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European Respiratory Review : An... Sep 2013Sleep apnoea is associated with significant daytime functioning impairment and marked cardiovascular morbidities, leading to a significant increase in mortality.... (Review)
Review
Sleep apnoea is associated with significant daytime functioning impairment and marked cardiovascular morbidities, leading to a significant increase in mortality. Sympathetic activation, oxidative stress and systemic inflammation have been shown to be the main intermediary mechanisms associated with sleep apnoea and intermittent hypoxia. There are now convincing data regarding the association between hypertension, arrhythmias, coronary heart disease, heart failure, increased cardiovascular mortality and sleep apnoea. This has been evidenced in sleep apnoea patients and is supported by experimental data obtained in intermittent hypoxia. Whether treating sleep apnoea enables chronic cardiovascular consequences to be reversed is not fully established as regard coronary heart disease, arrhythmias and heart failure. In this late condition, complex bidirectional relationships occur, with obstructive sleep apnoea being a risk factor for heart failure whilst central sleep apnoea mainly appears as a consequence of heart failure. It remains to be established in adequately designed studies, i.e. large randomised controlled trials, whether treating sleep apnoea can improve heart failure morbidity and mortality.
Topics: Animals; Cardiovascular Diseases; Heart; Hemodynamics; Humans; Prognosis; Risk Factors; Sleep Apnea Syndromes
PubMed: 23997061
DOI: 10.1183/09059180.00004513 -
Upsala Journal of Medical Sciences Jun 2017Sleep apnea is common in patients with atrial fibrillation, but the effect of the cardioversion of atrial fibrillation to sinus rhythm on central and obstructive apneas... (Observational Study)
Observational Study
BACKGROUND
Sleep apnea is common in patients with atrial fibrillation, but the effect of the cardioversion of atrial fibrillation to sinus rhythm on central and obstructive apneas is mainly unknown. The primary aim of the study was to analyze the association between cardioversion of atrial fibrillation and sleep apneas, to investigate whether obstructive or central sleep apneas are reduced following cardioversion. A secondary objective was to study the effect on sleep quality.
METHODS
Twenty-three patients with atrial fibrillation were investigated using overnight polysomnography, including esophagus pressure monitoring and ECG, before and after the cardioversion of persistent atrial fibrillation.
RESULTS
Obstructive sleep apnea occurred in 17/23 patients (74%), and central sleep apnea in 6/23 patients (26%). Five patients had both obstructive and central sleep apnea. Sinus rhythm at follow-up was achieved in 16 patients. The obstructive apnea-hypopnea index, central apnea-hypopnea index, and the number of patients with obstructive or central sleep apnea did not differ before and after restoration of sinus rhythm. Sleep time, sleep efficiency, time in different sleep stages, and subjective daytime sleepiness were normal and unaffected by cardioversion.
CONCLUSIONS
Both obstructive and central sleep apneas are highly prevalent in patients with persistent atrial fibrillation. Obstructive sleep apneas are unaffected by the cardioversion of atrial fibrillation to sinus rhythm. The sleep pattern is normal and unaffected by cardioversion in patients with atrial fibrillation.
CLINICAL TRIAL REGISTRATION
Trial number NCT00429884.
Topics: Aged; Atrial Fibrillation; Electric Countershock; Electrocardiography; Female; Humans; Male; Middle Aged; Polysomnography; Prevalence; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 28291376
DOI: 10.1080/03009734.2017.1291545 -
Sleep Aug 2023We aimed to characterize the cerebral hemodynamic response to obstructive sleep apnea/hypopnea events, and evaluate their association to polysomnographic parameters. The...
STUDY OBJECTIVES
We aimed to characterize the cerebral hemodynamic response to obstructive sleep apnea/hypopnea events, and evaluate their association to polysomnographic parameters. The characterization of the cerebral hemodynamics in obstructive sleep apnea (OSA) may add complementary information to further the understanding of the severity of the syndrome beyond the conventional polysomnography.
