Dissertations / Theses on the topic 'Sleep apnea syndromes'
To see the other types of publications on this topic, follow the link: Sleep apnea syndromes.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Sleep apnea syndromes.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Lam, Chung-mei Jamie. "Obstructive sleep apnea and cardiometabolic complications." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43085854.
Full text
2
Cloonan, Yona Keich. "Sleep outcomes in children with craniofacial microsomia /." Thesis, Connect to this title online; UW restricted, 2007. http://hdl.handle.net/1773/10877.
Full text
3
Gagnon, Victoria Lee. "Obstructive sleep apnea syndrome and associated health risks /." Abstract Full Text (HTML) Full Text (PDF), 2008. http://eprints.ccsu.edu/archive/00000538/02/1986FT.htm.
Full textAbstract:
Thesis (M.S.) -- Central Connecticut State University, 2008.Thesis advisor: Ruth Rollin. "... in partial fulfillment of the requirements for the degree of Master of Science in Biology." Includes bibliographical references (leaves 39-41). Also available via the World Wide Web.
4
Lam, Chung-mei Jamie, and 林頌眉. "Obstructive sleep apnea and cardiometabolic complications." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43085854.
Full text
5
Wong, Keith K. H. "Measuring sleep and neurobiological functional parameters in patients with obstructive sleep apnea." Connect to full text, 2007. http://hdl.handle.net/2123/2245.
Full textAbstract:
Thesis (Ph. D.)--University of Sydney, 2008.Title from title screen (viewed Mar. 12, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Discipline of Medicine, Faculty of Medicine. Degree awarded 2008; thesis submitted 2007. Includes bibliography. Also issued in print.
6
Patel, Mayur Mahendra. "A comparison of the edentulous and dentate prosthodontic patient for the occurrence of obstructive sleep apnea." Morgantown, W. Va. : [West Virginia University Libraries], 2004. https://etd.wvu.edu/etd/controller.jsp?moduleName=documentdata&jsp%5FetdId=3321.
Full textAbstract:
Thesis (M.S.)--West Virginia University, 2004.Title from document title page. Document formatted into pages; contains vii, 47 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 30-31).
7
Lam, Yau-min, and 林宥冕. "Obstructive sleep apnea in children with Down syndrome: a systematic review." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48423786.
Full textAbstract:
While obstructive sleep apnea among children with Down syndrome is very common, the pre-existing risk factors and its impact to neurodevelopment are not well known. The aims and objectives of this systematic review are to determine the prevalence of OSA among DS children and to identify the associated risk factors. 6 articles that met the inclusion criteria were retrieved after using PubMed and Google Scholar in literature searching. The prevalence of OSA has great variation among different countries but are relatively high, ranging from 57% to 79%. OSA was significant associated with obesity, age and tonsil size. It is also known to associate with behavioral problem in DS children and delay their neurodevelopment. Therefore, early treatment followed by appropriate modification in lifestyle and diet is crucial in managing OSA.published_or_final_version
Public Health
Master
Master of Public Health
8
Cheng, Hai-kiu Kelvin. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B4072041X.
Full text
9
Sam, Kim. "Short term effects of an oral appliance in the treatment of mild to moderate Obstructive Sleep Apnea in Chinese subjects." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B21879278.
Full text
10
Dingwall, Kylie. "Effects of medication on the sleep architecture of patients with obstructive sleep apnea syndrome (OSAS) /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe19264.pdf.
Full text
11
Revol, Bruno. "Pharmacoépidémiologie des apnées du sommeil Impact of concomitant medications on obstructive sleep apnoea Drugs and obstructive sleep apnoeas Diagnosis and management of central sleep apnea syndrome Baclofen and sleep apnoea syndrome: analysis of VigiBase® the WHO pharmacovigilance database Gabapentinoids and sleep apnea syndrome: a safety signal from the WHO pharmacovigilance database Valproic acid and sleep apnea: a disproportionality signal from the WHO pharmacovigilance database Ticagrelor and Central Sleep Apnea What is the best treatment strategy for obstructive sleep apnoea-related hypertension? Who may benefit from diuretics in OSA? A propensity score-matched observational study." Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALV026.
Full textAbstract:
Avant leur mise sur le marché, l'évaluation clinique des médicaments repose sur des essais contrôlés randomisés. Bien qu'ils représentent la méthode de référence, leurs résultats sont nécessairement limités aux patients inclus dans ces essais. De plus, ils sont d’abord conçus pour mesurer l'efficacité des traitements, avant d’évaluer leurs effets indésirables. Concernant le syndrome d'apnées du sommeil (SAS), alors que de nombreux essais médicamenteux ont été menés, la plupart des résultats sont de faible niveau de preuve, voire contradictoires. Outre la durée et les effectifs limités de ces essais, une explication est que le SAS est une pathologie hétérogène en termes de symptômes et de physiopathologie, incluant divers "phénotypes" de patients. Des données de vie réelle sont donc nécessaires pour définir quels médicaments pourraient améliorer le SAS ou les comorbidités associées et quels patients pourraient en bénéficier. Au contraire, les cliniciens doivent être avertis que certains médicaments peuvent induire ou aggraver le SAS.La pharmacoépidémiologie fait désormais partie de toute enquête de pharmacovigilance, car elle permet une approche à la fois descriptive et comparative des notifications spontanées. Des associations entre l'exposition à un ou plusieurs médicaments et l'apparition d'effets indésirables peuvent ainsi être recherchées. Comme pour toutes les études observationnelles, la principale difficulté consiste à contrôler les facteurs de confusion. L'un des modèles couramment utilisés est l'analyse cas/non-cas, qui étudie la disproportionnalité entre le nombre d’effets indésirables rapportés avec le médicament d’intérêt, par rapport aux effets notifiés pour les autres médicaments. Nous avons ainsi montré des associations significatives entre l'utilisation de baclofène, des gabapentinoïdes ou de l'acide valproïque et la survenue de SAS dans la base de pharmacovigilance de l'OMS, suggérant le rôle du système GABAergique dans la pathogenèse des apnées centrales d’origine médicamenteuse. Un signal de disproportionnalité a également été observé pour le ticagrélor, reposant sur un mécanisme d'action différent.Les analyses pharmacoépidémiologiques permettent également d'étudier le bénéfice des médicaments en vie réelle. Le score de propension est utilisé pour minimiser les biais de sélection et recréer des conditions de comparabilité proches de celles des essais randomisés. À l'aide de ces méthodes statistiques, nous avons évalué l'intérêt potentiel de cibler le système rénine-angiotensine pour la prise en charge de l'hypertension artérielle chez les patients atteints d’apnées obstructives, en particulier avec l’utilisation des sartans. Chez ces mêmes patients apnéiques et hypertendus, nos travaux suggèrent que les diurétiques pourraient diminuer la sévérité des apnées, notamment en cas de surpoids ou d’obésité modérée. Des études prospectives sont désormais nécessaires afin de confirmer ces résultats, car les données de vie réelle ne peuvent se substituer aux essais cliniques contrôlésThe clinical evaluation of drugs before approval is based on randomized controlled trials. Although they are considered as the gold standard for testing drugs, their results are necessarily limited to patients included in the trials. Moreover, almost all clinical trials are primarily designed to assess the efficacy of a treatment, so safety is only a secondary concern. Regarding sleep apnea syndrome (SAS), while many drug trials have been conducted, most of the results are weak or even contradictory. In addition to limited trial duration and population size, one explanation is that the sleep apnea population is highly heterogeneous with respect to symptoms and physiological traits linked to disease pathogenesis, giving various patient “phenotypes”. Real-life data are therefore needed to define which drugs could improve SAS or associated comorbidities and who might benefit from them. On the contrary, clinicians need to be aware that some drugs may induce or worsen sleep apnea.Pharmacoepidemiology is now part of any pharmacovigilance survey, as it provides both descriptive and comparative approaches of spontaneous reports. Associations between the exposure to one or more drugs and the occurrence of adverse effects can thus be sought. As for all observational studies, the major difficulty is to control for confounding factors. One of the study designs commonly used, is the case/non-case analysis, which investigates disproportionality between the numbers of adverse drug reactions reported with the drug of interest compared to the number reported with all other drugs. In this way, we showed significant associations between the use of baclofen, gabapentinoids or valproic acid and the reporting of SAS in the WHO drug adverse event database, suggesting a role of the GABAergic system in the pathogenesis of drug-induced central sleep apnea. A disproportionality signal was also found for ticagrelor, based on a different mechanism of action.Pharmacoepidemiological analyses also make it possible to study the benefit of drugs in real-life. Propensity scores are used to minimize selection bias, leading to a comparability between the exposure groups close to that observed in randomized trials. Using these statistical methods, we have investigated the potential value of targeting the renin-angiotensin system for the management of hypertension in obstructive sleep apnea (OSA) patients, especially the use of sartans. For hypertensive apneic patients, our work suggests that diuretics could decrease the severity of OSA, particularly in the overweight or moderately obese. Prospective studies are now needed to confirm these findings, because real-life data cannot be a substitute for controlled clinical trials
12
Mok, Yuk-wan Wendy. "A validation of the Calgary Sleep Apnea quality of life index (Chinese version) and an evaluation of treatment effectiveness and patient perference by physiological and neurobehavioural outcome measures in Chinese sleep apnea patients /." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B2520564x.
