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Pathophysiology of obstructive sleep apnea

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https://www.readbyqxmd.com/read/29440941/sleep-disturbances-in-women-with-polycystic-ovary-syndrome-prevalence-pathophysiology-impact-and-management-strategies
#1
REVIEW
Renae C Fernandez, Vivienne M Moore, Emer M Van Ryswyk, Tamara J Varcoe, Raymond J Rodgers, Wendy A March, Lisa J Moran, Jodie C Avery, R Doug McEvoy, Michael J Davies
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight...
2018: Nature and Science of Sleep
https://www.readbyqxmd.com/read/29429026/modulation-of-renal-sympathetic-innervation-recent-insights-beyond-blood-pressure-control
#2
REVIEW
Dominik Linz, Mathias Hohl, Adrian D Elliott, Dennis H Lau, Felix Mahfoud, Murray D Esler, Prashanthan Sanders, Michael Böhm
Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation...
February 10, 2018: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
https://www.readbyqxmd.com/read/29416383/obstructive-sleep-apnea-current-perspectives
#3
REVIEW
Amal M Osman, Sophie G Carter, Jayne C Carberry, Danny J Eckert
The prevalence of obstructive sleep apnea (OSA) continues to rise. So too do the health, safety, and economic consequences. On an individual level, the causes and consequences of OSA can vary substantially between patients. In recent years, four key contributors to OSA pathogenesis or "phenotypes" have been characterized. These include a narrow, crowded, or collapsible upper airway "anatomical compromise" and "non-anatomical" contributors such as ineffective pharyngeal dilator muscle function during sleep, a low threshold for arousal to airway narrowing during sleep, and unstable control of breathing (high loop gain)...
2018: Nature and Science of Sleep
https://www.readbyqxmd.com/read/29388824/research-priorities-in-pathophysiology-for-sleep-disordered-breathing-in-patients-with-chronic-obstructive-pulmonary-disease-an-official-american-thoracic-society-research-statement
#4
Atul Malhotra, Alan R Schwartz, Hartmut Schneider, Robert L Owens, Pamela DeYoung, MeiLan K Han, Jadwiga A Wedzicha, Nadia N Hansel, Michelle R Zeidler, Kevin C Wilson, M Safwan Badr
BACKGROUND: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are common conditions; the co-occurrence of these diseases, called the overlap syndrome (OVS), has been associated with poor health outcomes. PURPOSE: The purpose of this Official American Thoracic Society Research Statement is to describe pathophysiology, epidemiology, outcomes, diagnostic metrics, and treatment of OVS, as well as to identify important gaps in knowledge and make recommendations for future research...
February 1, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29387467/sleep-disordered-breathing-during-congestive-heart-failure-to-intervene-or-not-to-intervene
#5
Ali Valika, Maria Rosa Costanzo
Sleep-disordered breathing is common in heart failure patients and is associated with increased morbidity and mortality. Central sleep apnea occurs more commonly in heart failure-reduced ejection fraction, and obstructive sleep apnea occurs more frequently in heart failure with preserved ejection fraction. Although the two types of sleep-disordered breathing have distinct pathophysiologic mechanisms, both contribute to abnormal cardiovascular consequences. Treatment with continuous positive airway pressure for obstructive sleep apnea in heart failure has been well defined, whereas treatment strategies for central sleep apnea in heart failure continue to evolve...
November 2017: Cardiac failure review
https://www.readbyqxmd.com/read/29368899/-obesity-hypoventilation-syndrome-and-pulmonary-hypertension-an-association-little-known-in-mexico
#6
Ernesto Díaz-Domínguez, Martín Rosas-Peralta, Luis Efrén Santos-Martínez, Nielzer Armando Rodríguez-Almendros, José Antonio Magaña-Serrano, Gilberto Pérez-Rodríguez
The obesity hypoventilation syndrome (OHS) refers to the combination of obesity, daytime hypercapnia and sleep-disordered breathing. Obesity has risen to epidemic proportions in the last three decades in the United States, Mexico and Europe. The OHS is associated with obstructive sleep apnea syndrome in 30%. Without treatment, mortality is 46% at 50 months. So in this paper we analyze the OHS, obesity and pulmonary hypertension, the pathophysiology, clinical presentation and diagnosis as well as the treatment, which is aimed at the correction of sleep-disordered breathing and hypoxemia; although there is little experience with the use of specific pulmonary vasodilator drugs...
January 2018: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/29365388/-neuromuscular-properties-of-genioglossus-activity-in-healthy-adults-and-obstructive-sleep-apnea-patients
#7
Y Q Zhou, J Y Ye
Upper airway patency closely contact with neuromuscular airway regulation during respiratory, especially the activity of the pharyngeal dilators. The genioglossus is the largest pharyngeal dilators with its contraction playing the most important role in keeping the pharyngeal airway open. In healthy individuals, genioglossus activation shows a negative correlation with pharyngeal collapsibility and upper airway resistance. Negative pressure during inspiration can stimulate airway mechanoreceptors to produce a muscle reflex activity...
