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Sleep Apnea Syndromes: HELP
Articles from Germany
Based on 735 articles published since 2008
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These are the 735 published articles about Sleep Apnea Syndromes that originated from Germany during 2008-2019.
 
+ Citations + Abstracts
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476 Article Melatonin and omentin: influence factors in the obstructive sleep apnoea syndrome? 2013

Zirlik, S / Hildner, K M / Targosz, A / Neurath, M F / Fuchs, F S / Brzozowski, T / Konturek, P C. ·Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany. Sabine.Zirlik@uk-erlangen.de ·J Physiol Pharmacol · Pubmed #23959732.

ABSTRACT: The incidence of the obstructive sleep apnoea syndrome (OSAS) is rising as it is often associated with obesity. Actually, the adipose tissue is working as an endocrine organ with complex interactions. Recently, many adipokines such as omentin-1 were discovered. The role of omentin-1 in the pathogenesis of OSAS has not been clearly determined. Melatonin has a known influence on the sleep and wake rhythm. The data on the involvement of melatonin in OSAS are rare. Therefore we evaluated the changes in plasma levels of omentin-1 and melatonin before and after continuous positive airway pressure (CPAP) therapy in OSA patients. 10 patients with newly diagnosed OSAS were included in the study. They underwent diagnostic polysomnography with blood drawings in a 2 hour interval for 24 hours. In the second night sufficient CPAP therapy was established. After three months of CPAP therapy the measurements were repeated. As controls 10 healthy volunteers were recruited. The same blood analysis and a polygraphic measurement were made and compared with the patients. OSA patients showed significantly higher omentin-1 plasma levels (17.22±13.94 versus 9.24±4.85 ng/ml, p<0.05). After three months of therapy the plasma levels of omentin-1 decreased toward the values observed in the controls at 8.00 a.m. Melatonin showed the usual peak at 2.00 a.m. in the volunteer group. OSA patients showed a later peak of melatonin at 6.00 a.m. which returned to 2.00 a.m. after CPAP therapy. We conclude that omentin as well as melatonin seem to be involved in pathogenesis of OSAS. To what exent, further studies will have to face that question.

477 Article Effect of renal denervation on neurohumoral activation triggering atrial fibrillation in obstructive sleep apnea. 2013

Linz, Dominik / Hohl, Mathias / Nickel, Alexander / Mahfoud, Felix / Wagner, Michael / Ewen, Sebastian / Schotten, Ulrich / Maack, Christoph / Wirth, Klaus / Böhm, Michael. ·Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421 Homburg, Saar, Germany. Dominik.Linz@uks.eu. ·Hypertension · Pubmed #23959548.

ABSTRACT: Obstructive sleep apnea is characterized by repetitive collapses of the upper airway, negative thoracic pressure periods, and intermittent hypoxia, stimulating the autonomic nervous system. The increased sympathetic drive during obstructive sleep apnea results in postapneic blood pressure rises and neurohumoral activation potentially involved in the initiation and progression to permanent atrial fibrillation (AF). In a pig model mimicking obstructive sleep apnea, we studied the effects of repetitive obstructive respiratory events for 4 hours on the occurrence of spontaneous AF episodes, postapneic blood pressure rises, and neurohumoral activation. In addition, renal sympathetic denervation was performed to investigate the impact of the sympathetic nervous system. Repetitive obstructive respiratory events caused pronounced postapneic blood pressure rises, prolonged duration of spontaneous AF episodes triggered by spontaneous atrial beats, and increased plasma renin activity and aldosterone concentrations. This was associated with increased nicotinamide adenine dinucleotide phosphate-oxidase activity, reduced antioxidative capacity, and elevated expression of connective tissue growth factor, a redox-sensitive mediator of fibrosis. Renal sympathetic denervation inhibited postapneic blood pressure rises and decreased plasma renin activity and aldosterone concentrations. The occurrence and duration of spontaneous AF were reduced comparable with a combined pharmacological blockade of angiotensin receptor and β-adrenoceptor. Increased atrial oxidative stress, together with the activation of profibrotic pathways and intermittent hypoxia, was not attenuated after renal sympathetic denervation. Repetitive obstructive respiratory events triggered spontaneous AF, increased atrial oxidative stress, and activated profibrotic pathways in the atrium. Renal sympathetic denervation reduced spontaneous AF and postapneic blood pressure rises by combined reduction of sympathetic drive and components of the circulating renin-angiotensin system. However, the generation of atrial oxidative stress was not modulated.

478 Article Surgical cure of central sleep apnea? 2013

Held, Matthias / Meintz, Sebastian / Baron, Stefan / Roth, Christine / Wilkens, Heinrike / Schäfers, Hans Joachim / Jany, Berthold. ·Department of Internal Medicine, Medical Mission Hospital, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Würzburg, Germany. ·Am J Respir Crit Care Med · Pubmed #23905527.

