA) occurs when the upper airway narrows or collapses due to the loss of upper airway muscle activation at sleep onset. This study investigated the effectiveness of triggered kinesthetic stimulation in patients with OSA. This proof-of-concept, open-label, multicenter prospective study was conducted on 24 patients with severe OSA. During a one night evaluation, kinesthetic stimulation was intermittently delivered in 30 minute periods. The duration of apneas and hypopneas during Stim and Stim periods were compared. Five hospital-based university centers in France participated. Sleep studies were evaluated by a single scorer at a core laboratory (CHU Grenoble). Results show that during the Stim phases, statistically significant decreases in durations of apneas and hypopneas were observed in 56% and 46% of patients, respectively. Overall, 75% of patients showed an improvement in apneas or hypopneas durations. The mean reduction in durations for patients with a significant decrease was 4.86 seconds for apneas and 6.00 seconds for hypopneas. This proof of concept study is the first to identify kinesthetic stimulation as a potentially effective therapy for OSA. These data justify evaluation in a controlled study.
Topics: Adult; Apnea; Female; France; Humans; Kinesthesis; Male; Middle Aged; Polysomnography; Proof of Concept Study; Prospective Studies; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 29449609
DOI: 10.1038/s41598-018-21430-w -
Sleep Medicine Reviews Oct 2013Schizophrenia is associated with significantly increased physical morbidity and mortality particularly secondary to cardiometabolic disorders. In people with... (Review)
Review
Schizophrenia is associated with significantly increased physical morbidity and mortality particularly secondary to cardiometabolic disorders. In people with schizophrenia, rates of obesity and the metabolic syndrome are high compared to the general population. Whilst the weight gain secondary to antipsychotic medication is largely to blame, other factors include inactivity, poor diet and possibly the illness itself. Obstructive sleep apnoea (OSA) is a common and frequently under-recognized condition which may be associated with disabling symptoms including daytime sleepiness, cognitive impairment, depression, anxiety and long term increases in morbidity and mortality secondary to cardiometabolic disease. As the primary risk factor is obesity, elevated rates of sleep apnoea would therefore seem likely in association with schizophrenia. Thus, OSA might represent a treatable cause of psychiatric and physical co-morbidity in patients with schizophrenia. A review of the literature revealed a paucity of quality research in this area. Available data suggest increased rates of sleep apnoea in schizophrenia and that psychotic symptoms may improve when co-morbid sleep apnoea is treated. Health practitioners may be unaware of the need to screen for sleep apnoea in patients with schizophrenia and the disorder may be significantly under-recognised. Research is required to clarify the epidemiology, consequences and management of sleep apnoea in association with schizophrenia.
Topics: Biomedical Research; Comorbidity; Humans; Prevalence; Risk Factors; Schizophrenia; Sleep Apnea, Obstructive
PubMed: 23528272
DOI: 10.1016/j.smrv.2012.10.003 -
Sleep Medicine Reviews Jun 2002In patients with obstructive sleep apnoea syndrome (OSAS), pulmonary haemodynamics can show both transient perturbations during sleep and permanent alterations. During... (Review)
Review
In patients with obstructive sleep apnoea syndrome (OSAS), pulmonary haemodynamics can show both transient perturbations during sleep and permanent alterations. During sleep, repeated fluctuations in pulmonary artery pressure and pulmonary wedge pressure, coincident with apnoeas, can be observed. Calculation of transmural pressure values is preferable to intravascular pressures in OSAS, due to the marked swings in intrathoracic pressure associated with obstructive apnoeas. Pulmonary artery pressure may progressively increase during sleep, particularly in close sequences of highly desaturating apnoeas. Apnoea-induced hypoxia appears as the most important determinant of this pulmonary artery pressure behaviour. Stroke volume and cardiac output during obstructive apnoeas show changes mainly related to intrathoracic pressure variations. Permanent precapillary pulmonary hypertension at rest is observed in <50% OSAS patients, and is poorly reversible after OSAS treatment. It correlates best with diurnal respiratory function parameters. However, the finding of pulmonary hypertension in some patients with near normal diurnal lung function led to suggest that sleep respiratory disorders may contribute to permanent pulmonary haemodynamic impairment in predisposed subjects. Knowledge on right ventricle hypertrophy in OSAS is inconsistent. As to right ventricle failure, it is clinically evident in subjects with associated lung disease or morbid obesity, while it may be detected instrumentally in subjects without such alterations, presumably as effect of apnoeas themselves. Besides, it appears more fully reversible after long-term OSAS treatment than pulmonary hypertension.
