Bedtime Ethanol Increases Resistance of Upper Airways and Produces Sleep Apneas in Asymptomatic Snorers

Nasal continuous positive airway pressure (nasal CPAP) and polysomnography were used to analyze the time course of the effect of bedtime ethanol on resistance of upper airways and on the number of respiratory pauses during sleep. On one night, six asymptomatic nonalcoholic male snorers drank 2 ml/kg of 100 proof vodka mixed in orange juice (ethanol dose, 0.79 gm/kg, giving a peak blood alcohol level of 71.8 +/- 33.3 mg/dl). On a second night they received a placebo (1-2 drops of vodka floated on top of the orange juice). We measured (a) the minimum nasal (CPAP) required to eliminate snoring, (b) the number of hypopneas and apneas during each hour of sleep and (c) the arterial oxygen saturation (SaO2) by ear oximetry. On the alcohol night there was a significant increase in the CPAP pressure required to eliminate snoring (placebo 4.8 +/- 1.7 cm H2O, alcohol 6.2 +/- 1.5 cm H2O). The number of respiratory events per hour of sleep (apnea index) was 7.5 +/- 2.1 for ethanol nights versus 3.8 +/- 2.7 for placebo nights (p less than 0.0125). An apnea index of greater than 5 is generally considered abnormal. There was no significant difference in the number of desaturation events (declines of 4% or more in the SaO2) or in the mean SaO2, but the minimum SaO2 was significantly lower on the ethanol night (placebo 89.8% +/- 1.6, alcohol 86.8% +/- 2.7, p less than 0.05). The effect of this dose of alcohol on airway resistance was most pronounced during the first 2 hr after ingestion.     

Effect of three alcohol doses on breathing during sleep in 30-49 year old nonobese snorers and nonsnorers

To test the effect of alcohol ingestion and snoring on sleep-disordered breathing (SDB), the sleep and respiration of 31 nonobese healthy males ages 30-49 (15 snorers, 16 nonsnorers) were studied overnight after alcohol ingestion. Subjects received placebo, 0.32, 0.65, and 0.81 g alcohol/kg body weight prior to their evening bedtime, with each dose given on one of four nonconsecutive nights in a repeated-measures counterbalanced design. On each night, respiration was assessed by recording respiratory effort from intercostal surface electromyography (EMG), ventilation from oral and nasal thermistors, and arterial oxygen saturation (SaO2) from an ear oximeter (BIOX III). Snorers had significantly: (a) more total SDB, (b) more obstructive sleep apnea (OSA), and (c) lower minimum SaO2 than nonsnorers after the placebo and each alcohol dose. Snorers had more hypoxic events than nonsnorers after each alcohol dose but not after placebo. Increasing alcohol dose caused a statistically significant (p = 0.0004) decrease in minimum SaO2 in snorers only, but this decrease was small and probably not clinically important. Alcohol did not cause significant increases in SDB and hypoxic events, and did not have different effects on SDB and hypoxic events for snorers versus nonsnorers. Because this experiment included only nonobese 30-49-year-old males, these results do not imply that alcohol has no significant effects on obese subjects or those older than 50.     

阿罗洛尔降压疗效和对睡眠呼吸障碍的影响

目的：阿罗洛尔的抗高血压疗效和对睡眠呼吸状况的影响。方法：随机、单盲、自身对照法。２０例原发性高血压患者在治疗前后分别接受多导睡眠仪和动态血压等监测。结果：患者服药４周，收缩压从２１．７±２．０ｋＰａ（１６３±１５ｍｍＨｇ）降至１８．９±２．５ｋＰａ（１４２±１９ｍｍＨｇ）（Ｐ＝０．０００，ｎ＝２０），舒张压从１３．５±０．９ｋＰａ（１０１±７ｍｍＨｇ）降至１１．７±０．９ｋＰａ（８８±７ｍｍＨｇ）（Ｐ＝０．０００，ｎ＝２０）。合并睡眠呼吸暂停者治疗后呼吸紊乱指数从２４．６０降至１３．１６（Ｐ＜０．０５，ｎ＝５）。超声心动图结果提示患者心功能状态有显著改善。心率无明显下降，治疗后血浆高密度脂蛋白胆固醇增加，血浆肾素浓度降低。结论：阿罗洛尔有较好的降压疗效，可以减轻睡眠呼吸暂停患者的睡眠呼吸障碍，改善心功能，对代谢无不良影响     