Full text
13
Wichmann, Mark William. "A device for the treatment of adult Sleep Apnea Syndrome." Thesis, Virginia Tech, 1988. http://hdl.handle.net/10919/45960.
Full textAbstract:
An electronically-controlled positive-displacement bellows-type air pump has been developed in the Bio-medical Engineering Laboratory for the treatment of adult Sleep Apnea Syndrome (SAS). An electronically-controlled positive-displacement pump has been employed in order to eliminate the pressure regulator and accompanying noise of present therapeutic devices. The positive-displacement pump is found to quietly and effectively provide the required airway pressures for the treatment of adult Sleep Apnea Syndrome. New developments in the reduction of the size and noise levels of current therapeutic devices, however, preclude mass production of the bellows-type pump because of its size disadvantage. The custom nasal mask and exhalation valve, control system, pressure-monitoring alarm system, and the controlled humidifier of the positive-displacement pump should be incorporated within the present fanâ type Nasal Continuous Positive Airway Pressure (NCPAP) system to provide quieter, more comfortable, and safer NCPAP therapy. Before the design and development of the positive displacement NCPAP pump is detailed in this thesis, however, the problem of adult Sleep Apnea Syndrome is introduced, available therapies are investigated, and the current NCPAP therapy system is examined.
Master of Science
14
Ahrens, Anika. "A randomized clinical trial of the treatment of obstructive sleep apnoea using oral appliances." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B47849599.
Full textAbstract:
Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder and is associated with a range of adverse physical, social and psychological outcomes that affect quality of life (QoL). Two systematic reviews of the literature (part of this thesis work) found there is conflicting evidence of how different mandibular advancement device (MAD) designs features may affect clinical and subjective OSA outcomes in certain patients. Therefore, a randomized cross-over trial was conducted. Firstly, the correlation between clinical OSA indicators and QOL was explored among patients referred for OSA treatment using MADs. In addition, associations of OSA risk factors, dental status and demographic variables with clinical OSA indicators and QoL indices were determined. Secondly, the efficacy of two different MADs in the treatment of adult OSA patients was assessed and compared. Thirdly, the efficacy of the two MADs in the treatment of adult OSA patients from the subjective perspective of their bed partners was determined.
A consecutive sample of 45 adult OSA patients referred from Queen Mary Hospital Sleep Centre to the Prince Philip Dental Hospital for oral appliance therapy was recruited and treated with a monobloc MAD and a twinblock MADs for a period of 3 months per MAD (cross-over randomised trial). Changes in clinical OSA outcomes were assessed by polysomnography (PSG) and changes in subjective outcomes by the disease-specific Sleep Apnoea Quality of Life Index (SAQLI) questionnaire, the Functional Outcome of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Scale (ESS). Patient compliance, side-effects and MAD preference, as well as MAD treatment impact on the patients’ bed partner was also assessed.
At baseline, some clinical OSA indicators, subjective QoL and certain OSA risk factors were significantly correlated (p<0.05). There were significant variations in clinical OSA indicators and subjective QoL indices with respect to certain risk factors (p<0.05), demographic variables (p<0.05) and dental status (p<0.01).
There was a significant difference in favour of the monobloc MAD in terms of improving the apnoea-hypopnoea index (AHI) (p<0.05) and oxygen desaturation index (ODI) (p<0.01). Significantly more patients achieved clinical treatment success with the monobloc compared to the twinblock (p<0.05). Both MADs were efficacious in improving patients’ SAQLI score (p<0.01), FOSQ score (p<0.01) and ESS score (p<0.01). Significantly more patients achieved QoL treatment success with the monobloc (p<0.05) compared to the twinblock. More patients were ‘very satisfied’ with the monobloc treatment (p<0.05) and 63% preferred it to the twinblock.
No significant difference was found between patients’ and bed partners perceptions of symptom improvement post treatment, however, the monobloc resulted in a significant reduction in bed partners’ daytime sleepiness (p<0.01) and allowed significantly more co-sleeping at night (p<0.05).
This study concluded that the monobloc is superior in improving subjective QoL and clinical OSA indicators. The monobloc was the preferred MAD and patients were more satisfied with it; bed partners rated this MAD as superior in improving their own daytime sleepiness and co-sleeping.published_or_final_version
Dentistry
Doctoral
Doctor of Philosophy
15
Lai, Yuen-kwan Agnes, and 賴婉君. "Continuous positive airway pressure education on adherence in adults with obstructive sleep apnoea." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/198849.
Full textAbstract:
Poor adherence to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA) limits its therapeutic effectiveness and has a major impact on clinical outcomes. Effective education programme is important to enhance CPAP use. However, existing education programmes are either manpower or resource demanding and may not be feasible in clinical practice. Moreover, the Self-Efficacy Measure for Sleep Apnoea (SEMSA) has been widely adopted for assessing adherence-related cognitions on CPAP therapy in OSA patients, but it was not available for Chinese.
The aims of this thesis are: (i) to perform linguistic and psychometric evaluation of a Chinese version of SEMSA (SEMSA-C); (ii) to examine the efficacy of brief motivational enhancement education programme in addition to standard care versus standard care only on improving adherence to CPAP treatment in patients with OSA.
The SEMSA-C was obtained after the standard forward-backward translation process. A randomised controlled trial was then conducted on newly diagnosed OSA patients. Patients in the control group received standard care (SC) comprising advice on the importance of CPAP therapy and its care while those in the intervention group received SC plus motivational enhancement education programme (ME). ME focused to enhance subjects’ knowledge, motivation and self-efficacy to use CPAP, comprising one 45-minute session on the day after CPAP titration and one 10-minute telephone follow-up shortly after commencing CPAP treatment. Epworth Sleepiness Scale (ESS), SEMSA-C, and quality of life were assessed. CPAP usage data were downloaded at the completion of this 3-month study. The primary outcome was the CPAP adherence. Furthermore, 21 patients were randomly sampled at baseline and completed the SEMSA-C at one week.
100 patients (Men : Women, 84 : 16) with OSA indicated for CPAP treatment were recruited, with an average age of 52±10 years, and apnoea hypopnoea index (AHI) of 36.2±22 events/hour. Factor analysis of SEMSA-C identified three factors: risk perception, outcome expectancies and treatment self-efficacy. Their corresponding internal consistency was high with Cronbach’s alpha >0.88, which were larger than all correlations between subscales (Range: 0.14 to 0.58). The correlations between items and their hypothesized subscale (Range: 0.58 to 0.85) were generally higher than the correlations between items and their competing subscales (Range: -0.10 to 0.58). One-week test-retest intra-class correlation ranged from 0.70 to 0.82. CPAP adherence was associated with outcome expectancies and treatment self-efficacy at 3-month assessment. Furthermore, SEMSA-C demonstrated an improvement in self-efficacy (standardised response mean = 0.33, p = .044) but no significant changes were observed in the other two factors, after CPAP use.
The 100 patients were followed for 3 months. The interventional effects maintained during the 3-month study period. There were a better CPAP use [higher daily CPAP usage of 2 hours/day (Cohen d = 1.33, p < .001), four-fold the number of subjects using CPAP for ≥ 70% of days with ≥ 4 hours per day (p < 0.001)], and greater improvements in ESS by 2.2 (p = 0.001) and treatment self-efficacy by 0.2 (p = 0.012) in the intervention group, relative to the control group.
