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Sleep Apnea Syndromes: HELP
Articles from University of New Mexico
Based on 43 articles published since 2008
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These are the 43 published articles about Sleep Apnea Syndromes that originated from University of New Mexico during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial The High Road, the Low Road, or Both: Effects of Positive Airway Pressure Route of Administration on Treatment Efficacy for OSA. 2016

Cutrufello, Nicholas J / Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Chest · Pubmed #27938738.

ABSTRACT: -- No abstract --

2 Editorial Adaptive Servoventilation: Answer to a Sleep Physician's Dream? 2015

Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, School of Medicine, and the Department of Electrical and Computer Engineering, School of Engineering, University of New Mexico, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Chest · Pubmed #26621290.

ABSTRACT: -- No abstract --

3 Editorial Does sleep apnea damage the kidneys? 2015

Liang, Kelly / Unruh, Mark. ·Renal Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh PA. · Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM. ·Sleep · Pubmed #25581927.

ABSTRACT: -- No abstract --

4 Editorial Are we ready for "unisomnography"? 2015

Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM; Program in Sleep Medicine, University of New Mexico Health Sciences, Albuquerque, NM. ·Sleep · Pubmed #25515113.

ABSTRACT: -- No abstract --

5 Editorial Point: should board certification in sleep be required to prescribe CPAP therapy on the basis of home sleep testing? Yes. 2013

Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, School of Medicine and the Program in Sleep Medicine, Health Sciences Center, The University of New Mexico, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Chest · Pubmed #24297118.

ABSTRACT: -- No abstract --

6 Editorial Fatigue is the best pillow: sleepiness vs fatigue in sarcoidosis. 2013

Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicien, Albuquerque, NM; Program in Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Chest · Pubmed #23732574.

ABSTRACT: -- No abstract --

7 Editorial Noninvasive ventilatory support in obesity hypoventilation syndrome: backup early and often? 2013

Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, and the Program in Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Chest · Pubmed #23276838.

ABSTRACT: -- No abstract --

8 Editorial Achieving adherence to positive airway pressure therapy: modifying pressure and the Holy Grail. 2011

Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine; and the Program in Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Chest · Pubmed #21652553.

ABSTRACT: -- No abstract --

9 Review Positive Airway Pressure Therapy for Hyperventilatory Central Sleep Apnea: Idiopathic, Heart Failure, Cerebrovascular Disease, and High Altitude. 2017

Javaheri, Shahrokh / Brown, Lee K. ·Sleep Laboratory, Bethesda North Hospital, 10535 Montgomery Road, Suite 200, Cincinnati, OH 45242, USA; The University of Cincinnati, Cincinnati, OH, USA; The Ohio University Medical School, Columbus, OH, USA. Electronic address: shahrokhjavaheri@icloud.com. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue Northeast, Building #2, Albuquerque, NM 87102, USA; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue Northeast, Building #2, Albuquerque, NM 87102, USA. ·Sleep Med Clin · Pubmed #29108611.

ABSTRACT: Central sleep apnea (CSA) and Hunter-Cheyne-Stokes breathing (HCSB) are caused by failure of the pontomedullary pacemaker generating breathing rhythm. CSA/HCSB may complicate several disorders causing recurrent arousals and desaturations. Common causes of CSA in adults are congestive heart failure, stroke, and chronic use of opioids; opioids have hypoventilatory effects. Diagnosis and treatment of hyperventilatory CSA may improve quality of life, and, when associated with heart failure or cerebrovascular disease, reduce morbidity and perhaps mortality.

10 Review Positive Airway Pressure Device Technology Past and Present: What's in the "Black Box"? 2017

Brown, Lee K / Javaheri, Shahrokh. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA; Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, University of New Mexico Sleep Disorders Center, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM 87102, USA. Electronic address: lkbrown@alum.mit.edu. · Sleep Laboratory, Bethesda North Hospital, 10475 Montgomery Road, Cincinnati, OH 45242, USA; TriHealth Sleep Center, Pulmonary and Sleep Division, Bethesda North Hospital, University of Cincinnati College of Medicine, 10500 Montgomery Road, Cincinnati, OH 45242, USA; The Ohio State University College of Medicine, 473 West 12th Avenue, Columbus, OH 43210, USA. ·Sleep Med Clin · Pubmed #29108606.