ABSTRACT: -- No abstract --

479 Article Randomized controlled trial of noninvasive positive pressure ventilation (NPPV) versus servoventilation in patients with CPAP-induced central sleep apnea (complex sleep apnea). 2013

Dellweg, Dominic / Kerl, Jens / Hoehn, Ekkehard / Wenzel, Markus / Koehler, Dieter. ·Kloster Grafschaft, Pulmonary Medicine I, Home Mechanical Ventilation Unit and Sleep Laboratory, Schmallenberg, Germany. d.dellweg@fkkg.de ·Sleep · Pubmed #23904676.

ABSTRACT: STUDY OBJECTIVES: To compare the treatment effect of noninvasive positive pressure ventilation (NPPV) and anticyclic servoventilation in patients with continuous positive airway pressure (CPAP)-induced central sleep apnea (complex sleep apnea). DESIGN: Randomized controlled trial. SETTING: Sleep center. PATIENTS: Thirty patients who developed complex sleep apnea syndrome (CompSAS) during CPAP treatment. INTERVENTIONS: NPPV or servoventilation. MEASUREMENTS AND RESULTS: Patients were randomized to NPPV or servo-ventilation. Full polysomnography (PSG) was performed after 6 weeks. On CPAP prior to randomization, patients in the NPPV and servoventilator arm had comparable apnea-hypopnea indices (AHI, 28.6 ± 6.5 versus 27.7 ± 9.7 events/h (mean ± standard deviation [SD])), apnea indices (AI,19 ± 5.6 versus 21.1 ± 8.6 events/h), central apnea indices (CAI, 16.7 ± 5.4 versus 18.2 ± 7.1 events/h), oxygen desaturation indices (ODI,17.5 ± 13.1 versus 24.3 ± 11.9 events/h). During initial titration NPPV and servoventilation significantly improved the AHI (9.1 ± 4.3 versus 9 ± 6.4 events/h), AI (2 ± 3.1 versus 3.5 ± 4.5 events/h) CAI (2 ± 3.1 versus 2.5 ± 3.9 events/h) and ODI (10.1 ± 4.5 versus 8.9 ± 8.4 events/h) when compared to CPAP treatment (all P < 0.05). After 6 weeks we observed the following differences: AHI (16.5 ± 8 versus 7.4 ± 4.2 events/h, P = 0.027), AI (10.4 ± 5.9 versus 1.7 ± 1.9 events/h, P = 0.001), CAI (10.2 ± 5.1 versus 1.5 ± 1.7 events/h, P < 0.0001)) and ODI (21.1 ± 9.2 versus 4.8 ± 3.4 events/h, P < 0.0001) for NPPV and servoventilation, respectively. Other sleep parameters were unaffected by any form of treatment. CONCLUSIONS: After 6 weeks, servoventilation treated respiratory events more effectively than NPPV in patients with complex sleep apnea syndrome.

480 Article Sodium oxybate-induced central sleep apneas. 2013

Frase, Lukas / Schupp, Jonas / Sorichter, Stephan / Randelshofer, Wolfgang / Riemann, Dieter / Nissen, Christoph. ·Department of Psychiatry, University Medical Center, Freiburg, Germany. lukas.frase@uniklinik-freiburg.de ·Sleep Med · Pubmed #23834969.

ABSTRACT: Sodium oxybate (γ-hydroxybutyric acid, GHB) is a neurotransmitter in the human brain which exerts sedative effects and is used therapeutically in the treatment of narcolepsy. Current safety recommendations have been formulated for the use of GHB in patients with preexisting breathing disorders. We report the case of a 39-year-old female with narcolepsy and cataplexy revealing the de novo emergence of central sleep apneas in a Cheyne-Stokes pattern under constant treatment with GHB. After discontinuation of GHB, polysomnographic re-evaluation demonstrated the disappearance of central sleep apneas. To our knowledge, this is the first report of de novo central sleep apneas induced by GHB in a patient without pre-existing sleep-disordered breathing, suggesting that there is a need for further investigation and potentially an extension of the safety guidelines to patients without a pre-existing breathing disorder.

481 Article Pharyngeal chemosensitivity in patients with obstructive sleep apnea and healthy subjects. 2013

Heiser, Clemens / Zimmermann, Ingo / Sommer, J Ulrich / Hörmann, Karl / Herr, Raphael M / Stuck, Boris A. ·Departement of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany. hno@heiser-online.com ·Chem Senses · Pubmed #23821728.

