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Sleep Apnea Syndromes: HELP
Articles by Winfried J. Randerath
Based on 51 articles published since 2008
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Between 2008 and 2019, W. Randerath wrote the following 51 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Non-CPAP therapies in obstructive sleep apnoea. 2011

Randerath, W J / Verbraecken, J / Andreas, S / Bettega, G / Boudewyns, A / Hamans, E / Jalbert, F / Paoli, J R / Sanner, B / Smith, I / Stuck, B A / Lacassagne, L / Marklund, M / Maurer, J T / Pepin, J L / Valipour, A / Verse, T / Fietze, I / Anonymous2140689. ·Institute for Pneumology at the University Witten/Herdecke,Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. randerath@klinik-bethanien.de ·Eur Respir J · Pubmed #21406515.

ABSTRACT: In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.

2 Editorial Central sleep apnea: the problem of diagnosis. 2017

Randerath, W. ·University of Cologne, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhöherstraße 169-175, 42699, Solingen, Germany. Electronic address: randerath@klinik-bethanien.de. ·Sleep Med · Pubmed #28153696.

ABSTRACT: -- No abstract --

3 Editorial Continuous Positive Airway Pressure and Airway Hyperreactivity in Asthma: Lessons for Patients with Obstructive Sleep Apnea? 2016

Randerath, Winfried J. ·University of Cologne, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. ·Ann Am Thorac Soc · Pubmed #27831810.

ABSTRACT: -- No abstract --

4 Editorial New rules on driver licensing for patients with obstructive sleep apnoea: EU Directive 2014/85/EU. 2016

Bonsignore, Maria R / Randerath, Winfried / Riha, Renata / Smyth, Dan / Gratziou, Christina / Goncalves, Marta / McNicholas, Walter T. ·DiBiMIS, University of Palermo and Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council (CNR), Palermo, Italy marisa@ibim.cnr.it. · Pneumologie und Allergologie Zentrum für Schlaf - und Beatmungsmedizin, Krankenhaus Bethanien, Solingen, Germany. · Sleep and Respiratory Medicine, University of Edinburgh, Edinburgh, UK. · European Lung Foundation Chair. · Medical School, Athens University, Athens, Greece. · Institute of Public Health - University of Porto (ISPUP), Porto, Portugal. · Dept of Respiratory and Sleep Medicine, St. Vincent's University Hospital, University College Dublin, Dublin, Ireland. ·Eur Respir J · Pubmed #26721963.

ABSTRACT: -- No abstract --

5 Editorial Missing links. 2015

Randerath, W / Khayat, R / Arzt, M / Javaheri, S. ·Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Aufderhöher Str. 169, 42699 Solingen, Germany. Electronic address: randerath@klinik-bethanien.de. · Sleep Heart Program, The Ohio State University, Columbus, OH, USA. · Department of Internal Medicine II, University Hospital Regensburg, Germany. · Bethesda North Hospital, Professor Emeritus, University of Cincinnati, Cincinnati, Ohio, USA. ·Sleep Med · Pubmed #26611946.

ABSTRACT: -- No abstract --

6 Editorial Time for screening? 2014

Randerath, Winfried. ·Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhöher Straße 169-175, 42699 Solingen, Germany Tel.: 0049/212/63-6000; fax: 0049/212/63-6005.. Electronic address: randerath@klinik-bethanien.de. ·Sleep Med · Pubmed #25277662.

ABSTRACT: -- No abstract --

7 Editorial Sleep HERMES: a European training project for respiratory sleep medicine. 2011

De Backer, W / Simonds, A K / Horn, V / Andreas, S / Bonsignore, M / Calverley, P / Donic, V / Lévy, P / Mitchell, S / McNicholas, W T / Morrell, M / Randerath, W / Riha, R L / Trang, H / Verbraecken, J / Palange, P. · ·Eur Respir J · Pubmed #21885409.