ABSTRACT: Since the introduction of continuous positive airway pressure (PAP) for the treatment of obstructive sleep apnea (OSA) in 1981, PAP technology has diversified exponentially. Compact and quiet fixed continuous PAP flow generators, autotitrating PAP devices, and bilevel PAP devices that can treat multiple sleep-disordered breathing phenotypes including OSA, central sleep apnea (CSA), combinations of OSA and CSA, and hypoventilation are available. Adaptive servo-ventilators can suppress Hunter-Cheyne-Stokes breathing and CSA and treat coexisting obstructive events. Volume-assured pressure support PAP apparatus purports to provide a targeted degree of ventilatory assistance while also treating cooccurring OSA and/or CSA.

11 Review Epidemiology of Sleep-Disordered Breathing and Heart Failure: What Drives What. 2017

Dharia, Sushma M / Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM, 87102, USA. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, 1101 Medical Arts Avenue NE, Building #2, Albuquerque, NM, 87102, USA. lkbrown@alum.mit.edu. · Department of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque, NM, USA. lkbrown@alum.mit.edu. ·Curr Heart Fail Rep · Pubmed #28808861.

ABSTRACT: PURPOSE OF REVIEW: The bidirectional relationships that have been demonstrated between heart failure (HF) and central sleep apnea (CSA) demand further exploration with respect to the implications that each condition has for the other. This review discusses the body of literature that has accumulated on these relationships and how CSA and its potential treatment may affect outcomes in patients with CSA. RECENT FINDINGS: Obstructive sleep apnea (OSA) can exacerbate hypertension, type 2 diabetes, obesity, and atherosclerosis, which are known predicates of HF. Conversely, patients with HF more frequently exhibit OSA partly due to respiratory control system instability. These same mechanisms are responsible for the frequent association of HF with CSA with or without a Hunter-Cheyne-Stokes breathing (HCSB) pattern. Just as is the case with OSA, patients with HF complicated by CSA exhibit more severe cardiac dysfunction leading to increased mortality; the increase in severity of HF can in turn worsen the degree of sleep disordered breathing (SDB). Thus, a bidirectional relationship exists between HF and both phenotypes of SDB; moreover, an individual patient may exhibit a combination of these phenotypes. Both types of SDB remain significantly underdiagnosed in patients with HF and hence undertreated. Appropriate screening for, and treatment of, OSA is clearly a significant factor in the comprehensive management of HF, while the relevance of CSA remains controversial. Given the unexpected results of the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure trial, it is now of paramount importance that additional analysis of these data be expeditiously reported. It is also critical that ongoing and proposed prospective studies of this issue proceed without delay.

12 Review Relationships between obstructive sleep apnea and anxiety. 2016

Diaz, Shanna V / Brown, Lee K. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA. ·Curr Opin Pulm Med · Pubmed #27583672.

ABSTRACT: PURPOSE OF REVIEW: To summarize recent research investigating the interaction between obstructive sleep apnea (OSA) and anxiety, and contextualize their bidirectional relationship. RECENT FINDINGS: Recent investigations corroborate the bidirectional relationship between sleep-disordered breathing (SDB) and anxiety, evaluate the etiological and clinical manifestations through different mechanisms, and provide insight into clinical implications of this interaction. Much of the literature about anxiety as it relates to SDB is from small samples, using different tools of symptom measurement that are often subjectively quantified. The objective severity of OSA does not appear to be associated with subjectively reported sleepiness and fatigue, whereas physiological manifestations of anxiety are associated with the severity of subjective symptoms reported. Recent findings support that women are more likely to have comorbid SDB and anxiety than men. SDB may precipitate and perpetuate anxiety, whereas anxiety in OSA negatively impacts quality-of-life. Treating SDB may improve anxiety symptoms, whereas anxiety symptoms can be an obstacle and deterrent to appropriate treatment. SUMMARY: The interaction between anxiety and SDB is still poorly elucidated. Being aware of the clinical associations, risk factors, and treatment implications for SDB as related to anxiety disorders in different populations can help clinicians with the diagnosis and management of both SDB and anxiety.