January 7, 2018: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/29359806/the-role-of-hypoxia-inducible-factors-in-carotid-body-patho-physiology
#8
Gregg L Semenza, Nanduri R Prabhakar
Hypoxia-inducible factors mediate adaptive responses to reduced O2 availability. In patients with obstructive sleep apnea, repeated episodes of hypoxemia and reoxygenation (intermittent hypoxia) are sensed by the carotid body (CB). The ensuing CB chemosensory reflex activates the sympathetic nervous system and increased secretion of catecholamines by the adrenal medulla, resulting in hypertension and breathing abnormalities. In the CB, intermittent hypoxia induces the formation of reactive oxygen species (ROS) and increased intracellular Ca2+ levels, which drive increased expression of hypoxia-inducible factor 1α (HIF-1α) and a decrease in the levels of HIF-2α...
January 23, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29359203/rare-undiagnosed-primary-amyloidosis-unmasked-during-surgical-treatment-of-primary-hyperparathyroidism-a-case-report
#9
Kathleen C Gallagher, Ariana B Geromes, John Stokes, India A Reddy, James S Lewis, Naira Baregamian
Primary amyloidosis (PA) is a protein deposition disorder that presents with localized or multisystemic disease. The incidence is low in the general public, ranging from three to eight cases per million, and with nonspecific presenting symptoms typically occurring later in life. Due to late presentation, substantial and irreversible damage has usually already occurred by the time of the diagnosis. However, if inadvertent diagnosis occurs before irreversible damage has taken place, as it did in the following case, some patients may benefit from the disease-arresting treatment...
February 1, 2018: Journal of the Endocrine Society
https://www.readbyqxmd.com/read/29350460/three-generation-family-with-novel-contiguous-gene-deletion-on-chromosome-2p22-associated-with-thoracic-aortic-aneurysm-syndrome
#10
Bianca Quiñones-Pérez, Grace E VanNoy, Meghan C Towne, Yiping Shen, Michael N Singh, Pankaj B Agrawal, Sharon E Smith
Latent transforming growth factor binding proteins (LTBP) are a family of extracellular matrix glycoproteins that play an important role in the regulation of transforming growth factor beta (TGF-ß) activation. Dysregulation of the TGF-ß pathway has been implicated in the pathogenesis of inherited disorders predisposing to thoracic aortic aneurysms syndromes (TAAS) including Marfan syndrome (MFS; FBN1) and Loeys-Dietz syndrome (LDS; TGFBR1, TGFBR2, TGFB2, TGFB3, SMAD2, SMAD3). While these syndromes have distinct clinical criteria, they share clinical features including aortic root dilation and musculoskeletal findings...
January 19, 2018: American Journal of Medical Genetics. Part A
https://www.readbyqxmd.com/read/29327943/phenotyping-pharyngeal-pathophysiology-using-polysomnography-in-patients-with-obstructive-sleep-apnea
#11
Scott A Sands, Bradley A Edwards, Philip I Terrill, Luigi Taranto-Montemurro, Ali Azarbarzin, Melania Marques, Lauren Hess, David P White, Andrew Wellman
RATIONALE: Therapies for obstructive sleep apnea (OSA) could be administered based on a patient's own phenotypic causes ("traits") if a clinically-applicable approach were available. Here we present a novel approach to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography. METHODS: Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive...
January 12, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29318567/phenotyping-the-pathophysiology-of-obstructive-sleep-apnea-using-polygraphy-polysomnography-a-review-of-the-literature
#12
REVIEW
Marcello Bosi, Andrea De Vito, Bhik Kotecha, Luca Viglietta, Alberto Braghiroli, Joerg Steier, Martino Pengo, Giovanni Sorrenti, Riccardo Gobbi, Claudio Vicini, Venerino Poletti
Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients affected by obstructive sleep apnea syndrome (OSA). However, long-term compliance with CPAP therapy may result limited and alternatives to CPAP therapy are required to address the increasing need to provide tailored therapeutic options. Understanding the pathophysiological traits (PTs) of OSA patients [upper airway (UA) anatomical collapsibility, loop gain (LG), arousal threshold (AT), and UA gain (UAG)] lies at the heart of the customized OSA treatment...
January 9, 2018: Sleep & Breathing, Schlaf & Atmung
https://www.readbyqxmd.com/read/29275265/anesthetic-and-pharmacologic-considerations-in-perioperative-care-of-obese-children
#13
REVIEW
Vidya Chidambaran, Anurag Tewari, Mohamed Mahmoud
PURPOSE: Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children...
