Sleep apnoea syndrome--a report of 14 cases

Patients with sleep apnoea syndrome suffer considerable morbidity and an increased mortality. We reviewed the characteristics of 14 patients with sleep apnoea syndrome (11 males and 3 females) who were studied since 1986. All were less than or equal to 60 years of age with the majority in their 4th and 5th decade. Obesity was present in 8 patients (57%) and hypertension in 6 (43%). Overnight sleep studies showed that 11 patients had obstructive sleep apnoea, 2 had central and one had predominantly mixed sleep apnoea. Ten patients (71%) had some form of nose and/or throat pathology. Tonsillectomy seemed an effective therapeutic procedure in those with upper airway obstruction due to enlarged tonsils. Four out of 5 patients had significant symptomatic improvement post-tonsillectomy. Nasal continuous positive airway pressure was also effective in alleviating apnoeas and relieving symptoms in 4 other patients who had no obvious upper airway obstruction. A high proportion of our patients had obstructive sleep apnoea due to enlarged tonsils. Tonsillectomy offered a simple and effective therapy for such patients. Nasal continuous positive airway pressure was also effective in the treatment of obstructive sleep apnoea.     

Uvulopalatopharyngoplasty for snoring: the Belfast experience.

We have studied thirteen patients to assess the efficacy of uvulopalatopharyngoplasty on snoring and on oxygen desaturation during sleep. Pre- and post-operative overnight pulse oximetry studies were performed and the patients were divided into snorers and those with obstructive sleep apnoea on the basis of the preoperative test. Uvulopalatopharyngoplasty did not result in a significant change in the number of oxygen saturation dips in either snorers or those with the obstructive sleep apnoea syndrome. Subjectively, 85% (11/13) of patients reported good or excellent improvement in snoring following surgery.     

Obstructive sleep apnoea: a new disease for Papua New Guinea?

Obstructive sleep apnoea is a common disorder in western societies and has a strong association with obesity and alcohol use. The condition has not previously been recorded in Papua New Guinea. The clinical details of 2 patients from Papua New Guinea with obstructive sleep apnoea are described, and the principles of treatment of this condition are outlined. Sleep apnoea is likely to become an increasing problem in Papua New Guinea.     

Role of respiratory sleep disorders in the pathogenesis of nocturnal angina and arrhythmias.

This report documents how respiratory sleep disorders can adversely effect ischaemic heart disease. Three male patients (aged 60-67 years) with proven ischaemic heart disease are described. They illustrate a spectrum of nocturnal cardiac dysfunction, two with nocturnal angina and one with nocturnal arrhythmias. Full sleep studies were performed in a dedicated sleep laboratory on all patients, and one patient had 48 hours of continuous Holter monitoring. Two patients were found to have obstructive sleep apnoea with apnoea/hypopnoea indices of 57 and 36 per hour, respectively, the former with nocturnal arrhythmias and the latter with nocturnal angina. In both cases, nasal continuous positive airways pressure successfully treated the sleep apnoea, with an associated improvement in nocturnal arrhythmias and angina. The third patient who presented with nocturnal angina, did not demonstrate obstructive sleep apnoea (apnoea/hypopnoea index = 7.2) but had significant oxygen desaturation during rapid eye movement (REM) sleep. This patient responded to a combination of nocturnal oxygen and protriptyline, an agent known to suppress REM sleep, and had no further nocturnal angina. All patients were considered to be an optimum cardiac medication and successful symptom resolution only occurred with the addition of specific therapy aimed at their sleep-related respiratory problem. We conclude that all patients with nocturnal angina or arrhythmias should have respiratory sleep abnormalities considered in their assessment.     

Impact of heart failure on quality of sleep

Chronic heart failure is an important health problem associated with a high mortality and morbidity. Appropriate treatment reduces mortality and leads to improved exercise tolerance but many patients report poor quality of sleep. Sleep studies of patients with heart failure suggest that sleep disordered breathing is experienced in 50% of patients and is a powerful predictor of poor prognosis. Sleep disordered breathing broadly comprises obstructive sleep apnoea, when upper airway instability causes mechanical obstruction to breathing; and central sleep apnoea, characterised by an absence of ventilatory effort. Sleep disordered breathing occurring in patients with heart failure is in most part attributable to central sleep apnoea and reflects uncompensated instability of the ventilatory feedback mechanism.     

Non-traumatic acute paraplegia caused by cervical disc herniation in a patient with sleep apnoea

A 57-year-old man with obstructive sleep apnoea presented with acute progression of myelopathy into paraplegia resulting from cervical disc herniation at C4-C5 and C5-C6 levels. There was no associated history of trauma. Rapid progress to paraplegia from non-traumatic cervical disc herniation rarely occurs. Diagnostic and treatment modalities are discussed. The possible relationship between cervical myelopathy and sleep apnoea is also discussed.     

