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Continuous Positive Airway Pressure (continuous + positive_airway_pressure)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Anesthesia & Pain Management	12%
Cardiovascular Disease	8%

Kinds of Continuous Positive Airway Pressure

nasal continuous positive airway pressure

Terms modified by Continuous Positive Airway Pressure

continuous positive airway pressure therapy

Selected Abstracts

Changes in dreaming induced by CPAP in severe obstructive sleep apnea syndrome patients

JOURNAL OF SLEEP RESEARCH, Issue 4 2006
EVA CARRASCO
Summary To study dream content in patients with severe obstructive sleep apnea syndrome (OSAS) and its modification with Continuous Positive Airway Pressure (CPAP) therapy. We assessed twenty consecutive patients with severe OSAS and 17 healthy controls. Polysomnograms were recorded at baseline in patients and controls and during the CPAP titration night, 3 months after effective treatment and 2 years later in patients. Subjects were awakened 5,10 min after the beginning of the first and last rapid eye movement (REM) sleep periods and we measured percentage of dream recall, emotional content of the dream, word count, thematic units, sleep architecture and REM density. Dream recall in REM sleep was similar in patients at baseline and controls (51.5% versus 44.4% respectively; P = .421), decreased to 20% and 24.3% the first and third month CPAP nights, and increased to 39% 2 years later (P = 0.004). Violent/highly anxious dreams were only seen in patients at baseline. Word count was higher in patients than in controls. REM density was highest the first CPAP night. Severe OSAS patients recall dreams in REM sleep as often as controls, but their dreams have an increased emotional tone and are longer. Despite an increase in REM density, dream recall decreased the first months of CPAP and recovered 2 years later. Violent/highly anxious dreams disappeared with treatment. A dream recall decrease with CPAP is associated with normalization of sleep in OSAS patients. [source]

A Comparison of the Long-Term Outcome and Effects of Surgery or Continuous Positive Airway Pressure on Patients with Obstructive Sleep Apnea Syndrome

THE LARYNGOSCOPE, Issue 6 2006
Shih-Wei Lin
Abstract Objectives: To compare the long-term (3-year) outcome and effects of continuous positive airway pressure (CPAP) and extended uvulopalatoplasty (EUPF) treatment on patients with obstructive sleep apnea syndrome. Methods: Eighty-four patients who received CPAP titration and bought a CPAP machine to use from March 2000 to October 2001 were included as the CPAP group. Another 55 patients who underwent EUPF surgery were included as the EUPF group. Overnight polysomnography was performed 6 months and 3 years after CPAP titration or EUPF. The disease-specific questionnaire-Snore Outcome Survey (SOS), Epworth Sleepiness Scale (ESS), and the generic health questionnaire-MOSF-36 were administered at the 6-month and 3-year follow-up examinations. Results: The age, body mass index, respiratory disturbance index, and ESS before treatment were higher in the CPAP group. The snore index was higher in the surgery group. Fifty-four patients (64.3%) in CPAP group continued treatment for 6 months; the success rate for EUPF at 6 months was 82%. The polysomnographic variables improved significantly in both groups. Improvements in the SOS and ESS scores were better in surgery group than the CPAP group. The subscales of SF-36 in surgery group were more than those in CPAP group. Conclusions: EUPF had a better effect on snoring than CPAP 6 months after treatment in patients with obstructive sleep apnea syndrome (OSAS). This effect had gradually declined at the 3-year follow-up examination. Improvement in the quality of life of OSAS patients receiving EUPF is equal to those receiving CPAP treatment. [source]

Cardiogenic Unilateral Pulmonary Edema: An Unreported Complication of a Digestive Endoscopic Procedure

CONGESTIVE HEART FAILURE, Issue 5 2009
Enrique M. Baldessari MD
Unilateral pulmonary edema is an uncommon clinical situation that may be difficult to distinguish from other conditions that cause lung infiltrates. Most cases occur in the right lung, and there are no reports about cardiogenic unilateral pulmonary edema as a complication of an endoscopic procedure of gastrointestinal tract. The authors describe a case of a 79-year-old woman with acute cardiac heart failure that developed soon after a diagnostic upper and lower digestive endoscopy. Continuous positive airway pressure, intravenous nitroglycerin, and furosemide treatment resulted in rapid improvement of symptoms and the progressive resolution of left-sided infiltrates on chest radiography. This case is of particular importance because of the rarity of cardiogenic unilateral edema in the left lung. This clinical finding was associated with the prolonged rest on the left side during the gastrointestinal endoscopic procedure. [source]

Reversal of Sleep-Disordered Breathing with Opioid Withdrawal

PAIN PRACTICE, Issue 5 2009
Kannan Ramar MD
Abstract Obstructive sleep apnea, central sleep apnea, sleep related hypoventilation, Biot's or ataxic breathing, and cluster breathing are some of the commonly described sleep disorders in patients who are on long-term opioids. Continuous positive airway pressure that is commonly used to treat obstructive sleep apnea may not be effective in treating sleep-disordered breathing in long-term opioid users, and an adaptive servoventilator (ASV) may be needed. We present a 30-year-old woman with excessive daytime sleepiness and sleep-disordered breathing for the past 4 years. Medical history was complicated by chronic osteomyelitis, periorbital abscess, and chronic facial pain requiring methadone for pain control for the last 4 years. In this case, ASV, though effective, was not tolerable due to chronic facial pain, and successful withdrawal of methadone at our pain rehabilitation center resolved the sleep-disordered breathing and improved daytime sleepiness. This is to our knowledge the first case report of resolution of sleep-disordered breathing and improvement in daytime sleepiness after withdrawal of long-term opioid use. [source]

