Sunday, July 11, 2010
Tuesday, July 6, 2010
Anadolu Kardiyol Derg. 2010 Apr;10(2):168-75. doi: 10.5152/akd.2010.044.
Cardiovascular consequences of sleep apnea: II-Cardiovascular mechanisms.
Turgut Celen Y, Peker Y.
Department of Neurology and Rehabilitation Medicine, Skaraborg Hospital, Skövde, Sweden.
Abstract
Obstructive sleep apnea (OSA) is a common disorder with serious cardiovascular consequences. The pathogenesis in this context is likely to be multifactorial process including large negative swings in intrathoracic pressure, intermittent hypoxemia and hypercapnia, increased sympathetic nervous system activity, vascular endothelial dysfunction, oxidative stress, systemic inflammation, excessive platelet activation as well as metabolic dysregulation. Although there is scientific support for a considerable impact of OSA on vascular structure and function, it is likely that development of cardiovascular diseases is determined by multiple genotypic and phenotypic factors. The current article focuses on the available research evidence addressing the cardiovascular mechanisms in this context.
Cardiovascular consequences of sleep apnea: II-Cardiovascular mechanisms.
Turgut Celen Y, Peker Y.
Department of Neurology and Rehabilitation Medicine, Skaraborg Hospital, Skövde, Sweden.
Abstract
Obstructive sleep apnea (OSA) is a common disorder with serious cardiovascular consequences. The pathogenesis in this context is likely to be multifactorial process including large negative swings in intrathoracic pressure, intermittent hypoxemia and hypercapnia, increased sympathetic nervous system activity, vascular endothelial dysfunction, oxidative stress, systemic inflammation, excessive platelet activation as well as metabolic dysregulation. Although there is scientific support for a considerable impact of OSA on vascular structure and function, it is likely that development of cardiovascular diseases is determined by multiple genotypic and phenotypic factors. The current article focuses on the available research evidence addressing the cardiovascular mechanisms in this context.
Surgical options for the treatment of obstructive sleep apnea.
Med Clin North Am. 2010 May;94(3):479-515.
Holty JE, Guilleminault C.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA. jholty@stanford.edu
Abstract
Obstructive sleep apnea (OSA) is a prevalent condition characterized by repetitive airway obstruction during sleep with associated increased morbidity and mortality. Although CPAP is the preferred treatment, poor compliance is common. Patients intolerant of conventional OSA medical treatment may benefit from surgical therapy to alleviate pharyngeal obstruction. Case series suggest that maxillomandibular advancement has the highest surgical efficacy (86%) and cure rate (43%). Soft palate surgical techniques are less successful, with uvulopalatopharyngoplasty having an OSA surgical success rate of 50% and cure rate of 16%. Further research is needed to more thoroughly assess clinical outcomes (eg, quality of life, morbidity), better identify key preoperative patient and clinical characteristics that predict success, and confirm long-term effectiveness of surgical modalities to treat OSA.
Holty JE, Guilleminault C.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA. jholty@stanford.edu
Abstract
Obstructive sleep apnea (OSA) is a prevalent condition characterized by repetitive airway obstruction during sleep with associated increased morbidity and mortality. Although CPAP is the preferred treatment, poor compliance is common. Patients intolerant of conventional OSA medical treatment may benefit from surgical therapy to alleviate pharyngeal obstruction. Case series suggest that maxillomandibular advancement has the highest surgical efficacy (86%) and cure rate (43%). Soft palate surgical techniques are less successful, with uvulopalatopharyngoplasty having an OSA surgical success rate of 50% and cure rate of 16%. Further research is needed to more thoroughly assess clinical outcomes (eg, quality of life, morbidity), better identify key preoperative patient and clinical characteristics that predict success, and confirm long-term effectiveness of surgical modalities to treat OSA.
Clinical characteristics and outcomes of patients with obstructive sleep apnoea requiring intensive care.
Anaesth Intensive Care. 2010 May;38(3):506-12.
Hang LW, Chen W, Liang SJ, Lin YC, Tu CY, Chen HJ, Chiu KL.
Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Abstract
We reviewed the clinical characteristics, required intervention and short- and long-term outcomes in obstructive sleep apnoea (OSA) patients requiring intensive care. A retrospective, single-centre, observational cohort study was undertaken in a multidisciplinary teaching medical and surgical intensive care unit. Adult patients with OSA (apnoea-hypopnoea index of 5 or higher) requiring intensive care from January 2000 to January 2005 were included. Thirty-seven OSA patients (age: 58 +/- 14 years, male:female 27:10) were admitted due to respiratory (n=12, 32%), cerebrovascular (n=8, 22%), cardiovascular (n=16, 43%) and infectious events (n=1, 2.7%). Comparing the clinical features, polysomnographic data and outcome among these groups, we found that OSA patients admitted due to respiratory events had significantly higher Acute Physiology and Chronic Health Evaluation II scores, lower arterial blood gas pH, higher PaCO2, a higher incidence of respiratory failure (92%) and required non-invasive ventilation after extubation (73%), and higher intensive care unit readmission rates than patients admitted due to cerebrovascular events and cardiovascular events (P < 0.05). No difference was found in the in-hospital and long-term mortality rate. The most common reason for intensive care unit admission in critically ill OSA patients was a cardiovascular event, followed by respiratory and cerebrovascular events. The baseline polysomnographic data of the OSA patients were not correlated with their clinical features and outcomes in the intensive care unit. A more complicated clinical course and higher intensive care unit readmission rate were encountered in OSA patients admitted due to respiratory events. Further studies would be required to evaluate the efficacy of non-invasive ventilation for facilitation of extubation in OSA patients presenting with hypercapnic respiratory failure.
Hang LW, Chen W, Liang SJ, Lin YC, Tu CY, Chen HJ, Chiu KL.
Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Abstract
We reviewed the clinical characteristics, required intervention and short- and long-term outcomes in obstructive sleep apnoea (OSA) patients requiring intensive care. A retrospective, single-centre, observational cohort study was undertaken in a multidisciplinary teaching medical and surgical intensive care unit. Adult patients with OSA (apnoea-hypopnoea index of 5 or higher) requiring intensive care from January 2000 to January 2005 were included. Thirty-seven OSA patients (age: 58 +/- 14 years, male:female 27:10) were admitted due to respiratory (n=12, 32%), cerebrovascular (n=8, 22%), cardiovascular (n=16, 43%) and infectious events (n=1, 2.7%). Comparing the clinical features, polysomnographic data and outcome among these groups, we found that OSA patients admitted due to respiratory events had significantly higher Acute Physiology and Chronic Health Evaluation II scores, lower arterial blood gas pH, higher PaCO2, a higher incidence of respiratory failure (92%) and required non-invasive ventilation after extubation (73%), and higher intensive care unit readmission rates than patients admitted due to cerebrovascular events and cardiovascular events (P < 0.05). No difference was found in the in-hospital and long-term mortality rate. The most common reason for intensive care unit admission in critically ill OSA patients was a cardiovascular event, followed by respiratory and cerebrovascular events. The baseline polysomnographic data of the OSA patients were not correlated with their clinical features and outcomes in the intensive care unit. A more complicated clinical course and higher intensive care unit readmission rate were encountered in OSA patients admitted due to respiratory events. Further studies would be required to evaluate the efficacy of non-invasive ventilation for facilitation of extubation in OSA patients presenting with hypercapnic respiratory failure.
Cardiovascular consequences of obese and nonobese obstructive sleep apnea.
Med Clin North Am. 2010 May;94(3):465-78.
Ramar K, Caples SM.
Division of Pulmonary, Sleep and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55901, USA. ramar.kannan@mayo.edu
Abstract
Current evidence suggests a role for obstructive sleep apnea (OSA) in the development of cardiovascular disorders. However, obesity is an active confounder in this relationship. OSA and obesity share similar pathophysiologic mechanisms potentially leading to cardiovascular disorders. Presence of OSA in obese patients may further contribute to adverse cardiovascular outcomes when compared with each condition in isolation. In this review the authors explore the complex relationship between OSA and obesity (and nonobese subjects) in the development of cardiovascular disorders.
Ramar K, Caples SM.
Division of Pulmonary, Sleep and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, 200 First Street South West, Rochester, MN 55901, USA. ramar.kannan@mayo.edu
Abstract
Current evidence suggests a role for obstructive sleep apnea (OSA) in the development of cardiovascular disorders. However, obesity is an active confounder in this relationship. OSA and obesity share similar pathophysiologic mechanisms potentially leading to cardiovascular disorders. Presence of OSA in obese patients may further contribute to adverse cardiovascular outcomes when compared with each condition in isolation. In this review the authors explore the complex relationship between OSA and obesity (and nonobese subjects) in the development of cardiovascular disorders.
Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.
J Clin Sleep Med. 2010 Apr 15;6(2):117-23.
Larrain A, Kapur VK, Gooley TA, Pope CE 2nd.
Clinica Servet, Santiago, Chile.
Comment in: J Clin Sleep Med. 2010 Apr 15;6(2):124-6.
Abstract
OBJECTIVES: To determine the effect of the drug combination domperidone and pseudoephedrine on nocturnal oximetry measurements and daytime sleepiness in patients with obstructive sleep apnea.
METHODS: We recruited patients with severe snoring and apneic episodes willing to undergo repeated nocturnal oximetry testing. Following baseline clinical history, Epworth Sleepiness Scale administration, and home overnight nocturnal oximetry, patients were started on weight-adjusted doses of domperidone and pseudoephedrine. Follow-up oximetry studies were performed at the patient's convenience. On the final visit, a repeat clinical history, Epworth score, and oximetry were obtained.
RESULTS: Seventeen of 23 patients noted disappearance of snoring and apneic episodes. Another 2 patients reported improvement in snoring and no apneic episodes. All but one patient had a decrease in Epworth scores (mean decrease 9.4 (95% CI, 6.8-12.1, p < 0.0001). Mean oxygen saturation (2.5; 95% Cl, 0.66-4.41, p = 0.008), percent time with oxygen saturation < 90% (14.8; 95% CI, 24.4 to 5.2, p = 0.003), and the 4% oxygen desaturation index (18.2; 95% CI, 27.3 to 9.1, p < 0.0001) improved significantly. No adverse effects of treatment were noted.
CONCLUSIONS: The combination of domperidone and pseudoephedrine improved self reported snoring and sleepiness, and may have improved apneic episodes and sleep-related nocturnal oxygen desaturation in patients with obstructive sleep apnea provided the proportion of time spent asleep did not diminish. This drug combination warrants further study as a treatment for obstructive sleep apnea.
:Citation: Larrain A; Kapur VK; Gooley TA; Pope CE. Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.
Larrain A, Kapur VK, Gooley TA, Pope CE 2nd.
Clinica Servet, Santiago, Chile.
Comment in: J Clin Sleep Med. 2010 Apr 15;6(2):124-6.
Abstract
OBJECTIVES: To determine the effect of the drug combination domperidone and pseudoephedrine on nocturnal oximetry measurements and daytime sleepiness in patients with obstructive sleep apnea.
METHODS: We recruited patients with severe snoring and apneic episodes willing to undergo repeated nocturnal oximetry testing. Following baseline clinical history, Epworth Sleepiness Scale administration, and home overnight nocturnal oximetry, patients were started on weight-adjusted doses of domperidone and pseudoephedrine. Follow-up oximetry studies were performed at the patient's convenience. On the final visit, a repeat clinical history, Epworth score, and oximetry were obtained.
RESULTS: Seventeen of 23 patients noted disappearance of snoring and apneic episodes. Another 2 patients reported improvement in snoring and no apneic episodes. All but one patient had a decrease in Epworth scores (mean decrease 9.4 (95% CI, 6.8-12.1, p < 0.0001). Mean oxygen saturation (2.5; 95% Cl, 0.66-4.41, p = 0.008), percent time with oxygen saturation < 90% (14.8; 95% CI, 24.4 to 5.2, p = 0.003), and the 4% oxygen desaturation index (18.2; 95% CI, 27.3 to 9.1, p < 0.0001) improved significantly. No adverse effects of treatment were noted.
CONCLUSIONS: The combination of domperidone and pseudoephedrine improved self reported snoring and sleepiness, and may have improved apneic episodes and sleep-related nocturnal oxygen desaturation in patients with obstructive sleep apnea provided the proportion of time spent asleep did not diminish. This drug combination warrants further study as a treatment for obstructive sleep apnea.
:Citation: Larrain A; Kapur VK; Gooley TA; Pope CE. Pharmacological treatment of obstructive sleep apnea with a combination of pseudoephedrine and domperidone.
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