SUMMARYThe aim of this study was to evaluate the effects of nocturnal continuous positive airway pressure (CPAP) breathing on the emotional status and cognitive function in 20 patients with severe obstructive sleep apnoea (OSA) (mean±SD apnoea/hypopnoea index=67±16, mean overnight arterial oxygen saturation=83±10%). Psychological tests were performed before, after three, and after twelve months of CPAP treatment. At initial investigation, amongst cognitive functions, the most disturbed were concentration and recent memory. The majority of subjects demonstrated increased mental stress, depression, and anxiety. Anxiety correlated with AHI (r=0.68). Mental stress correlated with AHI (r=0.56) and deficiency of Stage 2 NREM sleep (r= −0.55). CPAP treatment resulted in significant improvement in cognitive function; concentration, recent verbal, visual and spatial memory were already seen at three months. No improvement in IQ and in emotional status after three months and one year of treatment was found. It is concluded that in patients with severe OSA CPAP treatment results in a significant early improvement in cognitive function but not in emotional status.
The MESAM 4 system, developed to monitor breathing sounds, heart rate, arterial oxygen saturation (SaO 2 ) and body position, was proposed as a screening method for obstructive sleep apnoea (OSA). The aim of the study was to assess the accuracy of hand-scoring versus automatic-scoring in screening for obstructive sleep apnoea.The study population consisted of 56 patients, 51 males, and 5 females, mean age 47±10 yrs, suspected of having obstructive sleep apnoea. Full polysomnography and MESAM 4 recordings were performed simultaneously. The apnoea+hypop-noea index was hand-scored in polysomnography and in MESAM 4. The handscoring in MESAM 4 was based on analysis of breathing sounds, heart rate and SaO 2 changes taken together. The automatic-scoring system of MESAM 4 calculated oxygen desaturation index, heart rate variation index and intermittent snoring index.The diagnosis of obstructive sleep apnoea (apnoea+hypopnoea index ≥10) was established by polysomnography in 37 patients. Sensitivity and specificity of handscored MESAM 4 diagnosis were 100 and 63%, respectively. Sensitivity and specificity of MESAM 4 diagnosis with automatic-scoring were: from oxygen desaturation index 100 and 27%; from heart rate variation index 81 and 74%; and from intermittent snoring index 92 and 16%, respectively.We suggest that hand-scoring of MESAM 4 is more accurate than automaticscoring in screening for obstructive sleep apnoea. Eur Respir J., 1994Respir J., , 7, 1771 Monitoring of physiological phenomena during sleep is more helpful in the recognition of OSA, than looking for signs which can be observed during wakefulness and are only indirectly connected with sleep-disordered breathing, i.e. nonspecific changes of the flow-volume loop or articulation of certain vowels.Simultaneous recording of several variables should, in principle, give better results than single parameter analysis. Such a device should be characterized by its noninvasiveness (interpreted as resulting in no interruption of sleep), accuracy and high stability of recording lasting for several hours, and also its simplicity in application and scoring [10].It seems that the MESAM 4 (Madaus Inc., Germany) fulfils these criteria. Its use was previously reported by STOOHS and GUILLEMINAULT [11]. However, in their study only automatic analysis of recorded variables was considered. The aim of this validation study was to assess the accuracy of hand-scoring versus automatic-scoring of MESAM 4 in screening for OSA. Material and methods PatientsWe studied patients who were referred to the sleep laboratory suspected of having sleep/wake disorders. They underwent general clinical examination and filled a typical sleep questionnaire, based on the Marburg questionnaire [12], in the presence of their bed-partners. The next step in the study consisted of eligible subjects complaining either of loud and irregular snoring or excessive daytime somnolence, or whose bed-partner observed apnoeic pauses during sleep.Fifty six patients were admitted to the study, 51 males and...
The aim of the study was to assess effects of acetazolamide in prevention of acute mountain sickness (AMS) and on overnight oxygenation, in patients with asthma treated at the altitude of 3,200 m. Sixteen patients with asthma, 6 males and 10 females, mean age 32 yrs, were first investigated at low altitude (760 m). They presented with mild airways obstruction, normal arterial blood gases, and normal oxygenation at night studied by pulse oximetry. After initial investigations, patients were divided by random number into the treated (T) and control (C) groups of eight patients each. T group patients received acetazolamide, 750 mg daily for 2 days, before the ascent and on the first day at altitude (3,200 m). Symptoms of AMS developed in seven patients from group C and in three from group T. The overnight pulse oximetry, performed on the first night at altitude, revealed that group T patients had statistically higher (p < 0.05) initial, 91 vs 87%, mean, 90 vs 86%, and minimum, 84 vs 75%, arterial oxygen saturation than group C patients. Overnight pulse oximetry was repeated on the 5th, 10th and 17th day at altitude, and showed that in group C patients, from the 5th day onwards, oxygenation improved to the level observed in group T patients on the first night. We conclude that pretreatment with acetazolamide before the ascent prevented patients with asthma from developing symptoms of AMS, and alleviated acute changes in arterial oxygen saturation brought about by the high altitude hypoxia.
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