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Older Japanese-American men complain rarely of snoring and sleep apnea. Among a group of 2,905 older men, those few who reported sleep apnea symptoms tended to snore habitually and to be sleepy during the day. Snorers were often heavier without evidence of cardiovascular disease, stroke, dementia, or cognitive dysfunction. Self-reported sleep apnea was related only to a history of pneumonia.

Backgrounds Obstructive sleep apnea syndrome (OSAS) is associated with an increased cardiovascular mtrbidity, including pulmonary hypertension. Little is known about factors influencing the degree of pulmonary hypertension and left ventricular dysfunction in patients with OSAS, especially in the absence of concomitant lung disease. Methods: Right heart catheterization, arterial blood gas analysis, and pulmonary function tests were performed in 92 consecutive patients (81 men and 11 women; mean+SD age, 53.1 + 11.0 years) with polysomnographically verified OSAS, in whom clinically significant lung disease was excluded. Results: Eighteen patients (20%) had mild pulmonary hypertension; 8 (44%) of them also had increased pulmonary capillary wedge pressures ([P.sub.pcw]) Left veutricular dysfunction was associated with arterial hypertension. Only [P.sub.pcw] (r=0.51; P[is less than].001) and the percentage of time during sleep spent with an oxygen saturation below 90% (as an indicator of the severity of OSAS) (r=0.34; P=.003) were significantly and independently associated with pulmonary artery pressure. Conclusions: Obstructive sleep apnea syndrome can cause mild pulmonary hypertension, even in the absence of pulmonary disease. In these patients, pulmonary hypertension is of the postcapillary type, or--in patients with normal left ventricular function--strongly related to the severity of OSAS. Our findings indicate that OSAS may constitute an important, and independent, risk factor for pulmonary hypertension.

This article provides an in-depth overview of the relationship between primary hypertension and adult obstructive sleep apnea syndrome. The background data and research are taken from the English-language literature through 1993. Primary hypertension is a common cause of major medical illnesses, including stroke, heart disease, and renal failure, in middle-aged males. Its prevalence in the United States is around 20%, with the rate of newly diagnosed hypertensive patients being about 3% per year. Sleep apnea syndrome is common in the same population. It is estimated that up to 2% of women and 4% of men in the working population meet criteria for sleep apnea syndrome. The prevalence may be much higher in older, non-working men. Many of the factors predisposing to hypertension in middle age, such as obesity and the male sex, are also associated with sleep apnea. Recent publications describe a 30% prevalence of occult sleep apnea among middle-aged males with so called 'primary hypertension.' Is this association fortuitous, related to a high prevalence of both diseases in the same population, or is it caused by a factor common to both diseases, such as obesity? Should the diagnosis of apnea be actively sought with sleep studies in hypertensive populations? If a diagnosis of 'asymptomatic' sleep apnea is made in a hypertensive person, should the apnea be treated? Current research data provide only partial answers to these and other questions regarding the association of apnea and hypertension. Logic dictates that clinically symptomatic patients in hypertensive clinics should receive appropriate evaluation for apnea, but broad populations of hypertensive individuals should not be referred for sleep studies.

It was hypothesized that obstructive sleep apnea may precipitate myocardial ischemia, reflected by ST-segment depression, in some patients during sleep. Overnight sleep studies and simultaneous 3-channel Holter monitoring were performed on 23 consecutive patients with obstructive sleep apnea without a history of coronary artery disease. Each patient was randomly assigned to nasal continuous positive airway pressure for the first half of the night and the alternate for tile SeCOnd half of the night. An episode of significant ST depression was defined as >1 mm from baseline for >1 minute. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Seven patients (30%) had ST depression during sleep. In all 7 patients the duration of ST depression decreased during nasal continuos positive airway pressure (30[plus or minus] 18 vs 11 [plus or minus] 13 minutes per hour of sleep) in association with a reduction in the apnea-hypepnea index (65 [plus or minus] 35 vs 7 [plus or minus] 6/hour), arousal index (49 [plus or minus] 14 vs 6 [plus or minus] 4/hour) and the duration that oxygen saturation was (Am J Cardiol 1993;71:1341-1345)