ABSTRACT: -- No abstract --

8 Review Device Therapy for Sleep-Disordered Breathing in Patients with Cardiovascular Diseases and Heart Failure. 2017

Randerath, Winfried / Herkenrath, Simon. ·Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology, University of Cologne, Aufderhöher Str. 169, Solingen 42699, Germany. Electronic address: randerath@klinik-bethanien.de. · Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Institute of Pneumology, University of Cologne, Aufderhöher Str. 169, Solingen 42699, Germany. ·Sleep Med Clin · Pubmed #28477778.

ABSTRACT: Pathophysiologic components of upper airway obstruction, reduced tidal volume, and disturbed respiratory drive characterize sleep-disordered breathing. Positive airway pressure (PAP) devices address these components by stabilizing the upper airways (continuous PAP), applying air volumes and mandatory breaths (bilevel PAP), or counterbalancing ventilation (adaptive servoventilation). Although PAP therapies have been shown to improve breathing disturbances, daytime symptoms, and left ventricular function in obstructive sleep apnea and cardiovascular diseases, the effects on mortality are controversial, especially in heart failure and central sleep apnea. Optimal treatment is selected based on polysomnographic findings and symptoms, and applied based on the underlying pathophysiologic components.

9 Review Clinical applications of adaptive servoventilation devices: part 2. 2014

Javaheri, Shahrokh / Brown, Lee K / Randerath, Winfried J. ·College of Medicine, University of Cincinnati, Cincinnati, OH. Electronic address: shahrokhjavaheri@icloud.com. · Department of Internal Medicine, School of Medicine, The University of New Mexico, Albuquerque, NM. · Zentrum für Schlaf- und Beatmungsmedizin Aufderhöher, Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen, Germany. ·Chest · Pubmed #25180729.

ABSTRACT: Adaptive servoventilation (ASV) is an automated treatment modality used to treat many types of sleep-disordered breathing. Although default settings are available, clinician-specified settings determined in the sleep laboratory are preferred. Depending on the device, setting choices may include a fixed expiratory positive airway pressure (EPAP) level or a range for autotitrating EPAP; minimum and maximum inspiratory positive airway pressure or pressure support values; and type of backup rate algorithm or a selectable fixed backup rate. ASV was initially proposed for treatment of central sleep apnea and Hunter-Cheyne-Stokes breathing associated with congestive heart failure (CHF), and numerous observational studies have demonstrated value in this setting. Other studies have reported varying efficacy in patients with complex sleep apnea syndromes, including those with mixtures of obstructive and central sleep-disordered breathing associated with CHF, renal failure, or OSA with central apneas developing on conventional positive airway pressure therapy. Patients with opioid-induced sleep apnea, both obstructive and central, may also respond to ASV. The variability in response to ASV in a given patient along with the myriad choices of specific models and settings demand a high degree of expertise from the clinician. Finally, randomized controlled studies are needed to determine long-term clinical efficacy of these devices.

10 Review Positive airway pressure therapy with adaptive servoventilation: part 1: operational algorithms. 2014

Javaheri, Shahrokh / Brown, Lee K / Randerath, Winfried J. ·College of Medicine, University of Cincinnati, Cincinnati, OH. Electronic address: shahrokhjavaheri@icloud.com. · Department of Internal Medicine, School of Medicine, The University of New Mexico, Albuquerque, NM. · Zentrum für Schlaf- und Beatmungsmedizin Aufderhöher, Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen, Germany. ·Chest · Pubmed #25091757.

ABSTRACT: The beginning of the 21st century witnessed the advent of new positive airway pressure (PAP) technologies for the treatment of central and complex (mixtures of obstructive and central) sleep apnea syndromes. Adaptive servoventilation (ASV) devices applied noninvasively via mask that act to maintain a stable level of ventilation regardless of mechanism are now widely available. These PAP devices function by continually measuring either minute ventilation or airflow to calculate a target ventilation to be applied as needed. The apparatus changes inspiratory PAP on an ongoing basis to maintain the chosen parameter near the target level, effectively controlling hypopneas of any mechanism. In addition, by applying pressure support levels anticyclic to the patient's own respiratory pattern and a backup rate, this technology is able to suppress central sleep apnea, including that of Hunter-Cheyne-Stokes breathing. Moreover, ASV units have become available that incorporate autotitration of expiratory PAP to fully automate the treatment of all varieties of sleep-disordered breathing. Although extremely effective in many patients when used properly, these are complex devices that demand from the clinician a high degree of expertise in understanding how they work and how to determine the proper settings for any given patient. In part one of this series we detail the underlying technology, whereas in part two we will describe the application of ASV in the clinical setting.