ABSTRACT: Signs of pharyngeal neurodegeneration have been detected in patients with obstructive sleep apnea (OSA). Along with this neurodegeneration, a decreased pharyngeal sensitivity to mechanical stimulation has been described. The decreased sensitivity may play a role in the pathophysiology of this disease. The aim of the study was to investigate the chemosensitivity of the pharyngeal mucosa in patients with OSA compared with controls. Healthy controls and patients with OSA (age: 30-60 years) were included. Testing of oropharyngeal chemosensitivity was performed with subjective intensity ratings of capsaicin (SIR, visual analogue scale 0-10), air puffs (presented with an olfactometer), and stimulation with CO2 at the posterior pharyngeal wall. A 2-point discrimination test at the soft palate, an intensity rating of capsaicin at the tongue, and a nasal lateralization test were performed. Twenty-six patients with OSA and 18 healthy controls were included. No differences were detected in the SIR of capsaicin at the tongue or in the nasal lateralization test. At the pharynx, a decreased sensitivity to capsaicin (OSA: 6.8 ± 2.3; healthy control: 8.6 ± 1.3), air puffs (OSA: 2.8 ± 1.9; healthy control: 4.2 ± 1.6), and stimulation with CO2 (OSA: 1.5 ± 1.7; healthy control: 2.8 ± 1.8) were demonstrated in patients with OSA (all P < 0.05). Two-point discrimination at the soft palate was reduced with statistical significance in the OSA group (OSA: 11.5 ± 5.4 mm; healthy control: 5.0 ± 2.4 mm). The results suggest reduced pharyngeal chemosensitivity in OSA patients in addition to the reduced mechanical pharyngeal sensitivity shown with 2-point discrimination. This demonstrates peripheral neurodegeneration in the context of this disease.

482 Article Cardiac workload in patients with sleep-disordered breathing early after acute myocardial infarction. 2013

Hetzenecker, Andrea / Buchner, Stefan / Greimel, Tanja / Satzl, Anna / Luchner, Andreas / Debl, Kurt / Husser, Oliver / Hamer, Okka W / Fellner, Claudia / Riegger, Günter A J / Pfeifer, Michael / Arzt, Michael. ·Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany. · Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany. · Department of Radiology, University Hospital Regensburg, Regensburg, Germany. · Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany; Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany. · Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany. Electronic address: michael.arzt@klinik.uni-regensburg.de. ·Chest · Pubmed #23715560.

ABSTRACT: BACKGROUND: Sleep-disordered breathing (SDB) may promote an increase in cardiac workload early after acute myocardial infarction (AMI). We tested the hypothesis that in the early phase after AMI, SDB is associated with increased 24-h arterial BP, heart rate (HR), and, thus, cardiac workload. METHODS: In this prospective study, 55 consecutive patients with AMI and subsequent percutaneous coronary intervention (78% men; mean age, 54 ± 10 y; mean BMI, 28.3 ± 3.6 kg/m²; mean left ventricular ejection fraction [LVEF], 47% ± 8%) underwent polysomnography and 24-h ambulatory BP and heart rate monitoring within 5 days after MI. Cardiac workload was calculated as systolic BP multiplied by HR. The presence of SDB was defined as ≥ 10 apneas and hypopneas per hour of sleep. RESULTS: Fifty-five percent of the patients had SDB, of which 40% was predominantly central in nature. Patients with SDB had higher 24-h HR and systolic and diastolic BP compared with those without SDB (115 vs 108 mm Hg, P = .029; 71 vs 67 mm Hg, P = .034; 69 vs 64 beats/min, P = .050, respectively). Use of antihypertensive medication and β-receptor blockers was similar in both groups. In a multivariate linear regression analysis, SDB was significantly associated with an increased 24-h cardiac workload (β-coefficient, 0.364; 95% CI, 0.071-0.657; P = .016), independently of age, sex, BMI, LVEF, and antihypertensive medication. CONCLUSION: Patients with AMI and SDB have significantly increased 24-h BP, HR, and cardiac workload. Treatment of SDB may be a valuable nonpharmacologic approach to lower cardiac workload in these patients.

483 Article [Telemonitoring of bike exercise training in patients with obstructive sleep apnoea]. 2013

Rühle, K-H / Franke, K J / Domanski, U / Schröder, M / Nilius, G. ·Klinik für Pneumologie, HELIOS-Klinik Ambrock Hagen, Hagen. Klinik-Ambrock.pneumo@t-online.de ·Pneumologie · Pubmed #23700134.

ABSTRACT: BACKGROUND: Patients with obstructive sleep apnoea (OSA) suffer from daytime sleepiness, cognitive disorders and are at increased risk of cardiovascular diseases. In addition to continuous positive airway pressure (CPAP), major lifestyle changes to increase physical activity contribute to risk reduction. The daily training duration should be at least 20 minutes to achieve a relevant effect. In addition to exercise training in groups, home training is useful. However, sufficiently intensive training is often not performed because of unavailable feedback (monitoring). It is not clear yet how many patients accept a bicycle home training and to what extent they meet the specified training time. METHOD: Of the 152 consecutive OSA patients surveyed, 74 (48.7 %) agreed to a 4-week home exercise bike training. After exclusion of 51 patients, 17 for logistical reasons, and 34 because of severe comorbidities, 23 patients remained (age 51.0 +/- 9.3 years, BMI 33.7 +/- 4.2, ESS score 10.4 +/- 6.7, AHI 33.8 +/- 24.0). The daily duration of training at the ventilatory threshold (VT1) was recorded and transmitted by a wireless module (Cinterion) via Internet to a doctor or instructor. RESULTS: The patients exercised during 27.3 +/- 2.9 days. 19 of the 23 patients (83 %) accomplished the training period of > 20 minutes per day. In 4 patients (17 %) the training time was well below this target level with 5.9 +/- 2.3 min. The average training time of all patients was 24.4 +/- 9.0 min. CONCLUSION: About 50 % of the OSA patients are interested in a regular physical exercise bike training with telemonitoring, and are performing it quite constantly. The described method of telemonitoring provides a simple and, compared to group training cost-effective way to reduce cardiovascular risk in OSA.