Latest news and product developments

PRESCRIBER, Issue 8 2008
Article first published online: 12 MAY 200
Glargine preferred to lispro as type 2 add-on Basal insulin glargine (Lantus) and insulin lispro (Humalog) at mealtimes improved glycaemic control equally well in patients with type 2 diabetes poorly controlled by oral agents, but patient satisfaction was greater with basal insulin (Lancet 2008;371:1073-84). The 44-week APOLLO trial, funded by Sanofi Aventis, was a nonblinded randomised comparison of basal and prandial insulin regimens added to oral treatment in 418 patients. It found similar reductions in HbA1C (,1.7 vs ,1.9 per cent respectively). Fasting and nocturnal glucose levels were lower with insulin glargine and postprandial levels were lower with insulin lispro. The basal regimen was associated with fewer hypoglycaemic events (5.2 vs 24 per patient per year), less weight gain (3.01 vs 3.54kg) and greater improvement in patient satisfaction scores. Treating hypertension cuts mortality in over-80s Treating hypertension in the over-80s reduces all-cause mortality by 21 per cent, the HYVET study has shown (N Engl J Med online: 31 March 2008; doi: 10.1056/NEJMoa 0801369). Compared with placebo, treatment with indapamide alone or with perindopril for an average of 1.8 years also reduced the incidence of fatal stroke by 39 per cent, cardiovascular death by 23 per cent and heart failure by 64 per cent. The incidence of stroke was reduced by 30 per cent but this was of borderline statistical significance. Fewer serious adverse events were reported with treatment than with placebo. New work for NICE The DoH has announced the 18th work programme for NICE. Seven public health interventions include preventing skin cancer, smoking by children and excess weight gain during pregnancy. Public health guidance will include the provision of contraceptive services for socially disadvantaged young people. Two new clinical guidelines are sedation in young people and management of fractured neck of femur. New technology appraisals may include eight therapies for cancer, two new monoclonal antibodies for psoriasis and rheumatoid arthritis, an oral retinoid for severe chronic hand eczema and methylnaltrexone for opioid-induced bowel dysfunction. Combinations no better against CV disease Taking ezetimibe and simvastatin (Inegy) does not appear to slow the progression of atherosclerosis more than high-dose simvastatin alone, say researchers from The Netherlands (N Engl J Med 2008;358: 1431-43). In patients with hypercholesterolaemia, there was no difference in regression or progression of atherosclerosis after two years' treatment with simvastatin 80mg per day alone or combined with ezetimibe 10mg per day. Adverse event rates were similar. In patients with vascular disease or high-risk diabetes, there was no difference between the ACE inhibitor ramipril 10mg per day or the ARB telmisartan (Micardis) 80mg per day as monotherapy, or their combination, in the risk of a composite outcome of cardiovascular death, MI, stroke and admission for heart failure (N Engl J Med 2008;358:1547-59). Combined treatment was associated with higher risks of hypotensive symptoms, syncope and renal dysfunction. Twice-daily celecoxib increases CV risk Taking celecoxib (Celebrex) twice daily carries a higher risk of cardiovascular events than the same total dose taken once daily, a metaanalysis suggests (Circulation 2008; doi: 10.1161/ CIRCULATIONAHA.108. 764530). The analysis of six placebo-controlled trials involving a total of 7950 patients taking celecoxib for indications other than rheumatoid arthritis found that the combined risk of cardiovascular death, myocardial infarction, stroke, heart failure or thromboembolic event increased with dose over the range 400-800mg per day. The risk was significantly greater with 200mg twice daily (HR 1.8) than 400mg once daily (HR 1.1). Patients at greatest baseline risk were at disproportionately increased risk from celecoxib. Long-term etanercept effective in AS An open-label study suggests that etanercept (Enbrel) remains effective in the treatment of ankylosing spondylitis in the long term (Ann Rheum Dis 2008;67:346-52). Of 257 patients who completed six months' treatment with etanercept and who entered the nonblinded extension study, 126 completed a total of 168-192 weeks' treatment. The commonest adverse events were injection-site reactions (22 per cent), headache (20 per cent) and diarrhoea (17.5 per cent). The annual rate of serious infections was 0.02 per person. Response and partial remission rates after 192 weeks were similar to those reported after 96 weeks. Metformin reduces risk Metformin reduces the risk of developing diabetes in individuals at increased risk, a meta-analysis suggests (Am J Med 2008;121:149-57.e2). The study included 31 mostly small, randomised, controlled trials involving a total of 4570 participants and lasting at least eight weeks (8267 patient-years of treatment). Metformin was associated with reductions in body mass (,5.3 per cent), fasting glucose (,4.5 per cent) and insulin resistance (,22.6 per cent); lipid profiles also improved. The odds of developing diabetes were reduced by 40 per cent,an absolute risk reduction of 6 per cent over 1.8 years. MHRA clarifies cough and colds advice Press reports mistakenly suggested that the MHRA had banned some cough and cold remedies when it issued new guidance on treating young children, the MHRA says. The Agency's advice followed a review of over-thecounter cough and cold medicines for children by the Commission on Human Medicines. Children under two are at increased risk of adverse reactions and should no longer be treated with products containing antihistamine (chlorphenamine, brompheniramine, diphenhydramine), antitussives (dextromethorphan, pholcodine), expectorants (guaifenesin, ipecacuanha) and decongestants (phenylephrine, pseudoephedrine, ephedrine, oxymetazoline and xylometazoline). The MHRA said these products, which are classified as general sale medicines, should be removed from open shelves until available in new packaging that complies with the advice. They may still be supplied by a pharmacist for the treatment of older children. Coughs and colds should be treated with paracetamol or ibuprofen for fever, a simple glycerol, honey or lemon syrup for cough, and vapour rubs and inhalant decongestants for stuffy nose. Saline drops can be used to thin and clear nasal secretions in young babies. Parents are being urged not to use more than one product at a time to avoid inadvertently administering the same constituent drug twice. Perindopril brand switch Servier Laboratories is replacing its current formulations of perindopril (Coversyl, Coversyl Plus) with a new product that is not bioequivalent. The current Coversyl brand contains perindopril erbumine (also known as tert -butylamine). The new formulation contains perindopril arginine; it will be distinguished by new brand names (Coversyl Arginine, Coversyl Arginine Plus) and new packaging. Coversyl 2, 4 and 8mg tablets are equivalent to Coversyl Arginine 2.5, 5 and 10mg. Servier says the change is part of the simplification and harmonisation of global manufacturing; the arginine salt is already used in other countries and offers greater stability and a longer shelf-life. Both Coversyl and Coversyl Arginine will be in the supply chain for the next few weeks. Generic perindopril will continue to be the erbumine salt and prescriptions for generic perindopril are not affected. New from NICE Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. Clinical Guidance No. 63, March 2008 This clinical guideline focuses on additional aspects of care for women with gestational diabetes (88 per cent of cases) or pre-existing diabetes (of which about 40 per cent is type 2 diabetes) and their babies. To date, insulin aspart (NovoRapid) is the only drug in the guideline specifically licensed for use in pregnancy and NICE advises obtaining informed consent to implement its recommendations for using other insulins and oral hypoglycaemic agents. As with other guidelines, NICE begins by stressing the importance of patient-centred care and involving women in decisions about their treatment. The guideline is divided into six sections, dealing with consecutive periods of pregnancy. Preconceptual planning should include empowering women to help them reduce risks, optimising glycaemic control (after retinal assessment) and increasing monitoring intensity, and providing information about the effects of pregnancy on diabetes. Metformin may be recommended as an adjunct or alternative to insulin, but other oral hypoglycaemic agents should be replaced with insulin, although glibenclamide is an option during pregnancy. Isophane insulin is the preferred long-acting insulin; lispro (Humalog) and aspart are considered safe to use. ACE inhibitors and angiotensin-II receptor blockers should be replaced with other antihypertensive agents and statins should be discontinued. Recommendations for screening and treatment of gestational diabetes build on previous guidance (CG62). Drug treatment will be needed by 10-20 per cent , this includes insulin (soluble, aspart or lispro) and/or metformin or glibenclamide, tailored to individual need. Antenatal care includes optimising glycaemic control. Insulin lispro or aspart should be considered in preference to soluble insulin. If glycaemic control cannot be achieved with insulin injections, an insulin pump may be indicated. The guideline includes a timetable for appointments and the care that should offered after each interval. Recommendations for intrapartum care, which supplement those in CG55, include frequent monitoring of blood glucose. Neonatal care includes recommendations for monitoring and screening the infant and the management of hypoglycaemia. Postnatal care (supplementing CG37) involves adjusting maternal treatment to avoid hypoglycaemia and recommendations for returning to community care. Metformin and glibenclamide are the only oral agents suitable for breastfeeding women. Women with gestational diabetes need advice about glycaemic control and planning for future pregnancies. Lifestyle advice and measurement of annual fasting plasma glucose should be offered. Inhaled corticosteroids for the treatment of chronic asthma in adults and in children aged 12 years and over. Technology Appraisal No. 138, March 2008 The latest technology appraisal of asthma treatments covers inhaled steroids for adults and children over 12 with chronic asthma. It makes only two recommendations. First, the cheapest appropriate option is recommended. Second, when a steroid and a long-acting beta2-agonist are indicated, the decision to prescribe a combined inhaler or separate devices should take into account therapeutic need and likely adherence. Combined inhalers are currently less expensive than separate devices, though they may not remain so. When a combined inhaler is chosen it should be the cheapest. NICE concludes that, at equivalent doses, there is little difference in the effectiveness or adverse event profile of the available steroids or the fixed-dose combinations. According to specialist advice, choosing the best device for an individual remains the overriding concern. Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome. Technology Appraisal No. 139, March 2008 NICE recommends continuous positive airway pressure (CPAP) for adults with moderate or severe obstructive sleep apnoea, and for those with a milder disorder if quality of life and functioning are impaired and alternative strategies such as lifestyle change have failed. Diagnosis and treatment is the responsibility of a specialist team. A CPAP device costs £250-£550 and lasts for seven years. Copyright © 2008 Wiley Interface Ltd [source]