13 Review Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. 2016

Khurshid, Kiran / Yabes, Jonathan / Weiss, Patricia M / Dharia, Sushma / Brown, Lee / Unruh, Mark / Jhamb, Manisha. ·Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. · Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. · Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA. · Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM. · Nephrology Division, Department of Internal Medicine, University of New Mexico, Albuquerque, NM. ·J Clin Sleep Med · Pubmed #27397663.

ABSTRACT: STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is an independent risk factor for hypertension (HTN). Increasing evidence from animal and human studies suggests that HTN exacerbates OSA. We performed a systematic review and meta-analysis of studies evaluating the effect of anti-hypertensive medications on the severity of OSA. METHODS: A literature search of PubMed and Embase was done using search concepts of OSA, HTN, and drug classes used to treat HTN. Studies that reported changes in the severity of OSA objectively by using apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) were included. Pooled mean difference estimates were calculated. Tests for heterogeneity, publication bias, and subgroup sensitivity analysis were conducted. RESULTS: Of 27,376 studies screened, only 11 met inclusion criteria, including 5 randomized controlled trials and 6 single-arm prospective trials. The pooled mean difference estimate (95% confidence interval [CI]), based on a random-effects model, was -5.69 (95% CI -10.74 to -0.65), consistent with an overall decrease in AHI or RDI attributable to antihypertensive medications. The effect size was even more pronounced, -14.52 (95% CI -25.65 to -3.39), when only studies using diuretics were analyzed. There was no significant heterogeneity or publication bias among the studies. Meta-regression indicated neither age, baseline AHI, nor change in systolic/diastolic blood pressure influenced the results. CONCLUSIONS: Collectively, findings from these relatively small, short-term studies tend to support the contention that treatment with antihypertensive agents confers a statistically significant, albeit small, reduction in the severity of OSA, which may be more pronounced with the use of diuretics.

14 Review Diabetic kidney disease and obstructive sleep apnea: a new frontier? 2016

Al Mawed, Saleem / Unruh, Mark. ·Department of Internal Medicine, Nephrology Division, University of New Mexico, Albuquerque, New Mexico, USA. ·Curr Opin Pulm Med · Pubmed #26574721.

ABSTRACT: PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) has been shown to be an independent risk factor for the development and progression of diabetes mellitus. Interestingly, there is also a strong correlation between OSA and the development and progression of chronic kidney disease (CKD). As diabetes mellitus is the most common cause of CKD, in this review we summarize the current literature regarding this interconnecting relationship between OSA, CKD, and diabetes mellitus. The literature increasingly supports a bidirectional relationship between CKD and OSA among diabetes mellitus patients leading to an increased rate of progression of diabetic nephropathy. RECENT FINDINGS: There is growing evidence that among patients with diabetes mellitus, OSA may be a strong risk factor for the development of diabetic nephropathy. The treatment of OSA in CKD patients may play a role in attenuating the rate of the progression of CKD. SUMMARY: Clinicians should have a low threshold for evaluating diabetic patients with CKD for OSA. Further studies examining if treatment of OSA would improve the outcomes of CKD patients in general and diabetic CKD patients in particular are needed.

15 Review Obesity hypoventilation syndrome: current theories of pathogenesis. 2015

Pierce, Aaron M / Brown, Lee K. ·aDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine bDepartment of Electrical and Computer Engineering, University of New Mexico School of Engineering, Albuquerque, New Mexico, USA. ·Curr Opin Pulm Med · Pubmed #26390338.

ABSTRACT: PURPOSE OF REVIEW: To summarize recent primary publications and discuss the impact these finding have on current understanding on the development of hypoventilation in obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome. RECENT FINDINGS: As a result of the significant morbidity and mortality associated with OHS, evidence is building for pre-OHS intermediate states that can be identified earlier and treated sooner, with the goal of modifying disease course. Findings of alterations in respiratory mechanics with obesity remain unchanged; however, elevated metabolism and CO2 production may be instrumental in OHS-related hypercapnia. Ongoing positive airway pressure trials continue to demonstrate that correction of nocturnal obstructive sleep apnea and hypoventilation improves diurnal respiratory physiology, metabolic profiles, quality of life, and morbidity/mortality. Finally, CNS effects of leptin on respiratory mechanics and chemoreceptor sensitivity are becoming better understood; however, characterization remains incomplete. SUMMARY: OHS is a complex multiorgan system disease process that appears to be driven by adaptive changes in respiratory physiology and compensatory changes in metabolic processes, both of which are ultimately counter-productive. The diurnal hypercapnia and hypoxia induce pathologic effects that further worsen sleep-related breathing, resulting in a slowly progressive worsening of disease. In addition, leptin resistance in obesity and OHS likely contributes to blunting of ventilatory drive and inadequate chemoreceptor response to hypercarbia and hypoxemia.