484 Article [Snoring and sleep disorders]. 2013

Orth, M / Rasche, K. ·Theresienkrankenhaus und St.Hedwig Klinik GmbH, Medizinische Onkologie, Allergologie, Pneumologische Onkologie, Allergologie, Schlaf-und Beatmungsmedizin Bassermannstr, Mannheim. maritta.orth@rub.de ·MMW Fortschr Med · Pubmed #23668177.

ABSTRACT: -- No abstract --

485 Article [Diabetes and sleep. What remains unrecognized by the patient]. 2013

Harsch, I A. ·Innere Medizin, Endokrinologie, Thüringen Kliniken Georgius Agricola, Saalfeld/Saale. iharsch@thueringen-kliniken.de ·MMW Fortschr Med · Pubmed #23654136.

ABSTRACT: -- No abstract --

486 Article Brainstem involvement as a cause of central sleep apnea: pattern of microstructural cerebral damage in patients with cerebral microangiopathy. 2013

Duning, Thomas / Deppe, Michael / Brand, Eva / Stypmann, Jörg / Becht, Charlotte / Heidbreder, Anna / Young, Peter. ·Department of Neurology, University Hospital of Muenster, Muenster, Germany. thomas.duning@ukmuenster.de ·PLoS One · Pubmed #23637744.

ABSTRACT: BACKGROUND: The exact underlying pathomechanism of central sleep apnea with Cheyne-Stokes respiration (CSA-CSR) is still unclear. Recent studies have demonstrated an association between cerebral white matter changes and CSA. A dysfunction of central respiratory control centers in the brainstem was suggested by some authors. Novel MR-imaging analysis tools now allow far more subtle assessment of microstructural cerebral changes. The aim of this study was to investigate whether and what severity of subtle structural cerebral changes could lead to CSA-CSR, and whether there is a specific pattern of neurodegenerative changes that cause CSR. Therefore, we examined patients with Fabry disease (FD), an inherited, lysosomal storage disease. White matter lesions are early and frequent findings in FD. Thus, FD can serve as a "model disease" of cerebral microangiopathy to study in more detail the impact of cerebral lesions on central sleep apnea. PATIENTS AND METHODS: Genetically proven FD patients (n = 23) and age-matched healthy controls (n = 44) underwent a cardio-respiratory polysomnography and brain MRI at 3.0 Tesla. We applied different MR-imaging techniques, ranging from semiquantitative measurement of white matter lesion (WML) volumes and automated calculation of brain tissue volumes to VBM of gray matter and voxel-based diffusion tensor imaging (DTI) analysis. RESULTS: In 5 of 23 Fabry patients (22%) CSA-CSR was detected. Voxel-based DTI analysis revealed widespread structural changes in FD patients when compared to the healthy controls. When calculated as a separate group, DTI changes of CSA-CSR patients were most prominent in the brainstem. Voxel-based regression analysis revealed a significant association between CSR severity and microstructural DTI changes within the brainstem. CONCLUSION: Subtle microstructural changes in the brainstem might be a neuroanatomical correlate of CSA-CSR in patients at risk of WML. DTI is more sensitive and specific than conventional structural MRI and other advanced MR analyses tools in demonstrating these abnormalities.

487 Article Sensitization of upper airway mechanoreceptors as a new pharmacologic principle to treat obstructive sleep apnea: investigations with AVE0118 in anesthetized pigs. 2013

Wirth, Klaus J / Steinmeyer, Klaus / Ruetten, Hartmut. ·Sanofi-Aventis Deutschland GmbH, R&D, Frankfurt am Main, Germany. Klaus.Wirth@sanofi.com ·Sleep · Pubmed #23633752.

