1/38. Nonlinear multivariable modeling and analysis of sleep apnea time series.This paper investigates the modeling and analysis of physiological data recorded from a 49-year-old male and are composed of three time series: blood oxygen saturation, heart rate and respiration. In particular, it is desired to verify if the models estimated from data can distinguish between the dynamics underlying two different breathing patterns (normal breathing and apnea). The estimated models are nonlinear autoregressive, moving average with exogenous inputs (NARMAX) and the regressors used to compose such models are carefully chosen, among hundreds of candidates, by an automatic procedure. The results discussed in this paper suggest that the dynamics underlying the data are nonlinear and basically deterministic. Using estimated models it seems to be possible to quantify the stability of the fixed point in phase space reconstructed using the blood oxygen time series. This, as discussed, could be the basis of an algorithmic monitoring system.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
2/38. Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy.At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position. At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8. Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep. This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
3/38. A case of sleep choking syndrome improved by the Kampo extract of Hange-koboku-to.A case of sleep choking syndrome with typical symptoms is presented. A 44-year-old Japanese male suffered from multiple episodes of choking, which suddenly appeared with fear of impending death about 30 min after falling asleep almost every night. Overnight polysomnography showed an apnea index of 0.92 events/h, an apnea-hypopnea index of 2.77 events/h, and normal respiration during sleep with the exception of the episodes of apnea and hypopnea. No choking episode occurred in the sleep laboratory. The administration of 500 mg of acetazolamide was ineffective, but the choking episode improved after the administration of Kampo extract of Hange-koboku-to (Ban-xia-hou-pu-tang). Hange-koboku-to may be effective in treating choking sensation during sleep as well as during wakefulness.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
4/38. Three-piece oral appliance with herbst attachments for persistent vegetative state patient with sleep-disordered breathing.PURPOSE: persistent vegetative state is a form of wakefulness without awareness. This report describes a dental appliance for the treatment of sleep breathing disorders in this condition. The device can be easily inserted and removed by the patient's family or nurse. MATERIALS AND methods: A 19-year-old woman had been in a persistent vegetative state since having hypoxic-ischemic encephalopathy because of cardiopulmonary arrest. Although she exhibited a sleep-wake cycle and normal respiration, she had sleep apnea and snoring, and produced snoring-like sounds even in an awake state. A three-piece device with Herbst attachments was fabricated to treat the symptoms. Overnight sleep studies were carried out to evaluate the effectiveness of the appliance. RESULTS: The device could be handled by the patient's family. snoring was satisfactorily reduced after insertion of the device. sleep apnea, desaturation, and minimal oxygen saturation were markedly improved. CONCLUSION: If the family of a persistent vegetative state patient wishes to treat sleep-disordered breathing, the appliance may be helpful as an alternative to relieve the symptoms. The device could be applied for sleep apnea patients who experience difficulties using other types of oral appliances.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
5/38. Obstructive sleep apnea in arnold-chiari malformation treated with acetazolamide.We studied respiratory patterns and transcutaneous gas pressures in two infants with Arnold-Chiari type II malformation referred to us due to repeated episodes of stridor and cyanosis. During both active and quiet sleep, respiration was irregular and absent or inverse thoracic breathing movements and frequent decreases in oxygen saturation to below 80% were observed. When breathing air with 2% CO2 or when given acetazolamide 10 mg/kg, chest wall movements normalized and oxygenation increased to near normal levels. After three months of treatment with acetazolamide 20 mg/kg/24 h no further episodes of hypoventilation or hypoxemia were observed and further treatment could be discontinued. We conclude that stimulation of respiration by CO2 or by acetazolamide appears to recruit chest wall muscles and promote upper airway patency in arnold-chiari malformation. A treatment trial with acetazolamide seems justifiable in these infants when respiratory problems are present.- - - - - - - - - - ranking = 2keywords = respiration (Clic here for more details about this article) |
6/38. sleep apnea and excessive daytime somnolence induced by vagal nerve stimulation.Vagal nerve stimulation (VNS) therapy affects respiration during sleep and can interrupt sleep. VNS has also been noted to improve excessive daytime sleepiness. The authors present a patient who developed excessive daytime sleepiness after VNS placement, as a consequence of apneas and arousals associated with intermittent electrical stimulation of the left vagus nerve.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
7/38. Reversal of nocturnal periodic breathing in primary pulmonary hypertension after lung transplantation.Nocturnal periodic breathing (PB) closely resembling cheyne-stokes respiration in congestive heart failure has been reported to occur in end-stage primary pulmonary hypertension (PPH). We herein describe the clinical course of a 56-year-old female patient with PPH and severe hypoxemia, hypocapnia, and right ventricular compromise in whom sleep-disordered breathing (SDB) resolved after successful double-lung transplantation. This case illustrates the crucial roles of blood gas alterations and hemodynamic impairment in the emergence of PB in PPH, and is in favor of a genuine association between advanced right heart failure and the development of SDB.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
8/38. Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment.A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed cheyne-stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.- - - - - - - - - - ranking = 5keywords = respiration (Clic here for more details about this article) |
9/38. death during polysomnography of a patient with cheyne-stokes respiration, respiratory acidosis, and chronic heart failure.A patient with chronic heart failure and chronic respiratory failure (CRF) underwent ambulatory polysomnography at home. She was found dead on the morning after the recording. The tracings confirmed severe sleep apnea syndrome. After 8 h of incessant cheyne-stokes respiration during sleep, respiratory arrest occurred, followed 7 min later by asystole. This report illustrates a case of respiratory drive failure during sleep as the mode of death in a patient with heart failure, sleep apnea syndrome, and CRF.- - - - - - - - - - ranking = 5keywords = respiration (Clic here for more details about this article) |
10/38. Dilated cardiomyopathy in Kugelberg-Welander disease: coexisting sleep disordered breathing and its treatment with continuous positive airway pressure.A rare complication of possible secondary dilated cardiomyopathy to Kugelberg-Welander disease was described in a 53-year-old patient with this inherent motor neuron disease, whom we diagnosed after a genetic analysis of the defective survival motor neuron gene. An association of sleep disordered breathing of cheyne-stokes respiration was diagnosed, which was virtually eliminated with continuous positive airway pressure via nasal mask. Considering the paucity of therapeutic options in most degenerative neuromuscular disorders, ameliorations in not only sleep quality but also cardiac function with continuous positive airway pressure have clinical implications.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
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