11 Review [Sleep disorders in asthma and chronic obstructive pulmonary disease (COPD)]. 2014

Böing, Sebastian / Randerath, Winfried J. ·Institut für Pneumologie an der Universität Witten Herdecke. · Klinik für Pneumologie und Allergologie, Schlaf- und Beatmungsmedizin, Bethanien Krankenhaus, Solingen. ·Ther Umsch · Pubmed #24794341.

ABSTRACT: Sleep disturbances (SD) are a frequent finding in patients with asthma and chronic obstructive pulmonary disease (COPD) and have a negative impact on quality of life and the clinical course of the disease. The causes of SD are multiple and include for example respiratory symptoms and comorbidities. On the other hand sleep goes along with multiple physiological changes in respiration, so that sleep itself interacts with asthma and COPD. This interaction favors respiratory symptoms and may lead to hypoxemia and hypercapnia. A further complication of the respiratory situation and the clinical course can be found in asthma and COPD patients with coexisting obstructive sleep apnea syndrome (OSAS). Due to the heterogeneity of SD in asthma and COPD, a detailed patient survey is the most important diagnostical tool. Based on the survey further technical examinations should be considered. Treatment strategies for the reduction of SD in asthma and COPD include an optimized medication and treatment of comorbidities. If indicated oxygen therapy, positive pressure breathing and pulmonary rehabilitation can contribute.

12 Review [Non-CPAP therapies in obstructive sleep apnoea: an overview]. 2013

Keymel, S / Kelm, M / Randerath, W J. ·Heinrich-Heine Universität Düsseldorf, Medizinische Fakultät, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf. ·Pneumologie · Pubmed #23247597.

ABSTRACT: Optimal treatment of the obstructive sleep apnoea syndrome (OSAS) requires an individually designed and interdisciplinary approach. Continuous positive airway pressure (CPAP) is accepted as the first line therapy for patients with OSAS. However, non-CPAP therapies may be indicated as supportive therapeutical approach in CPAP failure or as an alternative approach in CPAP intolerance. Overall, the level of evidence for the majority of non-CPAP therapies is low. Mandibular advancement devices as a medical non-CPAP treatment have proven to reduce respiratory disturbances to a level which may be sufficient in mild to moderate sleep apnoea. Apnoea triggered neurostimulation of upper airway muscles is an innovative approach that has shown promising results in preclinical studies. Surgical treatment has previously been performed as single level surgery of the nasal, the oropharyngeal or hypopharyngeal level. However, only tonsillectomy in the presence of tonsillar hypertrophy and maxillomandibular advancement are recommended in carefully selected cases. Due to low success rates for single level surgery, multilevel surgery has been proposed as the surgical approach for the future.

13 Review Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. 2012

Marklund, Marie / Verbraecken, Johan / Randerath, Winfried. ·Dept of Orthodontics, Faculty of Medicine, Umeå University, Umeå, Sweden. Marie.Marklund@odont.umu.se ·Eur Respir J · Pubmed #22075487.

ABSTRACT: Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report. Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA. In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

14 Review [Sleep medicine in pneumology]. 2011

Randerath, W J. ·Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien. randerath@klinik-bethanien.de ·Dtsch Med Wochenschr · Pubmed #21448832.

