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Pathophysiology of obstructive sleep apnea

Anna M May, David R Van Wagoner, Reena Mehra
A surge of data has reproducibly identified strong associations of obstructive sleep apnea (OSA) with cardiac arrhythmias. As an extension of epidemiologic and clinic-based findings, experimental investigations have made strides in advancing our understanding of the putative OSA and cardiac arrhythmogenesis mechanistic underpinnings. While most studies have focused on the links between OSA and atrial fibrillation (AF), relationships with ventricular arrhythmias have also been characterized. Key findings implicate OSA-related autonomic nervous system fluctuations typified by enhanced parasympathetic activation during and sympathetic surges subsequent to respiratory events which contribute to augmented arrhythmic propensity...
September 29, 2016: Chest
Emma L Gray, David K McKenzie, Danny J Eckert
STUDY OBJECTIVES: To determine the proportion and physiological characteristics of nonobese patients with obstructive sleep apnea (OSA) and their response to prescribed therapy. METHODS: Data from 163 consecutive in-laboratory diagnostic sleep studies for participants referred to an academic teaching-hospital sleep clinic for suspected OSA were assessed. Sleep and anthropometric parameters at baseline and follow-up (up to 22 mo) were examined and compared between obese and nonobese patients with a diagnosis of OSA (apnea-hypopnea index >5 events/h sleep)...
September 13, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Jacopo Cambi, Paola Staffa, Maria Carla Spinosi
Obstructive Sleep Apnea Hypopnoea Syndrome (OSAHS) is a common disorder characterized by partial (hypopnoea) or total (apnea) closure of the upper airways during sleep. It is associated with hypertension, stroke, car accidents, diabetes, metabolic syndrome and depression. Although this disease is related to major morbidity and mortality(1) , the prevalence of OSAHS is underestimated. The physiopathology of OSAHS is multifactorial and not yet fully understood. Numerous pathophysiological risk factors have been recognized: anatomical abnormalities, impaired upper airway dilators, unstable respiratory control and diminished arousal threshold...
September 7, 2016: Clinical Otolaryngology
Sameh Msaad, Rim Marrakchi, Malek Grati, Rahma Gargouri, Samy Kammoun, Kamel Jammoussi, Ilhem Yangui
BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with cardiovascular morbidity and mortality, which can be improved by using continuous positive airway pressure (CPAP) therapy. However, the pathophysiological links between the two kinds of disease and the mechanism of the CPAP effect remain incompletely understood. We aimed to inquire into the myocardial involvement in this relationship. We suggested that serum brain natriuretic peptide (BNP) is sensitive enough to detect myocardial stress caused by OSAHS...
2016: Libyan Journal of Medicine
M Winck, M Drummond, P Viana, J C Pinho, J C Winck
Sleep bruxism (SB) and obstructive sleep apnoea syndrome (OSAS) share common pathophysiologic pathways. We aimed to study the presence and relationship of SB in a OSAS population. Patients referred with OSAS suspicion and concomitant SB complains were evaluated using a specific questionnaire, orofacial evaluation and cardio-respiratory polygraphy that could also monitor audio and EMG of the masseter muscles. From 11 patients studied 9 had OSAS. 55.6% were male, mean age was 46.3±11.3 years, and apnea hypopnea index of 11...
August 23, 2016: Revista Portuguesa de Pneumologia
Young-Min Park, Hyun-Woo Shin
Zolpidem-induced sleep-related complex behaviors (SRCB) with anterograde amnesia have been reported. We describe herein a case in which the development of zolpidem-induced sleep-related eating disorder (SRED) and SRCB was strongly suspected. A 71-year-old Korean male was admitted to the Department of Psychiatry due to his repetitive SRED and SRCB with anterograde amnesia, which he reported as having occurred since taking zolpidem. The patient also had restless legs syndrome (RLS) and obstructive sleep apnea (OSA)...
August 31, 2016: Clinical Psychopharmacology and Neuroscience: the Official Scientific Journal of the Korean College of Neuropsychopharmacology
Judith Giunta, Moro O Salifu, Samy I McFarlane
Obesity is a major public health problem that is reaching pandemic proportion. Currently two thirds of the American population is either overweight or obese and worldwide, 39% of the population is overweight and 13% are considered obese [1,2]. This rapid rise in obesity is associated with increased in diabetes mellitus type 2 (DM2), hypertension (HTN), chronic kidney disease (CKD) and cardiovascular diseases (CVD), the major killer of adults in the USA. Parallel to this epidemic is the rapid rise of sleep disorders such as Obstructive Sleep Apnea (OSA)...