Use of continuous positive airway pressure in the acute management of laryngeal paralysis in a cat

AUSTRALIAN VETERINARY JOURNAL, Issue 10 2008
K Ticehurst
Continuous positive airway pressure (CPAP) has been is used widely in humans to manage obstructive sleep apnoea syndrome, but it has not been widely used in animals. A brachycephalic cat, with previously undiagnosed laryngeal paralysis, that developed acute upper respiratory tract obstruction on recovery from anaesthesia, is presented. The condition was managed by CPAP, delivered via a facial mask. [source]

Budesonide delivered by dosimetric jet nebulization to preterm very low birthweight infants at high risk for development of chronic lung disease

ACTA PAEDIATRICA, Issue 12 2000
B Jónsson
We investigated the effect of an aerosolized corticosteroid (budesonide) on the oxygen requirement of infants at high risk for developing chronic lung disease (CLD) in a randomized, double-blind study. The study objective was to attain a 30% decrease in FiO2 levels in the budesonide treatment group after 14 d of therapy. Thirty very low birthweight (VLBW) infants (median (range)) gestational age 26 wk (23,29) and birthweight 805 g (525,1227) were randomized. Inclusion criteria were mechanical ventilation on day 6 of life, or if extubated on nasal continuous positive airway pressure with FiO2± 0.3. The budesonide (PulmicortÔ dose was 500 ,g bid, or placebo. The aerosol was delivered with a dosimetric jet nebulizer, with variable inspiratory time and breath sensitivity. Inhalations were started on day 7 of life. Twenty-seven patients completed the study. A significant lowering of the FiO2 levels at 21 d of life was not detected. Infants who received budesonide were more often extubated during the study period (7/8 vs 2/9) and had a greater relative change from baseline in their oxygenation index (budesonide decreased 26% vs placebo increased 60%). Subsequent use of intravenous dexamethasone or inhaled budesonide in the treatment group was significantly less. All patients required O2 supplementation on day 28 of life. At 36 wk postconceptual age, 61% of infants in the budesonide group needed supplemental O2 as opposed to 79% in the placebo group. No side effects on growth or adrenal function were observed Conclusion: We conclude that inhaled budesonide aerosol via dosimetric jet nebulizer started on day 7 of life for infants at high risk for developing CLD decreases the need for mechanical ventilation similar to intravenous dexamethasone, but without significant side effects. [source]

Prevalence of Sleep Disordered Breathing in a Heart Failure Program

CONGESTIVE HEART FAILURE, Issue 5 2004
Robin J. Trupp MSN
Recent data show that a high percentage of patients with systolic left ventricular dysfunction have sleep-disordered breathing (SDB), contributing to the incidence of morbidity and mortality in heart failure. This study examines the prevalence of sleep disorders in stable heart failure patients regardless of ejection fraction. On three consecutive days in a heart failure clinic, all patients were asked to participate in a screening for SDB. This screening involved the placement of an outpatient device (ClearPath, Nexan, Inc., Alpharetta, GA), which collects thoracic impedance, oxyhemoglobin saturation, and 2-lead electrocardiogram data. Sixteen patients (42%) had moderate or severe SDB, and 22 patients (55%) had mild or no significant SDB. Fourteen of the 16 patients with moderate or severe SDB subsequently received treatment by confirming SDB and the continuous positive airway pressure in a sleep lab. Forty-two percent of patients with stable heart failure presenting to a heart failure clinic screened positive for SDB, despite receiving optimal standard of care. [source]

Effects of Continuous Positive Airway Pressure Therapy on Right Ventricular Function Assessment by Tissue Doppler Imaging in Patients with Obstructive Sleep Apnea Syndrome

ECHOCARDIOGRAPHY, Issue 10 2008
Nihal Akar Bayram M.D.
Objectives: The effects of continuous positive airway pressure (CPAP) therapy on right ventricular (RV) function in patients with obstructive sleep apnea syndrome (OSAS) has not been previously studied by tissue Doppler imaging (TDI). The aim of this study was to assess RV function using TDI in patients with OSAS before and after CPAP therapy. Methods: Twenty-eight patients with newly diagnosed OSAS in the absence of any confounding factors and 18 controls were included in this study. The peak systolic velocity (S,m), early (E,m) and late (A,m) diastolic myocardial peak velocities at tricuspid lateral annulus, isovolumic acceleration (IVA), myocardial precontraction time (PCT,m), myocardial contraction time (CT,m), and myocardial relaxation time (RT,m) were measured. All echocardiographic parameters were calculated 6 months after CPAP therapy. Results: The RV diastolic parameters such as E,m velocity and E,m-to-A,m ratio were significantly lower, RT,m was significantly prolonged, A,m velocity was similar in patients with OSAS compared to controls; and the RV systolic parameters such as IVA and CT,m were significantly lower and S,m was similar in patients with OSAS compared to controls. At the end of the treatment, 20 of 28 patients were compliant with CPAP therapy. E,m velocity, E,m-to-A,m ratio, IVA, and CT,m increased, PCT,m, PCT,m-to-CT,m ratio, and RT,m decreased significantly after therapy, whereas S,m velocity and A,m velocity did not change after CPAP treatment in the compliant patients. Conclusion: OSAS is associated with RV systolic and diastolic dysfunction, and 6 months of CPAP therapy improves the RV systolic and diastolic dysfunction. [source]