16 Review Central Sleep Apnea in Kidney Disease. 2015

Dharia, Sushma M / Unruh, Mark L / Brown, Lee K. ·Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM. · Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM. Electronic address: lkbrown@alum.mit.edu. ·Semin Nephrol · Pubmed #26355252.

ABSTRACT: Sleep is an essential function of life and serves a crucial role in the promotion of health and performance. Poor sleep quality and sleep disorders have been a recurrent finding in patients with chronic kidney disease (CKD). Sleep disorders such as obstructive sleep apnea (OSA) can contribute to hypertension, diabetes, cardiovascular disease, and worsen obesity, all of which are implicated in the etiology of CKD, but CKD itself may lead to OSA. Relationships between CKD/end-stage renal disease (ESRD) and OSA have been the subject of numerous investigations, but central sleep apnea (CSA) also is highly prevalent in CKD/ESRD but remains poorly understood, underdiagnosed, and undertreated in these patients. Emerging literature has implicated CSA as another contributor to morbidity and mortality in CKD/ESRD, and several studies have suggested that CSA treatment is beneficial in improving these outcomes. Patients with CKD/ESRD co-existing with congestive heart failure are particularly prone to CSA, and studies focused on managing CSA in congestive heart failure patients have provided important information concerning how best to manage CSA in kidney disease as well. Adaptive servo-ventilation ultimately may represent the treatment of choice in these patients, although a stepped approach using a variety of therapeutic modalities is recommended.

17 Review The Relationship Between Volume Overload in End-Stage Renal Disease and Obstructive Sleep Apnea. 2015

Roumelioti, Maria-Eleni / Brown, Lee K / Unruh, Mark L. ·Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico. · Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, and the Program in Sleep Medicine, University of New Mexico Health Sciences Centre, Albuquerque, New Mexico. ·Semin Dial · Pubmed #25940851.

ABSTRACT: Obstructive sleep apnea (OSA) is common, underdiagnosed, and undertreated among patients with end-stage renal disease (ESRD). As in all cases, pathogenesis of OSA is related to repeated upper airway (UA) occlusion or narrowing, but in ESRD, additional contributory factors likely include uremic destabilization of central respiratory control and anatomic changes in the UA related to fluid status. Pulmonary congestion is common in acute and chronic kidney failure and is a consequence of cardiomyopathy and fluid overload, two potentially reversible risk factors. Emerging evidence suggests that volume overload also reduces the UA caliber. The diminution in UA area as well as destabilization of ventilatory control in ESRD have been postulated as causes of increased OSA prevalence and severity in these patients, and creates a vicious cycle wherein OSA exacerbates fluid overload disorders such as in congestive heart failure (CHF) and ESRD, which then further worsen OSA. Dialysis modalities may differ in their effects on volume status, the accumulation of uremic toxins, and acid-base status, and as a consequence, on the emergence and severity of OSA. Given the contribution of excess fluid to both the severity of nocturnal hypoxia and UA narrowing, establishing and maintaining dry weight is of particular importance when managing OSA in ESRD. Clinical trials to determine the extent to which more aggressive fluid removal in ESRD patients may alleviate OSA are needed.

18 Review Sleep disorders in adults with epilepsy: past, present, and future directions. 2014

Grigg-Damberger, Madeleine M / Ralls, Frank. ·aDepartment of Neurology bUNM Sleep Disorder Center cDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA. ·Curr Opin Pulm Med · Pubmed #25250802.