December 21, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/29259576/obstructive-sleep-apnea-phenotypes-and-markers-of-vascular-disease-a-review
#14
REVIEW
Alberto R Ramos, Pedro Figueredo, Shirin Shafazand, Alejandro D Chediak, Alexandre R Abreu, Salim I Dib, Carlos Torre, Douglas M Wallace
Obstructive sleep apnea (OSA) is a chronic and heterogeneous disorder that leads to early mortality, stroke, and cardiovascular disease (CVD). OSA is defined by the apnea-hypopnea index, which is an index of OSA severity that combines apneas (pauses in breathing) and hypopneas (partial obstructions in breathing) associated with hypoxemia. Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29241747/pathophysiology-of-the-metabolic-syndrome
#15
Emma McCracken, Monica Monaghan, Shiva Sreenivasan
The metabolic syndrome-otherwise called syndrome X, insulin resistance syndrome, Reaven syndrome, and "the deadly quartet"-is the name given to the aggregate of clinical conditions comprising central and abdominal obesity, systemic hypertension, insulin resistance (or type 2 diabetes mellitus), and atherogenic dyslipidemia. It is a prothrombotic and proinflammatory state characterized by increased inflammatory cytokine activity. In addition to inflammatory dermatoses such as psoriasis, lichen planus, and hidradenitis suppurativa, metabolic syndrome is also commonly associated with accelerated atherosclerotic cardiovascular disease, hyperuricemia/gout, chronic kidney disease, and obstructive sleep apnea...
January 2018: Clinics in Dermatology
https://www.readbyqxmd.com/read/29228393/quantifying-the-arousal-threshold-using-polysomnography-in-obstructive-sleep-apnea
#16
Scott A Sands, Philip I Terrill, Bradley A Edwards, Luigi Taranto Montemurro, Ali Azarbarzin, Melania Marques, Camila M de Melo, Stephen H Loring, James P Butler, David White, Andrew Wellman
Objectives: Precision medicine for obstructive sleep apnea (OSA) requires non-invasive estimates of each patient's pathophysiological "traits". Here we provide the first, automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA. Methods: Ventilatory drive preceding clinically-scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill P et al...
November 9, 2017: Sleep
https://www.readbyqxmd.com/read/29225775/fibromax-based-nonalcoholic-fatty-liver-disease-in-chronic-obstructive-pulmonary-disease-patients-with-obstructive-sleep-apnea-methodological-considerations
#17
Denis Monneret
The relationship between nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA) has been well demonstrated, but remains to be evidenced in chronic obstructive pulmonary disease (COPD). Recently, Viglino et al. (Eur Respir J, 2017) attempted to determine the prevalence of liver fibrosis, steatosis and nonalcoholic steatohepatitis (NASH) in COPD patients, some of whom had OSA, basing the NAFLD diagnostic on three circulating biomarker-based liver scores: the FibroTest, SteatoTest and NashTest, from the Fibromax® panel...
2017: F1000Research
https://www.readbyqxmd.com/read/29223509/neuropeptides-and-breathing-in-health-and-disease
#18
REVIEW
Katarzyna Kaczyńska, Dominika Zając, Piotr Wojciechowski, Ewelina Kogut, Małgorzata Szereda-Przestaszewska
Regulatory neuropeptides control and regulate breathing in physiological and pathophysiological conditions. While they have been identified in the neurons of major respiratory areas, they can be active not only at the central level, but also at the periphery via chemoreceptors, vagal afferents, or locally within lungs and airways. Some neuropeptides, such as leptin or substance P, are respiratory stimulants; others, such as neurotensin, produce variable effects on respiration depending on the site of application...
December 6, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29214337/sleep-disordered-breathing-in-patients-with-sickle-cell-disease
#19
REVIEW
Vikram M Raghunathan, Peter L Whitesell, Seah H Lim
Sickle cell disease is one of the most common hereditary hemoglobinopathies worldwide, and its vaso-occlusive and hemolytic crises cause considerable patient morbidity. A growing body of evidence has shown that sleep-disordered breathing, and in particular, obstructive sleep apnea, occurs at high frequency in the sickle cell population, and that there is significant overlap in the underlying pathophysiology of these two conditions. Through a variety of mechanisms including nocturnal hypoxemia and increased oxidative stress, production of pro-inflammatory cytokines, and endothelial dysfunction, sickle cell anemia and sleep-disordered breathing potentiate each other's clinical effects and end-organ complications...
December 6, 2017: Annals of Hematology
https://www.readbyqxmd.com/read/29208538/sleep-related-painful-erections-a-meta-analysis-on-the-pathophysiology-and-risks-and-benefits-of-medical-treatments
#20
REVIEW
Sanne Vreugdenhil, Alida Cornelia Weidenaar, Igle Jan de Jong, Mels Frank van Driel
BACKGROUND: Patients with sleep-related painful erections (SRPEs) have frequent awakenings from deep penile pain during nocturnal erections. This results in severe sleep deprivation. AIM: To review the current literature on SRPEs and discuss the pathophysiologic theories and risks and benefits of medical treatments. METHODS: PubMed was searched using the terms sleep-related painful erections, nocturnal priapism, treatment, and sleep-related erections...
December 2, 2017: Journal of Sexual Medicine
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