ABSTRACT: STUDY OBJECTIVES: Drug treatment for obstructive sleep apnea (OSA) is desirable because at least 30% of patients do not tolerate continuous positive airway pressure (CPAP) treatment. The negative pressure reflex (NPR) involving superficially located mechanoreceptors in the upper airway (UA) is an important mechanism for UA patency inhibitable by topical UA anesthesia (lidocaine). The NPR may serve as a target for pharmacological intervention for a topical treatment of OSA. The objective was to determine the effect of pharmacological augmentation of the NPR on UA collapsibility. DESIGN: We developed a model of UA collapsibility in which application of negative pressures caused UA collapses in spontaneously breathing α-chloralose-urethane anesthetized pigs as indicated by characteristic tracheal pressure and air flow changes. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The potassium channel blocker AVE0118 administered topically to the UA in doses of 1, 3, and 10 mg per nostril sensitized the NPR, shifting the mechanoreceptor response threshold for the genioglossus muscle to more positive pressures (P < 0.001; n = 6 per group) and dose-dependently inhibited UA collapsibility. Ten mg of AVE0118 prevented UA collapses against negative pressures of -150 mbar (P < 0.01) for > 4 h in all pigs, while in control pigs the UA collapsed at -50 mbar or less negative pressures. The effect of AVE0118 was abolished by UA lidocaine anesthesia. Acute intravenous administration of naloxone or acetazolamide was ineffective; paroxetine and mirtazepine were weakly effective and fluoxetine was moderately effective in line with reported clinical efficacy. CONCLUSION: Topical administration of AVE0118 to the UA is a promising pharmacologic approach for the treatment of OSA.

488 Article [Pssst...AINS secrets! Today in the general surgery]. 2013

Bergold, Martin / Ockelmann, Pia / Gill-Schuster, Daniel / Zacharowski, Kai. ·Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai, Frankfurt am Main. ·Anasthesiol Intensivmed Notfallmed Schmerzther · Pubmed #23633253.

ABSTRACT: -- No abstract --

489 Article Prognostic impact of sleep duration and sleep efficiency on mortality in patients with chronic heart failure. 2013

Reinhard, Wibke / Plappert, Nina / Zeman, Florian / Hengstenberg, Christian / Riegger, Günter / Novack, Victor / Maimon, Nimrod / Pfeifer, Michael / Arzt, Michael. ·Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Germany. ·Sleep Med · Pubmed #23628241.

ABSTRACT: BACKGROUND: Both short and long self-reported sleep duration (SDSR) has been linked to increased mortality. Our analysis tested the hypothesis that long SDSR is paralleled by impaired objective sleep efficiency (SEPSG) measured by polysomnography (PSG) and that impaired SEPSG is a risk factor for death in patients with chronic heart failure (CHF). METHODS: SDSR and SEPSG were assessed by standardized questionnaire and PSG in 188 consecutive CHF patients (age range, 63±10 year; left ventricular ejection fraction, 34±10%) admitted to the Sleep Center of the University Hospital Regensburg between 1/2002 and 12/2009. The mean follow-up period was 44±26 months. RESULTS: SEPSG in CHF patients from the highest quintile of SDSR (≥9h) was significantly lower compared with the middle quintile (7.25-8h; 71±15% vs 77%±11%; p=0.032) and similar to the lowest quintile (≤5.75h; 71±15% vs 71±16%, p=0.950). SEPSG is an independent predictor for death in the multivariable model after accounting for the significant confounders age, left ventricular ejection fraction, cause of CHF, and NYHA class (hazard ratio [HR] per 5% increase, 0.85; 95% confidence interval [CI], 0.77-0.93; p<0.001). CONCLUSIONS: Data indicate that subjective long sleepers with CHF have poor sleep efficiency. Objectively measured SEPSG strongly predicts mortality in CHF patients, underscoring the importance of objective assessment of sleep.

490 Article Are there gender-specific aspects of gastric banding? Data analysis from the quality assurance study of the surgical treatment of obesity in Germany. 2013

Stroh, Christine / Groh, C / Weiner, R / Ludwig, K / Wolff, S / Kabelitz, M / Manger, T / Anonymous4400756. ·Department of General-, Abdominal- and Pediatric Surgery, SRH Hospital Gera, Straße des Friedens 122, 07548, Gera, Germany, christine.stroh@wkg.srh.de. ·Obes Surg · Pubmed #23612866.

ABSTRACT: BACKGROUND: Since 1 January 2005, the situation of bariatric surgery has been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. METHODS: Data collection on the results of gastric banding procedures was started in 2005, and the data are registered in an online database. Follow-up data were collected once a year. Participation in the quality assurance study is voluntary. RESULTS: Since 2005, 3,453 gastric banding procedures have been performed at 88 hospitals. The mean age of patients was 40.7 years, and the mean body mass index (BMI) was 45.2 kg/m2. BMI and comorbidities are significantly higher in male patients. Regarding gender-specific aspects, there are no significant differences in the perioperative complication rates. The amelioration rate of comorbidities in male patients is lower than in female patients. CONCLUSION: Gastric banding in Germany is generally performed in patients with a BMI below 45 kg/m2. The perioperative complication rate is low. Data from the nationwide survey of the German Bariatric Surgery Registry show significant differences in preoperative comorbidities and their amelioration between male and female patients. There is a need for further evaluation of gender-specific aspects of gastric banding procedures to optimize patient selection, reduce specific postoperative complications, and achieve long-term effects on weight loss and remission of comorbidities.

