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Timothy I Morgenthaler - One of the best experts on this subject based on the ideXlab platform.
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efficacy of adaptive servoventilation in treatment of complex and central sleep Apnea syndromes
Chest, 2007Co-Authors: Joanne Shirine Allam, Eric J Olson, Timothy I MorgenthalerAbstract:Background Complex sleep Apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central Apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep Apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV. Methods Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center. Results ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep Apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive Apneas decreased, but the appearance of central Apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AHI to a mean of 5 events per hour (range, 1 to 11) vs baseline and vs CPAP (p Conclusion The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.
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adaptive servoventilation versus noninvasive positive pressure ventilation for central mixed and complex sleep Apnea syndromes
Sleep, 2007Co-Authors: Timothy I Morgenthaler, Nancy Gordon, Lee K BrownAbstract:RATIONALE Although continuous positive airway pressure (CPAP) is most often effective in patients with obstructive sleep Apnea, optimal treatment of patients with predominantly mixed Apneas, central sleep Apnea syndrome/Cheyne-Stokes respiration (CSA/CSR), or complex sleep Apnea (CompSAS) is less straightforward, and may require alternative ventilatory assist modalities. OBJECTIVES To compare the efficacy of noninvasive positive pressure ventilation (NPPV) with adaptive servoventilation (ASV) in treating patients with centrally mediated breathing abnormalities. We hypothesized that NPPV and ASV would be equivalently efficacious in improving the Apnea/hypopnea index (AHI) and respiratory arousal index (RAI). METHODS Prospective randomized crossover clinical trial comparing NPPV with ASV in patients with CSA/CSR, predominantly mixed Apneas, and CompSAS in an acute setting. MEASUREMENTS AND MAIN RESULTS 21 patients (6 with CSA/CSR, 6 with predominantly mixed Apneas, and 9 with CompSAS) with initial diagnostic AHI +/- standard deviation 51.9 +/- 22.8/hr and RAI 45.5 < or = 26.5/hr completed the study. Following optimal titration with CPAP (N = 15), disturbed breathing and disturbed sleep remained high with mean AHI = 34.3 +/- 25.7 and RAI = 32.1 +/- 29.7. AHI and RAI were markedly reduced with both NPPV (6.2 +/- 7.6 and 6.4 +/- 8.2) and ASV (0.8 +/- 2.4 and 2.4 +/- 4.5). Treatment AHI and RAI were both significantly lower using ASV (P < 0.01). CONCLUSION These data confirm that in patients with CSA/CSR, mixed Apneas, and CompSAS, both NPPV and ASV are effective in normalizing breathing and sleep parameters, and that ASV does so more effectively than NPPV in these types of patients.
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complex sleep Apnea syndrome is it a unique clinical syndrome
Sleep, 2006Co-Authors: Timothy I Morgenthaler, Vadim Kagramanov, Viktor Hanak, Paul A DeckerAbstract:STUDY OBJECTIVES Some patients with apparent obstructive sleep Apnea hypopnea syndrome (OSAHS) have elimination of obstructive events but emergence of problematic central Apneas or Cheyne-Stokes breathing pattern. Patients with this sleep-disordered breathing problem, which for the sake of study we call the "complex sleep Apnea syndrome," are not well characterized. We sought to determine the prevalence of complex sleep Apnea syndrome and hypothesized that the clinical characteristics of patients with complex sleep Apnea syndrome would more nearly resemble those of patients with central sleep Apnea syndrome (CSA) than with those of patients with OSAHS. DESIGN Retrospective review SETTING Sleep disorders center. PATIENTS OR PARTICIPANTS Two hundred twenty-three adults consecutively referred over 1 month plus 20 consecutive patients diagnosed with CSA. INTERVENTIONS NA. MEASUREMENTS AND RESULTS Prevalence of complex sleep Apnea syndrome, OSAHS, and CSA in the 1-month sample was 15%, 84%, and 0.4%, respectively. Patients with complex sleep Apnea syndrome differed in gender from patients with OSAHS (81% vs 60% men, p < .05) but were otherwise similar in sleep and cardiovascular history. Patients with complex sleep Apnea syndrome had fewer maintenance-insomnia complaints (32% vs 79%; p < .05) than patients with CSA but were otherwise not significantly different clinically. Diagnostic Apnea-hypopnea index for patients with complex sleep Apnea syndrome, OSAHS, and CSA was 32.3 +/- 26.8, 20.6 +/- 23.7, and 38.3 +/- 36.2, respectively (p = .005). Continuous positive airway pressure suppressed obstructive breathing, but residual Apnea-hypopnea index, mostly from central Apneas, remained high in patients with complex sleep Apnea syndrome and CSA (21.7 +/- 18.6 in complex sleep Apnea syndrome, 32.9 +/- 30.8 in CSA vs 2.14 +/- 3.14 in OSAHS; p < .001). CONCLUSIONS Patients with complex sleep Apnea syndrome are mostly similar to those with OSAHS until one applies continuous positive airway pressure. They are left with very disrupted breathing and sleep on continuous positive airway pressure. Clinical risk factors don't predict the emergence of complex sleep Apnea syndrome, and best treatment is not known.
