- Orexin and Central Modulation of Cardiovascular and Respiratory Function. [Journal Article]
- CTCurr Top Behav Neurosci 2016 Dec 02
- Orexin makes an important contribution to the regulation of cardiorespiratory function. When injected centrally under anesthesia, orexin increases blood pressure, heart rate, sympathetic nerve activi...
Orexin makes an important contribution to the regulation of cardiorespiratory function. When injected centrally under anesthesia, orexin increases blood pressure, heart rate, sympathetic nerve activity, and the amplitude and frequency of respiration. This is consistent with the location of orexin neurons in the hypothalamus and the distribution of orexin terminals at all levels of the central autonomic and respiratory network. These cardiorespiratory responses are components of arousal and are necessary to allow the expression of motivated behaviors. Thus, orexin contributes to the cardiorespiratory response to acute stressors, especially those of a psychogenic nature. Consequently, upregulation of orexin signaling, whether it is spontaneous or environmentally induced, can increase blood pressure and lead to hypertension, as is the case for the spontaneously hypertensive rat and the hypertensive BPH/2J Schlager mouse. Blockade of orexin receptors will reduce blood pressure in these animals, which could be a new pharmacological approach for the treatment of some forms of hypertension. Orexin can also magnify the respiratory reflex to hypercapnia in order to maintain respiratory homeostasis, and this may be in part why it is upregulated during obstructive sleep apnea. In this pathological condition, blockade of orexin receptors would make the apnea worse. To summarize, orexin is an important modulator of cardiorespiratory function. Acting on orexin signaling may help in the treatment of some cardiovascular and respiratory disorders.
- Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing. [Journal Article]
- EAEur Arch Otorhinolaryngol 2016 Dec 1
- Our aim was to evaluate the long-term objective and subjective results of a modified expansion sphincter pharyngoplasty (ESP) technique in patients with sleep-disordered breathing. Single center pros...
Our aim was to evaluate the long-term objective and subjective results of a modified expansion sphincter pharyngoplasty (ESP) technique in patients with sleep-disordered breathing. Single center prospective study of 35 patients underwent an ESP as a primary surgical treatment between June 2012 and September 2015 at the hospital AZ Sint-Jan Bruges-Ostend. Patients were divided into non-OSAS and OSAS (AHI >5). Primary outcome parameters were the Epworth Sleeping Scale (ESS, reduction and score less then 10) and the Visual Analogue Score of snoring (VAS, assessed by partner) evaluated at 3 months and 1 year. In addition, the OSAS group underwent a polysomnography after 6 months to calculate the Apneu-Hypopneu Index (AHI) change. Secondary outcome parameters were possible complications and morbidity rate. The overall Epworth Sleepiness Scale showed a steady total reduction of, respectively, 42 and 48% at the two timepoints. All patients had a post-operative score of less than ten points. The Visual Analogue Score improved in 92% of the patients; of these, the snoring was reduced in 86% and disappeared in 6%. In the OSAS group, we noticed a reduction in AHI of more than 50 in 53% of the patients. A considerable reduction was found in the severe OSAS group, where we found a mean pre-operative average AHI of 41.3/h that was reduced 6 months after the operation to 17.4/h. There were no severe complications or increased morbidity rate observed. This first long-term study shows that the modified ESP seems to be a safe and promising technique in palatal surgery for patients with sleep-disordered breathing. Surgical effectiveness is sustained after 1 year, both in OSAS as in snoring pathology. The technique seems as approachable for the basic ENT surgeon as the uvulopalatopharynoplasty.
- Automatic snoring sounds detection from sleep sounds via multi-features analysis. [Journal Article]
- APAustralas Phys Eng Sci Med 2016 Dec 1
- Obstructive sleep apnea hypopnea syndrome (OSAHS) is a serious respiratory disorder. Snoring is the most intuitively characteristic symptom of OSAHS. Recently, many studies have attempted to develop ...
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a serious respiratory disorder. Snoring is the most intuitively characteristic symptom of OSAHS. Recently, many studies have attempted to develop snore analysis technology for diagnosing OSAHS. The preliminary and essential step in such diagnosis is to automatically segment snoring sounds from original sleep sounds. This study presents an automatic snoring detection algorithm that detects potential snoring episodes using an adaptive effective-value threshold method, linear and nonlinear feature extraction using maximum power ratio, sum of positive/negative amplitudes, 500 Hz power ratio, spectral entropy (SE) and sample entropy (SampEn), and automatic snore/nonsnore classification using a support vector machine. The results show that SampEn provides higher classification accuracy than SE. Furthermore, the proposed automatic detection method achieved over 94.0% accuracy when identifying snoring and nonsnoring sounds despite using small training sets. The sensitivity and accuracy of the results demonstrate that the proposed snoring detection method can effectively classify snoring and nonsnoring sounds, thus enabling the automatic detection of snoring.