The traditional Chinese SEMSA-C possesses satisfactory psychometric properties. It is a reliable and responsive instrument to measure perceived risks, outcome expectancies and treatment self-efficacy in Chinese patients with OSA. Moreover, the newly developed brief motivational enhancement education programme in addition to standard care is effective in improving adherence to CPAP treatment, treatment self-efficacy and daytime sleepiness.published_or_final_version
Nursing Studies
Doctoral
Doctor of Nursing
16
Ng, Kwok-keung Daniel. "Sleep related breathing disorders in children /." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36223724.
Full text
17
Ng, Kwok-keung Daniel, and 吳國強. "Sleep related breathing disorders in children." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B45007688.
Full text
18
Solin, Peter 1964. "Central sleep apnoea in heart failure : recognition and pathogenesis." Monash University, Dept. of Medicine, 2000. http://arrow.monash.edu.au/hdl/1959.1/8972.
Full text
19
Xu, Chun Wootton David Macmullen. "Computational mechanics models for studying the pathogenesis of obstructive sleep apnea (OSA) /." Philadelphia, Pa. : Drexel University, 2006. http://dspace.library.drexel.edu/handle/1860/746.
Full text
20
Ledman, Cassandra A. "The effect of continuous positive airway pressure treatment on physical activity levels in obstructive sleep apnea patients." Virtual Press, 2008. http://liblink.bsu.edu/uhtbin/catkey/1391676.
Full textAbstract:
Obstructive Sleep Apnea (OSA) is becoming an increasingly prevalent health problem, affecting 4% of men and 2% of women in North America. OSA is associated with many debilitating side-effects and co-morbidities; the most common being excessive daytime sleepiness (EDS), which effects the majority of OSA sufferers. EDS is negatively associated with physical activity (PA) and exercise. As a result, EDS may decrease the levels of PA performed by OSA patients. Previous research has revealed that the OSA population engages in less physical activity than the average healthy population. Studies show that CPAP treatment positively impacts EDS, and therefore; may impact PA. The primary purpose of this study was to objectively measure OSA patients' PA levels prior to CPAP treatment and 8 weeks after treatment initiation to assess whether CPAP treatment' impacts PA levels.Actigraph GT 1 M measures PA was assessed at baseline (prior to CPAP) and 8-weeks after. initiation of CPAP treatment. At each time frame, cardiovascular., blood data, body composition, and maximal cycle ergometer exercise measures were obtained. Also, subjective questionnaires, 1 reflective of sleep apnea and 1 regarding PA, were completed by the subjects.Six male subjects with severe OSA (AHI = 41.2 ± 28.4 events/hr) started and completed the study. No significant changes occurred in PA, represented as steps/day nor mean activity counts/day, throughout the 8 weeks of CPAP treatment. Significant changes were found in diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, and Epworth sleepiness scale scores. No significant changes occurred in any other body composition, heart rate, systolic blood pressure, triglycerides, and blood glucose. Exercise parameters, total test time, peak Watts, and V02max trended toward an increase and maximal heart rate and blood pressure toward a decrease, but none changed significantly.In conclusion, these results demonstrated that 8 weeks of CPAP treatment was not successful in increasing PA levels of severe OSA patients. The OSA subjects were categorized as sedentary according to their steps/day. Compliance to CPAP could have been an issue with subjects' average nightly usage ranging from 1.85 – 6.6hours/night. Consequently, more research regarding OSA patients PA habits and CPAP treatments effects on PA should be investigated.School of Physical Education, Sport, and Exercise Science
21
Lei, Ka-weng, and 李加穎. "Relationship between tonsil/adenoid size and the frequency of respiratory event in sleep-related breathing disorders in children." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44660182.
Full text
22
Appelberg, Jonas. "Ventilation and Lung Volume During Sleep and in Obstructive Sleep Apnea." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3363.
Full text
23
Pérez, Trenard Diego Oswaldo. "Optimal control of non-invasive neuromodulation for the treatment of sleep apnea syndromes." Thesis, Rennes 1, 2018. http://www.theses.fr/2018REN1S014/document.
Full textAbstract:
Le syndrome d'apnée du sommeil (SAS) est une maladie multifactorielle caractérisée par des épisodes récurrents de pauses respiratoires ou des réductions significatives de l'amplitude respiratoire pendant le sommeil. Ces épisodes peuvent provoquer des réactions cardiorespiratoires aiguës; délétères à long terme. Plusieurs thérapies ont été proposées, étant la pression positive continue des voies respiratoires (CPAP) le traitement de référence. Malgré ces excellents résultats chez les patients symptomatiques, le taux de refus initial est de 15% et une adhésion à long terme est difficile à atteindre. Par conséquent, le développement de méthodes de traitement non invasives, avec une meilleure acceptabilité, reste d’une importance majeure. Dans ce contexte, l’hypothèse qui sous-tend ce travail est qu’une stimulation kinesthésique contrôlée, délivrée au cours de la phase précoce de l’apnée, peut réduire la durée des événements respiratoires et, par la suite, limiter les désaturations d’oxygène associées, par une activation contrôlée du réflexe de sursaut. La première partie de ce manuscrit est consacrée à la description d'un nouveau système (PASITHEA) de surveillance en temps réel et de neuromodulation thérapeutique, qui fonctionne comme un dispositif polyvalent de diagnostic et de traitement de SAS par stimulation kinesthésique. Les principales contributions de cette thèse se concentrent sur les aspects du traitement du signal et du contrôle de ce système, ainsi que sur l'électronique associée. Une autre contribution est liée à l'évaluation de ces méthodes et dispositifs par des protocoles cliniques spécifiques. Dans une deuxième partie, nous proposons une première méthode de contrôle On/Off optimale pour délivrer la stimulation, en utilisant comme variable de contrôle la sortie d'un détecteur d'événements respiratoires en temps réel. Lors de la détection d'un événement, une stratégie de stimulation unique avec amplitude de stimulation constante est appliquée, cette dernière a été mise en œuvre dans le cadre d'un premier protocole clinique dédié à l'évaluation de la réponse du patient au traitement. Les résultats ont montré que 75% des patients répondaient correctement au traitement en termes de durées des épisodes respiratoires. De plus, des diminutions significatives de la variabilité du SaO2 ont également été constatées lors de la mise en œuvre d'une nouvelle méthode d'analyse aiguë. Puisque nous avons supposé qu'une sélection inappropriée des patients pourrait expliquer l'absence de réponse observée chez 25% des patients. Nous avons proposé une méthode pour différencier les patients qui pourraient bénéficier de cette thérapie, basée sur l'estimation d'indices de variabilité cardiaque. Les résultats de ces analyses ont montré que l'efficacité de cette thérapie semble corrélée à un système nerveux autonome fonctionnel. Enfin, une méthode améliorée de contrôle en boucle fermée, intégrant des correcteurs proportionnels-dérivés (PD) couplés et simultanés a été proposée afin de modifier de façon adaptative l’amplitude de stimulation kinesthésique délivrée au patient par le système thérapeutique, en utilisant comme variables de contrôle des signaux physiologiques enregistrés en temps réel. Un deuxième protocole clinique visant à valider l'algorithme de contrôle de la stimulation kinesthésique adaptative spécifique au patient a été initié. Plusieurs améliorations ont été effectuées à la première version du système afin de permettre l'intégration du contrôleur proposé. Les résultats préliminaires de cette étude ont validé le fonctionnement de notre contrôleur et ont montré que notre système était capable de fournir une stimulation kinesthésique adaptative en fonction des réponses propres au patient. Une autre phase de cette étude, mettant en œuvre le contrôleur avec un ensemble des paramètres de contrôle présélectionnés, est actuellement en coursSleep apnea syndrome (SAS) is a multifactorial disease characterized by recurrent episodes of breathing pauses or significant reductions in respiratory amplitude during sleep. These episodes may provoke acute cardiorespiratory responses along with alterations of the sleep structure, which may be deleterious in the long term. Several therapies have been proposed for the treatment of SAS, being continuous positive airway pressure the gold standard treatment. Despite its excellent results in symptomatic patients, there is a 15% initial refusal rate and long term adherence is difficult to achieve in minimally symptomatic patients. Therefore, the development of non-invasive SAS treatment methods, with improved acceptability, is of major importance. The objective of this PhD thesis is to propose new signal processing and control methods of non-invasive neuromodulation for the treatment of SAS. The hypothesis underlying this work is that bursts of kinesthetic stimulation delivered during the early phase of apneas or hypopneas may elicit a controlled startle response that can activate sub-cortical centers controlling upper airways muscles and the autonomic nervous system, stopping respiratory events without generating a cortical arousal. In this context, the first part of this manuscript is dedicated to the description of a novel real-time monitoring and therapeutic neuromodulation system, which functions as a multi-purpose device for SAS diagnosis and treatment through kinesthetic stimulation. This system has been developed in the framework of an ANR TecSan project led by our laboratory, with the participation of Sorin CRM SAS. The main contributions in this thesis are focused on the signal processing and control aspects of this system, as well as the electronics associated. Another contribution is related to the evaluation of these methods and devices through specific clinical protocols. In a second part, we propose a first optimal On/Off control method for delivering kinesthetic stimulation, using as control variable the output of a real-time respiratory event detector. A unique stimulation strategy where a constant stimulation amplitude is applied upon event detention was implemented in a first clinical protocol, dedicated to assessing the patient response to therapy. Results showed that 75% of the patients responded correctly to therapy, showing statistically significant reductions in respiratory event durations. Also, significant decreases in the SaO2 variability were also found when implementing a novel acute analysis method. Since we hypothesized that inappropriate patient selection could explain the observed lack of response in 25% of patients, we proposed a method to differentiate patients who could benefit from this therapy based on the estimation of complexity-based indexes of heart rate variability. Results of these analyses showed that the effectiveness of this therapy seems correlated to a functional autonomic nervous system. Finally, an improved closed-loop control method integrating concurrent, coupled proportional-derivative (PD) controllers in order to adaptively change the kinesthetic stimulation was proposed. It uses as control variables three physiological signals recorded in real-time: Nasal pressure, oxygen saturation and the electrocardiogram signal. A second clinical protocol with the main objective of validating the control algorithm for patient-specific adaptive kinesthetic stimulation was launched. Several improvements to the first version of the system were developed to allow the integration of the proposed controller. Preliminary results from the first phase of this study validated the proposed controller operation and showed that the controller was able to provide adaptive kinesthetic stimulation in function of the patient-specific responses. A second phase of this study implementing the proposed controller and the set of the selected control parameters from the first phase is currently ongoing
24
Shepherd, Kelly. "Gastro-oesophageal reflux in obstructive sleep apnoea : prevalence and mechanisms." University of Western Australia. School of Anatomy and Human Biology, 2009. http://theses.library.uwa.edu.au/adt-WU2009.0085.
