1/47. Transtracheal air in the treatment of obstructive sleep apnoea hypopnoea syndrome.A 49 year old woman with typical obstructive sleep apnoea hypopnoea syndrome underwent an unsuccessful trial with continuous positive airway pressure (CPAP) followed by uvulopalatopharyngoplasty with septorhinoplasty, treatment with protriptyline, and a second CPAP trial that was abandoned. Transtracheal air was then given and normalised sleep and breathing at a flow rate of 5 l/min. A sustained clinical improvement was observed at follow up visits. Transtracheal air could represent a simple and effective alternative to tracheotomy in patients with obstructive sleep apnoea hypopnoea syndrome in whom conventional treatments fail.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/47. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children: mid-face hypoplasia.We report the case of a 15-year-old boy with obstructive sleep apnea and obesity who was treated since the age of 5 with nasal continuous positive airway pressure. Due to the long-term use of a nasal mask, the child developed a mid-face hypoplasia. Chronic use of a nasal mask for home ventilation in children should always be associated with regular evaluations of maxillomandibular growth.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
3/47. Upper airway resistance syndrome--report of three cases.INTRODUCTION: patients with the upper airway resistance syndrome are frequently overlooked, and even if clinically suspected, often escape identification by polysomnographic monitoring. CLINICAL PICTURE: Three cases (2 women and a man) with excessive daytime sleepiness and fatigue were confirmed to have the upper airway resistance syndrome after undergoing polysomnography with oesophageal pressure monitoring. TREATMENT: Nasal CPAP during sleep was prescribed for 2 cases but 1 case refused all available treatment options. OUTCOME: After one month of CPAP therapy, the 2 cases reported improved symptoms and Epworth sleepiness scores. Lower daytime blood pressures were also recorded. CONCLUSIONS: Oesophageal pressure monitoring and EEG arousal analysis can greatly enhance the diagnostic accuracy in the upper airway resistance syndrome. Accurate diagnosis and effective treatment of this condition is important because of its sequelae of hypersomnolence and association with other disorders like systemic hypertension.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
4/47. Reversal of floppy eyelid syndrome with treatment of obstructive sleep apnoea.PURPOSE: To describe the beneficial effects of treatment of obstructive sleep apnoea on the symptoms and signs of floppy eyelid syndrome. METHOD: A case of sleep apnoea with associated floppy eyelid syndrome is reported. RESULTS: A 32-year-old man presented with left floppy eyelid syndrome and a known diagnosis of obstructive sleep apnoea. He underwent treatment for 4 years with continuous positive airways pressure by mask during sleep and the symptoms and signs of his floppy eyelid syndrome disappeared. CONCLUSION: Treatment of obstructive sleep apnoea may reverse the changes of floppy eyelid syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/47. papilledema and obstructive sleep apnea syndrome.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.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
6/47. Obstructive sleep apnea syndrome after reconstructive laryngectomy for glottic carcinoma.Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. The obstruction predominantly occurs along the pharyngeal airway but other sites of obstruction have occasionally been described. We report our experience with three patients suffering from OSAS suspected to be of laryngeal origin. OSAS developed after reconstructive laryngectomy for glottic carcinoma and upper airway obstruction seemed to be located in the reconstructed laryngeal area. The three patients were given nCPAP (nasal-continuous positive airway pressure) treatment associated with peroral endoscopic CO2 laser vaporization of the laryngeal edema. After CO2 laser treatment, one patient was able to stop nCPAP treatment. The other two have remained on nCPAP therapy. OSAS may arise in the post-operative period of reconstructive laryngectomy for glottic carcinoma and can be managed by CO2 laser vaporization (laryngeal edema in the reconstructed area) in association with nCPAP treatment.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/47. attention deficit hyperactivity disorder in adults and obstructive sleep apnea.attention deficit hyperactivity disorder (ADHD) is a common childhood illness with a prevalence between 3% and 16%. It is characterized by hyperactivity, impulsiveness, impairment in academic, social, and occupational functioning, short attention span, and onset of symptoms before age 7 years. In some patients, this illness can persist into adulthood. Obstructive sleep apnea (OSA) is a common disorder affecting 3% of the population and is characterized by hypersomnolence, snoring, disturbed sleep, and cognitive dysfunction. Some studies have suggested an association between OSA and ADHD in children. Because of the overlap of symptoms, patients with OSA may be considered to have ADHD. Significant improvement in symptoms has been reported with the use of continuous positive airway pressure in patients with OSA. We present reports of three adults who were being treated for ADHD and were found to have OSA.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/47. Severe obstructive sleep apnoea secondary to pressure garments used in the treatment of hypertrophic burn scars.Obstructive sleep apnoea (OSA) secondary to pressure garments used to treat hypertrophic scarring of burns has never been reported. The present study describes two children who presented with OSA following introduction of such garments for management of hypertrophic scars following severe facial and upper body burns. Complex sleep polysomnography confirmed severe OSA with desaturations sufficient to result in physiological dysfunction that significantly improved on removal of the garments. As there is little evidence to suggest that the use of such garments alters the end result, the potentially serious side effect of obstructive sleep apnoea should be considered before their use is advised.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
9/47. sleep apnoea and Turner's syndrome.A 32-yr-old female with Turner's syndrome and anatomical craniofacial abnormalities, presented with obstructive sleep apnoea syndrome. This was initially treated by nasal continuous positive airway pressure and secondarily cured by maxillomandibullar advancement osteotomy. Anatomical upper airway abnormalities and hormonal factors, which predispose Turner patients to develop obstructive sleep apnoea syndrome, are discussed. A systematic assessment and treatment of sleep-disordered breathing is probably of interest in these patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/47. Improvement of sleep apnea in a patient with cerebral palsy.Intrathecal baclofen (ITB) can reduce spasticity in adults and children with cerebral palsy. Benefits of ITB therapy include improved Ashworth scores, activities of daily living, and mobility. The impact of ITB therapy on sleep apnea in patients with cerebral palsy has not been reported. This case report describes a 29-yr-old female with mixed spastic athetoid quadriparetic cerebral palsy with dystonia, gross motor function IV, who had sleep apnea, requiring nightly continuous positive airway pressure. She received ITB with the goal to improve her wheelchair positioning and decrease her excessive movements. After the initiation of the ITB, reduction of her spasticity and dystonia was noted, as well as improvement of her sleep apnea. This case suggests that ITB therapy may improve respiratory function through reduction of respiratory muscle spasticity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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