ABSTRACT: PURPOSE OF REVIEW: To summarize recent studies on the complex relationships between sleep disorders, sleep, and epilepsy. RECENT FINDINGS: Insomnia in adults with epilepsy (AWE) warrants consideration of depression, anxiety, and suicidal ideation. Daytime sleepiness in AWE is more often due to undiagnosed sleep disorders. Sleep deprivation is an important provoker of seizures in juvenile myoclonic epilepsy. Abnormalities in frontal lobe executive function with difficulties making advantageous decisions may explain failure of juvenile myoclonic epilepsy patients to adhere to treatment recommendations and regulate their sleep habits. Sleep architecture in AWE is more likely to be abnormal if seizures are poorly controlled or occur during sleep. Obstructive sleep apnea is much more common in AWE who are man, older, heavier, or whose seizures are poorly controlled. Chronobiology and chronopharmacology of epilepsy is an emerging field worthy of future research and clinical applications. SUMMARY: Identifying and treating unrecognized sleep disorders and understanding the impact of circadian rhythms on epilepsy can improve quality of life and seizure control in AWE.

19 Review Adaptive servo-ventilation for the treatment of central sleep apnea in congestive heart failure: what have we learned? 2014

Brown, Lee K / Javaheri, Shahrokh. ·aDepartment of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico bUniversity of Cincinnati College of Medicine, Cincinnati, Ohio, USA. ·Curr Opin Pulm Med · Pubmed #25211247.

ABSTRACT: PURPOSE OF REVIEW: Positive airway pressure devices for the noninvasive treatment of sleep-disordered breathing are being marketed that have substantially expanded capabilities. Most recently, adaptive servo-ventilation devices have become available that are capable of measuring patient ventilation continuously and use that information to adjust expiratory positive airway pressure and pressure support levels to abolish central and obstructive apneas and hypopneas, including central sleep-disordered breathing of the Hunter-Cheyne-Stokes variety. Patients with congestive heart failure are particularly prone to developing central sleep apnea and/or Hunter-Cheyne-Stokes breathing, and studies have shown that suppression of these abnormal breathing patterns may improve cardiac function and, ultimately, mortality. RECENT FINDINGS: Over the last approximately 18 months, increasing numbers of studies have appeared demonstrating improvement in cardiac function and other important outcomes after both acute application of adaptive servo-ventilation as well as 3 to 6 months of use in patients with congestive heart failure and central sleep apnea/Hunter-Cheyne-Stokes breathing. Several of these studies are randomized controlled trials and several include assessment of cardiac event-free survival showing an advantage to treating with adaptive servo-ventilation. SUMMARY: As an adjunct to optimal pharmacological management, adaptive servo-ventilation shows considerable promise as a means to improve outcomes in patients with congestive heart failure complicated by central sleep apnea/Hunter-Cheyne-Stokes breathing. Larger randomized controlled trials will be necessary to demonstrate the ultimate role of this therapeutic modality in such patients.

20 Review Bidirectional relationship of hypertension with obstructive sleep apnea. 2014

Jhamb, Manisha / Unruh, Mark. ·aRenal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania bNephrology Division, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA. ·Curr Opin Pulm Med · Pubmed #25203003.

ABSTRACT: PURPOSE OF REVIEW: Hypertension (HTN) and obstructive sleep apnea (OSA) are coexistent in millions of people, and both have been associated with heart disease, stroke, and premature death. OSA is an important risk factor for HTN. However, the relationship between OSA and HTN may be bidirectional, with high blood pressure (BP) contributing to an increased risk and severity of OSA. The aim of this review is to summarize the current literature supporting a bidirectional relationship of sleep apnea and HTN. RECENT FINDINGS: The treatment of HTN to a lower BP target may improve sleep apnea by improving upper airway tone, by targeting hormone pathways (aldosterone, renin-angiotensin system) that may exacerbate OSA, and by reducing the nocturnal rostral fluid shifts through the use of a low-sodium diet, diuretics, and dialysis. SUMMARY: Intensive BP and volume overload control may be a promising approach to treat OSA. Future studies examining the hormonal mechanisms and comparing the effect of different antihypertensive medications on OSA are needed.

21 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.

22 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.

23 Review Cognitive dysfunction and obstructive sleep apnea: from cradle to tomb. 2012

Grigg-Damberger, Madeleine / Ralls, Frank. ·Department of Neurology, University of New Mexico School of Medicine, One University of New Mexico, Albuquerque, NM 87131-0001, USA. mgriggd@salud.unm.edu ·Curr Opin Pulm Med · Pubmed #22990657.