491 Article [Obstructive sleep apnea syndrome in the setting of Gorlin-Goltz syndrome]. 2013

Grundig, H / Sinikovic, B / Günther, J / Jungehülsing, M. ·Kopf- und Hautzentrum, Klinik für Hals-, Nasen-, Ohrenheilkunde, Zentrum für Schlafmedizin, Klinikum Ernst von Bergmann Potsdam, Charlottenstr. 72, 14467, Potsdam, Deutschland. Hans.Grundig@gmx.ch ·HNO · Pubmed #23463414.

ABSTRACT: Goltz-Gorlin syndrome is a rare autosomal dominant hereditary disease associated with a high rate of spontaneous mutation. Diagnosis is based on clinically defined major and minor criteria. The disease is caused by a gene mutation locating to chromosome 9q22-31. We report on a young Goltz-Gorlin syndrome patient with obstructive sleep apnea syndrome. Due to intolerance to continuous positive airway pressure (CPAP) therapy and in order to avoid a tracheotomy, we opted for an alternative therapy comprising interdisciplinary multi-level surgery.

492 Article Trilevel adaptive servoventilation for the treatment of central and mixed sleep apnea in chronic heart failure patients. 2013

Oldenburg, Olaf / Bitter, Thomas / Wellmann, Birgit / Fischbach, Thomas / Efken, Christina / Schmidt, Anke / Horstkotte, Dieter. ·Dept. of Cardiology, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. akleemeyer@hdz-nrw.de ·Sleep Med · Pubmed #23453905.

ABSTRACT: BACKGROUND: Sleep-disordered breathing (SDB) in patients with heart failure (HF) is of major prognostic impact, though treatment of simultaneously occurring central and mixed apnea events is challenging. The objective was to examine long-term effects of a new trilevel adaptive servoventilation (ASV) therapy in patients with systolic or diastolic HF. METHODS: A total of 45 consecutive patients with a history of HF, elevated N-terminal prohormone of brain natriuretic peptide levels, objective signs of cardiac dysfunction, and moderate to severe SDB (apnea-hypopnea index [AHI] > or =15/h) with combined central and mixed respiratory events were included in this study and ASV therapy (SOMNOvent CR, Weinmann) was offered. RESULTS: In 38 patients (84%), ASV therapy was successfully initiated, with 23 (51%) patients showing appropriate compliance (device use > or = 4 h/night for > or = 5d/w) after 3.6±1.2 months. In these patients ASV therapy and HF status were re-evaluated. A sustained reduction was achieved in AHI (42.8±17.5/h vs 8.9±5.8/h; p<0.001) and oxygen saturation. Improvements also were recorded in New York Heart Association (NYHA) functional class (2.4±0.5-1.9±0.4; p<0.001) and oxygen uptake during cardiopulmonary exercise testing (VO2 peak, 13.64±3.5-15.8±5.8 ml/kg/min; p<0.002). CONCLUSION: In selected HF patients, trilevel ASV therapy is able to treat SDB with combined central and mixed respiratory events. This treatment is associated with an improvement in HF symptoms and objective cardiopulmonary performance.

493 Article Evaluation of a noninvasive algorithm for differentiation of obstructive and central hypopneas. 2013

Randerath, Winfried J / Treml, Marcel / Priegnitz, Christina / Stieglitz, Sven / Hagmeyer, Lars / Morgenstern, Christian. ·Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany. randerath@klinik-bethanien.de ·Sleep · Pubmed #23450252.

ABSTRACT: STUDY OBJECTIVES: The clear discrimination of central and obstructive hypopneas is highly relevant to avoid misinterpretation and inappropriate treatment of complicated breathing patterns. Esophageal manometry is the accepted standard for the differentiation of the phenotypes of sleep apnea. However, it is limited in its use due to poor acceptance by patients and therefore rarely performed in routine clinical practice. Flattening of the inspiratory airflow curve, paradoxical breathing, arousal position, sleep stages, and breathing pattern at the end of the hypopnea can each give hints for the classification of hypopnea. The aim of this study was to evaluate a standardized algorithm combining these polysomnographic parameters for the discrimination of hypopneas in everyday practice. METHODS: Polysomnography (PSG) and esophageal manometry were performed in 41 patients suspected of having sleep apnea (33 male, 52.3 ± 15.9 yr, body mass index 28.6 ± 4.5 kg/m(2)). Hypopneas were independently discriminated by blinded investigators based on esophageal pressure and the PSG-based algorithm. Only those hypopneas that could be differentiated with both methods were evaluated. RESULTS: There were 1,175 of 1,837 hypopneas (64%) that could be defined by esophageal pressure, 1,812 (98.6%) by the PSG-based algorithm. Using esophageal pressure as a reference, the new algorithm correctly defined 76.9% of central and 60.5% of obstructive hypopneas. The overall accuracy was 68%. The isolated analysis of single PSG parameters revealed a lower accuracy compared with the combined algorithm. CONCLUSIONS: The PSG-based algorithm allows for discrimination of most hypopneas. It is advantageous in comparison with esophageal pressure because it is noninvasive and less impaired by artefacts. Therefore, it is a potentially helpful tool for sleep specialists. CITATION: Randerath WJ; Treml M; Priegnitz C; Stieglitz S; Hagmeyer L; Morgenstern C. Evaluation of a noninvasive algorithm for differentiation of obstructive and central hypopneas. SLEEP 2013;36(3):363-368.

