Background Sleep-disordered breathing （SDB） is known to occur frequently in and may predict worsening progression of patients with congestive heart failure （CHF）. SDB is also known to play an important role in the...Background Sleep-disordered breathing （SDB） is known to occur frequently in and may predict worsening progression of patients with congestive heart failure （CHF）. SDB is also known to play an important role in the development of idiopathic pulmonary arterial hyper- tension （PAH） via inducing endothelial dysfunction and vascular remodeling, a pathological process that can be significantly influenced by factors such as osteoprotegerin （OPG） and endothelial progenitor cells （EPCs）. The objective of this study is to determine if CHF with SDB is associated with changes in OPG, EPCs, and PAIl. Methods EPCs were isolated, cultured, and quantified from CHF patients with SDB （n = 52）, or without SDB （n - 68）. OPG and N-terminal pro-brain natriuretic peptide （NT-proBNP） from each group was analyzed and cor- related with EPCs and the mean pulmonary artery pressure （mPAP） measured by right heart catheterization. Results A significant decrease in circulating EPCs （29.30 ± 9.01 vs. 45.17 ± 10.51 EPCs/x 200 field; P 〈 0.05） was found in CHF patients with SDB compared to those without SDB. Both OPG （789.83 ±89.38 vs. 551.29 ± 42.12 pg/mL; P 〈 0.05） and NT-proBNP （5946.50 ± 1434.50 vs. 3028.60 ± 811.90 ng/mL; P 〈 0.05） were also significantly elevated in SDB CHF patients who also had significantly elevated mPAP （50.2 ± 9.5 vs. 36.4 ± 4.1 mm Hg; P 〈 0.05）. EPC numbers correlated inversely with the episodes of apnea and hypopnea per hour （RDI, r = -0.45, P = 0.037） and blood level of OPG （r =-0.53, P = 0.011）. Although NT-proBNP was also increased significantly in patients with SDB, it had no correlation with either EPCs or RD1. Conclusions SDBdue to hypoxemia from decompensated CHF is associated with （1） OPG elevation, （2） EPC depletion, and （3） mPAP elevation. The inverse relationship of circulating OPG with EPCs suggests a likely mechanism for hypoxemia and OPG in the development of pulmonary vascular dysfunction via depleting EPCs, thus worsening prognosis of CHF.展开更多
Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients...Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients' sleep apnea-hypopnea index.Methods Forty-four elderly patients (＞60 years) with cardiac pacemaker and their 44 controls matched for gender, age, body mass index and cardiovascular morbidity were studied using polysomnography or portable sleep monitoring device. Results Prevalence of sleep-disordered breathing (apnea-hypopnea index ≥5/h) was 44.7% and the mean apnea-hypopnea index was 8.2 ±4.1/h in the cardiac pacemaker group, which were significantly higher than those in control subjects (25% and 4.6±2.4/h, respectively, P＜0.01 and P＜0.05). The mean apnea-hypopnea index of patients with DDD or AAI pacemaker was significantly lower than that of patients with VVI pacemaker. Conclusions Sleep-disordered breathing was more common in patients who had their cardiac pacemaker implanted due to bradyarrhythmias than in their matched controls. Compared with VVI pacing, DDD or AAI pacing may be more beneficial to patients with bradyarrhythmias and sleep-disordered breathing.展开更多
Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). ...Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.展开更多
Stroke is a leading cause of death and disability.Despite expensive and elaborative research in finding out mechanisms of interrelation between sleep-disordered breathing(SDB)and stroke,there is yet much attention to ...Stroke is a leading cause of death and disability.Despite expensive and elaborative research in finding out mechanisms of interrelation between sleep-disordered breathing(SDB)and stroke,there is yet much attention to be given in stroke units worldwide to the prompt diagnosis and treatment of SDB in order to improve morbidity and mortality rates related with stroke.The preventive diagnosis and treatment of SDB reduce stroke rate and improves penumbra area in case of ischemic stroke.Stroke itself predispose to SDB,making the interrelationship more complicated.The review by Parra O and Arboix A reflects the results from carefully selected reviews reported in the literature so far.This review of the literature and presentation of the original study of the Authors based on their patients’data,enhances the conviction that there exists a direct relation between SDB and stroke.Diagnosis of SDB in new stroke cases should be sought and treated carefully whenever present.展开更多
The aim of this study was to assess the prevalence of sleep-disordered breathing (SDB) symptoms among primary schoolchildren, and to objectively determine the influence of SDB on the intra-oral environment through the...The aim of this study was to assess the prevalence of sleep-disordered breathing (SDB) symptoms among primary schoolchildren, and to objectively determine the influence of SDB on the intra-oral environment through the analysis of saliva. A questionnaire survey was conducted among approximately 400 children from a primary school in Hiroshima. Parents were asked to complete the questionnaire and provide their contact information if they allowed the collection of saliva samples from their children. Thirty-eight chil- dren agreed to participate in the saliva study. Habit- ual snoring and cessation of breathing during sleep were found in approximately 8% and 1% of children, respectively. The present results showed significant correlations between snoring and mouth breathing. A significant association between excessive daytime sle- epiness (EDS) and learning problems was found. Fur- thermore, among children between the ages of 7 and 12 years, those with EDS and learning problems tended to be older. SDB symptom scores were statisti- cally significant only in relation to EDS. The present study also demonstrated significantly higher levels of salivary IgA and cortisol in children with sleep-re- lated disorders. The present study determined the pre- valence and characteristics of SDB among Japanese primary schoolchildren and their effects on the oral environment. Approximately 8% of primary school- children with habitual snoring might need to be care- fully monitored for SDB symptoms and immune sta- tus to ensure proper psychological and physical deve- lopment.展开更多
Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angi...Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 % of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients. This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions, more frequently in men (P<0.05) and more frequently in those with severe disordered breathing (P<0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)展开更多
Many gastrointestinal complaints and motility disorders are described in patients suffering from different eating disorders. These have a negative impact on refeeding. This report evaluated–on admission-gastric empty...Many gastrointestinal complaints and motility disorders are described in patients suffering from different eating disorders. These have a negative impact on refeeding. This report evaluated–on admission-gastric emptying of a standardized solid meal with 13C octanoic acid breath test in anorexic adolescents. The results were compared with age and gender matched controls. Gastric emptying data were related to a subjective symptom score. 21 Anorexic girls and 3 boys (mean age: 15.6 y ± 1.3 y), body mass index (mean 15.6 kg/m2 ± 1.6 kg/m2), weight loss (mean: 22.2% ± 10.7%) were studied. T? of the gastric emptying time exceeded the P95 in 14/24 (58%) patients, classified as having delayed gastric emptying (DGE). One patient (4%) had a T? exceeding P75 and was classified as slow (SGE), whereas 9/24 (38%) patients had normal gastric emptying (NGE). In comparison to NGE, subjects with DGE had significantly higher symptom scores (p = 0.01) and more weight loss. The DGE and SGE patients lost 25.29% and 21.38% of weight respectively, whereas a weight loss of 17.64% was found in anorexics with NGE. In conclusion, gastric emptying is delayed in patients with anorexia. This is associated with more significant gastrointestinal symptoms and higher weight loss.展开更多
文摘Background Sleep-disordered breathing （SDB） is known to occur frequently in and may predict worsening progression of patients with congestive heart failure （CHF）. SDB is also known to play an important role in the development of idiopathic pulmonary arterial hyper- tension （PAH） via inducing endothelial dysfunction and vascular remodeling, a pathological process that can be significantly influenced by factors such as osteoprotegerin （OPG） and endothelial progenitor cells （EPCs）. The objective of this study is to determine if CHF with SDB is associated with changes in OPG, EPCs, and PAIl. Methods EPCs were isolated, cultured, and quantified from CHF patients with SDB （n = 52）, or without SDB （n - 68）. OPG and N-terminal pro-brain natriuretic peptide （NT-proBNP） from each group was analyzed and cor- related with EPCs and the mean pulmonary artery pressure （mPAP） measured by right heart catheterization. Results A significant decrease in circulating EPCs （29.30 ± 9.01 vs. 45.17 ± 10.51 EPCs/x 200 field; P 〈 0.05） was found in CHF patients with SDB compared to those without SDB. Both OPG （789.83 ±89.38 vs. 551.29 ± 42.12 pg/mL; P 〈 0.05） and NT-proBNP （5946.50 ± 1434.50 vs. 3028.60 ± 811.90 ng/mL; P 〈 0.05） were also significantly elevated in SDB CHF patients who also had significantly elevated mPAP （50.2 ± 9.5 vs. 36.4 ± 4.1 mm Hg; P 〈 0.05）. EPC numbers correlated inversely with the episodes of apnea and hypopnea per hour （RDI, r = -0.45, P = 0.037） and blood level of OPG （r =-0.53, P = 0.011）. Although NT-proBNP was also increased significantly in patients with SDB, it had no correlation with either EPCs or RD1. Conclusions SDBdue to hypoxemia from decompensated CHF is associated with （1） OPG elevation, （2） EPC depletion, and （3） mPAP elevation. The inverse relationship of circulating OPG with EPCs suggests a likely mechanism for hypoxemia and OPG in the development of pulmonary vascular dysfunction via depleting EPCs, thus worsening prognosis of CHF.
文摘Objective To investigate the prevalence of sleep-disordered breathing in elderly patients with permanent cardiac pacemaker implantation due to bradyarrhythmias, and the relationship between pacing mode and patients' sleep apnea-hypopnea index.Methods Forty-four elderly patients (＞60 years) with cardiac pacemaker and their 44 controls matched for gender, age, body mass index and cardiovascular morbidity were studied using polysomnography or portable sleep monitoring device. Results Prevalence of sleep-disordered breathing (apnea-hypopnea index ≥5/h) was 44.7% and the mean apnea-hypopnea index was 8.2 ±4.1/h in the cardiac pacemaker group, which were significantly higher than those in control subjects (25% and 4.6±2.4/h, respectively, P＜0.01 and P＜0.05). The mean apnea-hypopnea index of patients with DDD or AAI pacemaker was significantly lower than that of patients with VVI pacemaker. Conclusions Sleep-disordered breathing was more common in patients who had their cardiac pacemaker implanted due to bradyarrhythmias than in their matched controls. Compared with VVI pacing, DDD or AAI pacing may be more beneficial to patients with bradyarrhythmias and sleep-disordered breathing.