Review of non-invasive ventilation in the emergency department: clinical considerations and management priorities

JOURNAL OF CLINICAL NURSING, Issue 23 2009
Louise Rose
Aims and objectives., We aimed to synthesise evidence from published literature on non-invasive ventilation to inform nurses involved in the clinical management of non-invasive ventilation in the emergency department. Background., Non-invasive ventilation is a form of ventilatory support that does not require endotracheal intubation and is used in the early management of acute respiratory failure in emergency departments. Safe delivery of this intervention requires a skilled team, educated and experienced in appropriate patient selection, available devices and monitoring priorities. Design., Systematic review. Method., A multi-database search was performed to identify works published in the English language between 1998,2008. Search terms included: non-invasive ventilation, continuous positive airway pressure and emergency department. Inclusion and exclusion criteria for the review were identified and systematically applied. Results., Terminology used to describe aspects of non-invasive ventilation is ambiguous. Two international guidelines inform the delivery of this intervention, however, much research has been undertaken since these publications. Strong evidence exists for non-invasive ventilation for patients with acute exacerbation of congestive heart failure and chronic obstructive pulmonary disease. Non-invasive ventilation may be delivered with various interfaces and modes; little evidence is available for the superiority of individual interfaces or modes. Conclusions., Early use of non-invasive ventilation for the management of acute respiratory failure may reduce mortality and morbidity. Though international guidelines exist, specific recommendations to guide the selection of modes, settings or interfaces for various aetiologies are lacking due to the absence of empirical evidence. Relevance to clinical practice., Monitoring of non-invasive ventilation should focus on assessment of response to treatment, respiratory and haemodynamic stability, patient comfort and presence of air leaks. Complications are related to mask-fit and high air flows; serious complications are few and occur infrequently. The use of non-invasive ventilation has resource implications that must be considered to provide effective and safe management in the emergency department. [source]

Protein intake, growth and lung function of infants with chronic lung disease

JOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2009
E. Cillié
Background:, The increased survival rate of extremely preterm infants has not improved the incidence or outcome of infants diagnosed with chronic lung disease (CLD) (Riley, 2008). The relationship between optimal nutrition (particularly protein intake) and chronic lung disease has not been established. The aim of this study was to investigate the association between protein intake, growth and lung function in infants with CLD. Methods:, A CLD database, maintained for the past 10 years, was used to select participants that had reached 1 year of corrected age. Infants who were born during 2001,2006 with a birth weight of <1500 g, and who subsequently had a diagnosis of CLD, were included. Infants with evidence of intra-uterine growth restriction and abnormal cerebral pathology were excluded. Demographic, mean weight gain, protein intake and respiratory support data were collected retrospectively from the medical notes. Growth parameters and need for oxygen and inhalers up to 1 year of corrected age were collected from the CLD follow-up database. SPSS, version 15 (SPSS Inc., Chicago, IL, USA) were used for Pearson's or Spearmans correlation analysis and analysis of variance or the Wilcoxon test, as appropriate. Results:, Sixty infants were studied: 25 females and 35 males. The median (range) post-menstrual age at birth was 26 (22,31) weeks. The most common feed was breast milk; fortified breast milk was used for 37% of the total days studied. The mean (SD) protein intake was 2.28 (0.33) g kg,1 day,1 and the mean (SD) weight gain was 11.67 (1.77) g kg,1 day,1. There was a positive correlation between protein intake and weight gain (r = 0.32, P = 0.013), which was stronger in females (r = 0.51, P = 0.009). Protein intake was significantly associated with head circumference growth in females only (r = 0.47, P = 0.038). Protein intake was inversely related to the number of days spent mechanically ventilated (r = ,0.32, P = 0.015). There was no relationship between protein intake and growth at 1 year corrected age, time spent on continuous positive airway pressure, age weaned off oxygen, or the use of inhalers. There was an inverse correlation between total weeks of oxygen dependence and head circumference at 1 year (r = ,0.35, P = 0.022). Discussion:, The mean protein intake was <3 g kg,1 day,1, which is the minimum requirement for preterm infants (Tsang et al., 2005). This was associated with a sub-optimal weight gain in our participants of <15 g kg,1 day,1 (Steward & Pridham, 2002). The study demonstrates the known association between low protein intake and poor growth with ventilator dependence (Loui et al., 2008). Conclusions:, Low birth weight and low gestational age infants at risk of CLD should receive special attention to optimise their protein intake because sub-optimal protein intake potentially leads to poor growth when on a neonatal intensive care unit. References Loui, A., Tsalikaki, E., Maier, K., Walch, E., Kamarianakis, Y. & Obladen, M. (2008) Growth in high risk infants <1500 g birth weight during the first 5 weeks. Early Hum. Dev. 84, 645,650, Doi: 10.1016/j.earlhumdev.2008.04.005. Riley, K., Roth, S., Sellwood, M. & Wyatt, J.S. (2008) Survival and neurodevelopmental morbidity at 1 year of age following extremely preterm delivery over a 20-year period: a single centre cohort study. Acta Paediatr.97, 159,165. Steward, D.K. & Pridham, K.F. (2002) Growth patterns of extremely low-birth-weight hospitalised preterm infants. JOGN Nurs31, 57,65. Tsang, R.C., Uauy, R., Koletzko, B. & Zlotkin, S.H., eds. (2005) Nutrition of the Preterm Infant: Scientific Basis and Practical Guidelines. Cincinnati: Digital Educational Publishing. [source]

Short-term effects of a mandibular advancement device on obstructive sleep apnoea: an open-label pilot trial