METHODS
Severe OSA patients were studied during night sleep while monitored by polysomnography. Transcranial, bed-side diffuse correlation spectroscopy (DCS) and frequency-domain near-infrared diffuse correlation spectroscopy (NIRS-DOS) were used to follow microvascular cerebral hemodynamics in the frontal lobes of the cerebral cortex. Changes in cerebral blood flow (CBF), total hemoglobin concentration (THC), and cerebral blood oxygen saturation (StO2) were analyzed.
RESULTS
We considered 3283 obstructive apnea/hypopnea events from sixteen OSA patients (Age (median, interquartile range) 57 (52-64.5); females 25%; AHI (apnea-hypopnea index) 84.4 (76.1-93.7)). A biphasic response (maximum/minimum followed by a minimum/maximum) was observed for each cerebral hemodynamic variable (CBF, THC, StO2), heart rate and peripheral arterial oxygen saturation (SpO2). Changes of the StO2 followed the dynamics of the SpO2, and were out of phase from the THC and CBF. Longer events were associated with larger CBF changes, faster responses and slower recoveries. Moreover, the extrema of the response to obstructive hypopneas were lower compared to apneas (p < .001).
CONCLUSIONS
Obstructive apneas/hypopneas cause profound, periodic changes in cerebral hemodynamics, including periods of hyper- and hypo-perfusion and intermittent cerebral hypoxia. The duration of the events is a strong determinant of the cerebral hemodynamic response, which is more pronounced in apnea than hypopnea events.
Topics: Female; Humans; Sleep Apnea, Obstructive; Hemodynamics; Sleep Apnea Syndromes; Spectroscopy, Near-Infrared; Airway Obstruction
PubMed: 37336476
DOI: 10.1093/sleep/zsad122 -
Singapore Medical Journal Apr 2020Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an...
Sleep is an important component in a child's growth and development. Snoring is common in children and often perceived as benign, but habitual snoring may be an indication of obstructive sleep apnoea (OSA). OSA can have health, developmental and cognitive consequences. The three common risk factors for paediatric OSA are tonsillar and/or adenoidal hypertrophy, obesity and allergic rhinitis. Primary care providers are well-placed to identify children at risk by screening for habitual snoring and associated OSA risk factors during routine consultations. Physician awareness of OSA symptoms/signs facilitates diagnosis, management and referral decisions. A trial of medical treatment may be considered for habitual snoring with mild symptoms/signs before referral. Overnight polysomnography is the gold standard investigation utilised by paediatric sleep specialists to diagnose OSA. Adenotonsillectomy is the first-line management for OSA with adenotonsillar hypertrophy, but residual/recurrent OSA may occur, so follow-up by primary care providers is important after surgery.
Topics: Adenoidectomy; Child; Child, Preschool; Female; Humans; Male; Polysomnography; Risk Factors; Sleep Apnea, Obstructive; Snoring; Tonsillectomy
PubMed: 32500157
DOI: 10.11622/smedj.2020054 -
Chinese Medical Journal Nov 2020Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during... (Review)
Review
Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Topics: Continuous Positive Airway Pressure; Humans; Lung; Respiration; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 33009018
DOI: 10.1097/CM9.0000000000001125 -
Australian Journal of General Practice Sep 2023Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse... (Review)
Review
BACKGROUND
Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse daytime function, mental health and physical health than patients with either disorder alone. General practitioners may face unique challenges in the assessment and management of this prevalent and debilitating condition.
OBJECTIVE
This article aims to provide an overview of the prevalence, consequences, assessment and management of patients with comorbid insomnia and sleep apnoea in Australian general practice.
DISCUSSION
Patients with either insomnia or sleep apnoea should be assessed for both conditions. Treatments for both disorders should be offered to patients with both conditions. The recommended treatment for insomnia is cognitive behavioural therapy, whereas the recommended first-line treatment for moderate and severe obstructive sleep apnoea is lifestyle/weight management advice (where relevant) and continuous positive airway pressure therapy.
Topics: Humans; Australia; General Practitioners; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders
PubMed: 37666781
DOI: 10.31128/AJGP-12-22-6648 -
Respirology (Carlton, Vic.) Oct 2022
Topics: Humans; Sleep; Sleep Apnea, Obstructive
PubMed: 35871771
DOI: 10.1111/resp.14332 -
Sleep & Breathing = Schlaf & Atmung Sep 2022Obstructive sleep apnoea (OSA) is a cause of hypoxia, and the correlation between hypoxia and microvascular complications is well known. Microalbuminuria (MAU) is a...