- Patients presenting for colonoscopy: A great opportunity to screen for sleep apnea. [Journal Article]
- WJWorld J Gastrointest Endosc 2016 Nov 16; 8(19):697-700
- CONCLUSIONS: Risk for OSA is extremely common in a population presenting for a routine colonoscopy, and screening at the time of a colonoscopy offers an excellent opportunity to identify these patients.
- Atrial Fibrillation And Sleep Apnea: Considerations For A Dual Epidemic. [Review]
- JAJ Atr Fibrillation 2016 Apr-May; 8(6):1283
- Atrial fibrillation (AF) is the most common cardiac arrhythmia and shares many of the same risk factors as another common clinical condition, sleep apnea. The estimated prevalence of sleep apnea has ...
Atrial fibrillation (AF) is the most common cardiac arrhythmia and shares many of the same risk factors as another common clinical condition, sleep apnea. The estimated prevalence of sleep apnea has increased over the past decade, and reflects a parallel increase in the most prominent risk factors of obesity and overweight. Both obstructive and central sleep apnea have been associated with AF in multiple studies, with the risk of AF increasing 2-4-fold compared to those without sleep breathing disorder. Continuous positive airway pressure (CPAP) has been shown to reduce the rate of AF recurrence following catheter ablation in patients with sleep apnea. However, the mechanisms by which sleep apnea precipitates AF or vice versa, remain unclear. In this Review, we examine the current date linking AF and sleep apnea, discuss the existing data supporting a mechanistic link between the two conditions, present the existing evidence for the effectiveness of CPAP in this growing population, and suggest approaches to screen AF patients for sleep breathing disorders.
- The Severity of Sleep Disordered Breathing Induces Different Decrease in the Oxygen Saturation During Rapid Eye Movement and Non-Rapid Eye Movement Sleep. [Journal Article]
- PIPsychiatry Investig 2016; 13(6):652-658
- CONCLUSIONS: More severe hypoxemia was seen in REM than NREM sleep in the severe OSAS group. The differential oxygen decrease between REM and NREM sleep is likely due to the differentially occurring sleep breathing events in each sleep stage according to the SDB severity. The more AHI increases in the severe OSAS patients, the more prominent the hypoxemia of REM sleep compared with NREM sleep is likely to appear. This suggests that the pressure of continuous positive airway pressure should be increased to control the hypoxemia of REM sleep in extremely severe OSAS.
- [Historical review on obstructive sleep apnea in children]. [Journal Article]
- APArch Pediatr 2016 Nov 28
- An historical review on the discoveries on pediatric obstructive sleep apnea syndrome and sleep-disordered breathing is outlined. Starting with the description by Dickens of "Joe" the obese, snoring ...
An historical review on the discoveries on pediatric obstructive sleep apnea syndrome and sleep-disordered breathing is outlined. Starting with the description by Dickens of "Joe" the obese, snoring and sleepy individual, the authors trace more than 50 years of questions and research starting with the lean adult to the child and from the recognition of obstructive sleep apnea syndrome to the outline of upper-airway resistance syndrome. The pathophysiological knowledge on sleep-disordered breathing has evolved over time, as have treatment approaches in children, from tracheostomy to positive-airway-pressure therapy, to adenotonsillectomy with and without orthodontic treatments to oral-facial myofunctional therapy. Co-morbidities of sleep-disordered breathing are multiple, involving cognition, behavioral, and mood disorders, cardiovascular impairment, etc. There have been many advances in a short time due to the investigation of OSAS, but many questions still need responses.
- Renal artery denervation for treatment of patients with self-reported obstructive sleep apnea and resistant hypertension: results from the Global SYMPLICITY Registry. [Journal Article]
- JHJ Hypertens 2017; 35(1):148-153
- CONCLUSIONS: RDN resulted in significant BP reductions at 6 months in hypertensive patients with and without OSA, and regardless of continuous positive airway pressure usage in OSA patients.
- Endothelin contributes to the blood pressure rise triggered by hypoxia in severe obstructive sleep apnea. [Journal Article]
- JHJ Hypertens 2017; 35(1):118-124
- CONCLUSIONS: Endothelin contributes to the rise in SBP in response to acute hypoxia in patients with severely untreated OSA. This was not due to lower chemoreflex activation with bosentan.
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- Preoperative evaluation and preparation of the morbidly obese patient. [Journal Article]
- COCurr Opin Anaesthesiol 2016 Nov 30
- CONCLUSIONS: Synthesis of proper medical history-taking and physical examination as well as detailed search for obstructive sleep apnea and metabolic syndrome are key components of preoperative evaluation. Further testing should be based on the findings of these steps and comprise the cardiac risk of the surgical procedure.