JOURNAL OF ORAL REHABILITATION, Issue 8 2005
G. AARAB
summary, Obstructive sleep apnoea (OSA) is a common sleep disorder, which is, among others, associated with snoring. OSA has a considerable impact on a patient's general health and daily life. Nasal continuous positive airway pressure (nCPAP) is frequently used as a ,gold standard' treatment for OSA. As an alternative, especially for mild/moderate cases, mandibular advancement devices (MADs) are prescribed increasingly. Their efficacy and effectiveness seem to be acceptable. Although some randomized clinical trials (RCTs) have been published recently, most studies so far are case studies. Therefore, our department is planning a controlled RCT, in which MADs are compared with both nCPAP and a control condition in a parallel design. As a first step, an adjustable MAD was developed with a small, more or less constant vertical dimension at different mandibular positions. To test the device and the experimental procedures, a pilot trial was performed with 10 OSA patients (six mild, four moderate; one women, nine men; mean age = 47·9 ± 9·7 years). They all underwent a polysomnographic recording before as well as 2,14 weeks after insertion of the MAD (adjusted at 50% of the maximal protrusion). The apnoea,hypopnoea index (AHI) was significantly reduced with the MAD in situ (P = 0·017). When analysed as separate groups, the moderate cases showed a significantly larger decrease in AHI than the mild cases (P = 0·012). It was therefore concluded from this pilot study that this MAD might be an effective tool in the treatment of, especially, moderate OSA. [source]

Exposure to noise during continuous positive airway pressure: influence of interfaces and delivery systems

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2008
F. CAVALIERE
Background: We measured noise intensity and perceived noisiness during continuous positive airway pressure (CPAP) performed with two interfaces (face-mask, helmet) and four delivery systems. Methods: Eight healthy volunteers received CPAP in random order with: two systems provided with a flow generator using the Venturi effect and a mechanical expiratory valve (A: Venturi, Starmed; B: Whisperflow-2, Caradyne Ltd); one ,free-flow' system provided with high flow O2 and air flowmeters, an inspiratory gas reservoir, and a water valve (C: CF800, Drägerwerk, AG); and a standard mechanical ventilator (Servoventilator 300, Siemens-Elema). Systems A, B, and C were tested with a face-mask and a helmet at a CPAP value of 10 cm H2O; the mechanical ventilator was only tested with the face mask. Noise intensity was measured with a sound-level meter. After each test, participants scored noisiness on a visual analog scale (VAS). Results: The noise levels measured ranged from 57±11 dBA (mechanical ventilator plus mask) to 93±1 and 94±2 dBA (systems A and B plus helmet) and were significantly affected by CPAP systems (A and B noisier than C and D) and interfaces (helmet CPAP noisier than mask CPAP). Subjective evaluation showed that systems A and B plus helmet were perceived as noisier than system C plus mask or helmet. Conclusions: Maximum noise levels observed in this study may potentially cause patient discomfort. Less noisy CPAP systems (not using Venturi effect) and interfaces (facial mask better than helmet) should be preferred, particularly for long or nocturnal treatments. [source]

Continuous positive airway pressure treatment for obstructive sleep apnoea reduces resting heart rate but does not affect dysrhythmias: a randomised controlled trial

JOURNAL OF SLEEP RESEARCH, Issue 3 2009
SONYA CRAIG
Summary Obstructive sleep apnoea (OSA) is associated with cardiovascular morbidity and may precipitate cardiac dysrhythmias. Uncontrolled reports suggest that continuous positive airway pressure (CPAP) may reduce dysrhythmia frequency and resting heart rate. We undertook a randomised controlled trial of therapeutic CPAP and compared with a subtherapeutic control which included an exploration of changes in dysrhythmia frequency and heart rate. Values are expressed as mean (SD). Eighty-three men [49.5 (9.6) years] with moderate,severe OSA [Oxygen Desaturation Index, 41.2 (24.3) dips per hour] underwent 3-channel 24-h electrocardiograms during normal daily activities, before and after 1 month of therapeutic (n = 43) or subtherapeutic (n = 40) CPAP. Recordings were manually analysed for mean heart rate, pauses, bradycardias, supraventricular and ventricular dysrhythmias. The two groups were well matched for age, body mass index, OSA severity, cardiovascular risk factors and history. Supraventricular ectopics and ventricular ectopics were frequently found in 95.2% and 85.5% of patients, respectively. Less common were sinus pauses (42.2%), episodes of bradycardia (12%) and ventricular tachycardias (4.8%). Compared with subtherapeutic control, CPAP reduced mean 24-h heart rate from 83.0 (11.5) to 79.7 (9.8) (P < 0.002) in the CPAP group compared with a non-significant rise (P = 0.18) from 79.0 (10.4) to 79.9 (10.4) in the subtherapeutic group; this was also the case for the day period analysed separately. There was no significant change in the frequencies of dysrhythmias after CPAP. Four weeks of CPAP therapy reduces mean 24-h heart rate possibly due to reduced sympathetic activation but did not result in a significant decrease in dysrhythmia frequency. [source]

Daytime sympathetic hyperactivity in OSAS is related to excessive daytime sleepiness

JOURNAL OF SLEEP RESEARCH, Issue 3 2007
VINCENZO DONADIO
Summary The aim of this study was to investigate the relationships among sympathetic hyperactivity, excessive daytime sleepiness (EDS) and hypertension in obstructive sleep apnoea syndrome (OSAS). Ten newly diagnosed OSAS patients with untreated EDS and daytime hypertension underwent polysomnography (PSG) and daytime measurements of plasma noradrenaline (NA), ambulatory blood pressure (BP), muscle sympathetic nerve activity (MSNA) by microneurography and objective assessment of EDS before and during 6 months of compliance-monitored continuous positive airway pressure (CPAP) treatment. One month after the start of CPAP, BP, MSNA and NA were significantly lowered, remaining lower than baseline also after 3 and 6 months of treatment. CPAP use caused a significant improvement of sleep structures, and reduced EDS. A statistical correlation analysis demonstrated that EDS was not correlated with sleep measures obtained from baseline PSG (% sleep stages, apnoea and arousal index, mean oxygen saturation value), whereas daytime sleepiness was significantly correlated with MSNA. Furthermore, MSNA and BP showed no correlation. Our data obtained from selected patients suggest that the mechanisms inducing EDS in OSAS are related to the degree of daytime sympathetic hyperactivity. Additionally, resting MSNA was unrelated to BP suggesting that factors other than adrenergic neural tone make a major contribution to OSAS-related hypertension. The results obtained in this pilot study need, however, to be confirmed in a larger study involving more patients. [source]

Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age ,27 weeks)

PEDIATRIC ANESTHESIA, Issue 4 2007
ANGELA KRIBS MD
Summary Background:, Spontaneous breathing supported by nasal continuous positive airway pressure (nCPAP) is thought to have some advantages compared with mechanical ventilation in extremely premature infants. In addition, early or prophylactic surfactant administration has been shown to be superior to delayed use. A strategy to combine these two principles was tested in our neonatal intensive care unit (NICU). The aim of this feasibility study was to describe the procedure and compare short-term results with a historical control. Methods:, The study took place in a level III NICU. In the observational period all extremely premature infants with clinical signs of moderate to severe respiratory distress syndrome despite nCPAP received 100 mg·kg,1 of a natural surfactant preparation via an intratracheal catheter during spontaneous breathing. In the historical control period those infants were intubated and ventilated to receive surfactant. Results:, Twenty-nine of 42 infants fulfilled the criteria and were treated with the new approach. In five cases ventilation with manual bag was necessary after administration of surfactant but all infants could be retransferred to nCPAP within a few minutes. Ten infants were intubated later during the first 3 days. Mortality was 7% in the group of infants treated in this way and 12% in all infants treated during the observational period. Mortality was 35% in the historical control period. Morbidity was within ranges reported by other authors. Conclusions:, Surfactant administration during nCPAP is feasible. First results indicate that early complications are rare. This warrants a prospective randomized trial. [source]