ABSTRACT: Diagnosis and treatment of sleep related breathing disorders have become an essential challenge of internal medicine. They are highly important clinically because of the impairment of daytime performance, attention and concentration with elevated risk of accidents in workplace and traffic and because of their consequences on cardiovascular and metabolic disorders. The obstructive sleep apnoea syndrome (OSAS) has proven to be one of the most important risk factors for arteriosclerosis, especially in the cerebral vessels. OSAS induces arterial hypertention and increases mortality due to cardiovascular diseases. Sleep related breathing disorders induce hyperglycemia and dyslipidemia. OSAS and the metabolic syndrome increase the cardiovascular risk additively. Moreover, cardiac disorders, such as arterial hypertention, heart failure and arterial fibrillation, can induce central breathing disturbances. This impairs the prognosis of affected patients substantially. Atypical symptoms of obstructive sleep apnoea (daytime sleepiness, snoring, witnessed apnoea) are often absent in these patients. In contrast patients often suffer from fatigue, reduced daytime performance, and depression which is a major challenge to diagnosis. This review presents new data on these aspects. Moreover, the association of sleep apnoea and pulmonary embolism and the question of optimal sleep duration are addressed.

15 Review [Pathophysiology of the obesity hypoventilation syndrome]. 2008

Randerath, W J / Stieglitz, S / Galetke, W / Laumanns, C / Duchna, H-W / Schäfer, T. ·Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien. randerath@klinik-bethanien.de ·Pneumologie · Pubmed #18398785.

ABSTRACT: The obesity hypoventilation syndrome (OHS) is defined by extreme overweight (BMI 30 kg/m2), daytime hypoventilation (PaCO2 > 45 mm Hg, the absence of other known causes of hypoventilation) and sleep-related breathing disorders. Obesity impairs breathing due to a restrictive ventilatory disorder, reduction of the capacity of respiratory muscles and diminishment of the ventilatory response. The restriction cannot serve as the only explanation of OHS because body weight or compliance on the one hand and hypoventilation on the other hand only correlate weakly. Obesity increases the work of breathing by greater body mass with its increased oxygen demand, impaired diaphragmatic mobility, upper airway obstruction, and oxygen desaturation which result in an inadequacy of oxygen demand and supply. The adjustment of the chemoreceptors can avoid the overload on the capacity of the respiratory muscles, at least in a number of patients or in the course of the disease. This disproportion results in hypercapnia. Furthermore, the level of leptin is an important factor in the pathophysiology of OHS. The blood level of leptin correlates with the body fat mass in humans. However, there seems to be a relative leptin deficiency in the brain in overweight humans. Therefore, in contrast to animals, leptin cannot sufficiently increase ventilation in man to avoid hypercapnia.

16 Clinical Trial Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA). 2018

Herkenrath, Simon Dominik / Treml, Marcel / Priegnitz, Christina / Galetke, Wolfgang / Randerath, Winfried J. ·Institute of Pneumology at the University of Cologne, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhoeherstraße 169-175, 42699, Solingen, Germany. · Krankenhaus der Augustinerinnen, Jakobstraße 27, 50678, Cologne, Germany. · Institute of Pneumology at the University of Cologne, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhoeherstraße 169-175, 42699, Solingen, Germany. randerath@klinik-bethanien.de. ·Sleep Breath · Pubmed #29080065.

ABSTRACT: PURPOSE: Different forms of training focusing on the muscles of the upper airways showed limited effects on obstructive sleep apnea (OSA) and/or snoring. We investigated the effect of generalized respiratory muscle training (RMT) in lean patients with mild to moderate OSA. METHODS: Nine male subjects (52.0 ± 10.8 years, BMI 29.1 ± 2.1 kg/m RESULTS: Patients trained effectively, seen by a significant (p < 0.01) increase of breathing frequency (23.3 ± 1.5 /min vs. 30.6 ± 2.9 /min) and minute volume (81.2 ± 13.7 L vs. 109.1 ± 21.9 L). AHI, snoring and ESS remained unchanged after training. QoL as measured by SF-36 significantly (p < 0.05) improved after the training in the subscales "bodily pain" (79 ± 21 vs. 90 ± 12) and "change of health" (3.1 ± 0.3 vs. 2.4 ± 0.5). CONCLUSIONS: There is no evidence that AHI, pulmonary function or daytime sleepiness are affected by 5 weeks of RMT. Nevertheless, there is an improvement of parameters of quality of life. TRIAL REGISTRATION: ClinicalTrials.gov , register no. NCT 00936286.