Apnoeic episodes induced by smothering: two cases identified by covert video surveillance

Recurrent cyanotic episodes associated on some occasions with loss of consciousness due to cerebral hypoxia were investigated by long term tape recordings of breathing activity, oxygen saturation, air flow, electrocardiographic activity, and in some cases electroencephalographic activity. In 51 infants and children the mechanisms for the cyanotic episodes were identified (prolonged expiratory apnoea in 45, sleep related airway obstruction in three, seizure induced apnoea in one, behaviour induced apnoea in one). In one child apnoea was suspected as being caused by suffocation (smothering) by the mother. This was confirmed after enlisting the help of the police, who undertook covert video surveillance during cyanotic episodes. Each cyanotic episode was associated with a pattern of disturbance on the multichannel tape recordings which may be pathognomonic of this type of apnoea. A second infant with cyanotic episodes in whom smothering was suspected was referred for similar investigation after the availability of video recordings became established. Maternal smothering was again supported by specific patterns on multichannel tape recordings and confirmed by video surveillance. Diagnosis by video surveillance produces unequivocal evidence in these cases and avoids the need for medical and nursing staff to confront the mother with a possibly incorrect suspicion or in a court of law.     

Hypertension and catecholamine levels in sleep apnoea

Background

Sleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association.

Method

In this sleep clinic-based study, 82 newly diagnosed patients of sleep-disordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP).

Results

The prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoea-hypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catechol-amines in both the cases.

Conclusion

Hypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecholamine levels are more valid measures of sympathetic activity than spot plasma samples.Key Words: catecholamines, hypertension, sleep apnoea, sleep-disordered breathing, sympathetic     

Road traffic accidents in patients with obstructive sleep apnoea

Three patients involved in road traffic accidents were suspected to have obstructive sleep apnoea (OSA). Two of them fell asleep while riding motorcycles and one patient fell asleep behind the wheel of a truck causing it to overturn. The diagnosis of OSA in each case was suspected based on a history of loud snoring, restless sleep, and excessive daytime somnolence and was confirmed by sleep studies.     

Nocturnal enuresis and obstructive sleep apnoea in two children

Nocturnal enuresis was a symptom of childhood obstructive sleep apnoea, OSAS. We reported two children with secondary nocturnal enuresis which disappeared after tonsillectomy and adenoidectomy for proven OSAS. Pathogenesis of secondary nocturnal enuresis in OSAS was discussed.     

高血压杂志

如何在肱动脉水平正确地测量平均压？2型糖尿病合并高血压患者的肾功能与心血管事件的风险：RENAAL和LIEF研究;接受降压药物治疗的患者中胰岛素敏感性增加和动脉内皮功能增强之间的不一致.     

Multiple level pharyngeal surgery for obstructive sleep apnoea

The aim of the study is to evaluate the results of multiple level pharyngeal surgery in patients with moderate to severe obstructive sleep apnoea in Changi General Hospital, Singapore. 13 patients who failed non-surgical treatment underwent surgery which includes uvulopharyngopalatoplasty, genioglossal advancement and modified hyoid myotomy and suspension. Epworth sleepiness scale, Cephalometric analysis and Sleep study were performed pre- and post-operatively to evaluate the results. 76.9% of the patients achieved more than 50% reduction in AHI with post-operative AHI of less than 20. Cephalometric analysis showed an average of 5.2 mm increase in posterior airway space. All patients achieved improvement in Epworth sleepiness scale with an average improvement of 11.8 points. The mean follow-up period of the 13 patients is 12.6 months. Our preliminary results suggest that multiple level pharyngeal surgery is an effective option in the treatment of moderate to severe obstructive sleep apnoea.     

Fatal distraction: a case series of fatal fall-asleep road accidents and their medicolegal outcomes

Obstructive sleep apnoea is associated with an increased risk of sleep-related motor vehicle accidents. Seven recent legal cases of fatal motor vehicle accidents on NSW roads are presented, where the driver who caused the accident was suffering from an unrecognised or under-treated sleep disorder. The legal outcomes in these cases were variable: some of the drivers have been acquitted and others have been jailed. All remained licensed to drive immediately after their accidents. In some of the cases, the driver was cleared of any culpable driving offence because of a defence of sleepiness or a sleep attack without warning ("Jiminez defence"). This appears at odds with current medical research and legal opinion in other countries. More research is needed to understand the relation between sleep disorders and awareness of sleepiness. Medical practitioners need to be aware of current advice and guidelines with respect to obstructive sleep apnoea and driving.     

Obstructive sleep apnoea associated with syringomyelia.

We present a case of obstructive sleep apnoea in association with syringomyelia. We describe the successful treatment of the respiratory obstruction by continuous positive airway pressure and then by surgical means. This rare combination of conditions and the management is reviewed.     

Hypertension and catecholamine levels in sleep apnoea

Background

Sleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association.

Method

In this sleep clinic-based study, 82 newly diagnosed patients of sleep-disordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP).

Results

The prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoea-hypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catechol-amines in both the cases.

Conclusion

Hypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecholamine levels are more valid measures of sympathetic activity than spot plasma samples.     