The Distribution of Alcohol Consumption—30 years on

The Ledermann theory and its implications for alcohol control policy have been the source of considerable controversy. This paper describes the original theory and subsequent modifications, and a brief review of the extensive debate on the subject is presented. It is concluded that the implications of the Ledermann theory concerning alcoholism and the experience of alcohol-related harm are based on an inadequate foundation. More precise estimation of risk functions relating harm to consumption will be of importance in the development and acceptability of alcohol control policy.     

Little Effect of Ordinary Antihypertensive Therapy on Nocturnal High Blood Pressure in Patients with Sleep Disordered Breathing

The antihypertensive effects of four different antihypertensive medications (β-blocking agent, atenolol 50 mg; calcium-antagonist, isradipine SRO [slow release] 2.5 mg; diuretic, hydrochlorothiazide [HCTZ] 25 mg; and angiotension converting enzyme-inhibitor, spirapril 6 mg) on obese patients with sleep disordered breathing and hypertension were compared by the ambulatory blood pressure measurement (ABPM).Eighteen patients were randomized in a double-blind, crossover fashion to receive each of the four different medications for 8 weeks. ABPM was performed at baseline and after an 8-week treatment with these medications. A 2- to 3-week washout period occurred both at baseline and between each of the four medications. Three patients were omitted from statistical analysis because of technical problems of ABPM.Atenolol, isradipine SRO, and spirapril decreased significantly (P < .01) the mean 24-h systolic blood pressure, whereas HCTZ did not. The mean 24-h diastolic blood pressure decreased significantly after all four medications: 12 (SD ± 14) mm Hg with atenolol, 7 (SD ± 10) mm Hg with isradipine SRO, 3 mm Hg (SD ± 14) with HCTZ, and 6 (SD ± 15) mm Hg with spirapril (P < .01). During nighttime none of the medications reduced the mean diastolic or systolic blood pressure significantly. According to the 24-h blood pressure curve the influence of these four medications during the whole measurement period was not similar. Atenolol and spirapril lost their antihypertensive effect during the early morning hours. The antihypertensive effect of HCTZ varied markedly from hour to hour. The trough-to-peak ratio of no medication was >0.50.Negative correlation was observed between the apnea time and the mean systolic 24-h (r = −0.604, P = NS) and the mean systolic nocturnal blood pressure change (r = −0.590, P = NS).Our study revealed that the daytime high blood pressure was quite easily controlled by the ordinary monotherapy in these patients with partial upper airway obstruction and hypertension. Instead none of the medications used decreased nocturnal high blood pressure markedly.     

Puberty‐Dependent Sleep Regulation and Alcohol Use in Early Adolescents

Background: Research has shown a bi‐directional relation between alcohol use and sleep regulation in adults. Much less is known about this association in early adolescents, while profound puberty‐dependent transitions regarding sleep patterns take place in early adolescence. Moreover, puberty has been associated with an increase in alcohol use of adolescents. Methods: In this study, we investigated the associations between pubertal development, sleep preference, sleep problems, and alcohol use in 431 early adolescents (mean age: 13.66). Second, it was studied whether the associations changed when controlling for adolescent internalizing and externalizing problems. Furthermore, we included gender as a moderator on all the associations. Results: Results showed that pubertal development was positively associated with sleep problems and more evening‐type tendencies (e.g., favoring later bedtimes), which in turn were positively related to alcohol use. Underlying psychopathology, gender and educational level did not change these relationships. Conclusions: From this study, it can be concluded that both puberty and sleep regulation are important factors in explaining alcohol use in early adolescence.     

