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Hypopnoea Index (hypopnoea + index)
Selected AbstractsDoes propofol and alfentanil-induced sedation cause periodic apnoea in chronic renal failure patients?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2010S. M. Lee Summary Aims:, There is evidence suggesting that the respiratory response to sedation is different in patients with sleep apnoea, which is common in patients with chronic renal failure (CRF). This study examined the respiratory response of sedation with propofol and alfentanil, whose pharmacokinetics are not affected by the renal function, in CRF patients. Methods:, Chronic renal failure patients who underwent arteriovenous-fistular surgery (CRF group) and patients who underwent chemoport insertion (control group) were enrolled in this study. Sedation was induced by infusing propofol 1.5 ,/ml and alfentanil 0.2 ,/kg/min continuously in both groups. In the desaturation study, the respiratory rate and peripheral oxygen saturation in room air were checked. In the apnoea,hypopnoea study, the patient's sedation (Observer's Assessment of Alertness/Sedation) score, apnoea,hypopnoea index (AHI) was recorded using a portable ventilation effort recorder (microMesam) while applying 5 l/min of oxygen through a facial mask. Results:, The desaturation event was more common (21.5/h vs. 2/h, p = 0.001) in the CRF patients. Apnoea and hypopnoea (AHI: 13.0 vs. 1.6, p = 0.012, per cent of patients with an AHI > 5: 53.3% vs. 7.1%, p = 0.014) occurred more frequently in the CRF patients but the sedation score was not different. Conclusion:, Chronic renal failure patients have a higher risk of developing apnoea and hypopnoea during sedation, which highlights the need for careful monitoring and management in these patients. [source] Effects of a mandibular advancement device on the upper airway morphology: a cephalometric analysisJOURNAL OF ORAL REHABILITATION, Issue 5 2009M. H. J. DOFF Summary, The aims of this study were to assess changes in the upper airway morphology associated with an oral appliance in situ in patients suffering from the obstructive sleep apnoea,hypopnoea syndrome and to relate these changes to treatment response. Changes in upper airway morphology as a result of an oral appliance were assessed in 52 patients with obstructive sleep apnoea,hypopnoea syndrome by means of cephalometric analysis. Lateral cephalograms were taken at baseline and after 2,3 months of treatment. Baseline and follow-up cephalograms were traced twice and cephalometric variables were compared. The predictive value of changes in upper airway morphology for the treatment response was evaluated in univariate and multivariate regression analyses. Oral appliance therapy resulted in an increased posterior airway space at the level of the second vertebra, the uvular tip and the base of the tongue. The increase of the posterior airway space at the level of the second vertebra and the uvular tip were the best predictors for relative improvement of the apnoea,hypopnoea index. However, the predictive value for treatment response of these cephalometric upper airway changes should be interpreted with caution. [source] Short-term effects of a mandibular advancement device on obstructive sleep apnoea: an open-label pilot trialJOURNAL OF ORAL REHABILITATION, Issue 8 2005G. 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] Evolution of upper airway resistance syndromeJOURNAL OF SLEEP RESEARCH, Issue 3 2009LUIZA JONCZAK Summary The question of whether upper airway resistance syndrome (UARS) is a distinct disease or an initial feature of obstructive sleep apnoea syndrome is still a matter of debate. We evaluated a retrospective group of UARS patients to determine the evolution of UARS over time and the relationship between clinical evolution and subjects' phenotype. Investigations were performed in 30 patients, in whom UARS was diagnosed between 1995 and 2000 by the use of full polysomnography (PSG) without oesophageal pressure (Pes) measurement. The time between initial and follow-up investigations was 6.6 ± 2.6 years. All subjects had full PSG with Pes measurement and completed a sleep questionnaire, including the Epworth Sleepiness Scale. In 19 subjects, PSG results were compatible with UARS. In nine subjects, obstructive sleep apnoea,hypopnoea syndrome (OSAHS) was diagnosed. In two subjects, PSG did not demonstrate breathing abnormalities. The mean ± SD apnoea,hypopnoea index in the UARS group was 1.5 ± 1.7 h,1 and 25.2 ± 19 h,1 in the OSAHS group (P < 0.01). The increase in body mass index (BMI) between initial and follow-up investigations in the UARS group was from 29.4 ± 4 to 31 ± 5.7 kg m,2 (P = 0.014) and in the OSAHS group from 30 ± 4.1 to 32.4 ± 4.7 kg m,2(P = 0.004). Amplitude of Pes swings during respiratory events was significantly higher in OSAHS than that in UARS (P = 0.014). Our results suggest that UARS is part of a clinical continuum from habitual snoring to OSAHS. Progression from UARS to OSAHS seems to be related to an increase in the BMI. [source] Increase of the apnoea,hypopnoea index after uvulopalatopharyngoplasty: analysis of failure,CLINICAL OTOLARYNGOLOGY, Issue 6 2004N.S. Hessel From 70 patients who had uvulopalatopharyngoplasty (UPPP) operation and a pre- and postoperative sleep registration, we could retrospectively determine the failures and the correlation between variables such as age, gender, body mass index (BMI), earlier or concomitant tonsillectomy, unilevel (uvula,palate,tonsil) or multilevel (base of tongue as well) obstruction during sleep endoscopy and treatment outcome. From 70 patients, the preoperative sleep registration classified 15 social unacceptable snorers and 55 obstructive sleep apnoea syndrome (OSAS) patients. In this study we focused on the OSAS patients. From the 55 OSAS patients, 32 were classified as successful after UPPP, because they had a decreased apnoea,hypopnoea index (AHI) after surgery (,20). Eight patients had a decreased AHI, but more than 20 apnoeas/hypnoeas per hour. Fifteen patients were identified as UPPP failures with an equal or increased AHI and/or subjective deterioration of snoring. We were unable to find a statistically difference between the two groups with respect to variables such as age, BMI and AHI preoperative (P > 0.56) as between the level of obstruction(s) (P > 0.24). For earlier or concomitant tonsillectomy we found a statistically difference (P > 0.039), but a very small number in the high failure group (n = 8). We conclude that although sleep endoscopy adds to better patient selection and better results, paradoxically, the finding of obstruction on palate,uvula level during sleep endoscopy can still give UPPP failures. [source] | ||||||||||