Sleep apnoea syndrome--a study of 5 cases

Sleep apnoea syndrome (SAS) is common in the West but its prevalence is uncertain in Southeast Asia. Five Chinese patients seen in a Sleep Assessment Unit in Hong Kong are presented to illustrate the spectrum of clinical features and treatment methods involved in obstructive and central sleep apnoea. The first patient is a 45-year old woman with severe obstructive SAS and cardiopulmonary complications who improved significantly after tracheostomy. The second patient is a 43-year old man who improved with weight reduction and protriptyline. The third is a 42-year old man whose SAS did not improve with uvulopalatopharyngoplasty but with continuous positive airway pressure (CPAP). The fourth is a 12-year old girl with obstructive SAS who improved significantly after tonsillectomy. The last patient is a 52-year old man with central SAS who improved with CPAP.     

Uvulopalatopharyngoplasty as a treatment for snoring

Uvulopalatopharyngoplaty was performed in 18 consecutive patients (15 men and three women; mean +/- standard deviation [SD] age, 46.3 +/- 7.5 years) who presented for the treatment of heavy habitual snoring. No attempt was made to select patients who were ideal anatomically for palatal modification. The loudness of snoring was measured during sleep by integrating the output of a calibrated microphone. An assessment before operation showed that nine patients had obstructive sleep apnoea; four patients had an apnoea index of greater than or equal to 25 apnoeas per hour. The patients were overweight and consumed, on average, 38 g of alcohol per day, but these variables did not change after the operation. The postoperative assessment was performed 138 +/- 44 days after uvulopalatopharyngoplasty. Fourteen patients showed a reduction in the loudness of their snoring, although snoring was abolished in one patient only (average snoring loudness in arbitrary units/min of sleep, 2.8 +/- 2.1 before operation compared with 1.4 +/- 1.5 units/min of sleep after the operation; P less than 0.05. The loudest snore in arbitrary units measured 7.1 +/- 3.3 units compared with 4.8 +/- 3.3 units, respectively; P less than 0.05). The percentage of the sleep time that was spent at an arterial oxygen saturation of less than 90% was reduced after uvulopalatopharyngoplasty (28% +/- 32% of total sleep time compared with 17% +/- 24% of total sleep time, respectively; P less than 0.05). There was no change in the apnoea index. The diastolic blood pressure was lower at the postoperative assessment (94 +/- 11 mmHg compared with 87 +/- 8 mmHg; P less than 0.05); six of 10 subjects whose diastolic blood pressures were greater than or equal to 95 mmHg before the operation had a diastolic blood pressure of less than 95 mmHg after uvulopalatopharyngoplasty (P less than 0.02). Computed tomographic scans showed an increase in the upper airway cross-sectional area at 3 cm and 4 cm above the hyoid bone after uvulopalatopharyngoplasty (P less than 0.05). We conclude that uvulopalatopharyngoplasty is an effective treatment for habitual, heavy snoring in many patients, but it is not the treatment of choice for patients with clinically-significant obstructive sleep apnoea.     

Snoring in children: is it pathological?

Some children who snore heavily, have been shown to have periods of apnoea which, if frequent, are known as the obstructive sleep apnoea syndrome (OSA). Twenty patients with OSA, who presented to the Department of Thoracic Medicine, Royal Children's Hospital, Melbourne, over a three-year period, were reviewed. The findings indicated that OSA is more common than is generally supposed and that it can present with a wide range of symptoms. It is important that an early diagnosis of this syndrome is made, to prevent major complications and to allow appropriate therapy.     

Metabolic syndrome

Metabolic syndrome is a clustering of different risk factors that collectively increases the risk of developing cardiovascular disease and type 2 diabetes mellitus. The syndrome itself is associated with various metabolic abnormalities, including insulin resistance, non-alcoholic fatty liver disease, obstructive sleep apnoea, male hypogonadism and polycystic ovary syndrome. This review aims to discuss recent developments related to the syndrome, including the associated metabolic complications and goals for therapeutic strategies.     

PTT与PSG同步监测鼾症患者的临床研究

目的评估脉搏传导时间检测仪（PTT）与多导睡眠仪（PSG）同步监测鼾症患者的一致性.方法 33例鼾症患者同步使用PSG和PTT监测,对所记录数据进行统计学分析.结果 PSG与PTT所记录心率、血氧饱和度、呼吸事件次数、事件发生时间及事件持续时间均可一一对应.两组阻塞性呼吸暂停指数（O-AI）间差异有显著性意义（P=0.000）;两组低通气指数（HI）间差异无显著性意义（P=0.549）;两组中枢性呼吸暂停指数（C-AI）间差异有显著性意义（P=0.033）;两组混合性呼吸暂停指数（MIX-AI）间差异有显著性意义（P=0.002）;对两组呼吸紊乱指数（RDI）进行相关分析,r=0.995,表明PSG与PTT监测所得RDI有高度相关性.结论 PTT用于OSAHS临床诊断与PSG具有一致性,用于呼吸努力程度的判断较PSG更准确.