Full textAbstract:
Background. Obstructive Sleep Apnoea (OSA) is associated with an increase in nocturnal gastro-oesophageal reflux (nocturnalGOR) events and symptoms, however the mechanism for this remains undefined. Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to reduce nocturnalGOR in individuals with OSA however the reasons for this reduction are not clear. The combination of OSA and nocturnalGOR could be particularly problematic for individuals who have had a lung transplant in whom Bronchiolitis Obliterans Syndrome (BOS) limits survival. It is thought that GOR plays a role in the development of BOS in these individuals. Methods and Results. Five interrelated studies were undertaken. The first two studies sought to determine and compare the prevalence and risk factors of nocturnalGOR in OSA patients with the general population. To do this, a GOR questionnaire was completed by 2,042 members of the general community as part of the Busselton Health Survey and by 1,116 patients with polysomnography-diagnosed OSA. Risk of OSA in the general population was determined using a standardised sleep questionnaire. 137 of the OSA patients completed the questionnaire before and after treatment with CPAP. The prevalence of nocturnalGOR symptoms reported more than once a week (frequent symptoms) was greater in OSA patients (10.1%) than the general population (5.8%) (p<0.001), in individuals from the general population at high (11.2%) than low risk of OSA (4.5%) (p<0.001) and in patients with severe (14.7%) than mild OSA (5.2%) (p<0.001). Treatment of OSA with CPAP decreased the prevalence of frequent nocturnalGOR from 9.0% to 3.8% (p=0.04). In the general population, high risk of OSA was independently associated with a 2.4-fold increased risk of frequent ABSTRACT vi nocturnalGOR symptoms than low risk. In the OSA group, disease severity was independently associated with nocturnalGOR symptoms, with an adjusted odds ratio of 1.7 for frequent nocturnalGOR symptoms.
25
Dolan, Diana C. Taylor Daniel J. "Cognitive dysfunction in middle-aged adults vs. older adults with obstructive sleep apnea." [Denton, Tex.] : University of North Texas, 2009. http://digital.library.unt.edu/permalink/meta-dc-11049.
Full text
26
Cheung, Yuk-mei Agnes. "Validation of a questionnaire instrument for prediction of obstructive sleep apnea syndrome in Hong Kong Chinese children." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971635.
Full text
27
Wakwella, Ajith S. "Processing of snore related sounds for the diagnosis of obstructive sleep apnoea (OSA) /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18755.pdf.
Full text
28
KATSUMATA, YOSHINAO, MASAYOSHI TERASHIMA, TATSURO OHTA, TAMOTSU OKADA, and KAZUO KATSUMATA. "Incidence of Sleep Apnea Syndromes in General Patients at a Hospital for Internal Medicine." Nagoya University School of Medicine, 1986. http://hdl.handle.net/2237/17491.
Full text
29
Han, Qian, and 韩茜. "Effects of intermittent hypoxia and hyperlipidemia-in vivo and in vitro studies on pathogenetic mechanisms linking obstructive sleepapnea to cardiovascular disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46918371.
Full text
30
Pinto, Paula Maria Gonçalves. "Síndrome de apneia hipopneia obstrutiva do sono e óxido nítrico : que relação ?" Doctoral thesis, Faculdade de Ciências Médicas. Universidade Nova de Lisboa, 2009. http://hdl.handle.net/10362/5522.
Full textAbstract:
RESUMO: A síndrome de apneia hipopneia obstrutiva do sono (SAHOS), pela sua prevalência e consequências clínicas, nomeadamente as de natureza cardiovascular, é actualmente considerada um problema de saúde pública.
A patogénese da doença cardiovascular na SAHOS não está ainda completamente
estabelecida, mas parece ser multifactorial, envolvendo diversos mecanismos que
incluem a hiperactividade do sistema nervoso simpático, a disfunção endotelial, a
activação selectiva de vias inflamatórias, o stress oxidativo vascular e a disfunção
metabólica.
A terapêutica com CPAP diminui grandemente o risco de eventos cardiovasculares
fatais e não fatais. O CPAP está inequivocamente indicado para o tratamento da
SAHOS grave, no entanto, não é consensual a sua utilização nos doentes com SAHOS
ligeira/moderada sem hipersonolência diurna associada. Tendo em conta este facto, é
fundamental que as indicações terapêuticas do CPAP nestes doentes tenham uma
relação custo-eficácia favorável. Assim, dado o posicionamento do estado da arte
relativamente ao estudo da disfunção endotelial e da activação do sistema nervoso
simpático estar centrada maioritariamente nos doentes com SAHOS grave,
desenvolvemos este estudo com o objectivo de comparar os níveis plasmáticos de
nitratos, os níveis de catecolaminas urinárias e os valores de pressão arterial nos doentes com SAHOS ligeira/moderada e grave e avaliar a resposta destes parâmetros ao tratamento com CPAP durante um mês.
Realizámos um estudo prospectivo, incidindo sobre uma população de 67 doentes do
sexo masculino com o diagnóstico de SAHOS (36 com SAHOS ligeira/moderada e
31com SAHOS grave). O protocolo consistia em 3 visitas: antes da terapêutica com
CPAP (visita 1), uma semana após CPAP (visita 2) e um mês após CPAP (visita 3). Nas visitas 1 e 3, eram submetidos a três colheitas de sangue às 11 pm, 4 am e 7 am para
doseamento dos nitratos plasmáticos e na visita 2 apenas às 7 am. Nas visitas 1 e 3 era
também efectuada uma colheita de urina de 24 horas para o doseamento das
catecolaminas urinárias e eram submetidos a uma monitorização ambulatória da pressão
arterial de 24 horas (MAPA). Foi ainda estudado um grupo controlo de 30 indivíduos do
sexo masculino não fumadores sem patologia conhecida e sem evidência de SAHOS.
Antes da terapêutica com CPAP, verificou-se uma diminuição significativa dos níveis
de nitratos ao longo da noite quer nos doentes com SAHOS ligeira/moderada, quer nos
doentes com SAHOS grave. No entanto, esta redução diferia nos 2 grupos de doentes,
sendo significativamente superior nos doentes com SAHOS grave (27,6±20,1% vs
16,5±18,5%; p<0,05). Após um mês de tratamento com CPAP, verificou-se um
aumento significativo dos valores de nitratos plasmáticos apenas nos doentes com
SAHOS grave, mantendo-se os níveis de nitratos elevados ao longo da noite, já não
existindo o decréscimo desses valores ao longo da mesma.
