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Central sleep apnea syndromes comprise a heterogeneous group of central breathing disturbances that often occur in the context of other underlying diseases. Pathophysiologically, it is important to distinguish between hypo-/normocapnic central sleep apnea (CSA) with high loop gain and hypercapnic CSA with reduced ventilatory drive. The classification of CSA in adults includes CSA with Cheyne–Stokes respiration (CSR) in heart failure, CSA in another underlying disease, altitude-induced CSA/periodic breathing, opioid-induced central breathing disturbance, treatment-emergent CSA, and idiopathic CSA. The prevalence of CSA is significantly lower than that of obstructive sleep apnea (OSA), although both forms of sleep-related breathing disorders often occur together. The most common form is CSA/CSR in heart failure, and as it is associated with an unfavorable prognosis and is often symptomatic, evidence-based treatment options to improve symptoms and outcome are particularly important for this group. [ABSTRACT FROM AUTHOR]

Continuous positive airway pressure (CPAP) treatment for sleep apnoea can be challenging for patients to master. Given limited evidence on this topic, we used constructionist grounded theory methodology to explore experiences of living with CPAP from participants' perspectives. Adults (n=16) were recruited through a main-center respiratory service in New Zealand and participated in semi-structured interviews. Data were analyzed until theoretical saturation was achieved. In this article, we present the newly constructed grounded theory of bargaining and balancing life with CPAP, which explains how participants made a series of personal decisions about whether to use and how to master CPAP. To situate, support and provide explanatory power the new theory is discussed in the context of change and decision theories to illustrate the varying phases of readiness experienced by persons preparing to engage with CPAP and the decision-making process required for effective management of CPAP at home. This study provides valuable CPAP-user centered information for the development of interventions to optimize CPAP use. Acknowledging individuals' abilities to make reasoned healthcare decisions and providing clinical environments that support the active process of bargaining and balancing may increase uptake of CPAP, and potentially other long-term therapies.

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There is lack of studies investigating procedures aiming at a decrease in perioperative mortality in patients with obstructive sleep apnoea (OSA). During anesthetic evaluation, identification of patients with OSA as well as using a risk score has been recommended by the American Society of Anesthesiology in order to identify the best perioperative strategy. Perioperative attention should be focused on a secure airway and the duration of monitoring that is necessary regarding severity of OSA, surgical stress and respiratory function. Postoperatively, residual neuromuscular blockade and a supine position have to be avoided. Continuous pulse oximetry should be used as long as patients remain at increased risk and should be applied until oxygen saturation remains above 90% with room air during sleep. Opioids should be excluded for pain management whenever possible, and CPAP or NIPPV should be administered as soon as feasible after surgery to patients who have been receiving it preoperatively. [ABSTRACT FROM AUTHOR]

Question of the study As a consequence of new guidelines, patients with a typical history and respiratory disturbance index (RDI) findings (increased apnoea and hypopnoea activity per hour of registration by ambulatory 6-channel monitoring) should be treated with continuous positive airway pressure (CPAP) without further evaluation by polysomnography. This strategy has not been evaluated concerning its usefulness and consequences during the daily routine. In this pilot study, the results of an unattended polygraphy in the ambulatory setting were compared with those of a polysomnography in sleep centres. The main question of the study was what percentage of patients would be misclassified using the exemplary respiratory disturbance index (RDI) and apnoea-hypopnoea index (AHI) threshold of 10/h. Patients and methods In total, 243 patients were referred to 9 sleep centres, 191 men and 52 women. The ESS score was 9.4 ± 5.1. The RDI of only 153 patients was communicated. Results In I6/153 patients, a false-negative score (10.5 %) was obtained because the RDI was measured at < 10/h; the polysomnographic measurement however resulted in an AHT > 10. In 10/153 patients with an RD1 > 10/h, the AHI was polysonmographically < 10/h. Thus 6.5 % without increased apnoea or hypopnoea activity would be treated inappropriately. Conclusions Ambulatory monitoring is not suitable to exclude or confirm sleep-related disorders with AHI greater than or less than 10/h. CPAP therapy without polysomnography cannot be recommended. [ABSTRACT FROM AUTHOR]