Inflammation and Sleep Disordered Breathing in Children: A State‐of‐the‐Art Review

Sleep disordered breathing (SDB) represents a spectrum of breathing disorders, ranging from snoring to obstructive sleep apnea syndrome (OSAS), that disrupt nocturnal respiration and sleep architecture. OSAS is a common disorder in children, with a prevalence of 2–3%. It is associated with neurobehavioral, cognitive, and cardiovascular morbidities. In children, adenotonsillectomy is the first choice for treatment and is reserved for moderate to severe OSAS, as defined by an overnight polysomnography. In adults, OSAS is the result of mechanical dysfunction of the upper airway, manifesting as severity‐dependent nasal, oropharyngeal, and systemic inflammation that decrease after continuous positive airway pressure therapy. Inflammatory changes have been reported in upper airway samples from children with OSAS, and systemic inflammation, as indicated by high‐sensitivity C‐reactive protein (hsCRP) levels, has been shown to decrease in children with OSAS after adenotonsillectomy. Anti‐inflammatory treatments for children with mild OSAS are associated with major improvements in symptoms, polysomnographic respiratory values, and radiologic measures of adenoid size. Inflammation is correlated to some extent with OSAS‐related neurocognitive morbidity, but the role of inflammatory markers in the diagnosis and management of OSAS, and the role of anti‐inflammatory treatments, remains to be clarified. This review examines the role of inflammation in the pathophysiology of sleep‐disordered breathing in pediatric patients and the potential therapeutic implications. Pediatr. Pulmonol. 2008; 43:1151–1160. © 2008 Wiley‐Liss, Inc.     

The Development of Alcohol Consumption in the Netherlands: 1958–1981

Between 1958 and 1981 the increase in per capita consumption in the Netherlands was more than 300 per cent. Survey dam of 1958, 1970 and 1981 are used to study changes in mean consumption and in the frequency distribution of consumption of different subpopulations. In most subpopulations the percentage of abstainers did not show significant changes. Differences in mean consumption between subpopulations have generally become larger, especially between 1958 and 1970. All subpopulations with an increase in mean consumption, show a strong increase in percentage of drinkers in the highest consumption category. The opposite tendency, stable or decreasing percentages of drinkers in the highest consumption category in subpopulations with a stable or decreasing mean consumption, was not found in our data.     

Alcohol consumption and binge drinking in Novosibirsk, Russia, 1985–95

Aims . It has been suggested that the effects of alcohol, and binge drinking in particular, contributed to the dramatic fluctuations in Russian mortality rates: rapid decline in 1985‐87, slow increase in 1988‐91 and sharp increase in 1992‐94. To date, there have been no data available to substantiate this claim. We examine for the first time the trends in alcohol intake and binge drinking in a Russian urban population. Methods . Independent random samples of men and women aged 25‐64 in two districts of Novosibirsk city (Western Siberia) have been examined in 1985/86 (1535 men and 1296 women), 1988/89 (1700 men, no women), and 1994/95 (1539 men and 1511 women). Response rates ranged from 71% to 73%. The subjects reported frequency of drinking alcohol, average amount of alcohol consumed at a typical occasion, and their alcohol intake in the week preceding the interview. Two cut‐off points to define binge drinking were adopted: ≥ 80 g and ≥ 120 g at a single occasion. Results . The proportion of men who drank at least once a week increased from 27% in 1985/86 to 38% in 1994/95; corresponding figures among women were 0.6% and 6.5%, respectively. The mean consumption of pure alcohol at a single occasion in men was 90 g in 1985/86, 119 g in 1988/89 and 112 g in 1994/95; in women, it was 33 g in 1985/86 and 32 g in 1994/95. Between the first and the last survey, the mean weekly intake of pure alcohol increased from 120 g to 184 g in men and from 31 g to 41 g in women. Prevalence rates of binge drinking (≥ 80 g at least once a month) in the three surveys were 36%, 52% and 51%, respectively, in men, and 0.4% in the first and 5% in the last survey among women. Conclusion . Alcohol consumption and prevalence of binge drinking were high in men and low in women. The frequency of binge drinking among men increased between 1985/86 and 1988/89 and remained stable between 1988/89 and 1994/95. This is not consistent with trends in mortality. Shorter‐term fluctuations between surveys, however, cannot be excluded.     