494 Article [Sleep-disordered breathing in patients with chronic heart failure: epiphenomenon or bidirectional relationship]. 2013

Zeller, J / Hetzenecker, A / Arzt, M. ·Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg. ·Pneumologie · Pubmed #23424035.

ABSTRACT: Sleep-disordered breathing (SDB) constitutes a highly prevalent comorbidity in patients with chronic heart failure (HF, approximately 45%). Both diseases are related in a bidirectional way: Obstructive sleep apnoea (OSA) can contribute to the development of HF via multiple mechanisms. Apnoea-related acute rise of cardiac afterload as well as manifest hypertension may contribute to the development of myocardial hypertrophy and thus HF. In addition, OSA increases the risk for myocardial infarction and impaired recovery of cardiac function after the event. Impaired cardiac function itself may contribute to the development of obstructive and central sleep apnoea (SA). Therefore, optimal medical management of HF is part of the therapy of SDB in such patients. Treatment of SDB with different modes of positive airway pressure suppresses apnoeas and hypopnoeas, improves sleep and may improve related symptoms and cardiac function of affected patients. Considering the high coincidence of SDB and HF, the adequate diagnosis of SDB and evaluation of indication for therapy of SDB performed in a specialised centre is advised.

495 Article Usefulness of sleep-disordered breathing to predict occurrence of appropriate and inappropriate implantable-cardioverter defibrillator therapy in patients with implantable cardioverter-defibrillator for primary prevention of sudden cardiac death. 2013

Kreuz, Jens / Skowasch, Dirk / Horlbeck, Fritz / Atzinger, Carolin / Schrickel, Jan W / Lorenzen, Henning / Nickenig, Georg / Schwab, Jörg O. ·Department of Medicine, Cardiology/Pneumology, University Hospital Bonn, Bonn, Germany. jens.kreuz@ukb.uni-bonn.de ·Am J Cardiol · Pubmed #23411108.

ABSTRACT: Advanced heart failure (HF) is associated with severe sleep-disordered breathing (SDB). In addition, most patients with HF are treated with an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death. The incidence of ICD therapy in such a patient cohort with SDB has never been investigated. The present study sought to determine the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with a categorical primary prevention ICD indication. A total of 133 consecutive ICD patients with New York Heart Association class II-III HF and depressed left ventricular function (≤35%) with no history of ventricular arrhythmia underwent a sleep study before ICD implantation and were followed for 24 ± 8 months, prospectively. A relevant SDB was defined as an apnea-hypopnea index of ≥10 events/hour. Of these 133 patients, 82 (62%) had SDB. Overweight (body mass index >29.1 vs 24.7 kg/m(2); p <0.001) was identified as the only independent risk factor for SDB. Appropriate ICD therapy intervention was significantly greater among patients with SDB than among patients without SDB (54% vs 34%, p = 0.03). Inappropriate ICD therapy intervention was documented more often in patients with SDB (n = 24 [29%] vs 7 [14%]; p = 0.04). An apnea-hypopnea index >10 events/hour was an independent predictor of appropriate ICD therapy on multivariate analysis (odds ratio 2.5, 95% confidence interval 1.8 to 4.04; p = 0.01). In conclusion, the present study is the first trial exploring the effect of SDB on the incidence of appropriate and inappropriate ICD therapy in patients with HF with a primary prevention indication. These results indicate that a preimplantation sleep study will identify patients with HF prone to receive appropriate and inappropriate ICD therapy.

496 Article Sleep apnea in precapillary pulmonary hypertension. 2013

Dumitrascu, Rio / Tiede, Henning / Eckermann, Jan / Mayer, Konstantin / Reichenberger, Frank / Ghofrani, Hossein Ardeschir / Seeger, Werner / Heitmann, Jörg / Schulz, Richard. ·University of Giessen Lung Center, Germany. ·Sleep Med · Pubmed #23340085.