Karl A Franklin - One of the best experts on this subject based on the ideXlab platform.
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mandibular advancement devices in 630 men and women with obstructive sleep Apnea and snoring tolerability and predictors of treatment success
Chest, 2004Co-Authors: Marie Marklund, Hans Stenlund, Karl A FranklinAbstract:Study objective: To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep Apnea. Design: Prospective study. Setting: Departments of Respiratory Medicine and Orthodontics, Umea University. Patients: Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep Apnea and snoring from February 1989 to August 2000, were followed up. They had a mean Apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42). Measurements: Interviews, questionnaires, and overnight sleep Apnea recordings. Patients with an Apnea-hypopnea index of > 10 in the supine and/or lateral position were considered to have obstructive sleep Apnea. A lateral Apnea-hypopnea index of 10, defined supine-dependent sleep Apneas. Results: One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an Apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p 0.01). In the women, the odds ratios for treatment success were 12 for mild sleep Apnea (p 0.04), and 0.1 for complaints of nasal obstruction (p 0.03). In the men, the odds ratios for treatment success were 6.0 for supinedependent sleep Apneas (p < 0.001), 2.5 for mild sleep Apnea (p 0.04), 1.3 for each millimeter of mandibular advancement (p 0.03), and 0.8 for each kilogram of weight increase (p 0.001). Conclusions: The mandibular advancement device is recommended for women with sleep Apnea, for men with supine-dependent sleep Apneas defined by a lateral Apnea-hypopnea index of < 10, and for snorers without sleep Apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep Apnea recording with the device. (CHEST 2004; 125:1270 –1278)
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the effect of a mandibular advancement device on Apneas and sleep in patients with obstructive sleep Apnea
Chest, 1998Co-Authors: Marie Marklund, Karl A Franklin, Carin Sahlin, Rune LundgrenAbstract:Objective To evaluate the effects of a mandibular advancement device on Apneas and sleep in mild, moderate, and severe obstructive sleep Apnea. Design Prospective study. Subjects Forty-four of 47 patients included. Intervention Individually adjusted mandibular advancement devices. Measurements Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings. Results The device reduced the median obstructive Apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p Conclusions A mandibular advancement device reduces Apneas and improves sleep quality in patients with obstructive sleep Apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive Apneas without subjective snoring with the device.
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reversal of central sleep Apnea with oxygen
Chest, 1997Co-Authors: Karl A Franklin, Carin Sahlin, Rune Lundgren, Peter ErikssonAbstract:Objective To examine the effect of oxygen on Apneas and sleep quality in patients with frequent central Apneas during sleep. Design/subjects Prospective intervention study of 20 consecutive patients with predominant central Apnea identified from 570 patients referred for suspected sleep Apnea syndrome. Sixteen patients had congestive heart failure and seven of them had a previous stroke. Three of the remaining four patients without heart failure had experienced a previous stroke, and one was being treated with morphine. Setting The Department of Pulmonary Medicine at Umea (Sweden) University Hospital. Interventions: The patients were investigated for one night receiving nasal oxygen and one night without it. Measurements Overnight polysomnography with transcutaneous Pco 2 and arterial blood gases. Results: Central Apneas occurred during Cheyne-Stokes respiration in 18 of 20 patients and two patients had idiopathic central Apneas. Without oxygen, the median number of all central Apneas and hypopneas was 33.5 (range, 8.0 to 52.0) per hour of sleep. These episodes decreased to 5.0 (range, 0.0 to 31.0) (p Conclusions Oxygen effectively reduces central sleep Apnea in eucapnic patients.