17 Clinical Trial Combined adaptive servo-ventilation and automatic positive airway pressure (anticyclic modulated ventilation) in co-existing obstructive and central sleep apnea syndrome and periodic breathing. 2009

Randerath, Winfried J / Galetke, Wolfgang / Kenter, Marlene / Richter, Kerstin / Schäfer, Thorsten. ·Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Aufderhöherstrasse 169-175, Solingen, Germany. randerath@klinik-bethanien.de ·Sleep Med · Pubmed #19303811.

ABSTRACT: BACKGROUND: The co-existence of obstructive and central sleep apnea/hypopnea syndrome (OSAS) and periodic breathing is common in patients with and without underlying heart diseases. While automatic continuous positive airway pressure (APAP) has proven to effectively treat OSAS, the adaptive servo-ventilation (ASV) sufficiently improves periodic breathing. This is the first trial on a device which combines both treatment modes. METHODS: Pilot study on a two-week treatment in patients with co-existing obstructive and central and periodic breathing disturbances during sleep. Twelve consecutive patients (9 male, 3 female, age 56.9+/-10.6 years, BMI 32.4+/-5.5 kg/m(2)) were treated with a new algorithm which combines APAP and ASV (also called anticyclic modulated ventilation (ACMV), SOMNOventCR, Weinmann, Hamburg, Germany). Seven suffered from arterial hypertension, coronary heart disease and mitral regurgitation, none from congestive heart failure. RESULTS: The total apnea-hypopnea index (AHI) improved from 43.8+/-24.0/h to 2.1+/-2.4 (p<0.01), the obstructive AHI from 12.8+/-14.3/h to 0.3+/-0.6/h (p<0.01) and the central AHI from 31.0+/-17.5/h to 1.7+/-2.0/h (p<0.01). Moreover, there was a significant improvement in the total number of arousals, respiratory induced arousals, oxygen saturation and sleep profile. CONCLUSION: The algorithm combining automatic continuous positive airway pressure (CPAP) and ASV normalizes all types of co-existing obstructive and central apnea/hypopnea and periodic breathing.

18 Clinical Trial [Evaluation of a new automatic CPAP algorithm in the treatment of obstructive sleep apnoea syndrome]. 2009

Galetke, W / Stieglitz, S / Anduleit, N / Kenter, M / Kühnel, J / Osagie-Paech, R / Richter, K / Randerath, W. ·Krankenhaus Bethanien Solingen, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Universität Witten/Herdecke, 42699 Solingen. galetke@klinik-bethanien.de ·Pneumologie · Pubmed #19229797.

ABSTRACT: BACKGROUND: Automatic continuous positive airway pressure (automatic CPAP, APAP) is an effective treatment option in the obstructive sleep apnoea syndrome (OSAS). The differentiation of obstructive and central respiratory events is crucial in adjusting the optimal pressure in this treatment mode. In this pilot study we evaluated a new automatic CPAP algorithm in OSAS patients. METHODS: 14 patients with newly diagnosed obstructive sleep apnoea syndrome were enrolled. After a diagnostic polysomnography, patients were treated for one night with a new APAP device based on flow, snoring, relative minute volume and the obstructive pressure peak signal. RESULTS: The total apnoea/hypopnoea index (AHI) was 30.0 +/- 21.4/h at baseline and 3.7 +/- 5.3/h with APAP ( P < 0.005). Both obstructive AHI (22.7 +/- 20.5/h at baseline, 1.5 +/- 3.5/h with APAP, P < 0.005) and central AHI (7.3 +/- 4.9/h and 2.2 +/- 2.5/h, respectively, P < 0.01) as well as the arousal index (25.4 +/- 18.1/h and 5.1 +/- 3.8/h, respectively, P < 0.005) were reduced significantly with the new algorithm. CONCLUSIONS: The new algorithm of an automatic CPAP device is effective in the treatment of obstructive sleep apnoea syndrome.