During the last years, high-resolution ultrasonography of large arteries has significantly contributed to our further understanding of the pathophysiology of obstructive sleep apnoea (OSA)-related cardiovascular disease. Measurements of flow-mediated vasodilation (FMD) of the brachial artery have demonstrated that untreated OSA patients have reduced endothelial-dependent vasodilation, i.e. endothelial dysfunction. This is an established precursor lesion for both arterial hypertension and atherosclerosis. Probably the cause of endothelial dysfunction in OSA is increased oxidative stress with reduced bioavailability of the endothelial-derived vasodilator nitric oxide. Furthermore, it was shown that the reduction in FMD is correlated with the apnoea--hypopnoea index and the degree of nocturnal hypoxia even after adjustment for confounding factors. Effective continuous positive airway pressure (CPAP) therapy leads to an improvement of vasoreactivity in OSA. Measurements of intima-media thickness at the level of the common carotid artery (CCA-IMT) have shown that OSA patients have higher values of this parameter when compared to matched controls without sleep-disordered breathing. CCA-IMT reflects the early stages of atherosclerosis, and increased CCA-IMT is associated with an elevated cardiovascular risk (myocardial infarction and stroke). CCA-IMT is also related to OSA severity, i.e. it increases with the degree of nocturnal hypoxia. It has not yet been investigated whether long-term CPAP therapy leads to a decrease in CCA-IM'E [ABSTRACT FROM AUTHOR]

Zusammenfassung: In der Polysomnographie von Patienten mit OSAS kann häufig ein erhöhter PLMS-Index beobachtet werden. Die Ursache ist häufig ein Arousal als Folge eines obstruktiven Ereignisses, sei es eine Apnoe, Hypopnoe oder nur Flattening. Die Obstruktion kann bei Registrierung lediglich mit Thermistor nicht exakt erfasst werden. Anhand eines Falles mit initial OSAS und im späteren Verlauf Schnarchen und PLMS wird die Problematik der Erfassung von obstruktiven Ereignissen der oberen Luftwege im Zusammenhang mit dem PLMS-Syndrom dargestellt. Die Möglichkeit der Fehlinterpretation als primäres PLMS-Syndrom kann durch eine sensitivere Diagnose mittels Nasenkanüle verhindert werden. [ABSTRACT FROM AUTHOR]

Copyright of Somnologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The following overview deals with the different methods of positive pressure breathing in important sleep-related breathing disorders—namely, obstructive sleep apnoea and Cheyne-Stokes respiration and/or central sleep apnoea syndrome—demonstrating the application modalities and advantages but also the constraints. Because of the socioeconomic consequences of the diseases, it is recommended to apply clear-cut decision-making rules before prescribing CPAP, BIPAP or APAP. These criteria are based on widely accepted clinical experience and studies with strong evidence. After the treatment decision, usually manual titration is performed. However, the titration procedure differs from laboratory to laboratory. The objective consists in eliminating the sleep-related breathing disorders. There is a large degree of consensus concerning the success criteria. Even though constant PAP is the most commonly used therapy, in the future subgroups with pressure intolerance or high variability of pressure requirement might be identified that could benefit from automatic CPAP. Patients with Cheyne-Stokes respiration and/or central sleep apnoea syndrome (CSA/CSR) often respond badly to simple CPAP, BIPAP or APAP. By applying adaptive servoventilation (ASV) in chronic heart failure, quality of life and daytime sleepiness are improved and neurohumoral activation can be reduced. Treatment with positive pressure ventilation has to be performed over many years. The required effective pressure varies due to aging and weight changes. Therefore, follow-up measurements with time intervals based on clinical experience should be assigned to check the treatment success. [ABSTRACT FROM AUTHOR]