2016: Epidemiology: Current Research
Philipp Fassbender, Frank Herbstreit, Matthias Eikermann, Helmut Teschler, Jürgen Peters
BACKGROUND: Obstructive sleep apnea (OSA) is a common disorder of breathing but is probably underappreciated as a perioperative risk factor. METHODS: This review is based on pertinent articles, published up to 15 August 2015, that were retrieved by a selective search in PubMed based on the terms "sleep apnea AND anesthesia" OR "sleep apnea AND pathophysiology." The guidelines of multiple specialty societies were considered as well. RESULTS: OSA is characterized by phases of upper airway obstruction accompanied by apnea/hypoventilation, with hypoxemia, hypercapnia, and recurrent overactivation of the sympathetic nervous system...
July 11, 2016: Deutsches Ärzteblatt International
Donato Lacedonia, Ersilia Nigro, Maria Gabriella Matera, Olga Scudiero, Maria Ludovica Monaco, Rita Polito, Giovanna Elisiana Carpagnano, Maria Pia Foschino Barbaro, Gennaro Mazzarella, Andrea Bianco, Aurora Daniele
Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder; obesity represents a major risk factor for the development and progression of OSAS although obese patients do not necessarily suffer from OSAS. Adipose tissue communicates with lung in both physiologic and pathologic conditions through the production of adipokines, hormones active in metabolic and inflammatory processes. To explore the extent to which Acrp30 impacts on pathophysiology of OSAS and whether these proteins could be considered as targets for both diagnosis and therapy through enzyme-linked immunosorbent assay, western blotting analysis and fast protein liquid chromatography we have analyzed total levels as well as oligomer distribution in OSAS patients...
October 2016: Pulmonary Pharmacology & Therapeutics
Yanru Li, Robert L Owens, Scott Sands, Jeremy Orr, Walter Moraes, Pamela DeYoung, Erik Smales, Rachel Jen, Atul Malhotra
RATIONALE: Obstructive sleep apnea (OSA) has multiple pathophysiological causes. A low respiratory arousal threshold (ArTh) and a high loop gain (unstable ventilatory control) can contribute to recurrent respiratory events in patients with OSA. Prior small studies have shown that donepezil, an acetylcholinesterase inhibitor, might improve OSA, but the mechanism is unknown. OBJECTIVES: To determine whether a single dose of donepezil lowers the apnea hypopnea index (AHI) by modulating the ArTh or loop gain...
July 21, 2016: Annals of the American Thoracic Society
Peilin Hui, Shuangbao Jia, Wei Ma, Lijun Zhao, Jinfeng Wang, Xiaoquan Wei, Liya Zhou, Manke Dai, Wenjuan Zhang, Yuping Xie
OBJECTIVE: To investigate the significance of tumor necrosis factor-alpha (TNF-α) and plasma endothelium (ET) in pathophysiologic process of patients with obstructive sleep apnea hypopnea syndrome(OSAHS) with type 2 diabetes mellitus (T2DM). METHOD: All observed subjects were divided into 4 groups. A number of 80 patients with OSAHS, 65 cases of OSAHS with T2DM patients, 20 patients with T2DM, and 32 cases of healthy control group were observed in this study. The serum levels of TNF-α and ET were detected by double antibody sandwich ELISA, the content of TNF-α and ET were compared between OSAHS group and OSAHS + T2DM group...
February 2016: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Zhenhong Li, Jocelyn Celestin, Richard F Lockey
Obstructive sleep apnea syndrome (OSAS) may be central neurologic (<5%) or obstructive (>95%) in origin and is a relatively prevalent condition in children. It affects 1%-5% of children aged 2-8 years and is caused by a variety of different pathophysiologic abnormalities. Cardiovascular, metabolic, and neurocognitive comorbidities can occur in both children and adults when left untreated. It also can cause severe behavioral problems in children. The American Academy of Pediatrics recommends that all children be screened with an appropriate history and physical examination for symptoms and signs suggestive of OSAS...
September 2016: Journal of Allergy and Clinical Immunology in Practice
Mak Adam Daulatzai
Aging, hypertension, diabetes, hypoxia/obstructive sleep apnea (OSA), obesity, vitamin B12/folate deficiency, depression, and traumatic brain injury synergistically promote diverse pathological mechanisms including cerebral hypoperfusion and glucose hypometabolism. These risk factors trigger neuroinflammation and oxidative-nitrosative stress that in turn decrease nitric oxide and enhance endothelin, Amyloid-β deposition, cerebral amyloid angiopathy, and blood-brain barrier disruption. Proinflammatory cytokines, endothelin-1, and oxidative-nitrosative stress trigger several pathological feedforward and feedback loops...