19 Article Sleep-disordered breathing in patients with cardiovascular diseases cannot be detected by ESS, STOP-BANG, and Berlin questionnaires. 2018

Reuter, Hannes / Herkenrath, Simon / Treml, Marcel / Halbach, Marcel / Steven, Daniel / Frank, Konrad / Castrogiovanni, Alessandra / Kietzmann, Ilona / Baldus, Stephan / Randerath, Winfried J. ·Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. · Evangelisches Klinikum Köln-Weyertal, Weyertal 76, 50931, Cologne, Germany. · Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany. · Bethanien Hospital gGmbH, Solingen, Aufderhöher Str. 169-175, 42699, Solingen, Germany. · Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany. randerath@klinik-bethanien.de. · Bethanien Hospital gGmbH, Solingen, Aufderhöher Str. 169-175, 42699, Solingen, Germany. randerath@klinik-bethanien.de. ·Clin Res Cardiol · Pubmed #29845331.

ABSTRACT: Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular diseases (CVD) and associated with poor outcome. At least 50% of heart failure (HF) patients present with SDB, equally divided in obstructive sleep apnea (OSA) and central sleep apnea (CSA). CVD patients with SDB do not always present with typical SDB symptoms. Therefore, we asked whether established questionnaires allow for the reliable detection of SDB. In this prospective cohort study, 89 CVD patients (54 male, 59 ± 15 years, BMI 30 ± 6 kg/m

20 Article Challenges in obstructive sleep apnoea. 2018

McNicholas, Walter T / Bassetti, Claudio L / Ferini-Strambi, Luigi / Pépin, Jean Louis / Pevernagie, Dirk / Verbraecken, Johan / Randerath, Winfried / Anonymous9430936. ·Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin 4 Ireland; School of Medicine, University College Dublin, Ireland; First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Electronic address: walter.mcnicholas@ucd.ie. · Neurology Department, Inselspital, Bern University Hospital, Bern, Switzerland. · Department of Neurology OSR-Turro, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy. · HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels Division, Grenoble Alpes University Hospital, Grenoble, France. · Sleep Medicine Center, Kempenhaeghe Foundation, Heeze, Netherlands; Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium. · Department of Pulmonary Medicine, and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. · Institute of Pneumology at the University of Cologne, Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Solingen, Germany. ·Lancet Respir Med · Pubmed #29428843.

ABSTRACT: -- No abstract --

21 Article REM Sleep Imposes a Vascular Load in COPD Patients Independent of Sleep Apnea. 2017

Grote, Ludger / Sommermeyer, Dirk / Ficker, Joachim / Randerath, Winfried / Penzel, Thomas / Fietze, Ingo / Sanner, Bernd / Hedner, Jan / Schneider, Hartmut. ·a Center for Sleep and Wakefulness Disorders , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden. · b Department of Respiratory and Critical Care Medicine , Johns Hopkins University , Baltimore , USA. · c ochschule Mannheim - University of Applied Sciences , Department of Information Technology , Mannheim , Germany. · d Department of Respiratory Medicine, Allergology and Sleep Medicine , Klinikum Nuremberg/ Paracelsus Medical University , Nuremberg , Germany. · e Department of Pulmonary Medicine, Bethanien Hospital , Solingen , Germany. · f Department of Cardiology , University Hospital Charité , Berlin , Germany. · g Department of Pulmonary Medicine , Bethesda Hospital , Wuppertal , Germany. ·COPD · Pubmed #28949781.

ABSTRACT: Arterial stiffness, a marker for cardiovascular risk, is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The specific influence of both on arterial stiffness during sleep is unknown. Nocturnal arterial stiffness (Pulse Propagation Time (PPT) of the finger pulse wave) was calculated in 142 individuals evaluated for sleep apnea: 27 COPD patients (64.7 ± 11y, 31.2 ± 8 kg/m

22 Article [Positionpaper on Telemonitoring in Sleep-Related Breathing Disorders]. 2017

Randerath, W / Bögel, M / Franke, C / Hellmann, A / Jany, B / Nilius, G / Penzel, T / Voshaar, T / Wiater, A. ·Für die Deutsche Gesellschaft für Schlafforschung und Schlafmedizin. · Für den Bundesverband der Pneumologen, Schlaf- und Beatmungsmediziner. · Für die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin. · Für den Verband Pneumologischer Kliniken. ·Pneumologie · Pubmed #28222476.