Neuromodulatory Effect of Endogenous Opioids on the Intensity and Unpleasantness of Breathlessness during Resistive Load Breathing in COPD

Background: Endogenous opioids are naturally occurring peptides released by the brain in response to noxious stimuli. Although these naturally occurring peptides modulate pain, it is unknown whether endogenous opioids affect the perception of breathlessness associated with a specific respiratory challenge. The hypothesis is that intravenous administration of naloxone, used to block opioid signaling and inhibit neural pathways, will increase ratings of breathlessness during resistive load breathing (RLB) in patients with chronic obstructive pulmonary disease (COPD). Methods: Fourteen patients with COPD (age, 64 ± 9 years) inspired through resistances during practice sessions to identify an individualized target load that caused ratings of intensity and/or unpleasantness of breathlessness ≥ 50 mm on a 100 mm visual analog scale. At two intervention visits, serum beta-endorphins were measured, naloxone (10 mg/25 ml) or normal saline (25 ml) was administered intravenously, and patients rated the two dimensions of breathlessness each minute during RLB. Results: Patient ratings of intensity (p = 0.0004) and unpleasantness (p = 0.024) of breathlessness were higher with naloxone compared with normal saline. Eleven patients (79%) reported that it was easier to breathe during RLB with normal saline (p = 0.025). RLB led to significant increases in serum beta-endorphin immunoreactivity and decreases in inspiratory capacity. There were no significant differences in physiological responses between interventions. Conclusions: Endogenous opioids modulate the intensity and the unpleasantness of breathlessness in patients with COPD. Differences in breathlessness ratings between interventions were clinically relevant based on the patients’ global assessment.     

Alcohol and suicide in Denmark 1911-24–experiences from a 'natural experiment'

In 1916-17, prices of alcoholic beverages increased dramatically in Denmark, and alcohol consumption decreased strongly. On the basis of this ‘natural experiment’, the effect of variations in per capita alcohol consumption on suicide rates is estimated, and compared to Norström's analysis of Danish data from the period 1931-80, as well as similar analyses from other countries. It is concluded that per capita alcohol consumption is probably related to the suicide rate in Denmark, but to a less extent than in some other countries.     

Sleep and Breathing in Recreational Climbers at an Altitude of 4200 and 6400 Meters: Observational Study of Sleep and Patterning of Respiration During Sleep in a Group of Recreational Climbers

Background: The increasing popularity of mountain climbing will result in greater numbers of the general population being at risk for the disturbances known to occur with altitude exposure. Methods: Observations of sleep and breathing were made in 6 healthy travellers (5 males and 1 female, 38 to 62 years of age) before, during, and after a recreational climb. We modified a portable seven channel polygraph to record sleep state, oxygen saturation, respiratory movements, body position, and oronasal airflow 4 weeks prior to the expedition at home (500m), at base camp (4200m) and in 3 climbers at 6400m. All had a repeat study at 500m altitude 4 weeks after the expedition. Results: For the group, the total number of obstructive apneas and hypopneas (OA/H) at night increased from 36 at home to 68 at base camp over a one night recording. Separately counted central apneas and hypopneas (CA/CS) increased from 6.7 to 45. In one climber, who had a history of recurrent snoring and observed apneas at home, the number of apneas increased from 201 at 4200m to 322 at 6400m, whereas in 2 climbers measured at 6400m, all apneas decreased. The total sleep time (TST) increased in all 6 climbers by 10% at base camp in comparison to home records. In the 3 climbers attaining an altitude of 6400m, the REM (rapid eye movement) sleep declined by 10% compared to the record at 4200m. Conclusion: Respiratory disturbances at low altitude are amplified by exposure to high and extreme altitude. In those without symptoms of sleep apnea, significant physiologic alterations will occur at high altitude but at extreme altitude regular ventilation is re-established.