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit

PEDIATRIC ANESTHESIA, Issue 9 2006
ALEX VELDMAN MD
Summary Background :,Unplanned extubation events (UEE) are a serious hazard to patient safety, especially on a neonatal intensive care unit (NICU), where reestablishing a secure airway can be difficult. The following study was undertaken to analyze characteristics of UEE and develop prevention strategies. Methods :,A retrospective cohort study on a level III single center NICU was undertaken. Patient records of a 12-month period from December 2003 to December 2004 were analyzed using a standardized evaluation form. Fischer's exact t -test and the Mann,Whitney U -Ranked Sum test were used for statistical analysis. Results :,One hundred and four neonates with a total ventilation time of 14 495 h were included in this study. Of these patients 12 UEE were observed (1 UEE/1208 h of ventilation time). Neither median birth weight [1445 g (range 460,4650) vs 1755 g (range 460,3570 g)] nor median gestational age [31.5 weeks (range 25.6,39.6 weeks) vs 32.7 weeks (range 23.9,41.5 weeks)] differed significantly between neonates with UEE compared with the total group. When the UEE occurred, the neonates were cared for by experienced nursing staff with a median of 10 years nursing experience. The workload for the individual nurse was high: during shifts when UEE happened, each nurse had to take care of 3.85 patients (range 1.8,5 patients). This workload was higher than the average of 3 (range 1.6,6) patients/nurse during the study period. The most frequently reported reason for UEE was difficult fixation of the tracheal tube (TT) (four patients), followed by handling of the infant by nursing staff or physiotherapy (two patients) or an active infant in whom dislocation of the TT occurred without external manipulations (three patients). In three instances, the reason for the UEE was not documented. Of the 12 UEE observed in 10 patients, three required immediate reintubation, five were managed with nasal continuous positive airway pressure and four did not require further respiratory support. Of those who required support, FiO2 increased by 14% over baseline compared with the FiO2 prior to UEE. Conclusions :,Inadequate TT fixation could be identified as the main contributor to UEE and should be targeted in prevention strategies. The reintubation rate after UEE was only 25%. Overall, UEE did not result in an adverse outcome in terms of mortality. Length of stay on NICU was significantly longer in UEE patients. [source]

Delivery characteristics of a combined nitric oxide nasal continuous positive airway pressure system

PEDIATRIC ANESTHESIA, Issue 6 2002
DEAA, R. Lindwall MD
Summary Background: Nitric oxide (NO), when inhaled, has a synergistic effect with airway recruitment strategies such as positive endexpiratory pressure (PEEP) or continuous positive airway pressure (CPAP) in improving oxygenation in lung injury. Methods: We modified a commercially available nasal CPAP (nCPAP) system to enable the concomitant delivery of inhaled NO (iNO) and nCPAP to neonates and term babies. Oxygen, NO and nitrogen dioxide (NO2) concentrations were measured, comparing the effects of using 50 or 1000 parts per million (p.p.m.) NO stock gas cylinders. Results: Stable and accurate delivery of iNO was found for both stock gas concentrations. Using a 50 p.p.m. NO stock gas resulted in limited NO2 formation, with a maximum inspired NO2 concentration of , 0.3 p.p.m. (dose range up to 37 p.p.m. iNO), which was interpreted as the result of progressive dilution with nitrogen. In contrast, using a 1000 p.p.m. NO stock gas cylinder, inspired NO2 levels increased nonlinearly as expected with an increasing inspired concentration of NO. Conclusions: Inhaled NO can be safely and reliably delivered by the system we describe. The NO2 levels generated by the system are low, at least up to a dose of 37 p.p.m. NO, regardless of a stock gas concentration of 50 or 1000 p.p.m. NO. Using a 50 p.p.m. NO stock gas concentration, up to 80% oxygen can be given at 10 p.p.m. iNO. [source]

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Sexual Function and Obstructive Sleep Apnea,Hypopnea: A Randomized Clinical Trial Evaluating the Effects of Oral-Appliance and Continuous Positive Airway Pressure Therapy

THE JOURNAL OF SEXUAL MEDICINE, Issue 4ii 2007
Aarnoud Hoekema DMD
ABSTRACT Introduction., The obstructive sleep apnea,hypopnea syndrome (OSAHS) is associated with sexual dysfunction. Although successful treatment with continuous positive airway pressure (CPAP) has been demonstrated to improve sexual function, the effects of oral-appliance therapy are unknown. Aim., The aims of this study were to determine to what extent untreated male OSAHS patients experience sexual dysfunctions compared with control subjects, and second, to evaluate the effects of oral-appliance and CPAP therapy on sexual functioning. Methods., Sexual functioning was determined in 48 OSAHS patients with the Golombok Rust inventory of sexual satisfaction (GRISS) and a testosterone measurement. GRISS outcomes were compared with 48 age-matched male controls without any sexual problems. Patients were randomized for either oral-appliance or CPAP therapy. After 2,3 months of treatment, the GRISS and testosterone measurements were repeated. Main Outcome Measure., The outcomes on the GRISS were used as the main outcome measure. Results., Compared with controls, OSAHS patients had significantly more erectile dysfunction (mean ± standard deviation; OSAHS 8.7 ± 3.8 vs. controls 6.8 ± 2.6) and sexual dissatisfaction (mean ± standard deviation; OSAHS 9.7 ± 4.2 vs. controls 8.1 ± 2.6) as indicated by the GRISS. No significant changes in the GRISS or testosterone levels were observed in the 20 and 27 patients completing the follow-up review for oral-appliance and CPAP therapy. A correlation was demonstrated between the extent of erectile dysfunction at baseline and improvements in erectile function following treatment (r = ,0.547, P = 0.000). Conclusions., This study confirms that male OSAHS patients show more sexual dysfunctions compared with age-matched control subjects. Although significant improvements in sexual functioning in neither the oral-appliance nor CPAP-treated group could be established, our findings suggest that untreated OSAHS patients with pronounced erectile dysfunction experience some improvement following treatment. Hoekema A, Stel A-L, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, and de Bont LGM. Sexual function and obstructive sleep apnea,hypopnea: A randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med 2007;4:1153,1162. [source]