Os valores de noradrenalina basais eram significativamente superiores nos doentes com
SAHOS grave comparativamente com os doentes com SAHOS ligeira/moderada
(73,9±30,1μg/24h vs 48,5±19,91μg/24h; p<0,05). Após um mês de terapêutica com
CPAP, apenas se verificou uma redução significativa nos valores da noradrenalina nos
doentes com SAHOS grave (73,9±30,1μg/24h para 55,4±21,8 μg/24h; p<0,05).
Os doentes com SAHOS grave apresentaram valores de pressão arterial mais elevados
do que os doentes com SAHOS ligeira/moderada, nomeadamente no que diz respeito aos valores de pressão arterial média, sistólica média de 24 horas, diurna e nocturna e diastólica média de 24 horas, diurna e nocturna. Após um mês de terapêutica com CPAP, verificou-se uma redução significativa dos valores tensionais apenas nos doentescom SAHOS grave, para a pressão média (-2,32+5,0; p=0,005), para a sistólica média de 24 horas (-4,0+7,9mmHg; p=0,009), para a pressão sistólica diurna (-4,3+8,8mmHg;
p=0,01), para a pressão sistólica nocturna (-5,1+9,0mmHg; p=0,005), para a pressão
diastólica média de 24 horas (-2,7+5,8mmHg; p=0,016), para a pressão diastólica diurna
(-3,2+6,3mmHg; p=0,009) e para a pressão diastólica nocturna (-2,5+7,0mmHg;
p=0,04). Os níveis tensionais dos doentes com SAHOS grave após CPAP atingiram
valores semelhantes aos dos doentes com SAHOS ligeira/moderada, relativamente a
todos os parâmetros avaliados no MAPA.
Este estudo demonstrou que antes do tratamento com CPAP, existe uma redução dos
níveis de nitratos ao longo da noite não só nos doentes com SAHOS grave mas também
nos doentes com SAHOS ligeira/moderada. No entanto, a terapêutica com CPAP leva a
um aumento significativo dos valores de nitratos plasmáticos apenas nos doentes com
SAHOS grave, mantendo-se os níveis de nitratos elevados ao longo da noite, já não
existindo o decréscimo desses valores ao longo da mesma.
O tratamento com CPAP durante um mês, apenas reduz os níveis de noradrenalina urinária e os valores de pressão arterial nos doentes com SAHOS grave.------------ ABSTRACT: In severe obstructive sleep apnea (OSA) reduced circulating nitrate, increased levels of
urinary norepinephrine (U-NE) and changes in systemic blood pressure (BP) have been
described and are reverted by Continuous Positive Airway Pressure (CPAP). However,
the consequences of mild/moderate OSA on these parameters and the CPAP effect upon
them are not well known.
We aimed to: 1) compare the levels of plasma nitrate (NOx) and U-NE of mild/moderate
and severe male OSA patients 2) compare BP in these patient groups; and 3) determine
whether CPAP improves sympathetic dysfunction, nitrate deficiency and BP in these patients.
This prospective study was carried out in 67 consecutive OSA patients (36 mild/moderate and 31 severe patients) and NOx (11 pm, 4 am, 7 am), 24-h U-NE and ambulatory blood pressure monitoring were obtained before and after 4 weeks of CPAP. Baseline: NOx levels showed a significant decrease (p<0.001) during the night in both groups of patients. The U-NE and BP were significantly higher in the severe group. Post CPAP: After one month of CPAP, there was a significant increase of NOx, a reduction of U-NE and BP only in severe patients. This study shows that in contrast to severe OSA patients, those with mild/moderate OSA, which have lower values of BP and U-NE at baseline, do not benefit from a 4 weeks CPAP treatment as measured by plasma nitrate, 24-h U-NE levels and BP.
31
Joffe, David. "Obstructive sleep apnoea the genesis of daytime somnolence and cognitive impairment : arousals, hypoxia and circadian rhythm /." Connect to full text, 1997. http://hdl.handle.net/2123/382.
Full textAbstract:
Thesis (Ph. D.)--University of Sydney, 1998.Title from title screen (viewed Apr. 15, 2008). Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Dept. of Respiratory Medicine, Royal North Shore Hospital, Faculty of Medicine. Degree awarded 1998; thesis submitted 1997. Includes bibliography. Also available in print form.
32
Yang, Qiao. "The effects of acute and short-term continuous positive airway pressure treatment withdrawal on sleep and neurobehavioural function in patients with obstructive sleep apnea." Thesis, The University of Sydney, 2007. https://hdl.handle.net/2123/28138.
Full textAbstract:
This study systematically examined the changes in sleep parameters, neurobehavioural performance
and markers of objective and subjective sleepiness after an acute (one night) and short-term (seven
nights) period of withdrawal from Continuous Positive Airway Pressure (CPAP) treatment in
patients with obstructive sleep apnea (OSA). The effects of one night of CPAP reintroduction
immediately following CPAP withdrawal on these parameters were also investigated.
CPAP treatment can effectively eliminate upper airway obstruction at night but patients frequently
withdraw from CPAP therapy for short periods. The effects of intermittent CPAP use on sleep and
subsequent neurobehavioural function have not been systematically examined. It is important to
determine the neurobehavioural effects of short-term CPAP withdrawal.
Using a repeated-measurement-within-subject design, 20 participants receiving optimal, long-term
CPAP therapy were withdrawn from routine CPAP therapy. Polysomnograms were performed on
NO (with CPAP), N1 and N7 (without CPAP) and N8_R (with CPAP).
Acute CPAP withdrawal resulted in the recurrence of sleep-disordered breathing (SDB) with sleep
disruption, hypoxemia and increased subjective sleepiness. Short-term CPAP withdrawal
exacerbated hypoxemia and increased delta activity in EEG quantified by power spectral analysis.
Protracted time off CPAP also increased subjective and objective sleepiness, and poor mood
ratings. Autonomic arousals measured using respiratory-related reductions in finger blood volume
by peripheral arterial tonometry (PAT) decreased from N1 to N7.
Neurobehavioural functioning assessed using the psychomotor vigilance task was impaired
following N7 and associated with hypoxemia and changes in morning tumour necrosis factor-alpha
(TNF-a) levels. However, other neurobehavioural measures were not affected. Simulated driving
performance was also unaffected. Interestingly, despite this, EEG recordings demonstrated
neurophysiological evidence of increased sleepiness and greater time-on-task induced EEG
changes.
Resumption of CPAP treatment on N8_R eliminated most airway obstruction, maintained
oxygenation, reversed daytime sleepiness and some vigilance decrements. The immediate benefits
of CPAP treatment on sleep consolidation and subjective sleepiness were marked.
33
Dolan, Diana C. "Cognitive Dysfunction in Middle-Aged Adults vs. Older Adults with Obstructive Sleep Apnea." Thesis, University of North Texas, 2009. https://digital.library.unt.edu/ark:/67531/metadc11049/.
Full textAbstract:
The presence of cognitive deficits in obstructive sleep apnea (OSA) is well-documented. Specifically, short- and long-term memory, attention/vigilance, and executive function (e.g. processing speed, mental flexibility, and problem solving) are affected. Cognitive deficits in aging occur in similar areas (i.e., memory and processing speed). Given that a greater percentage of older adults experience sleep-disordered breathing as compared to middle-aged adults, it is possible that OSA may account for some of the deficits typically attributed to aging. This study investigated this hypothesis by comparing middle-aged and older adults with and without OSA on computer-based measures of cognitive performance. No effect of OSA or an interaction between OSA and age on cognitive function was found; an effect of age on processing speed, distinguishing stimuli rapidly, attention, spatial ability/mental flexibility, and both working memory and short-term visual memory was found. This study also explored whether or not cognitive function may be improved in persons with OSA by re-assessing those participants one month after treatment. An effect of treatment on improvements on processing speed, distinguishing stimuli rapidly, mental flexibility, and short term memory was found. Overall, findings reflect the ability of treatment to improve cognitive function among OSA patients, regardless of lack of deficits when compared to those without OSA.
34
Holmlund, Thorbjörn. "Evaluation of surgical methods for sleep apnea and snoring." Doctoral thesis, Umeå universitet, Institutionen för klinisk vetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118944.
