Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches

Obstructive sleep apnea syndrome (OSAS), a chronic condition characterized by collapse of the pharynx during sleep, has been increasingly recognized as a health issue of growing importance over the last decade. Recently emerging evidence suggests that there is a causal link between OSAS and hypertension, and hypertension represents an independent risk factor in OSAS patients. However, the pathophysiological basis for patients with OSAS having an increased risk for hypertension remains to be elucidated. The main acute physiological outcomes of OSAS are intermittent hypoxia, intrapleural pressure changes, and arousal from sleep, which might induce endothelial dysfunction, sympathetic activation, renin–angiotensin–aldosterone system activation, lipid metabolism dysfunction, and increased oxidative stress. This brief review focuses on the current understanding of the complex association between OSAS and hypertension.     

Effect of Lavender cream with or without footbath on sleep quality and fatigue in pregnancy and postpartum: a randomized controlled trial

Sleep disturbance and fatigue are frequent complaints during pregnancy and postpartum. We assessed the effectiveness of Lavender cream and footbath on sleep quality and fatigue in pregnancy and postpartum. In this trial, 141 women with sleep disturbance at 25–28 weeks gestation were recruited from public health centers in Tabriz, Iran, from May 2013 until January 2014 and randomized into one of three groups receiving: Lavender and footbath, Lavender alone, or placebo cream. Sleep quality was assessed using the Pittsburgh sleep quality index at the 4th and 8th weeks after intervention and the 6th week postpartum. Fatigue was assessed with the multidimensional assessment of fatigue scale at the 6th week after intervention and the 6th week postpartum. Repeated measures ANOVA and ANCOVA were used. Compared with the placebo group, the global sleep quality score post-intervention in pregnancy and the postpartum were significantly lower in the Lavender and footbath and the Lavender cream only groups. Fatigue in both intervention groups was significantly improved only at the 6th week postpartum. No statistically significant differences were observed between the two intervention groups. Lavender cream with or without footbath may improve sleep quality in pregnancy and postpartum.     

Investigation and Treatment of Ovulatory Failure

After gonadal dysgenesis or developmental failure have been ruled out and therapy initiated for secondary amenorrhea in appropriate cases, there remains a group of women in whom measures to overcome infertility can be undertaken with reasonable expectation of success. The first need is to determine if ovulation is occurring; if it is not, a variety of means is now available to induce it.     

Pseudoventricular Tachycardia

This program is acceptable for 24 hours of Prescribed credit by the American Academy of Family Physicians and 24 hours of Category 1 credit toward the Physician's Recognition Award of the American Medical Association. If movies are viewed, additional credits are available. Further information and registration and hotel reservation forms can be secured by writing to: Interstate Postgraduate Medical Association, PO Box 1109, Madison, WI 53701.     

A mixed method evaluation of a group‐based educational programme for CPAP use in patients with obstructive sleep apnea

Rationale, aims and objectives Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long‐term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group‐based programme using problem‐based learning (PBL) for CPAP initiation. Educational programme The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months. Methods A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi‐structured interviews using a phenomenographic approach. Results 72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle. Conclusion and practice implications A group‐based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.     

Insomnia,Sleepiness, and Depression in Adolescents Living in Residential Care Facilities

The main objective of this study was to document sleep patterns and disturbances reported by youths temporarily living in residential care facilities. A secondary objective was to examine the relationships between sleep disturbances and mood and daytime sleepiness. A self-reported questionnaire on sleep patterns and habits assessing duration, frequency, and consequences of sleep difficulties, the Beck Depression Inventory-2, and the Epworth Sleepiness Scale were administered to a sample of 66 adolescents. Results suggest a high rate of sleep disturbances in this sample, with 41% reporting insomnia symptoms and 21% meeting diagnostic criteria for an insomnia syndrome. Those with more severe insomnia syndrome showed more severe depressive symptoms and daytime consequences.     

Chemotherapy‐Induced Neuropathic Pain and Its Relation to Cluster Symptoms in Breast Cancer Patients Treated with Paclitaxel

Abstract The majority of patients with breast cancer receiving chemotherapy report multiple symptoms. Compelling evidence has shown that subgroups of patients can be clustered by the severity of symptoms. Recent studies demonstrate that chemotherapy with such substances as paclitaxel can cause neuropathic pain (CINP) and consequently neural damage. Objectives: the present study examined the relationship between symptom clusters and CINP among 40 patients with breast cancer. The study was based on 2 sessions conducted before and during paclitaxel treatment. In each session, neuropathic pain was assessed by the DN4 Questionnaire. In the second session, the Lee Fatigue Scale, the General Sleep Disturbance Scale, and the Center for Epidemiological Studies–Depression Scale were also administered, and the worst pain intensity was assessed. Using cluster analysis, 2 symptom clusters were identified on the basis of the severity of the 4 symptoms scores. Patients in the High Cluster (37%) experienced a high level of all symptoms, whereas patients in the Low Cluster (63%) experienced a low level of all symptoms. Twenty patients (50%) were diagnosed with CINP. A subgroup of patients (23%) from the High Cluster was identified as having CINP; 35% were in the Low Cluster and free of CINP. In conclusion, there appears to be a specific subgroup of patients with hypersensitive cancer who need greater attention to symptom management. Early detection of symptoms, together with careful dose selection and assessment of early stages in the development of neuropathic pain, are essential for preventing the simultaneous occurrence of severe multiple symptoms and CINP.     

下颌后缩致阻塞性睡眠呼吸暂停综合征的正颌外科治疗

目的：探讨正颌外科技术对下颌后缩致阻塞性睡眠呼吸暂停综合征(OSAS)的外科冶疗效果。方法：对7例经多导睡眠图(PSG)测试确诊为OSAS的下颌后缩患者进行手术矫治。结果：7例患者打鼾、呼吸暂停、白天嗜睡等主观症状明显改善。PSG检查呼吸暂停指教(AHI)下降35％-55％，血氧饱和度(SaO2)升高10％-20％，晨起血压下降30-20mmHg／20-10mmHg，心律失常纠正。且所有患者对面形的改善均感满意。结论：正颌外科技术不仅能矫治下颌后缩畸形所致的美容缺憾，并对由其引起的OSAS有良好的治疗作用。是美容与治病融为一体的有效治疗OSAS的方法，值得继续研究与临床推行。     

吻内侧被盖核(RMTg)参与吗啡引起的大鼠睡眠紊乱

 目的 旨在阐明吻内侧被盖核(rostromedial tegmental nucleus,RMTg)是否参与吗啡引起的大鼠睡眠障碍。方法 将雄性SD大鼠随机分为溶剂对照组和吗啡组,每组7只,对照溶剂为人工脑脊液(artificial cerebrospinal fluid,ACSF)。采用脑立体定位、核团微量注射和睡眠记录与解析等技术观察RMTg内给予吗啡对大鼠睡眠-觉醒周期的影响。结果 与对照组相比,双侧RMTg 给予吗啡(16 mmol/L,每侧0.5 μL)可以引起大鼠长达4 h的觉醒,期间非快动眼(non-rapid eye movement,NREM)睡眠深度降低、快动眼(REM)睡眠减少的现象与吗啡临床用药所引起的睡眠障碍的表现相一致。结论 RMTg参与吗啡引起的大鼠睡眠紊乱。