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The findings demonstrate the feasibility and therapeutic potential for hypoglossal nerve stimulation in obstructive sleep apnea.

R Re ed du uc ct ti io on n i in n s sy ym mp pa at th he et ti ic c a ac ct ti iv vi it ty y a af ft te er r l lo on ng g--t te er rm m C CP PA AP P t tr re ea at tm me en nt t i in n s sl le ee ep p a ap pn no oe ea a: : c ca ar rd di io ov va as sc cu ul la ar r i im mp pl li ic ca at ti io on ns s It is concluded that obstructive sleep apnoea is associated with high sympathetic activity both during sleep and waking periods. Urinary metanephrine excretion seemed to reflect blood pressure, but neither daytime nor night-time catecholamine excretion was directly related to disease severity in patients with severe obstructive sleep apnoea. In spite of a marked reduction of catecholamine excretion at followup, BP and cardiac structure remained unchanged. Although increased sympathetic activity may act as a contributory trigger for cardiovascular disease in sleep apnoea, a reduction of activity after nasal CPAP is not associated with changes in blood pressure or cardiac structure.

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The relative influence of body mass index (BMI) and sleep apnea (SA) on blood pressure and prevalence of hypertension was investigated in 377 consecutive subjects admitted to a sleep laboratory. Among patients, 124 (33%) had SA, 153 (41%) were obese, and 93 (25%) had systemic hypertension. Both oxygen desaturation (OD) and minimal oxygen saturation (SaO2min) were related to BMI (p < 0.001) in patients without antihypertensive medication. Systolic and diastolic blood pressures were related to BMI and disease severity. Moreover, casual blood pressure, frequency of hypertension as well as OD and SaO2min were all significantly related to age. In a multivariate logistic regression analysis, age, BMI, and SA were all identified as independent predictors of hypertension. The relative risk associated with age was 4.3 (40 to 59 yr), with obesity 2.7 (> or = kg/m2) and with SA 2.1 (> 30 desaturation/6 h). The relative risk for hypertension increased with increasing age and BMI. In SA, however, the relative risk was unchanged in patients with a higher number of desaturations (OD > or = 60, 2.2). Combined obesity and SA resulted in a 3.9 times increase in hypertension prevalence. We concluded that age, SA, and overweight represent both independent and additive risk factors for development of systemic hypertension.

Esophageal cancer often presents as advanced stage disease with a dismal prognosis, with only 10-15% of patients surviving 5 years. Therefore, in a large proportion of patients, palliative treatment is the only option available. The aim of this study was to prospectively compare the palliative effect of self-expandable stent placement with that of endoluminal brachytherapy regarding the effect on quality of life and on specific symptoms. Sixty-five patients with advanced cancer of the esophagus or gastroesophageal junction were randomized to treatment with either an Ultraflex expandable stent or high-dose-rate endoluminal brachytherapy with 7 Gy x 3 given in 2-4 weeks. Clinical assessment and health-related quality of life (HRQL) were measured at inclusion and 1, 3, 6, 9 and 12 months later. The HRQL was measured with standardized questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oesophageal Module and Hospital Anxiety and Depression Scale). Twenty-eight patients completed the stent treatment and 24 patients the brachytherapy. The group of patients treated with stent reported significantly better HRQL scores for dysphagia (P < 0.05) at the 1-month follow-up, but most other HRQL scores, including functioning and symptom scales, deteriorated. Among brachytherapy-treated patients, improvement was found for the dysphagia-related scores at the 3-months follow-up, whereas other significant changes of scores were few. The median survival time was comparable in the two groups (around 120 days). In conclusion, insertion of self-expandable metal stents offered a more instant relief of dysphagia compared to endoluminal brachytherapy, but HRQL was more stable in the brachytherapy group.