The following overview deals with the different methods of positive pressure breathing in important sleep-related breathing disorders -- namely, obstructive sleep apnoea and Cheyne-Stokes respiration and/or central sleep apnoea syndrome -- demonstrating the application modalities and advantages but also the constraints. Because of the socioeconomic consequences of the diseases, it is recommended to apply clear-cut decision-making rules before prescribing CPAP, BIPAP or APAP. These criteria are based on widely accepted clinical experience and studies with strong evidence. After the treatment decision, usually manual titration is performed. However, the titration procedure differs from laboratory to laboratory. The objective consists in eliminating the sleep-related breathing disorders. There is a large degree of consensus concerning the success criteria. Even though constant PAP is the most commonly used therapy, in the future subgroups with pressure intolerance or high variability of pressure requirement might be identified that could benefit from automatic CPAP. Patients with Cheyne-Stokes respiration and/or central sleep apnoea syndrome (CSA/CSR) often respond badly to simple CPAP, BIPAP or APAP. By applying adaptive servoventilation (ASV) in chronic heart failure, quality of life and daytime sleepiness are improved and neurohumoral activation can be reduced. Treatment with positive pressure ventilation has to be performed over many years. The required effective pressure varies due to aging and weight changes. Therefore, follow-up measurements with time intervals based on clinical experience should be assigned to check the treatment success. [ABSTRACT FROM AUTHOR]

Question of the study The assessment of sleep in patients with obstructive sleep apnoea syndrome (OSAS) is orientated towards estimated standard (norm) values. However, the degree to which the extent of OSAS disturbs sleep is incalculable and, consequently, the effect of any therapy is also incalculable. The purpose of our study is therefore to analyse sleep structure before and during an effective therapy depending on the severity of obstructive sleep apnoea (OSA). Patients and methods In this retrospective analysis, 171 patients (154 men, 17 women) aged 56.6 ± 6.6, mean body mass index (BMI) 30.5 ± 4.5 kg/m², were examined. Sleep was measured one night before therapy initiation and during the second night after the positive pressure therapy had commenced. By means of an apnoea-hypopnoea index it was possible to divide the patients into three categories: mild sleep apnoea, moderate sleep apnoea, and severe sleep apnoea. Within these groups the parameters of sleep before the start of the therapy were compared with the data from 22 sleep-healthy test cases. The short-term effects of the therapy were also investigated. Results In comparison to the sleep-healthy cases, in all OSA patients there was evidence of an increase in sleep phase 1 and a decrease in sleep phase 2. In addition, the number of arousals increased. A deep and REM sleep deficit was evident in patients with moderate or severe OSA. When comparing the three OSA groups, a change in the sleep structure was primarily seen in the severe cases of OSAS. In the mild OSA cases, sleep phase 1, deep sleep, and the number of arousals changed primarily under therapy. In severe OSAS, all sleep parameters, except phase 2 and sleep efficiency, changed after initiation of therapy. Conclusions The extent of sleep disorder in OSAS patients varies from individual to individual but is dependent on the severity of the disease. In mild OSAS, changes in sleep structure under... [ABSTRACT FROM AUTHOR]

Question of the Study Alterations in baroreceptor sensitivity (BRS) during the transition from waking to sleep are known to depend on sleep depth, and have been studied in patients suffering from diseases such as arterial hypertension and obstructive sleep apnoea syndrome (OSAS). The goal of the present study was the analysis of BRS in sleep, both in subjects with healthy sleep and as a function of the NREM-REM stage of sleep, as well as in patients with mild to moderate OSAS in comparable apnoea-free phases in NREM and REM. Patients and Methods A total of 43 subjects (45.4 ± 10.7 years of age) and 21 OSAS patients (55 ± 7 years) were studied by polysomnography. Blood pressure was measured continuously by noninvasive means. Intervals with normal respiration were selected in REM and NREM sleep, and the BRS parameters α-LF, α-HF and α-LFHF were extracted by spectral analysis from spontaneous changes in cardiac cycle duration and in systolic blood pressure. Results Findings for healthy sleepers revealed BRS in NREM sleep that was significantly greater than that in REM sleep, both for the α-LFHF (P < 0.02) as well as for the α-HF (P < 0.001) index. For the entire group of OSAS patients, and in contrast to normal subjects, a greater α-HF index in both REM and in NREM sleep (P < 0.05) was consequently determined, with significantly reduced BRS in NREM sleep (α-LF, α-HF, α-LFHF). Existence of arterial hypertension stabilized by medication has no effect on these results. Conclusions Disturbed nocturnal BRS in patients with mild to moderate OSAS is the consequence of loss of vagal tone in NREM sleep, also in apnoea-free intervals, and reflects the noctumal cardiovascular risks in these patients. [ABSTRACT FROM AUTHOR]