Respiratory Dysrhythmias during Sleep

Bleich, Howard L.; Moore, Mary Jean; Cherniack, Neil S.

doi:10.1056/nejm198108063050606

Cited by 166 publications

(8 citation statements)

References 25 publications

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“…History of snoring also provide a clue to diagnosis. [25] These patients are also candidates for difficult intubation oxygen desaturation in the post operative period is a common occurrence,[26] as well as occurrence of cardiac arrhythmias,[27] haemodynamic instability, myocardial ischemia or infacction and increased incidence of intubation and mechanical ventilation. [28]…”

Section: Discussionmentioning

confidence: 99%

Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study

et al. 2013

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Background:Obstructive sleep apnea (OSA) is often not diagnosed in patients presenting for surgical procedures thereby increasing the incidence of adverse perioperative course. Early diagnosis of this disease is important in modifying anesthetic management as well as utilizing specific means which may decrease the complications and improve the patient outcome.Methods:Patients greater than eighteen years of age, ASA I-III scheduled for elective surgical procedures under anesthesia were randomly selected. Their demographic data, diagnosis and nature of surgery were noted in a semi-structured performa. They were then screened for the presence of OSA with the help of a STOP BANG questionnaire.Results:This study included two hundred four patients randomly selected. Slight female predominance was seen in this sample (55.4%). Mean age of the subjects was 42.7 years (SD=15.08). 24.5% subjects were at high risk for OSA (STOP-BANG>3) with a male predominance (72% versus 37% in low risk group; X2=18.62; P<0.001). High risk OSA subjects had higher prevalence of cardiovascular risk factors (57% vs. 11.7% in low risk group; X2=33.35; P<0.001). Similarly, this group had a higher prevalence of asthma and chronic obstructive pulmonary disease (COPD) (14% versus 3.8% in low risk group; X2=6.54; P=0.03). Prevalence of diabetes mellitus (22%) and hypothyroidism (6%) was also higher in this group (5.2% and 1.9% in low risk group respectively; X2=15.42; P<0.001).Conclusion:High degree of suspicion and knowledge of association of OSA and medical diseases may help in detection of such cases and decrease the rate of perioperative complications thus improving patients safety.

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Section: Discussionmentioning

confidence: 99%

Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study

et al. 2013

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“…Such a complex system can become unstable. Instability of the system is best explained by the loop gain principal,144–146 which is an engineering concept. Loop gain is the ratio of a corrective response (ventilation) to the disturbance itself.…”

Section: Pathophysiology Of Osamentioning

confidence: 99%

Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options

Gharibeh¹,

Mehra²

2010

NSS

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Sleep apnea is an entity characterized by repetitive upper airway obstruction resulting in nocturnal hypoxia and sleep fragmentation. It is estimated that 2%–4% of the middle-aged population has sleep apnea with a predilection in men relative to women. Risk factors of sleep apnea include obesity, gender, age, menopause, familial factors, craniofacial abnormalities, and alcohol. Sleep apnea has been increasingly recognized as a major health burden associated with hypertension and increased risk of cardiovascular disease and death. Increased airway collapsibility and derangement in ventilatory control responses are the major pathological features of this disorder. Polysomnography (PSG) is the gold-standard method for diagnosis of sleep apnea and assessment of sleep apnea severity; however, portable sleep monitoring has a diagnostic role in the setting of high pretest probability sleep apnea in the absence of significant comorbidity. Positive pressure therapy is the mainstay therapy of sleep apnea. Other treatment modalities, such as upper airway surgery or oral appliances, may be used for the treatment of sleep apnea in select cases. In this review, we focus on describing the sleep apnea definition, risk factor profile, underlying pathophysiologic mechanisms, associated adverse consequences, diagnostic modalities, and treatment strategies.

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“…Sleep is a time of particular vulnerability when protective upper airway reflexes are attenuated (37, 38, 68, 132, 156, 157), leaving the upper airway susceptible to collapse (102). Recent evidence suggests that the pathogenesis of sleep apnea involves a complex interplay of upper airway anatomy (121), pharyngeal dilator motor control (69, 132), ventilatory control instability (loop gain) (17, 50, 154, 160), alone and/or in combination. The contribution of each of these factors to OSA in a given individual is quite variable (115), emphasizing the importance of defining the underlying mechanism of OSA in afflicted patients to achieve the goal of individualized, targeted therapy (115).…”

Section: Introductionmentioning

confidence: 99%

Mechanical Properties of the Upper Airway

Strohl

Butler

Malhotra

2012

Comprehensive Physiology

110

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The importance of the upper airway (nose, pharynx, and larynx) in health and in the pathogenesis of sleep apnea, asthma, and other airway diseases, discussed elsewhere in the Comprehensive Physiology series, prompts this review of the biomechanical properties and functional aspects of the upper airway. There is a literature based on anatomic or structural descriptions in static circumstances, albeit studied in limited numbers of individuals in both health and disease. As for dynamic features, the literature is limited to studies of pressure and flow through all or parts of the upper airway and to the effects of muscle activation on such features; however, the links between structure and function through airway size, shape, and compliance remain a topic that is completely open for investigation, particularly through analyses using concepts of fluid and structural mechanics. Throughout are included both historically seminal references, as well as those serving as signposts or updated reviews. This article should be considered a resource for concepts needed for the application of biomechanical models of upper airway physiology, applicable to understanding the pathophysiology of disease and anticipated results of treatment interventions.

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Respiratory Dysrhythmias during Sleep

Cited by 166 publications

References 25 publications

Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study

Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study

Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options

Mechanical Properties of the Upper Airway

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