ABSTRACT: The use of telemonitoring in the care of patients with Sleep-related Breathing Disorders (SBD) can enhance medical support significantly. Telemonitoring aims at helping physicians to detect therapy problems early and thus improve patients' therapy adherence. Diagnostics and therapy decisions in the telemonitoring process nevertheless remain the responsibility of sleep specialists. The selection of data monitored, their evaluation and resulting consequences fall to the physician, who makes decisions and prescribes therapy in consultation with the patient. In light of professional legal and ethical requirements, it must be ensured that the extensive changes to the process flow in sleep medicine are designed in a way to guarantee high-quality patient care. In this position paper, the German Sleep Society, the German Respiratory Society, the Association of Pneumological Hospitals and the Federal Association of German Pneumologists comment on important aspects for implementation of telemonitoring for SRBD and describe the basic conditions required for its use.

23 Article Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. 2017

Randerath, Winfried / Verbraecken, Johan / Andreas, Stefan / Arzt, Michael / Bloch, Konrad E / Brack, Thomas / Buyse, Bertien / De Backer, Wilfried / Eckert, Danny Joel / Grote, Ludger / Hagmeyer, Lars / Hedner, Jan / Jennum, Poul / La Rovere, Maria Teresa / Miltz, Carla / McNicholas, Walter T / Montserrat, Josep / Naughton, Matthew / Pepin, Jean-Louis / Pevernagie, Dirk / Sanner, Bernd / Testelmans, Dries / Tonia, Thomy / Vrijsen, Bart / Wijkstra, Peter / Levy, Patrick. ·Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany randerath@klinik-bethanien.de. · These authors contributed equally. · Task force chairs. · Dept of Pulmonary Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. · Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany. · Lung Clinic Immenhausen, Krs. Kassel, Germany. · Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. · University Hospital Zurich, Dept of Pulmonology and Sleep Disorders Center, Zurich, Switzerland. · Dept of Internal and Pulmonary Medicine, Kantonsspital Glarus, Glarus, Switzerland. · Dept of Pulmonary Medicine, KU Leuven, Leuven, Belgium. · Neuroscience Research Australia (NeuRA) and the University of New South Wales, Sydney, Australia. · Sleep Disorders Center, Dept of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. · Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany. · Center for Healthy Aging and Danish Center for Sleep Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. · Dept of Cardiology, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano, Pavia, Italy. · Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital and University College Dublin, Dublin, Ireland. · Laboratori del Son, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. · General Respiratory and Transplantation, Alfred Hospital and Monash University, Melbourne, Australia. · Laboratoire du sommeil explorations fonct. respire., Centre Hospitalier Universitaire Grenoble, Grenoble, France. · Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands. · Dept of Internal Medicine, Agaplesion Bethesda Hospital Wuppertal, Wuppertal, Germany. · Institute of Social and Preventive Medicine, Universtity of Bern, Bern, Switzerland. · Dept of Pulmonology/Home Mechanical Ventilation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. ·Eur Respir J · Pubmed #27920092.

ABSTRACT: The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a "marker" of disease severity or a "mediator" of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.

24 Article Vascular stiffness determined from a nocturnal digital pulse wave signal: association with sleep, sleep-disordered breathing, and hypertension. 2016

Svedmyr, Sven / Zou, Ding / Sommermeyer, Dirk / Ficker, Joachim H / Randerath, Winfried / Fietze, Ingo / Sanner, Bernd / Hedner, Jan / Grote, Ludger. ·aDepartment of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg bDepartment of Internal Medicine and Clinical Nutrition, Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden cInstitut für Assistenzsysteme und Qualifizierung e.V., Karlsruhe dDepartment of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuernberg, Nuremberg eDepartment of Pulmonary Medicine, Bethanien Hospital, Solingen fInterdisciplinary Center of Sleep Medicine, Charité - Universitätsmedizin Berlin, Berlin gDepartment of Pulmonary Medicine, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal hParacelsus Medical University Nuernberg, Nuremberg, Germany. ·J Hypertens · Pubmed #27607460.

