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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Signs and symptoms of obstructive sleep apnea and central sleep apnea somewhat overlap. The most common signs and symptoms include loud snoring, stopping breathing during sleep, gasping for air during sleep, waking up with a dry mouth, a morning headache, insomnia, hypersomnia, difficulty paying attention when awake, and irritability.
Lifestyle and Diet
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Obstructive Sleep Apnea (OSA) is one of the three forms of sleep apnea which is characterized by short pauses in breathing or abnormally low breathing while asleep. Sleep apneas are divided into three categories: central, obstructive, and complex (a combination of obstructive and central sleep apneas). Central sleep apnea involves dysfunction of the central respiratory control centers in the brain (93). The most common type of sleep apnea is Obstructive Sleep Apnea (OSA). OSA is a breathing disorder that occurs during sleep, characterized by a partial or complete blockage of the upper airway. OSA is caused by the collapse of soft tissue and muscles in the upper airway between the hard plate and the larynx (98, 99). The apneic moment is usually terminated by a slight arousal, as well as an increase in sympathetic tone, as airway patency is re-established. OSA affects nearly 7% of the general population (93). Untreated OSA is associated with long-term health consequences including cardiovascular disease, metabolic disorders, cognitive impairment, and depression. Common symptoms include excessive daytime sleepiness, fatigue, non-refreshing sleep, nocturia, morning headache, irritability, and memory loss. Untreated OSA is also associated with lost productivity and workplace and motor vehicle accidents resulting in injury and fatality (99).
Aortic valve disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Madhur A. Roberts, Ryan K. Kaple, Wilbert S. Aronow
Exertional dyspnea, paroxysmal nocturnal dyspnea, orthopnea, and pulmonary edema may be caused by pulmonary venous hypertension associated with AS. Coexistent CAD and hypertension may contribute to CHF in elderly patients with AS. Cardiac arrhythmias may also precipitate CHF in these patients. Small cohort studies have also demonstrated higher prevalence of sleep-related breathing disorders (obstructive and central sleep apnea) in elderly patients with severe AS (44–46). Sleep-related breathing disorders may be associated with increased perioperative risk. Furthermore, a causal relationship may exist between severe AS and central sleep apnea, as some studies report a significant improvement in central sleep apnea after TAVR (46,47).
Successful microvascular decompression surgery for dolichoectatic vertebral artery compression of medulla oblongata in a patient with hypersomnia disorder
Published in British Journal of Neurosurgery, 2023
Mohammad Ghorbani, Maziar Azar, Karan Bavand, Hamidreza Shojaei, Reza Mollahoseini
A 43 year old male presenting with hypersomnia from 7 years ago referred to our practice for more diagnostic and therapeutic interventions. His symptoms exacerbated with snoring, slurred speech and sleep apnea since 6 months which was affected his job as a driver. He had a past history of palatine surgery that was not helpful for him. On admission time, his physical examinations seemed normal. Early diagnostic evaluation was done with polysomnography and revealed a central sleep apnea. Therefore a brain MRI was requested and showed a vertebrobasilar dolichoectatasia (Figure 1). Also a spiral brain CT angiography was performed and confirmed that an abnormal vascular loop has kinked the brainstem. After ruling out of other causes and considering disable condition of the patient, consultation with him and his family was done and then the authors decided to do microvascular decompression surgery for him.
Sleep apnea and atrial fibrillation: challenges in clinical and translational research
Published in Expert Review of Cardiovascular Therapy, 2022
Benedikt Linz, Julie Norup Hertel, Jeroen Hendriks, Arnela Saljic, Dobromir Dobrev, Mathias Baumert, Thomas Jespersen, Dominik Linz
Even though most AF patients suffer predominantly from obstructive sleep apnea (OSA) and single obstructive respiratory events are described to increase AF-susceptibility, central sleep apnea has also been associated with AF. The most common cause for central sleep apnea is congestive heart failure [31]. In heart failure patients, increased sensitivity of chemoreceptors, pulmonary congestion, and slowing in circulation may impair regulated respiratory control and predispose for central apneic events [32–34]. Additionally, a change in posture at night from upright to supine is associated with a prominent distribution of body fluid from the lower body part to the chest and neck area, also called rostral shift [35]. This is associated with an increase in neck volume, which increases the risk for upper airway collapsibility. Moreover, heart failure is associated with increased atrial volume and stretch and reduced repolarizing potassium currents, which might contribute to early or late afterdepolarizations, thus increasing AF-trigger formation [36].
Diagnosis and management of central sleep apnea syndrome
Published in Expert Review of Respiratory Medicine, 2019
Sébastien Baillieul, Bruno Revol, Ingrid Jullian-Desayes, Marie Joyeux-Faure, Renaud Tamisier, Jean-Louis Pépin
As mentioned by Randerath et al. in their recent task force report, idiopathic central sleep apnea is rare and of unknown prevalence and origin [1], occurring in patients without any underlying cardiac or neurological disease [9]. Described as an hypocapnic CSA, the episodes of CSB are approximatively 30–40 seconds long, mainly driven by an elevated chemosensitivity to PaCO2 (high-loop gain per se) [9]. Arousals, occurring in a characteristic manner at the peak of hyperventilation, contribute to the increase in ventilation, perpetrating cyclical breathing patterns through enhanced chemo-responsiveness [9]. Controlling PaCO2 levels, as well as reducing the arousal index are two potential therapeutic targets. Thus, added dead space, by elevating CO2 levels, or CO2 inhalation have been proposed as treatment strategies for idiopathic CSA. Zolpidem and Acetazolamide have shown efficacy in reducing arousals and central apneas in this condition [9]. Sharing the same mechanisms, hyperventilation syndrome (HVS), a frequent behavioral condition, is associated with CSA [42]. Taking into account the underlying mechanisms, ASV may be indicated for symptomatic idiopathic CSA and HVS.