INTRODUCTION
Obstructive sleep apnoea (OSA) is a cause of hypoxia, and the correlation between hypoxia and microvascular complications is well known. Microalbuminuria (MAU) is a marker for endovascular dysfunction and an indicator of cardiovascular events and all-cause mortality in the general population. The aim of this study was to investigate the relationship between microvascular damage and the metabolic complications of OSA based on the presence of MAU.
MATERIAL AND METHOD
Urinary albumin/creatinine ratio (ACR) and microalbumin level were examined in patients with an apnoea-hypopnoea index (AHI) greater than 5/h (study group) and in patients with an AHI less than 5/h (control group). The exclusion criteria were other possible causes of MAU (hypertension, nephropathy, coronary artery disease, and severe thyroid dysfunction).
RESULTS
Of 103 patients enrolled, 80 formed the group with OSA and 23 served as controls. According to the AHI values, the patients were divided into four groups as normal, mild, moderate and severe. There was no significant difference between the four groups in terms of the microalbumin level and urinary albumin/creatinine ratio.
CONCLUSION
In this study, no significant relationship was found between MAU and sleep apnoea.
Topics: Albumins; Albuminuria; Creatinine; Humans; Hypoxia; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34386891
DOI: 10.1007/s11325-021-02461-6 -
Tidsskrift For Den Norske Laegeforening... Sep 2009Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and... (Review)
Review
BACKGROUND
Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and consequences of untreated disease, in children and adults.
MATERIAL AND METHOD
The paper is based on own clinical experience and literature identified through a non-systematic search of PubMed and various books.
RESULTS
The prevalence of SRDB in children and adults is about 10-15% and that for the most serious type, OSAS (Obstructive Sleep Apnoea Syndrome), is about 2-4%. A sleep study is required to confirm the diagnosis. The clinical symptoms of SRBD in adults are heavy snoring, observed apnoeas, gasping for air leading to frequent arousals, disturbed sleep and daytime sleepiness. Children are often hyperactive and have learning and behaviour difficulties. Untreated patients have increased mortality and morbidity. The primary treatment option for patients with medium to serious breathing disorders is continuous positive-pressure ventilation. Other treatment options are oral devices and surgery. In children, surgery (adenotonsilectomy) is the treatment of choice.
INTERPRETATION
OSAS is the most severe diagnosis among SRBD. Both adults and children show reduced cognitive function and quality of life. Various treatment options are available.
Topics: Adenoidectomy; Adult; Child; Continuous Positive Airway Pressure; Humans; Occlusal Splints; Otorhinolaryngologic Surgical Procedures; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Smoking Cessation; Tonsillectomy; Weight Loss
PubMed: 19756060
DOI: 10.4045/tidsskr.08.0497 -
IEEE Transactions on Bio-medical... Apr 2022The physiological mechanisms involved in cardio-respiratory responses to sleep apnea events are not yet fully elucidated. A model-based approach is proposed to analyse...
OBJECTIVE
The physiological mechanisms involved in cardio-respiratory responses to sleep apnea events are not yet fully elucidated. A model-based approach is proposed to analyse the acute desaturation response to obstructive apneas.
METHODS
An integrated model of cardio-respiratory interactions was proposed and parameters were identified, using an evolutionary algorithm, on a database composed of 107 obstructive apneas acquired from 10 patients (HYPNOS clinical study). Unsupervised clustering was applied to the identified parameters in order to characterize the phenotype of each response to obstructive apneas.
RESULTS
A close match was observed between simulated oxygen saturation ( SaO) and experimental SaO in all identifications (median RMSE = 1.3892 %). Two clusters of parameters, associated with different dynamics related to sleep apnea and periodic breathing were obtained.
CONCLUSION AND SIGNIFICANCE
The proposed patient and event-specific model-based analysis provides understanding on specific desaturation patterns, consequent to apnea events, with potential applications for personalized diagnosis and treatment.
Topics: Airway Obstruction; Humans; Oxygen; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34665719
DOI: 10.1109/TBME.2021.3121170