Rune Lundgren - One of the best experts on this subject based on the ideXlab platform.
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the effect of a mandibular advancement device on Apneas and sleep in patients with obstructive sleep Apnea
Chest, 1998Co-Authors: Marie Marklund, Karl A Franklin, Carin Sahlin, Rune LundgrenAbstract:Objective To evaluate the effects of a mandibular advancement device on Apneas and sleep in mild, moderate, and severe obstructive sleep Apnea. Design Prospective study. Subjects Forty-four of 47 patients included. Intervention Individually adjusted mandibular advancement devices. Measurements Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings. Results The device reduced the median obstructive Apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p Conclusions A mandibular advancement device reduces Apneas and improves sleep quality in patients with obstructive sleep Apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive Apneas without subjective snoring with the device.
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reversal of central sleep Apnea with oxygen
Chest, 1997Co-Authors: Karl A Franklin, Carin Sahlin, Rune Lundgren, Peter ErikssonAbstract:Objective To examine the effect of oxygen on Apneas and sleep quality in patients with frequent central Apneas during sleep. Design/subjects Prospective intervention study of 20 consecutive patients with predominant central Apnea identified from 570 patients referred for suspected sleep Apnea syndrome. Sixteen patients had congestive heart failure and seven of them had a previous stroke. Three of the remaining four patients without heart failure had experienced a previous stroke, and one was being treated with morphine. Setting The Department of Pulmonary Medicine at Umea (Sweden) University Hospital. Interventions: The patients were investigated for one night receiving nasal oxygen and one night without it. Measurements Overnight polysomnography with transcutaneous Pco 2 and arterial blood gases. Results: Central Apneas occurred during Cheyne-Stokes respiration in 18 of 20 patients and two patients had idiopathic central Apneas. Without oxygen, the median number of all central Apneas and hypopneas was 33.5 (range, 8.0 to 52.0) per hour of sleep. These episodes decreased to 5.0 (range, 0.0 to 31.0) (p Conclusions Oxygen effectively reduces central sleep Apnea in eucapnic patients.
Marie Marklund - One of the best experts on this subject based on the ideXlab platform.
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mandibular advancement devices in 630 men and women with obstructive sleep Apnea and snoring tolerability and predictors of treatment success
Chest, 2004Co-Authors: Marie Marklund, Hans Stenlund, Karl A FranklinAbstract:Study objective: To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep Apnea. Design: Prospective study. Setting: Departments of Respiratory Medicine and Orthodontics, Umea University. Patients: Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep Apnea and snoring from February 1989 to August 2000, were followed up. They had a mean Apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42). Measurements: Interviews, questionnaires, and overnight sleep Apnea recordings. Patients with an Apnea-hypopnea index of > 10 in the supine and/or lateral position were considered to have obstructive sleep Apnea. A lateral Apnea-hypopnea index of 10, defined supine-dependent sleep Apneas. Results: One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an Apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p 0.01). In the women, the odds ratios for treatment success were 12 for mild sleep Apnea (p 0.04), and 0.1 for complaints of nasal obstruction (p 0.03). In the men, the odds ratios for treatment success were 6.0 for supinedependent sleep Apneas (p < 0.001), 2.5 for mild sleep Apnea (p 0.04), 1.3 for each millimeter of mandibular advancement (p 0.03), and 0.8 for each kilogram of weight increase (p 0.001). Conclusions: The mandibular advancement device is recommended for women with sleep Apnea, for men with supine-dependent sleep Apneas defined by a lateral Apnea-hypopnea index of < 10, and for snorers without sleep Apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep Apnea recording with the device. (CHEST 2004; 125:1270 –1278)
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the effect of a mandibular advancement device on Apneas and sleep in patients with obstructive sleep Apnea
Chest, 1998Co-Authors: Marie Marklund, Karl A Franklin, Carin Sahlin, Rune LundgrenAbstract:Objective To evaluate the effects of a mandibular advancement device on Apneas and sleep in mild, moderate, and severe obstructive sleep Apnea. Design Prospective study. Subjects Forty-four of 47 patients included. Intervention Individually adjusted mandibular advancement devices. Measurements Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings. Results The device reduced the median obstructive Apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p Conclusions A mandibular advancement device reduces Apneas and improves sleep quality in patients with obstructive sleep Apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive Apneas without subjective snoring with the device.