June 27, 2016: Journal of Neuroscience Research
T M Berghaus, A Witkowska, T Wagner, C Faul, M Schwaiblmair, W von Scheidt
BACKGROUND: Obstructive sleep apnea (OSA) might be an independent risk factor for acute pulmonary embolism (APE). AIM OF THE STUDY: A prospective cohort study was conducted to investigate if APE is sleep-related in untreated OSA syndrome or not. METHODS: 206 APE patients were evaluated by portable monitoring and polysomnography. APE symptoms which caused an arousal from sleep or occurred within the first hour after wake-up were considered to be sleep-related...
November 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Justin P McCormick, Douglas M Hildrew, Claire M Lawlor, Jesse A Guittard, N Knight Worley
BACKGROUND: Obstructive sleep apnea (OSA) is a growing problem affecting millions of people in the United States. The prevalence of OSA has risen drastically in the past few decades concurrently with the increasing prevalence of obesity. Subsequently, there has been an ever-increasing rise in the use of continuous positive airway pressure (CPAP) devices. While using CPAP devices may lead to many adverse effects, the majority of these effects are described as relatively benign. CASE REPORT: We describe the detailed clinical course and outcome for a patient with otic barotrauma as a result of excessive self-titration of CPAP therapy in an in-home setting...
2016: Ochsner Journal
Xun Zhao, Philip Wong
Sleep disturbances, particularly daytime sleepiness and insomnia, are common problems reported by patients suffering from liver cirrhosis. Poor sleep negatively impacts patients' quality of life and cognitive functions and increases mortality. Although sleep disturbances can be an early sign of hepatic encephalopathy (HE), many patients without HE still complain of poor quality sleep. The pathophysiology of these disturbances is not fully understood but is believed to be linked to impaired hepatic melatonin metabolism...
2016: Scientifica
David P White
The concept of pharmacologic therapy for obstructive sleep apnea (OSA) treatment has always been considered but no agent has had a large enough effect size to drive substantial adoption. A new construct of the pathophysiology of OSA is that there are 4 primary physiologic traits that dictate who develops OSA. These traits vary substantially between patients, meaning OSA may develop for quite different reasons. This encourages new thinking regarding pharmacologic therapy and continued attempts to find the ideal or acceptable drug...
June 2016: Sleep Medicine Clinics
John Ciriello, Jason M Moreau, Aaron McCoy, Douglas L Jones
Intermittent hypoxia (IH) is a major pathophysiological consequence of obstructive sleep apnea. Recently, it has been shown that IH results in changes in body energy balance, leptin secretion and concomitant alterations in arcuate nucleus (ARC). In this study, the role of leptin on these changes was investigated in leptin-deficient rats exposed to IH or normoxic control conditions. Body weights, consumatory and locomotor behaviours, and protein signaling in ARC were assessed immediately after IH exposure. Compared to normoxia, IH altered body weight, food intake, locomotor pattern, and the plasma concentration of leptin and angiotensin II in the wild-type rat...
July 28, 2016: Neuroscience Letters
Deborah Weatherspoon, Debra Sullivan, Christopher A Weatherspoon
One factor that may contribute to an increased risk for airway compromise is obstructive sleep apnea (OSA). Sedation in this population carries an increased risk for hypopnea. Critical care nurses must decide on the amount and type of sedation to administer at the point of care. It is important for them to understand OSA and the routinely prescribed sedatives that may affect this disorder. This article discusses the pathophysiology of OSA and traits that may help identify patients with undiagnosed OSA. The most commonly prescribed sedative pharmacologic agents and adjunctive airway support mechanisms are reviewed for use in this population...
June 2016: Critical Care Nursing Clinics of North America
Abhinav Agrawal, Isha Verma, Varun Shah, Abhishek Agarwal, Rutuja R Sikachi
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, parenchymal disease of the lung with an estimated prevalence of 14-43 per 100,000. Patient usually presents with coughing and exertional dyspnea, which can lead to acute respiratory failure. IPF has been associated with various co-morbidities such as lung cancer, emphysema, obstructive sleep apnea (OSA), GERD and multiple cardiovascular consequences. The cardiovascular manifestations of IPF include pulmonary hypertension, heart failure, coronary artery disease, cardiac arrhythmias & cardiac manifestations of drugs used to treat IPF...
May 2016: Intractable & Rare Diseases Research
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