The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome,,

THE LARYNGOSCOPE, Issue 1 2009
FACS, Michael Friedman MD
Abstract Objective: To investigate the effect of multilevel upper airway surgery (USA) on subsequent continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design: Fifty-two patients who underwent multilevel UAS with persistent symptoms of OSAHS represent the cohort for this study. All patients had undergone manual CPAP titrations both pre- and postoperatively. Patients were used as their own controls and were compared pre- and postoperatively with regard to body mass index, full night polysomnography (PSG), optimal CPAP pressure settings, presence of rapid eye-movement (REM) sleep, identification of mouth leakage, and CPAP compliance. Results: Postoperative values for apnea index (AI), apnea hypopnea index (AHI), and minimum oxygen saturation (min SaO2) were all significantly decreased from their preoperative levels. Compliance with CPAP therapy significantly increased from a mean 0.02 ± 0.14 hours per night prior to surgery to a 3.2 ± 2.6 hours per night following surgery (P < .001). In addition, the optimal CPAP pressure setting decreased significantly for a preoperative value of 10.6 ± 2.1 cm H2O to 9.8 ± 2.1 cm H2O following surgery. Fifty of the 52 patients (96.2%) studied were able to maintain optimal pressure settings without mouth leak, postoperatively. Conclusions: In this study, most patients who had persistent symptoms of OSAHS after multilevel UAS did not have significant mouth leak that would preclude CPAP therapy. In this cohort of patients, CPAP pressure setting as well as compliance was significantly improved postoperatively. Laryngoscope, 119:193,196, 2009 [source]

A Comparison of the Long-Term Outcome and Effects of Surgery or Continuous Positive Airway Pressure on Patients with Obstructive Sleep Apnea Syndrome

Endoscopic Laryngotracheal Cleft Repair Without Tracheotomy or Intubation

THE LARYNGOSCOPE, Issue 4 2006
Kishore Sandu MD
Abstract Objectives: The objectives of this study are to present the technique and results of endoscopic repair of laryngotracheoesophageal clefts (LTEC) extending caudally to the cricoid plate into the cervical trachea and to revisit the classification of LTEC. Methods: The authors conducted a retrospective case analysis consisting of four infants with complete laryngeal clefts (extending through the cricoid plate in three cases and down into the cervical trachea in one case) treated endoscopically by CO2 laser incision of the mucosa and two-layer endoscopic closure of the cleft without postoperative intubation or tracheotomy. Results: All four infants resumed spontaneous respiration without support after a mean postoperative period of 3 days with continuous positive airway pressure (CPAP). They accepted oral feeding within 5 postoperative days (range, 3,11 days). No breakdown of endoscopic repair was encountered. After a mean follow up of 48 months (range, 3 mos to 7 y), all children have a good voice, have no sign of residual aspiration, but experience a slight exertional dyspnea. Conclusion: This limited experience on the endoscopic repair of extrathoracic LTEC shows that a minimally invasive approach sparing the need for postoperative intubation or tracheotomy is feasible and safe if modern technology (ultrapulse CO2 laser, endoscopic suturing, and postoperative use of CPAP in the intensive care unit) is available. [source]

Effectiveness of Multilevel (Tongue and Palate) Radiofrequency Tissue Ablation for Patients with Obstructive Sleep Apnea Syndrome,

THE LARYNGOSCOPE, Issue 12 2004
David L. Steward MD
Abstract Objectives: The primary objective is to determine the effectiveness of multilevel (tongue base and palate) temperature controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). The secondary objective is to compare multilevel TCRFTA to nasal continuous positive airway pressure (CPAP). Study Design and Methods: The study is a controlled case series of one investigator's experience with multilevel TCRFTA for patients with OSAS. Twenty-two subjects with mild to severe OSAS, without tonsil hypertrophy, completed multilevel TCRFTA (mean 4.8 tongue base and 1.8 palate treatment sessions) and had both pre- and posttreatment polysomnography. Primary outcomes included change from baseline in apnea/hypopnea index (AHI), daytime somnolence, and reaction time testing measured 2 to 3 months after TCRFTA. Secondary outcomes included change in other respiratory parameters, OSAS related quality of life, and upper airway size. Comparison of 18 patients treated with TCRFTA for mild to moderate OSAS (AHI > 5 and , 40) is made with 11 matched patients treated with nasal CPAP for mild to moderate OSAS. Results: Multilevel TCRFTA significantly improved AHI (P = .001), apnea index (P = .02), as well as respiratory and total arousal indices (P = .0002 and P = .01). Significant improvement with moderate or large treatment effect sizes were noted for OSAS related quality of life (P = .01) and daytime somnolence (P = .0001), with a trend toward significant improvement in reaction time testing (P = .06), with mean posttreatment normalization of all three outcome measures. Fifty-nine percent of subjects demonstrated at least a 50% reduction in AHI to less than 20. The targeted upper airway, measured in the supine position, demonstrated a trend toward significant improvement in mean cross sectional area (P = .05) and volume (P = .10). Side effects of TCRFTA were infrequent, mild, and self-limited. No significant correlation between pretreatment parameters and outcome improvement was noted. Nasal CPAP resulted in significant improvement in AHI (P = .0004) to near normal levels, with an associated improvement in OSAS related quality of life (P = .02) and a trend toward significant improvement in daytime somnolence (P = .06). Reaction time testing demonstrated no significant improvement (P = .75). No significant differences were seen for change in AHI, OSAS related quality of life, daytime somnolence, or reaction time testing between multilevel TCRFTA and CPAP. Conclusion: Multilevel (tongue base and palate) TCRFTA is a low-morbidity, office-based procedure performed with local anesthesia and is an effective treatment option for patients with OSAS. On average, abnormalities in daytime somnolence, quality of life, and reaction time testing demonstrated improvement from baseline and were normalized after treatment. Polysomnographic respiratory parameters also demonstrated significant improvement with multilevel TCRFTA. [source]

The Long-Term Evaluation of Tracheostomy in the Management of Severe Obstructive Sleep Apnea,

THE LARYNGOSCOPE, Issue 2 2003
Gentry W. Thatcher MD
Abstract Objective To determine the long-term success and morbidity of tracheostomies for patients with severe obstructive sleep apnea. Study Design A retrospective study of patients who have undergone tracheostomy for documented obstructive sleep apnea at Hennepin County Medical Center since 1979. Methods Retrospective chart review of all tracheostomy patients operated January 1, 1979, to June 30, 1999, were evaluated. Follow-up data from patient records, death certificates, and DMV. Results Seventy-nine patients (70 men and 9 women; age range, 25,70 y; mean age, 47 y) received tracheostomies at a regional sleep disorder center. Respiratory distress index ranged from 45 to 146 (mean value, 81). Tracheostomy eliminated obstructive sleep apnea in all cases. Follow-up ranged from 3 months to 20 years (mean period, 8.3 y). In all, 16 patients had decannulation (range, 2 mo to 13 y): 5 of the patients chose continuous positive airway pressure, 3 grew intolerant of their tracheostomy, 3 had obstructive sleep apnea fully resolve after uvulopalatopharyngoplasty, 3 unknown diagnosis for decannulation, 2 had significant weight loss. Morbidity seen within the first year was primarily limited to granulation tissue, infection, and stoma revision. Fourteen deaths were identified. Average age at time of death was 62 years. Five deaths were cardiopulmonary related, four were from cancer, two were from postoperative complications of unrelated surgery, and one was from aspiration. Tracheostomy-related mortality included one postoperative myocardial infarction and one tracheal-innominate fistula. Conclusion Severe obstructive sleep apnea and its comorbid conditions are effectively treated in the long term with tracheostomy. Initial management of more frequent complication is well tolerated. Significant morbidity and mortality are low. Chances of obstructive sleep apnea resolution allowing decannulation remain poor. [source]