Full textAbstract:
Background: Snoring and obstructive sleep apnea (OSA) are both common disorders with a number of negative health effects. The safety and efficacy of treating snoring and OSA surgically have been questioned and there has been a lack of studies in the field. Aims: 1) To investigate the frequency of serious complications, including death, after surgery for the treatment of snoring and sleep apnea; 2) to evaluate the effect on daytime sleepiness after radiofrequency surgery of the soft palate in snoring men with mild or no OSA; 3) to evaluate the effect of tonsillectomy on sleep apnea in adults with OSA and tonsillar hypertrophy; 4) to investigate the morphology and cytoarchitecture of muscle fibers in human soft palatal muscles with immunohistochemical and morphological techniques. Methods and results: In paper 1, a retrospective database study. All Swedish adults who were treated surgically because of snoring or OSA from January 1997 to December 2005 were identified in the National Patient Register. None of the surgically treated patients died in the peri- and postoperative period. Severe complications were recorded in 37.1 of 1,000 patients treated with uvulopalatopharyngoplasty (UPPP), in 5.6 of 1,000 patients after uvulopalatoplasty (UPP) and in 8.8 of 1,000 patients after nasal surgery. In paper 2, the study was designed as a randomized, controlled trial. 35 snoring men with mild or no OSA were randomized to either radiofrequency or sham surgery of the soft palate. Radiofrequency surgery was not found to be effective since there was no significant difference between the two groups in relation to the Epworth Sleepiness Scale (ESS) or apnea-hypopnea index (AHI) at follow-up. Paper 3 was a prospective study, including 28 patients with an AHI of >10 and with large tonsils. In these patients, tonsillectomy was an effective treatment for OSA; the mean AHI was reduced from 40 units/h to 7 units/h (p<0.001), and the mean ESS was reduced from 10.1 to 6.0 (p<0.001) at the six-month follow-up after surgery. Minor and moderate swallowing dysfunction was found in seven of eight patients investigated before surgery and the swallowing function improved in 5 of them after surgery, while no one deteriorated. In paper 4, we investigated the morphology and cytoarchitecture in normal soft palate muscles. Human limb muscles were used as reference. The findings showed that the soft palate muscle fibers have a cytoskeletal architecture and cellmembrane complex that differs from that of the limb muscles. Conclusions No case of death related to surgery was found among 4,876 patients treated with UPPP, UPP or nasal surgery for snoring or OSA in Sweden between 1997 and 2005. Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring or apnea frequency in snoring men with mild or no OSA. Tonsillectomy can be an effective treatment for OSA in adults with large tonsils. A subgroup of muscle fibers in the human soft palate appears to have special biomechanical properties and their unique cytoarchitecture must be taken into account while assessing function and pathology in oropharyngeal muscles.Snarkning och obstruktiv sömnapné (OSA) är idag en global folksjukdom. Snarkning är det ”oljud” som uppstår när luftvägen under sömn förminskas och vävnaden börjar vibrera under andning. Vid obstruktiv sömnapné faller vävnaden samman och blockerar luftflödet till lungorna. Ett andningsuppehåll, en s.k. apné inträffar. Ett andningsuppehåll kan pågå allt ifrån några sekunder till mer än en minut och kan uppstå hundratals gånger per natt. För att klassificeras som en patologisk apné enligt internationell standard måste andningsuppehållet vara längre än 10 sek. Snarksjukdomen förvärras sannolikt över tid och övergår succesivt i obstruktiv sömnapné med ökande antal andningsuppehåll under sömn. Detta leder till ett stresspåslag för kroppen med oftast uttalad dagtrötthet och en mängd negativa hälsoeffekter. Snarksjukdom och sömnapné ökar risken för bl.a. högt blodtryck och hjärt-kärlsjukdom samt också för att den drabbade ska orsaka trafikolyckor på grund av försämrad koncentrationsförmåga och trötthet. En del av den negativa utvecklingen från snarkning till sömnapné anses bero på att snarkvibrationer kan ge neuromuskulära skador i gom och svalg. Dessa vävnadsskador anses också vara orsaken till att personer som snarkat länge ofta uppvisar störd sväljningsfunktion i form av felsväljning, där maten i uttalade fall hamnar i luftstrupen istället för i matstrupen. I dagsläget är förstahandsbehandling vid sömnapné CPAP, en mask som placeras över näsa och mun och som skapar ett övertryck i luftvägen vilket förhindrar att luftvägen faller samman och att andningsstopp uppstår. CPAP har enligt flera studier den bästa effekten mot andningsuppehåll. En annan vanlig behandling är en bettskena som för underkäken nedåt och framåt så att luftvägen bli mer öppen. Bettskenan är en vanlig och effektiv behandlingsmetod för personer utan kraftig övervikt vid vanemässig snarkning eller måttlig sömnapné. För ett tjugotal år sedan var kirurgi förstahandsmetoden vid behandling av snarkning och måttlig sömnapné. Man utförde då ofta operationer i svalg och gomm, s.k. gomplastiker. Bruket av kirurgisk behandling har dock minskat med tiden, dels p.g.a. biverkningar men också för att det saknades vetenskapliga studier som bevisade att kirurgin gav önskad och långsiktig effekt. Kirurgi utgör dock fortfarande ett komplement till behandling av snarkning och sömnapné när CPAP eller bettskena av olika skäl inte fungerar eller kan tolereras av patienten. 8 Även barn kan lida av snarkning och sömnapné men behandlingsprinciperna för barn skiljer sig från dem hos vuxna och berörs inte i avhandlingen. I denna avhandling studeras: i) biverkningsfrekvenser efter olika typer av snarkkirurgi, ii) effekten av radiovågsbehandling i mjuka gommen på vuxna män med snarkning, iii) effekten av att operera bort halsmandlarna på vuxna med sömnapné och stora halsmandlar, iv) muskelvävnadens struktur och molekylära uppbyggnad i mjuka gommen hos friska personer som inte snarkar. Avhandlingen består av fyra delstudier: 1. En registerstudie med kartläggning av svåra biverkningar efter kirurgi i form av uvulopalatopharyngoplastik, uvulupalatoplastik samt näskirurgi för behandling av sömnapné och snarkning och utfört i Sverige mellan åren 1997-2005. Studien omfattade 4 876 patienter. Inga dödsfall noterades. Komplikationsrisken var störst vid operationer där man tog bort delar av mjuka gommen samt halsmandlarna, där i snitt 37 av 1000 opererade fick biverkningar, framförallt p.g.a. infektioner eller blödningar. 2. I en prospektiv, randomiserad placebostudie utvärderades effekten av radiovågsbehandling i mjuka gommen vid snarkning och lindrig sömnapne. Trettiotvå patienter lottades till att få radiovågsbehandling eller placebo behandling. Patienterna visste inte vilken grupp de tillhörde. Vid uppföljning efter 12 månader var det inga statistiska belägg för att radiovågsbehandling minskade vare sig antal andningsuppehåll eller dagtrötthet. 3. Effekten av att ta bort halsmandlarna på patienter med stora halsmandlar och olika grad av sömnapné utvärderades i denna studie. Totalt deltog 28 patienter. Vid uppföljning 6 månader efter operationen hade antalet andningsuppehåll sjunkit drastiskt, från i snitt 40 till 7 andningsuppehåll per timme nattsömn. Inga allvarliga biverkningar uppstod. Dessa fynd talar för att man som förstahandsmetod ska erbjuda patienter med sömnapné och stora halsmandlar att ta bort halsmandlarna. 4. I detta projekt undersökte vi utseendet och uppbyggnaden av cellskelettet i två normala muskler i mjuka gommen hos friska personer utan känd snarkning och sömnapné. Muskler från armar och ben användes som referens. Fynden i studien visar att de normala muskelfibrernas uppbyggnad i mjuka gomen skiljer sig från jämförade muskler i armar och ben. Detta kan vara ett uttryck för en evolutionär utveckling för att möjligöra de komplexa funktioner som krävs av svalgets muskulatur. 9 Sammanfattningsvis kan vi konstatera: Att inga dödsfall har skett i Sverige efter operationer i gom, svalg eller näsa, utförda för att behandla snarkning och sömnapné under åren 1997 till 2005. Att radiovågsbehandling av mjuka gommen hos snarkande män med lindrig sömnapné inte har någon effekt på dagtrötthet, snarkning eller andningsuppehåll vid uppföljning efter 12 månader. Metoden kan därför inte rekommenderas. Att när man opererar bort stora halsmandlar på personer med andningsuppehåll så leder detta ofta till att andningsuppehållen minskar drastiskt. Metoden kan därför oftast rekommenderas som en förstahandsbehandling för denna patientgrupp. Att mjuka gommens muskelfibrer är uppbyggda på ett unikt sätt indikerar att deras specifika biomekaniska egenskaper skiljer sig från referens muskler i armar och ben.