ABSTRACT: PURPOSE OF REVIEW: To understand clinical characteristics and risk factors for cognitive impairment in patients with obstructive sleep apnea (OSA) syndromes. RECENT FINDINGS: Primary snoring increases the risk of neurocognitive impairment and lower intelligence quotients in infants and children. Middle-aged adults with severe OSA are at greater risk for cognitive impairment than young adults with apnea of equal severity. Older women with OSA are at increased risk for minimal cognitive impairment or dementia, 5 years later. SUMMARY: Certain age groups (younger and older) are particularly susceptible to the negative effects of OSA on cognition. Other influences that increase the risk for cognitive dysfunction in OSA include premature birth, apolipoprotein e4 allele status and other genetic polymorphisms, lower socioeconomic status, fewer years of education, and ethnicity.

24 Review Roles of gender, age, race/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes. 2012

Ralls, Frank M / Grigg-Damberger, Madeleine. ·Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico School of Medicine, University of New Mexico Hospital Sleep Disorders Center, Albuquerque, New Mexico 87102, USA. fralls@salud.unm.edu ·Curr Opin Pulm Med · Pubmed #22990656.

ABSTRACT: PURPOSE OF REVIEW: Review recent research on the roles of gender, race/ethnicity, residential socioeconomics and age in obstructive sleep apnea syndromes (OSA) and their treatment. RECENT FINDINGS: Men have a higher prevalence of OSA than women and require higher continuous positive airway pressure (CPAP) pressures for treatment, given similar severity of OSA. When comparing age, women have less severe apnea at all ages. Menopause, pregnancy and polycystic ovarian syndrome increase the risk for OSA in women. Neck fat and BMI influence apnea-hypopnea index (AHI) severity in women; abdominal fat and neck-to-waist ratio do so in men. Obesity, craniofacial structure, lower socioeconomic status and neighborhood disadvantage may better explain ethnic/racial differences in the prevalence and severity of OSA. Ethnicity was no longer significantly associated with OSA severity when WHO criteria for obesity were used. SUMMARY: OSA has a male predominance; women have a lower AHI than men during certain stages of sleep; women require less CPAP pressure for treatment of similar severity of OSA, and there are ethnic/racial differences in the prevalence and severity of OSA but these may be due to environmental factors, such as living in disadvantaged neighborhoods.

25 Review The AASM Scoring Manual four years later. 2012

Grigg-Damberger, Madeleine M. ·University of New Mexico School of Medicine, MSC 10 5620, One University of NM, Albuquerque, New Mexico 87131-0001, USA. MGriggD@salud.unm.edu ·J Clin Sleep Med · Pubmed #22701392.

ABSTRACT: PURPOSE OF REVIEW: Review published studies and critiques which evaluate the impact and effects of the American Academy of Sleep Medicine (AASM) Sleep Scoring Manual in the four years since its publication. FINDINGS: USING THE AASM MANUAL RULES TO SCORE SLEEP AND EVENTS IN A POLYSOMNOGRAM (PSG) RESULTS IN: (1) very large differences in apnea-hypopnea indexes (AHI) when using the recommended and alternative rule for scoring hypopneas in adults; (2) increases in NREM 1 and sleep stage shifts with compensatory decreases in NREM 2 in children and adults when following rule 5.C.b. for ending NREM 2 sleep; (3) increases in NREM 3 in adults scoring slow wave activity in the frontal EEG derivations; (4) improved interscorer reliability; and (5) successfully identified fragmented sleep in children with obstructive sleep apnea (OSA) from primary snorers or normal controls because they had more NREM 1 and stage shifts using rule 5.C.b. Criticism of the Manual most often cited: (1) two rules for scoring hypopneas; (2) alternative EEG montage cancellation effects; (3) scoring stages 3 and 4 as NREM 3; and (4) too few rules for scoring arousals and REM sleep without atonia. SUMMARY: Four years have passed since the AASM Scoring Manual was published with far less criticism than those who developed it feared. The AASM Manual provides a foundation upon which we all can build rules and methods which identify the complexity of sleep and its disorders.

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