Retropharyngeal Lipoma Causing Obstructive Sleep Apnea: Case Report Including Five-Year Follow-Up,

THE LARYNGOSCOPE, Issue 9 2002
Neil G. Hockstein MD
Abstract Objectives/Hypothesis Lipomas of the retropharyngeal space are rare and do not cause symptoms until they reach a large size. Although retropharyngeal lipoma is an uncommon entity, several reports of it appear in the literature, and the treatment has routinely been surgical excision. Such fatty tumors also carry the rare possibility of being liposarcomas, which further warrants their excision. We present the case of a lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum causing symptoms of obstructive sleep apnea. The patient had multiple medical problems and was on a regimen of anticoagulation therapy; therefore, he opted against surgical treatment. He has used continuous positive airway pressure and has been followed clinically and radiographically for 5 years. Radiographic follow-up of a retropharyngeal lipoma after a needle biopsy confirming its benign nature is a legitimate means of management of this rare condition. Study Design Case report of a 64-year-old man presenting with this rare lesion. Methods Computed tomography-guided needle biopsy of the mass was performed to obtain tissue diagnosis. Thereafter, the patient has been followed for 5 years with annual magnetic resonance imaging scans to determine growth or changes of the retropharyngeal mass. Results Fine-needle aspiration of the mass revealed mature adipose tissue intermixed with fibroconnective tissue, consistent with lipoma. Based on this result, we opted to follow this patient with serial magnetic resonance imaging scans, which have shown no change in size. There has also been no change in the patient's symptoms. Conclusions Large lipomas warrant excision, especially when their location produces pressure symptoms. However, when surgical morbidity is high, fine-needle aspiration biopsy and serial magnetic resonance imaging scans are a safe alternative. [source]

Pandemic (H1N1) 2009 influenza: experience from the critical care unit

ANAESTHESIA, Issue 11 2009
M. Patel
Summary This case series details experience of critical care admissions with pandemic (H1N1) 2009 influenza from an intensive care unit in the West Midlands. We present four critically ill patients admitted with severe hypoxia. Two of the patients failed a trial of continuous positive airway pressure and all underwent controlled ventilation within 24 h of admission. Bilevel and high frequency oscillatory ventilation were the most useful modes. Our patients generally had one organ failure and were ventilator dependent for relatively short periods of time. Three of the patients made a full recovery and one required ongoing dialysis. We also discuss service planning and our response to the pandemic. We were well prepared with stocks of personal protective equipment but had to modify plans as the outbreak progressed. Our cases and discussion provide useful information for other intensive care units preparing for the predicted autumn surge of H1N1 cases. [source]

Sexual functions of men with obstructive sleep apnoea syndrome and hypogonadism may improve upon testosterone administration: a pilot study

ANDROLOGIA, Issue 3 2009
V. N. Zhuravlev
Summary This study examined 72 patients with obstructive sleep apnoea syndrome (OSAS), confirmed by polysomnography. Thirty-two patients were suffering from erectile dysfunction (ED) assessed by IIEF-5 questionnaires and confirmed by nocturnal penile tumescence examination. Their testosterone levels were measured. Eight patients had normal testosterone levels and were treated with a PDE-5 inhibitor (vardenafil) only; after 6 months of treatment, 6 of these patients (75%) showed significant improvement in erectile function. The remaining 24 patients with OSAS, ED and hypogonadism (total testosterone <12 nmol l,1), were divided into two groups based on the indication for continuous positive airway pressure (CPAP) therapy: five patients received CPAP therapy (group 1) and 19 patients did not (group 2). The patients of group 2 received only a PDE-5 inhibitor (vardenafil 20 mg) for ED; and eight patients (42%) showed an improvement after 3 months of treatment. The five patients receiving CPAP therapy were treated with a combination of parenteral testosterone undecanoate and a PDE-5 inhibitor (vardenafil) and all had normal erectile function after 3 months of therapy. The results suggest positive effects of addition of testosterone to treatment with PDE-5 inhibitors in hypogonadal men with OSAS, which should be confirmed in larger controlled studies. [source]

Heart Rate Variability in Obstructive Sleep Apnea: A Prospective Study and Frequency Domain Analysis

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2003
Lorne J Gula F.R.C.P.C.
Background: Cyclic variation of the heart rate is observed during apneic spells in obstructive sleep apnea (OSA). We hypothesized that autonomic changes would affect frequency-domain measures of heart rate variability (HRV). Methods: We studied 20 patients (15 men, 5 women, mean age 47.2 ± 12.2 years) with suspected OSA undergoing overnight polysomnography, and five patients (4 men, 1 woman, mean age 49.2 ± 8.6 years) with recently diagnosed sleep apnea undergoing polysomnography while wearing continuous positive airway pressure (CPAP). Holter monitors were applied during sleep studies and data were analyzed in 5-minute blocks over the course of the night. Using spectral analysis, low frequency (LF) and high frequency (HF) powers were calculated for each interval. Overall mean and standard deviation (SD) for LF power, HF power, and the LF:HF ratio were recorded for each patient. Comparisons were made between patients with severe OSA (apnea hypopnea index (AHI) > 30, n = 8), moderate OSA (AHI 1,30, n = 5), without OSA (AHI < 10, n = 7), and patients wearing CPAP (n = 5). Results: Assessment of overnight LF or HF power revealed no significant difference between the four groups. The LF:HF ratio, which represents sympathovagal balance, was higher among those with moderate disease compared to normals and those with severe OSA (both P = 0.037). The standard deviation of the LF:HF ratio was higher among those with moderate disease compared to normals (P = 0.0064) and those with severe OSA (P = 0.0006). OSA patients receiving CPAP behaved like patients with moderate OSA, with increased SD of the LF:HF ratio. Conclusions: The observed changes in the LF:HF ratio and its SD suggest an increased sympathetic tone and discordance in sympathovagal activity in moderate OSA, which is blunted in severe OSA. CPAP may restore autonomic defects, characteristic of severe OSA, to moderate levels. [source]