35
Williams, Shaun C. J. "Modafinil effects during acute interruption of continuous positive airway pressure in patients with obstructive sleep apnea." Thesis, The University of Sydney, 2009. https://hdl.handle.net/2123/28456.
Full textAbstract:
Continuous positive airway pressure (CPAP) is associated with a reduction in the risk of motor vehicle accidents in patients with obstructive sleep apnea (OSA). It also improves simulated driving performance in these patients. However, CPAP compliance can be poor and even regular users may temporarily withdraw from therapy due to reasons that might include travel, mask-related problems or upper respiratory tract infections. Acute interruptions of CPAP result in immediate recurrence of OSA and are associated with impairment in neurobehavioural performance. Pharmacotherapy to manage daytime symptoms associated with acute CPAP withdrawal may be warranted. The wakefulness promoter, modafinil, is a candidate for such a treatment approach. Modafinil induces wakefulness primarily by inhibiting dopamine and noradrenaline re-uptake transporters. However, there is substantial inter-individual variability in the neurobehavioural response to modafinil and previous studies have linked this to the Vall158Met polymorphism of the catechol-O-methyl transferase (COMT) gene. The c.1083 T>C polymorphism of the adenosine receptor A2A receptor (ADORAZA) gene is another with which the variability in the response to modafinil may be associated. Adenosine is involved in the regulation of dopamine release and the development of sleepiness through its binding to the adenosine AzA receptor (ADORAZA). Although modafinil does not directly interact with ADORAZA, it is possible that a functional polymorphism of this receptor may predict sensitivity to the action
of modafinil.
In a preliminary study we examined the effects of 200mg modafinil administration on morning simulated driving performance, neurobehavioural performance and subjective alertness in a placebo-controlled crossover trial including N=l2 OSA patients acutely removed from CPAP for one night. In the preliminary study, modafinil administration did not result in a statistically superior simulated driving performance or neurobehavioural performance the morning following CPAP withdrawal, but did result in better subjective sleepiness compared to placebo. However, we were encouraged by the medium to large effect sizes.
In a larger second study, we examined the effects of 200mg modafinil administration on daytime simulated driving performance, neurobehavioural performance and subjective alertness in a randomised, double-blind, cross-over trial including N=21 OSA patients acutely removed from CPAP for 2 nights. Additionally, we investigated the effect of the COMT and ADORAZA polymorphisms on the response to modafinil. Conversely, in the larger scale study modafinil administration did result in an improved simulated driving performance, neurobehavioural performance and subjective alertness. Polymorphisms in the COMT and ADORAZA genes did not explain the variability in the response to modafinil. These findings support the potential use of modafinil as a short-term treatment option in preventing the decline of daytime function in OSA patients who require an acute interruption of their CPAP therapy for up to 2 nights.
36
O'Neil, Jennifer Ann. "The relationships between obesity, obstructive sleep apnea, and commercial motor vehicle operator performance /." Online version of thesis, 2010. http://hdl.handle.net/1850/11873.
Full text
37
Tinworth, Kellie. "Arousal, Sleep and Cardiovascular Responses to Intermittent Hypercapnic Hypoxia in Piglets." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/1116.
Full textAbstract:
Clinical studies have demonstrated an arousal deficit in infants suffering Obstructive Sleep Apnoea (OSA), and that treatment to alleviate the symptoms of OSA appears to reverse the deficit in arousability. Some sudden infant deaths are thought to be contingent upon such an arousal deficit. This research utilised young piglets during early postnatal development, and exposed them to intermittent hypercapnic hypoxia (IHH) as a model of clinical respiratory diseases. Arousal responses of control animals were compared to the animals exposed to IHH. Comparisons were also made between successive exposures on the first and the fourth consecutive days of IHH. Time to arouse after the onset of the respiratory stimulus, and frequency of arousals during recovery, demonstrated that arousal deficits arose after successive exposures and that these were further exacerbated on the fourth study day. After an overnight recovery period, the arousal deficit was apparently dormant, and only triggered by HH exposure. These studies confirm that both acute and chronic deficits can be induced on a background of otherwise normal postnatal development, suggesting that deficits observed in the clinical setting may be a secondary phenomenon.
38
Tinworth, Kellie. "Arousal, Sleep and Cardiovascular Responses to Intermittent Hypercapnic Hypoxia in Piglets." University of Sydney, 2003. http://hdl.handle.net/2123/1116.
Full textAbstract:
Master of Science (Medicine)Clinical studies have demonstrated an arousal deficit in infants suffering Obstructive Sleep Apnoea (OSA), and that treatment to alleviate the symptoms of OSA appears to reverse the deficit in arousability. Some sudden infant deaths are thought to be contingent upon such an arousal deficit. This research utilised young piglets during early postnatal development, and exposed them to intermittent hypercapnic hypoxia (IHH) as a model of clinical respiratory diseases. Arousal responses of control animals were compared to the animals exposed to IHH. Comparisons were also made between successive exposures on the first and the fourth consecutive days of IHH. Time to arouse after the onset of the respiratory stimulus, and frequency of arousals during recovery, demonstrated that arousal deficits arose after successive exposures and that these were further exacerbated on the fourth study day. After an overnight recovery period, the arousal deficit was apparently dormant, and only triggered by HH exposure. These studies confirm that both acute and chronic deficits can be induced on a background of otherwise normal postnatal development, suggesting that deficits observed in the clinical setting may be a secondary phenomenon.
39
莫玉雲 and Yuk-wan Wendy Mok. "A validation of the Calgary Sleep Apnea quality of life index (Chineseversion) and an evaluation of treatment effectiveness and patientperference by physiological and neurobehavioural outcome measures inChinese sleep apnea patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B3122653X.
Full text
40
Loadsman, John Anthony. "Perioperative Sleep and Breathing." Thesis, The University of Sydney, 2005. http://hdl.handle.net/2123/689.
Full textAbstract:
Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.
41
Loadsman, John Anthony. "Perioperative Sleep and Breathing." University of Sydney. College of Health Sciences, 2005. http://hdl.handle.net/2123/689.
Full textAbstract:
Sleep disruption has been implicated in morbidity after major surgery since 1974. Sleep-related upper airway obstruction has been associated with death after upper airway surgery and profound episodic hypoxaemia in the early postoperative period. There is also evidence for a rebound in rapid eye movement (REM) sleep that might be contributing to an increase in episodic sleep-related hypoxaemic events later in the first postoperative week. Speculation regarding the role of REM sleep rebound in the generation of late postoperative morbidity and mortality has evolved into dogma without any direct evidence to support it. The research presented in this thesis involved two main areas: a search for evidence of a clinically important contribution of REM sleep rebound to postoperative morbidity, and a re-examination of the role of sleep in the causation of postoperative episodic hypoxaemic events. To assess the latter, a relationship between airway obstruction under anaesthesia and the severity of sleep-disordered breathing was sought. In 148 consecutive sleep clinic patients, 49% of those with sleep-disordered breathing (SDB) had a number of events in non-rapid eye movement sleep (NREM) that was greater than or equal to that in REM and 51% had saturation nadirs in NREM that were equal to or worse than their nadirs in REM. This suggests SDB is not a REM-predominant phenomenon for most patients. Of 1338 postoperative deaths occurring over 6.5 years in one hospital only 37 were unexpected, most of which were one or two days after surgery with no circadian variation in the time of death, casting further doubt on the potential role of REM rebound. Five of nine subjects studied preoperatively had moderately severe SDB. Unrecognised and significant SDB is common in middle-aged and elderly patients presenting for surgery suggesting overall perioperative risk of important adverse events from SDB is probably small. In 17 postoperative patients, sleep macro-architecture was variably altered with decreases in REM and slow wave sleep while stage 1 sleep and a state of pre-sleep onset drowsiness, both associated with marked ventilatory instability, were increased. Sleep micro-architecture was also changed with an increase in power in the alpha-beta electroencephalogram range. These micro-architectural changes result in ambiguity in the staging of postoperative sleep that may have affected the findings of this and other studies. Twenty-four subjects with airway management difficulty under anaesthesia were all found to have some degree of SDB. Those with the most obstruction-prone airways while anaesthetised had a very high incidence of severe SDB. Such patients warrant referral to a sleep clinic.