Hypertension, or high blood pressure, affects 20 percent of persons and increases the risk of heart disease and circulatory disorders of the brain. However, the mechanism underlying the development of hypertension in many cases is not known. Hypertension has been associated with the sleep apnea syndrome (SAS), a sleep disorder. In SAS, breathing ceases during sleep for at least 10 seconds and this cessation of breathing occurs 30 or more times during the course of sleep. Breathing may cease due to inactivity of the respiratory muscles or blockage of the airways. SAS affects more than one percent of the population. Studies show that circulatory changes occur during apnea and the persistence of such changes may contribute to the development of hypertension and other circulatory disorders. However, more evidence for a role of SAS in causing hypertension is needed to justify the use of costly screening tests for this sleep disorder among hypertensive patients. Hence, the causal relation between SAS and hypertension was assessed by reviewing five epidemiologic studies conducted between 1978 and 1989. The current evidence suggests that SAS is consistently and specifically associated with hypertension. Possible mechanisms underlying the development of both SAS and hypertension are discussed. Although SAS appears to increase the risk of hypertension, the risk relation is not stable and does not justify the need for SAS screening of hypertensive patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Snoring while sleeping is common, occurring in roughly 20 percent of the adult population. It is estimated that 60 percent of men over the age of 40 snore while sleeping. Snoring is a symptom of sleep apnea (reduced or irregular breathing while sleeping). Many people who snore complain of being tired in the morning and lack of quality sleep. This article describes a study that was performed to determine the effects of snoring on sleep architecture, or patterns, and sleep efficiency (getting a good night's sleep). Eight heavy snorers and six non-snorers participated in the study. All participants were monitored during sleep for breathing patterns using a polysomnograph. The snoring index was calculated based on the number of snores per hour. The snoring frequency was determined by the number of snores per minute. The stages of sleep during which snoring occurred was dependent on the degree of snoring. Light snorers (those making the least amount of noise) snored throughout all stages of sleep, while the heavy snorers snored mainly during slow-wave and REM sleep (rapid eye movement sleep, the stage of sleep required for getting a good night's rest). Snoring index and frequency were the same for all stages of sleep in the light snorers, but were greater during slow-wave sleep for the heavy snorers. It is concluded that snoring does not affect sleep patterns, but it does influence the efficiency of sleep. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sleep apnea is a disorder characterized by cessation of breathing during sleep. Episodes of apnea usually last for 10 seconds and occur 30 or more times during a 7-hour sleep period. The obstructive form of sleep apnea results from inability to breathe due to obstruction of the upper airway. Patients with obstructive sleep apnea are usually middle-aged, obese men with a history of daytime sleepiness and sleep apnea accompanied by snoring and gasping sounds. Obstructive sleep apnea syndrome is associated with insufficient oxygenation of the blood, elevated blood pressure, and respiratory acidosis (excessive acidity of body fluids due to impaired lung function and retention of carbon dioxide). Hypertension or elevated blood pressure is prevalent in more than 60 percent of these patients. Conversely, 25 to 35 percent of patients with hypertension have undiagnosed sleep apnea. Hemodynamic or circulatory abnormalities are greatest when patients with obstructive sleep apnea attempt to inhale against an obstructed airway. Circulation disorders improve with the use of methods or agents that open the airway. A case is described of a hypertensive patient with obstructive sleep apnea, who underwent plastic surgery to reconstruct portions of the oropharynx, or upper airway, in order to improve sleep apnea. Surgical correction of the obstructed upper airway reduced the number of apneic episodes and improved the abnormal elevations of blood pressure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sleep apneas are periods of interrupted breathing during sleep. They may be due to upper or lower airway obstruction, abnormal central nervous system control, or a combination of both. Sleep apneas can reduce the oxygen concentration of the blood sufficiently to contribute to pulmonary hypertension and right-sided heart failure. In a study of 32 patients with sleep apnea, researchers determined which aspects of apnea had the greatest influence on the oxygen concentration of the blood. They found that obstructive apneas produced greater desaturation of oxygen than central apneas. Furthermore, the investigators found that the stage of sleep played a significant role in the consequences of apnea. Desaturation which occurred during obstructive apnea was greater in REM sleep than non-REM sleep. (REM, of course, stands for Rapid Eye Movement sleep, a state in which the brain displays an almost waking form of activity.) In some cases, outflow of air can continue to occur during the apneic episode. These instances of expiratory obstructive apnea were also associated with a great reduction in oxygen saturation, regardless of whether the apnea occurred during REM or non-REM sleep. (Consumer Summary produced by Reliance Medical Information, Inc.)