ABSTRACT: OBJECTIVES: Pilot studies have described the occurrence of sleep apnea in patients with precapillary pulmonary hypertension (PH). However, there are no data on the prevalence of sleep-related breathing disorders in larger patient cohorts with PH. METHODS: 169 patients with a diagnosis of PH confirmed by right heart catheterisation and clinically stable in NYHA classes II or III were prospectively investigated by polygraphy (n = 105 females, mean age: 61.3 years, mean body mass index: 27.2 kg/m(2)). Recruitment was independent of sleep-related symptoms and the use of vasodilator drugs or nasal oxygen. RESULTS: 45 patients (i.e. 26.6%) had an apnea-hypopnea-index (AHI) >10/h. Of these, 27 patients (i.e. 16%) had obstructive sleep apnea (OSA) and 18 patients (i.e. 10.6%) had central sleep apnea (CSA). The mean AHI was 20/hour. As a polygraphy had been performed with nasal oxygen in half of the patients without evidence for sleep apnea, the frequency of CSA was probably underestimated. Patients with OSA were characterized by male gender and higher body mass index whereas, those with CSA were older and hypocapnic. CONCLUSIONS: At least every fourth patient with PH suffers from mild-to-moderate sleep apnea. Considering the anthropometric characteristics of the patients studied, the prevalence of both OSA and CSA seem to be higher in PH than in the general population.

497 Article [Long-term adaptation to chronic hypoxemia. Clinical presentation]. 2013

Wichmann, D / Baumann, H J / Kluge, S. ·Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg. d.wichmann@uke.de ·Med Klin Intensivmed Notfmed · Pubmed #23314793.

ABSTRACT: -- No abstract --

498 Article Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. 2013

Kepplinger, Jessica / Barlinn, Kristian / Albright, Karen C / Schrempf, Wiebke / Boehme, Amelia K / Pallesen, Lars-Peder / Schwanebeck, Uta / Graehlert, Xina / Storch, Alexander / Reichmann, Heinz / Alexandrov, Andrei V / Bodechtel, Ulf. ·Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. Jessica.Kepplinger@uniklinikum-dresden.de ·J Neurol · Pubmed #23263538.

ABSTRACT: Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0-15), median ESS 5 (0-13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea-hypopnea index ≥ 5/h (median: 20/h [0-79]); 32 % (18/56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients.

499 Article [Diagnosis of sleep disordered breathing using portable methods]. 2013

Penzel, T / Blau, A / Garcia, C / Schöbel, C / Sebert, M / Baumann, G / Fietze, I. ·Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin. thomas.penzel@charite.de ·Pneumologie · Pubmed #23247596.

ABSTRACT: Portable monitoring of sleep disordered breathing is the first diagnostic method not only in Germany but today in other countries as well. The conditions under which portable monitoring can be done with reliable results are now well defined. The limitations for the use of portable monitoring are specified as well. The devices used for portable monitoring are classified in four categories according to the number and the kind of signals recorded. New technical developments in the field of portable monitoring (polygraphy) use an indirect assessment of sleep disordered breathing based on signals not directly recording respiration. The recording of ECG and deriving respiration, the analysis of the plethysmographically recorded pulse wave, the recording of jaw movements using magnets, and advanced analysis of respiratory sounds are recent approaches. These new methods are presented with few studies until now. More and larger clinical studies are needed in order to show which of these systems is useful in the diagnosis of sleep disordered breathing and which are the specific strengths and weaknesses.

500 Article Auto-servoventilation in heart failure with sleep apnoea: a randomised controlled trial. 2013

Arzt, Michael / Schroll, Stephan / Series, Frederic / Lewis, Keir / Benjamin, Amit / Escourrou, Pierre / Luigart, Ruth / Kehl, Victoria / Pfeifer, Michael. ·Division of Respirology, University Hospital Regensburg, Regensburg. ·Eur Respir J · Pubmed #23222879.

ABSTRACT: We tested the hypotheses that in patients with congestive heart failure (CHF) and sleep disordered breathing (SDB) auto-servoventilation (ASV) improves cardiac function and quality of life. Between March 2007 and September 2009, patients with stable CHF (left ventricular ejection fraction (LVEF) ≤ 40%) and SDB (apnoea/hypopnoea index ≥ 20 events · h(-1)) were randomised to receive either ASV (BiPAP ASV (Philips Respironics, Murrysville, PA, USA), n=37) and optimal medical management, or optimal medical management alone (n=35). Outcomes were assessed at baseline and 12 weeks. The apnoea/hypopnoea index assessed with polysomnography scored in one core laboratory was significantly more reduced in the ASV group (-39 ± 16 versus -1 ± 13 events · h(-1); p<0.001) with an average use of 4.5 ± 3.0 h · day(-1). Both groups showed similar improvements of the primary end-point LVEF (+3.4 ± 5 versus +3.5 ± 6%; p=0.915) assessed with echocardiography. In the ASV group, reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) was significantly greater (-360 ± 569 versus +135 ± 625 ng · mL(-1); p=0.010). No differences were observed between the groups in subjective quality of life. In patients with CHF and SDB, ASV reduced NT-proBNP levels, but improvement of LVEF or quality of life was not greater than in the control group. The data support that such patients can be randomised in large-scale, long-term trials of positive airway pressure therapy versus control to determine effects on cardiovascular outcome.

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