42
Badgley, Jennifer Ayala Chute Douglas L. "Sleep-disordered breathing in children and adolescents with Systemic Lupus Erythematosus and its association with executive functioning /." Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2802.
Full text
43
Sam, Kim, and 岑儉. "Short term effects of an oral appliance in the treatment of mild to moderate Obstructive Sleep Apnea in Chinese subjects." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31973036.
Full text
44
鄭希翹 and Hai-kiu Kelvin Cheng. "Evaluation on the quality of life for patients with obstructive sleep apnea using the continuous positive airway pressure device treatment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B4072041X.
Full text
45
Lysdahl, Michael. "Rhonchopathy : long-term clinical results after palatal surgery /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-319-8.
Full text
46
Cheung, Yuk-mei Agnes, and 張育美. "Validation of a questionnaire instrument for prediction of obstructivesleep apnea syndrome in Hong Kong Chinese children." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971635.
Full text
47
Waters, Karen Ann. "Sleep disordered breathing and its treatment in children." Thesis, The University of Sydney, 1993. https://hdl.handle.net/2123/26603.
Full textAbstract:
The establishment of a dedicated paediatric sleep unit over the past three years has allowed detailed investigation of a large number of children with sleep associated upper airway obstruction. This thesis explores the characteristics of upper airway obstruction and sleep associated breathing control abnormalities, in children who have been investigated in that unit. The "unit" began with three or four people performing children’s sleep studies at the Sleep Unit (for adults) at RPAH; the results presented here include those studies. The methods used in this thesis have evolved through practical experience acquired in caring for children with breathing disorders in sleep.
This thesis is presented in two parts. The studies in the first section provide an overview of the presentation and treatment of the syndrome of obstructive sleep apnoea (OSA) as it occurs in infants and children. The second section is a more detailed exploration of OSA and its treatment in achondroplasia. These latter studies provide further insights into the disorder in this specific group, and therefore into some aspects of OSA in the broader population of children.
48
Rodrigues, Marcos Marques 1981. "Avaliação volumétrica da via aérea superior em pacientes com apneia obstrutiva do sono." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312436.
Full textAbstract:
Orientadores: Luis Augusto PasseriTexto em português e inglês
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-25T05:58:07Z (GMT). No. of bitstreams: 1 Rodrigues_MarcosMarques_M.pdf: 3650782 bytes, checksum: df078c3da580a9e227359e7addaff54e (MD5) Previous issue date: 2014
Resumo: Introdução: A apneia obstrutiva do sono (AOS) ocorre por colapsos recorrentes da via aérea superior durante o sono o que resulta em redução total (apneia) ou parcial (hipopneia) do fluxo aéreo. Tem íntima relação com as alterações na via aérea superior (VAS). A tomografia de feixe cônico permite a análise da VAS e do seu volume, por meio de reconstrução tridimensional. Objetivo: Avaliar as alterações volumétricas da via aérea superior em pacientes com apneia obstrutiva do sono. Metodologia: Dissertação desenvolvida a partir de dois artigos científicos. Ambos são estudos retrospectivos, por meio da revisão de 33 prontuários de pacientes adultos com queixas sugestivas de AOS. Resultados: Foram avaliados 19 pacientes do gênero masculino e 14 do gênero feminino, com índice de massa corpórea (IMC) médio de 30,38kg/m2 e idade média de 49,35 anos. Destes, 14 apresentavam AOS grave, 7 moderada, 7 leve e 5 indivíduos não eram portadores da patologia. No artigo 1 foi avaliada a relação entre o volume da via aérea e a gravidade da AOS. O índice de correlação de Spearman entre o volume da VAS e o Índice de Apneia e Hipopnéia foi de -0,100 com p= 0,580. O teste de Mann-Whitney entre as categorias da AOS e o volume teve p = 0,4630. O artigo 2 avaliou a relação entre o volume da VAS e o Sistema de Estagiamento de Friedman (SEF). O teste de ANOVA comparando o Volume com o SEF foi de 0,018. Conclusão: O volume da via aérea superior não apresenta relação linear com a gravidade da Apneia Obstrutiva do Sono, quando avaliada pelo Índice de Apneia e Hipopneia. O volume da via aérea superior apresentou uma relação significativa e inversa com o Sistema de Estadiamento de Friedman, ou seja, quanto maior a classificação de Friedman menor o volume da via aérea superior. Introdução: A apneia obstrutiva do sono (AOS) ocorre por colapsos recorrentes da via aérea superior durante o sono o que resulta em redução total (apneia) ou parcial (hipopneia) do fluxo aéreo. Tem íntima relação com as alterações na via aérea superior (VAS). A tomografia de feixe cônico permite a análise da VAS e do seu volume, por meio de reconstrução tridimensional. Objetivo: Avaliar as alterações volumétricas da via aérea superior em pacientes com apneia obstrutiva do sono. Metodologia: Dissertação desenvolvida a partir de dois artigos científicos. Ambos são estudos retrospectivos, por meio da revisão de 33 prontuários de pacientes adultos com queixas sugestivas de AOS. Resultados: Foram avaliados 19 pacientes do gênero masculino e 14 do gênero feminino, com índice de massa corpórea (IMC) médio de 30,38kg/m2 e idade média de 49,35 anos. Destes, 14 apresentavam AOS grave, 7 moderada, 7 leve e 5 indivíduos não eram portadores da patologia. No artigo 1 foi avaliada a relação entre o volume da via aérea e a gravidade da AOS. O índice de correlação de Spearman entre o volume da VAS e o Índice de Apneia e Hipopnéia foi de -0,100 com p= 0,580. O teste de Mann-Whitney entre as categorias da AOS e o volume teve p = 0,4630. O artigo 2 avaliou a relação entre o volume da VAS e o Sistema de Estagiamento de Friedman (SEF). O teste de ANOVA comparando o Volume com o SEF foi de 0,018. Conclusão: O volume da via aérea superior não apresenta relação linear com a gravidade da Apneia Obstrutiva do Sono, quando avaliada pelo Índice de Apneia e Hipopneia. O volume da via aérea superior apresentou uma relação significativa e inversa com o Sistema de Estadiamento de Friedman, ou seja, quanto maior a classificação de Friedman menor o volume da via aérea superior
Abstract: Introduction : Obstructive Sleep Apnea (OSA) occurs by recurrent collapse of the upper airway during sleep, resulting in total (apnea) or partial (hypopnea)reduction of airflow and has relationship with changes in upper airway (UA). The cone beam tomography allows the analysis of UA¿s volume (UAV) by three-dimensional reconstruction. Objective: Evaluate the volumetric changes of the upper airway in patients with obstructive sleep apnea. Methodology: Dissertation developed from two scientific articles. Both are retrospective studies by reviewing the medical records of 33 adult patients with complaints suggestive of OSA. Results: We evaluated 19 male and 14 female, with average body mass index (BMI) of 30.38 kg/m2 and mean age of 49.35 years. Among them, 14 had severe OSA, 7 moderate, 7 mild and 5 subjects were heatlhy. In article 1 the relationship between the UAV and severity of OSA was evaluated. The index Spearman correlation between UAV and the Apnea-Hypopnea Index was -0.100 with p=0.580. The Mann-Whitney between categories of OSA and UAV was p=0.4630. Article 2 evaluated the relationship between UAV and the Friedman Staging System (FSS). The ANOVA test comparing the volume with the FSS was 0.018. Conclusion: The volume of the upper airway has no linear relationship with the severity of obstructive sleep apnea, as measured by the apnea-hypopnea index. The volume of the upper airway showed a significant inverse relationship with Friedman Staging System, high FSS is found in subjects with low volume of the upper airway
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências
49
Wang, David. "Sleep disordered breathing in stable methadone maintenance treatment patients /." Connect to thesis, 2006. http://eprints.unimelb.edu.au/archive/00002992.
Full text
50
Larkin, Emma Katherine. "A Genetic Analysis of Correlated Traits: The Apnea Hypopnea Index and Body Mass Index." Connect to text online, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1175825365.
Full textAbstract:
Thesis (Ph. D.)--Case Western Reserve University, 2007.[School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.