Synopsis: Middle-aged men with sleep apnea have an increased risk of cardiovascular disease compared with controls, even when controlling for age, body mass index, and blood pressure. Effective treatment reduces [...]

Background. Proteinuria severe enough to be in the nephrotic range has been noted on occasion in patients with obstructive sleep apnea (OSA), but it is not known what factors are [...]

2001 JAN 27 -- (NewsRx.com) -- by Michael Greer, staff medical writer -- Neurologists warn that vagus nerve stimulation (VNS), used primarily for the treatment of epilepsy and some forms [...]

Objectives: To characterize the pathogenesis and clinical features of optic disc edema associated with obstructive sleep apnea syndrome (SAS). Methods: A series of 4 patients with SAS and papilledema (PE) underwent complete neuro-ophthalmologic evaluation and lumbar puncture. In 1 patient, continuous 24-hour intracranial pressure (ICP) monitoring was also performed. Results: All 4 patients had bilateral PE that was asymmetric in 2. Three patients had optic nerve dysfunction, asymmetric in 1, unilateral in 2. Daytime cerebrospinal fluid pressure measurements were within normal range. Nocturnal monitoring performed in one patient, however, demonstrated repeated episodes of marked ICP elevation associated with apnea and arterial oxygen desaturation. Conclusions: We propose that PE in SAS is due to episodic nocturnal hypoxemia and hypercarbia resulting in increased ICP secondary to cerebral vasodilation. In these individuals, intermittent ICP elevation is sufficient to cause persistent disc edema. These patients may be at increased risk for developing visual loss secondary to PE compared with patients with obesity-related pseudotumor cerebri because of associated hypoxemia. The diagnosis of SAS PE may not be appreciated because daytime cerebrospinal fluid pressure measurements are normal and because patients tend to present with visual loss rather than with symptoms of increased ICP. Arch Ophthalmol. 2000;118:1626-1630

A tocodynamometer is an instrument specifically used for measuring the force of uterine contractions. The instrument may also record maternal coughing and respirations and some types of fetal activity, although such recording is usually artifactual and unintended. The case is described of a 27-year-old obese, diabetic, and pregnant woman being monitored with a tocodynamometer where artifacts of the recordings were useful in diagnosing a serious problem. The patient's pregnancy was carefully monitored because of her medical condition. Beginning at 32 weeks' gestation, nonstress testing using a tocodynamometer was begun to monitor fetal heart rate and uterine activity. The patient had begun complaining of excessive sleepiness during the day and she fell asleep during each of the stress tests. During these sleep episodes there were recurrent periods of apnea (cessation of breathing) followed by loud snoring. The tocodynamometer, initially thought to be recording uterine activity, picked up her respiratory patterns during these sleep episodes. Subsequent examination of these recordings showed they were picking up severe sleep apnea. The patient developed preeclampsia, a condition involving pregnancy-related high blood pressure, at 37 weeks of gestation, but she eventually delivered a healthy baby. A sleep study performed on the patient after she delivered diagnosed the severe obstructive sleep apnea. This case study reveals another type of artifact that may show up on tocodynamometer recordings. (Consumer Summary produced by Reliance Medical Information, Inc.)

LAS VEGAS -- Disturbances in oxygen levels that occur with obstructive sleep apnea may explain the extensive list of complications that can stem from sleep apnea, Dr. Bashir Chaudhary said [...]

Children with epilepsy have a higher than normal rate of apnea, and the apnea appears to be associated with mood and behavior disturbances, Danielle Becker said at the annual meeting [...]

Children with epilepsy have a higher than normal rate of apnea, which appears to be associated with mood and behavior disturbances, Danielle Becker said at the annual meeting of the [...]