Jerome A Dempsey - One of the best experts on this subject based on the ideXlab platform.
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central sleep Apnea misunderstood and mistreated
F1000Research, 2019Co-Authors: Jerome A DempseyAbstract:Central sleep Apnea is prevalent in patients with heart failure, healthy individuals at high altitudes, and chronic opiate users and in the initiation of “mixed” (that is, central plus obstructive Apneas). This brief review focuses on (a) the causes of repetitive, cyclical central Apneas as mediated primarily through enhanced sensitivities in the respiratory control system and (b) treatment of central sleep Apnea through modification of key components of neurochemical control as opposed to the current universal use of positive airway pressure.
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central sleep Apnea
Comprehensive Physiology, 2013Co-Authors: Shahrokh Javaheri, Jerome A DempseyAbstract:Neurophysiologically, central Apnea is due to a temporary failure in the pontomedullary pacemaker generating breathing rhythm. As a polysomnographic finding, central Apneas occur in many pathophysiological conditions. Depending on the cause or mechanism, central Apneas may not be clinically significant, for example, those that occur normally at sleep onset. In contrast, central Apneas occur in a number of disorders and result in pathophysiological consequences. Central Apneas occur commonly in high-altitude sojourn, disrupt sleep, and cause desaturation. Central sleep Apnea also occurs in number of disorders across all age groups and both genders. Common causes of central sleep Apnea in adults are congestive heart failure and chronic use of opioids to treat pain. Under such circumstances, diagnosis and treatment of central sleep Apnea may improve quality of life, morbidity, and perhaps mortality. The mechanisms of central sleep Apnea have been best studied in congestive heart failure and hypoxic conditions when there is increased CO2 sensitivity below eupnea resulting in lowering eupneic PCO2 below apneic threshold causing cessation of breathing until the PCO2 rises above the apneic threshold when breathing resumes. In many other disorders, the mechanism of central sleep Apnea (CSA) remains to be investigated.
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pharyngeal narrowing occlusion during central sleep Apnea
Journal of Applied Physiology, 1995Co-Authors: M S Badr, F Toiber, James B Skatrud, Jerome A DempseyAbstract:We hypothesized that subatmospheric intraluminal pressure is not required for pharyngeal occlusion during sleep. Six normal subjects and six subjects with sleep Apnea or hypopnea (SAH) were studied during non-rapid-eye-movement sleep. Pharyngeal patency was determined by using fiber-optic nasopharyngoscopy during spontaneous central sleep Apnea (n = 4) and induced hypocapnic central Apnea via nasal mechanical ventilation (n = 10). Complete pharyngeal occlusion occurred in 146 of 160 spontaneously occurring central Apneas in patients with central sleep Apnea syndrome. During induced hypocapnic central Apnea, gradual progressive pharyngeal narrowing occurred. More pronounced narrowing was noted at the velopharynx relative to the oropharynx and in subjects with SAH relative to normals. Complete pharyngeal occlusion frequently occurred in subjects with SAH (31 of 44 Apneas) but rarely occurred in normals (3 of 25 Apneas). Resumption of inspiratory effort was associated with persistent narrowing or complete occlusion unless electroencephalogram signs of arousal were noted. Thus pharyngeal cross-sectional area is reduced during central Apnea in the absence of inspiratory effort. Velopharyngeal narrowing consistently occurs during induced hypocapnic central Apnea even in normal subjects. Complete pharyngeal occlusion occurs during spontaneous or induced central Apnea in patients with SAH. We conclude that subatmospheric intraluminal pressure is not required for pharyngeal occlusion to occur. Pharyngeal narrowing or occlusion during central Apnea may be due to passive collapse or active constriction.