Topics: Hemodynamics; Humans; Hypertension, Pulmonary; Lung; Sleep Apnea, Obstructive; Sleep, REM; Ventricular Dysfunction, Right; Wakefulness
PubMed: 12531120
DOI: 10.1053/smrv.2001.0185 -
The Cochrane Database of Systematic... 2002The treatment of choice for moderate to severe obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP) via a mask during sleep. However this is not... (Review)
Review
BACKGROUND
The treatment of choice for moderate to severe obstructive sleep apnoea (OSA) is continuous positive airway 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. The mechanisms by which drugs might reduce OSA include; a reduction in the proportion of rapid eye movement (REM) sleep (during which apnoeas tend to be more frequent), an increase in ventilatory drive or an increase in upper airway muscle tone during sleep.
OBJECTIVES
To determine the efficacy of drug therapies in the treatment of sleep apnoea.
SEARCH STRATEGY
Searches were carried out on the Cochrane Airways Group RCT Register. Additional hand searching was performed as relevant.
SELECTION CRITERIA
Double blind, randomised placebo controlled trials were included, involving patients with confirmed obstructive sleep apnoea. Trials were excluded 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
A total of 51 references were identified by electronic searches. 42 studies were retrieved for selection and 9 trials were included in the review. The results for 91 patients were available. No response for further information was forthcoming from the study authors. Results were expressed as (WMD) and 95% Confidence Intervals (95% CI) MAIN RESULTS: Only acetazolamide reduced the Hypopnoea Index (1 crossover trial of 9 patients, Weighted Mean Difference -24; 95%Confidence Intervals (95% CI): -4, -44). However there was no symptomatic response and the drug was poorly tolerated. Protriptyline led to a symptomatic improvement (improved vs not improved) in two out of three crossover trials (13 patients, Peto Odds Ratio 29.2; 95%CI 2.8, 301.1) but there was no change in the apnoea frequency. No beneficial effects were found for medroxy progesterone, clonidine, buspirone, aminophylline, theophylline or sabeluzole.
REVIEWER'S CONCLUSIONS
The data available do not support the use of drugs as a therapy for OSA. Although the studies examined had limitations there was little to justify further trials of these particular drugs.
Topics: Humans; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive
PubMed: 12076464
DOI: 10.1002/14651858.CD003002 -
The Cochrane Database of Systematic... 2001Obstructive sleep apnoeas are due to transient closure of the upper airway during sleep and merge into hypopnoeas in which the airway narrows, but some airflow... (Review)
Review
BACKGROUND
Obstructive sleep apnoeas are due to transient closure of the upper airway during sleep and merge into hypopnoeas in which the airway narrows, but some airflow continues. They are due to the forces compressing the airway overcoming those which stabilise its patency. The commonest association is obesity in which fatty tissue is deposited around the airway. Exercise has been recommended as a method of losing weight, but other techniques which achieve this are also thought to improve symptoms due to sleep apnoeas. Sleep hygiene may alter the sleep structure and the control of the upper airway during sleep and thus promote its patency.
OBJECTIVES
The objectives of this review are to determine whether weight loss, sleep hygiene and exercise are effective in the treatment of obstructive sleep apnoeas.
SEARCH STRATEGY
The Cochrane Airways Group Trials Register, MEDLINE, EMBASE, CINAHL and reference lists of review articles have been searched.
SELECTION CRITERIA
Randomised, single or double blind placebo controlled, either parallel group or crossover design studies of any of these interventions were to have been included.
DATA COLLECTION AND ANALYSIS
No completed trials have been identified.
MAIN RESULTS
No randomised trial data were available for analysis.
REVIEWER'S CONCLUSIONS
There is a need for randomised controlled trials of these commonly used treatments in obstructive sleep apnoeas. These should identify which sub groups of patients with sleep apnoeas benefit most from each type of treatment and they should have clear and standardised outcome measures.
Topics: Exercise; Humans; Life Style; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Weight Loss
PubMed: 11279768
DOI: 10.1002/14651858.CD002875 -
Sleep Medicine Reviews Jun 2002This article is a review of the current evidence that links systemic hypertension with obstructive sleep apnoea. Whilst a causal association has been suspected for some... (Review)
Review
This article is a review of the current evidence that links systemic hypertension with obstructive sleep apnoea. Whilst a causal association has been suspected for some time, the day to day variability of both blood pressure and sleep apnoea severity, and clustering of confounding cardiovascular risk factors in sleep apnoea patients has made this association difficult to prove. There is unassailable evidence that obstructive apnoeas raise blood pressure acutely in both animal models and humans, through a combination of autonomic and state dependent arousal with some mechanical influences, and these rises can be controlled by nasal continuous positive airway pressure. Thus, although repetitive apnoeas alter the blood pressure variability and raise sleeping blood pressure in patients with OSA and sophisticated animal models have demonstrated increases in daytime blood pressure after the onset of OSA in the short term, such effects on diurnal BP have yet to be proven in humans. Recent rigorously designed large epidemiological studies have proven an independent association between OSA and systemic hypertension in both general and sleep clinic populations, with closely matched case control series also reporting raised blood pressure in OSA patients. A direct temporal causal association between the onset of obstructive sleep apnoea and raised blood pressure is expected to be confirmed by longitudinal data from the continuing epidemiological population studies. Finally, several studies on the beneficial effects of nasal continuous positive airway pressure in reducing blood pressure in OSA patients have preliminary results in abstract form, with one published in full.