ABSTRACT: OBJECTIVES: Reflection of the finger pulse wave form is a valid measure of arterial stiffness, which may be continuously assessed during sleep. We investigated the relationships between sleep, sleep-disordered breathing, hypertension, and pulse propagation time (PPT) in patients with suspected sleep apnea. METHODS: The digital photoplethysmographic signal derived from finger pulse oximetry was recorded during overnight sleep studies in 440 patients (64% men, age 55 ± 12 years, BMI 30 ± 6 kg/m, apnea-hypopnea index 19 ± 19 n/h). PPT, defined as the time interval between the systolic and diastolic peak of the finger pulse wave, was calculated. The influence of sleep stages on PPT were assessed in patients undergoing polysomnography. Generalized linear models were used to study predictors of PPT and hypertension. RESULTS: Mean overnight PPT was independently associated with age (β = -1.34, P < 0.001), height (β = 0.47, P = 0.047), history of smoking (β = -9.44, P = 0.005), and apnea-hypopnea index (β = -0.18, P = 0.043). PPT was shorter in hypertensive patients compared with normotensive patients (160 ± 33 vs. 177 ± 47 ms, P < 0.001) and independently associated with a diagnosis of hypertension (P = 0.043). PPT was influenced by sleep stage (highest PPT during slow wave sleep compared with wake and all other sleep stages, all P < 0.001) and varied across sleep apnea severity groups in normotensive but not in hypertensive patients (P = 0.028 and 0.64, respectively). CONCLUSION: Overnight PPT by oximetry was strongly associated with factors known to determine daytime vascular stiffness. In addition, PTT provides information on functional and structural vascular properties during sleep. This novel technique offers new opportunities to noninvasively monitor vascular function during the sleeping period.

25 Article Parameters of Overnight Pulse Wave under Treatment in Obstructive Sleep Apnea. 2016

Randerath, Winfried J / Treml, Marcel / Priegnitz, Christina / Hedner, Jan / Sommermeyer, Dirk / Zou, Ding / Ficker, Joachim H / Fietze, Ingo / Penzel, Thomas / Sanner, Bernd / Grote, Ludger. ·Sleep Disorders Center, Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden. ·Respiration · Pubmed #27576684.

ABSTRACT: BACKGROUND: Sleep-related breathing disorders may promote cardiovascular (CV) diseases. A novel and differentiated approach to overnight photoplethysmographic pulse wave analysis, which includes risk assessment and measurement of various pulse wave characteristics, has been evaluated in obstructive sleep apnea (OSA). OBJECTIVES: The purpose of this study was to assess if and which of the differentiated pulse wave characteristics might be influenced by OSA treatment with positive airway pressure (PAP). METHODS: The study included two protocols. In the case-control study (group A), pulse wave-derived CV risk indices recorded during PAP therapy were compared with those obtained in age, body mass index, and CV risk class-matched patients with untreated OSA (n = 67/67). In the prospective PAP treatment study (group B), 17 unselected patients undergoing a full-night sleep test at baseline and after 23 ± 19 weeks of treatment were analyzed. RESULTS: In untreated OSA patients (group A), the overnight hypoxic load was increased (SpO2 index 38.7 ± 17.5 vs. 24.0 ± 11.1, p < 0.001) and the pulse wave attenuation index (PWA-I) was lower (29.4 ± 9.2 vs. 33.5 ± 11.8, p = 0.022) than in treated patients. In group B, PAP therapy reduced the hypoxic load and increased the PWA-I significantly. The composite CV risk index was slightly but not significantly reduced. CONCLUSIONS: PAP therapy modified the hypoxic load and pulse wave-derived markers. The PWA-I - associated with sympathetic vascular tone - was most prominently modified by PAP. This novel approach to markers of CV function should be further evaluated in prospective studies.

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