文摘Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.
文摘Stroke is a leading cause of death and disability.Despite expensive and elaborative research in finding out mechanisms of interrelation between sleep-disordered breathing(SDB)and stroke,there is yet much attention to be given in stroke units worldwide to the prompt diagnosis and treatment of SDB in order to improve morbidity and mortality rates related with stroke.The preventive diagnosis and treatment of SDB reduce stroke rate and improves penumbra area in case of ischemic stroke.Stroke itself predispose to SDB,making the interrelationship more complicated.The review by Parra O and Arboix A reflects the results from carefully selected reviews reported in the literature so far.This review of the literature and presentation of the original study of the Authors based on their patients’data,enhances the conviction that there exists a direct relation between SDB and stroke.Diagnosis of SDB in new stroke cases should be sought and treated carefully whenever present.
文摘The aim of this study was to assess the prevalence of sleep-disordered breathing (SDB) symptoms among primary schoolchildren, and to objectively determine the influence of SDB on the intra-oral environment through the analysis of saliva. A questionnaire survey was conducted among approximately 400 children from a primary school in Hiroshima. Parents were asked to complete the questionnaire and provide their contact information if they allowed the collection of saliva samples from their children. Thirty-eight chil- dren agreed to participate in the saliva study. Habit- ual snoring and cessation of breathing during sleep were found in approximately 8% and 1% of children, respectively. The present results showed significant correlations between snoring and mouth breathing. A significant association between excessive daytime sle- epiness (EDS) and learning problems was found. Fur- thermore, among children between the ages of 7 and 12 years, those with EDS and learning problems tended to be older. SDB symptom scores were statisti- cally significant only in relation to EDS. The present study also demonstrated significantly higher levels of salivary IgA and cortisol in children with sleep-re- lated disorders. The present study determined the pre- valence and characteristics of SDB among Japanese primary schoolchildren and their effects on the oral environment. Approximately 8% of primary school- children with habitual snoring might need to be care- fully monitored for SDB symptoms and immune sta- tus to ensure proper psychological and physical deve- lopment.
文摘Objective To investigate the occurrence of nocturnal myocardial ischemia and its relationship with sleep-disordered breathing (apneas and oxygen desaturations) in patients with angina pectoris undergoing coronary angiography.Methods Eighty-two men and 14 women referred for consideration of coronary intervention were randomly selected. Observation by an overnight sleep monitor and Holter recording were performed to study sleep-disordered breathing (oxyhemoglobin desaturations≥4% and apnea-hypopneas),heart rates, and ST-segment depressions (≥ 1mm, ≥1 min).Results Nocturnal ST-segment depressions occurred in 37 % of the patients. ST-segment depression within 2 min after an apnea-hypopnea or desaturation occurred in 17% of the patients. This temporal association was seen in 21% of the patients with nocturnal ST-segment depressions, more frequently in men (P<0.05) and more frequently in those with severe disordered breathing (P<0.05).Most of these ST-segment depressions were preceded by a series of breathing events: repeated apnea-hypopneas or desaturations or both in 73% of the patients. Conclusions Episodes of nocturnal myocardial ischemia are common in patients with angina pectoris. A temporal relationship between sleep-disordered breathing and myocardial ischemia was present in some of our patients, and occurs more frequently in men and in those with severely disordered breathing. (J Geriatr Cardiol 2004;1(2):90-94.)
文摘Many gastrointestinal complaints and motility disorders are described in patients suffering from different eating disorders. These have a negative impact on refeeding. This report evaluated–on admission-gastric emptying of a standardized solid meal with 13C octanoic acid breath test in anorexic adolescents. The results were compared with age and gender matched controls. Gastric emptying data were related to a subjective symptom score. 21 Anorexic girls and 3 boys (mean age: 15.6 y ± 1.3 y), body mass index (mean 15.6 kg/m2 ± 1.6 kg/m2), weight loss (mean: 22.2% ± 10.7%) were studied. T? of the gastric emptying time exceeded the P95 in 14/24 (58%) patients, classified as having delayed gastric emptying (DGE). One patient (4%) had a T? exceeding P75 and was classified as slow (SGE), whereas 9/24 (38%) patients had normal gastric emptying (NGE). In comparison to NGE, subjects with DGE had significantly higher symptom scores (p = 0.01) and more weight loss. The DGE and SGE patients lost 25.29% and 21.38% of weight respectively, whereas a weight loss of 17.64% was found in anorexics with NGE. In conclusion, gastric emptying is delayed in patients with anorexia. This is associated with more significant gastrointestinal symptoms and higher weight loss.