Topics: Animals; Blood Pressure Monitoring, Ambulatory; Case-Control Studies; Humans; Hypertension; Polysomnography; Positive-Pressure Respiration; Sleep Apnea, Obstructive
PubMed: 12531119
DOI: 10.1053/smrv.2001.0189 -
Australian Family Physician Jun 2015Obstructive sleep apnoea (OSA) is a condition causing repetitive episodes of upper airway obstruction during sleep, leading to hypoxia and/or sleep disturbance. OSA... (Review)
Review
BACKGROUND
Obstructive sleep apnoea (OSA) is a condition causing repetitive episodes of upper airway obstruction during sleep, leading to hypoxia and/or sleep disturbance. OSA affects 1-5% of children and has important implications for learning, behaviour and cardiovascular health.
OBJECTIVE
The aim of this article is to provide a suggested approach to case finding and treatment of OSA for general practitioners.
DISCUSSION
Snoring or noisy breathing during sleep is the cardinal symptom of OSA, and should be specifically sought in children with disturbed sleep, nasal obstruction and large tonsils. Multi-channel physiological recording in a paediatric sleep laboratory is available to formally define the condition. Treatment with adenotonsillectomy usually leads to improvements in key domains. Milder disease may respond to intranasal steroids or anti-inflammatory agents.
Topics: Child; Child, Preschool; General Practice; Humans; Sleep Apnea, Obstructive; Snoring
PubMed: 26209982
DOI: No ID Found -
The Lancet. Child & Adolescent Health Jul 2022Unexplained episodic apnoea in infants (aged ≤1 year), including recurrent brief (<1 min) resolved unexplained events (known as BRUE), can be a diagnostic challenge.... (Review)
Review
Unexplained episodic apnoea in infants (aged ≤1 year), including recurrent brief (<1 min) resolved unexplained events (known as BRUE), can be a diagnostic challenge. Recurrent unexplained apnoea might suggest a persistent, debilitating, and potentially fatal disorder. Genetic diseases are prevalent among this group, particularly in those who present with paroxysmal or episodic neurological symptoms. These disorders are individually rare and challenging for a general paediatrician to recognise, and there is often a delayed or even posthumous diagnosis (sometimes only made in retrospect when a second sibling becomes unwell). The disorders can be debilitating if untreated but pharmacotherapies are available for the vast majority. That any child should suffer from unnecessary morbidity or die from one of these disorders without a diagnosis or treatment having been offered is a tragedy; therefore, there is an urgent need to simplify and expedite the diagnostic journey. We propose an apnoea gene panel for hospital specialists caring for any infant who has recurrent apnoea without an obvious cause. This approach could remove the need to identify individual rare conditions, speed up diagnosis, and improve access to therapy, with the ultimate aim of reducing morbidity and mortality.
Topics: Apnea; Child; Humans; Infant; Nervous System Diseases; Risk Factors
PubMed: 35525254
DOI: 10.1016/S2352-4642(22)00091-8 -
Current Opinion in Pulmonary Medicine Nov 2017To provide guidance in the management of mild obstructive sleep apnoea syndrome (OSAS) in the context of a very high prevalence, poor correlation with symptom profile,... (Review)
Review
PURPOSE OF REVIEW
To provide guidance in the management of mild obstructive sleep apnoea syndrome (OSAS) in the context of a very high prevalence, poor correlation with symptom profile, and lack of evidence that mild OSAS significantly contributes to comorbidity or early mortality.
RECENT FINDINGS
Mild obstructive sleep apnoea defined by hourly frequency of apnoeas or hypopnoeas (AHI) between 5 and 15 affects up to 35% of the general adult population but is much less prevalent when associated daytime symptoms are included. The poor correlation between symptoms and AHI complicates diagnosis and reports that mild OSAS is not significantly associated with comorbidity casts doubt on clinical significance. The diagnosis is complicated by night-to-night variability and by underestimation of AHI in ambulatory sleep studies that do not include sleep assessment. Active management of mild OSAS can be symptom-driven and offers a broad range of options. Lifestyle measures may be sufficient in many cases and mandibular advancement devices or positional therapy may be more effective in mild OSAS. Sleepy patients with low AHI may warrant a trial of continuous positive airway pressure therapy to establish the relationship between sleep disordered breathing and symptoms.
SUMMARY
Management of mild OSAS can focus on symptom relief to the individual patient.
Topics: Continuous Positive Airway Pressure; Health Behavior; Humans; Mandibular Advancement; Polysomnography; Severity of Illness Index; Sleep Apnea, Obstructive
PubMed: 28858969
DOI: 10.1097/MCP.0000000000000420