Terapia delle malattie da russamento (Roncopatie)
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Una ricerca dell'Henry Ford Hospital di Detroit
dimostra che russare di notte mette a serio rischio la salute delle persone in
sovrappeso, di quelle con il colesterolo alto e dei fumatori. I pericoli
maggiori sono l'ispessimento e le anomalie della carotide, precursori
dell'aterosclerosi, indurimento delle arterie responsabile di molte malattie
vascolari. "Russare e' un'attivita' molto piu' rischiosa di quanto si pensi e
non deve essere ignorata", ha spiegato Robert Deeb, autore dello studio
pubblicato sulla rivista Laryngoscope. "Si tende a liquidare il russare come un
semplice fastidio notturno ma non e' cosi'", ha continuato Deeb. "I pazienti che
russano devono farsi curare allo stesso modo dei pazienti che soffrono di apnea
del sonno, pressione alta e di altri fattori di rischio correlati alle malattie
cardiovascolari", ha aggiunto. Lo studio ha dimostrato che russare provoca
cambiamenti nella carotide anche in quelle persone che non sono soggette ad
apnea del sonno. Le mutazioni nella carotide sono probabilmente provocate dalle
infiammazioni e dai traumi causati dalle vibrazioni del russare. "Le malattie
cardiovascolari possono insorgere nelle persone che russano molto prima che il
disturbo si trasformi in apnea ostruttiva del sonno", ha concluso.
5/01/2012 - MAGNETIC RESONANCE
SPECTROSCOPY IN OSA BEFORE AND AFTER CPAP
Fergal J. O'Donoghue, MBBCh, PhD1,2,4; R. Mark Wellard, BSc(hons), MSc, PhD2,3; Peter D. Rochford, B App Sci1; Andrew Dawson, BA (hons)1; Maree Barnes, MBBS1; Warren R. Ruehland, BSc(hons)1,4; Melinda L. Jackson, PhD1; Mark E. Howard, MBBS, PhD1,4; Robert J. Pierce, MBBS, MD1,4; Graeme D. Jackson, BSc, MBBS, MD2,4
for Breathing and Sleep, Austin Health, Heidelberg, Australia; 2Brain
Research Institute, Florey Neuroscience Institutes, Heidelberg West,
University of Technology, Brisbane, Australia; 4University
of Melbourne, Parkville, Australia
To determine whether cerebral metabolite changes may underlie abnormalities of neurocognitive function and respiratory control in OSA.
Observational, before and after CPAP treatment.
Two tertiary hospital research institutes.
30 untreated severe OSA patients, and 25 age-matched healthy controls, all males free of comorbidities, and all having had detailed structural brain analysis using voxel-based morphometry (VBM).
Measurements and Results:
Single voxel bilateral hippocampal and brainstem, and multivoxel frontal metabolite concentrations were measured using magnetic resonance spectroscopy (MRS) in a high resolution (3T) scanner. Subjects also completed a battery of neurocognitive tests. Patients had repeat testing after 6 months of CPAP. There were significant differences at baseline in frontal N-acetylaspartate/choline (NAA/Cho) ratios (patients [mean (SD)] 4.56 [0.41], controls 4.92 [0.44], P = 0.001), and in hippocampal choline/creatine (Cho/Cr) ratios (0.38 [0.04] vs 0.41 [0.04], P = 0.006), (both ANCOVA, with age and premorbid IQ as covariates). No longitudinal changes were seen with treatment (n = 27, paired t tests), however the hippocampal differences were no longer significant at 6 months, and frontal NAA/Cr ratios were now also significantly different (patients 1.55 [0.13] vs control 1.65 [0.18] P = 0.01). No significant correlations were found between spectroscopy results and neurocognitive test results, but significant negative correlations were seen between arousal index and frontal NAA/Cho (r = −0.39, corrected P = 0.033) and between % total sleep time at SpO2 < 90% and hippocampal Cho/Cr (r = −0.40, corrected P = 0.01).
OSA patients have brain metabolite changes detected by MRS, suggestive of decreased frontal lobe neuronal viability and integrity, and decreased hippocampal membrane turnover. These regions have previously been shown to have no gross structural lesions using VBM. Little change was seen with treatment with CPAP for 6 months. No correlation of metabolite concentrations was seen with results on neurocognitive tests, but there were significant negative correlations with OSA severity as measured by severity of nocturnal hypoxemia.
O'Donoghue FJ; Wellard RM; Rochford PD; Dawson A; Barnes M; Ruehland WR; Jackson ML; Howard ME; Pierce RJ; Jackson GD. Magnetic resonance spectroscopy and neurocognitive dysfunction in obstructive sleep apnea before and after CPAP treatment. SLEEP 2012;35(1):41-48.
21/12/2010 IL COSTO SOCIO-ECONOMICO DEI DISTURBI DEL SONNO
02/12/2010 - Loud Snoring Predicts Metabolic Syndrome
Difficulty falling asleep, snoring loudly, and unrefreshing sleep were
significant predictors of metabolic syndrome (P<0.05). Snoring
doubled the risk, while difficulty falling asleep increased the risk by
80%, Wendy Troxel, PhD, of the University of Pittsburgh, and colleagues
reported in Sleep.
The study evaluated 2,000 patients enrolled in an ongoing, community-based prospective heart health study. Patients were ages 45 to 74, lived in or around the Pittsburgh metropolitan area, and had no comorbidity limiting life expectancy to less than five years.
Exclusion criteria included non-black or non-white race, presence of metabolic syndrome or diabetes at baseline, and missing sleep or covariate data at baseline.
The final sample included 812 patients, with a subset of 294 patients agreeing to undergo further evaluation at home in a follow-up analysis adjusted for AHI.
The primary outcome was the presence or absence of metabolic syndrome at the three-year follow-up. Waist circumference, fasting glucose, and lipids were measured at baseline and annually for three years.
Patients were given the Insomnia Sleep Questionnaire and the Multivariable Apnea Prediction Questionnaire to evaluate sleep-disordered breathing and insomnia symptoms. Covariate measures included history of smoking, alcohol consumption, physical activeness, and depressive symptoms.
At the three year follow-up, 14% of patients developed metabolic syndrome. After adjustment for loud snoring, difficulty falling asleep remained a significant predictor (OR 1.78, 95% CI 1.05 to 3.02), while unrefreshing sleep showed marginal significance (OR 1.56, 95% CI 0.96 to 2.53).
The significant symptoms also were compared against the AHI. Only loud snoring remained significant as a predictor (OR 3.01, 95% CI 1.39 to 6.55), while difficulty falling asleep was marginal (OR 1.91, 95% CI 0.80 to 4.58).
Researchers noted the study was limited by self-reported sleep disturbance and lack of sleep duration measures. The AHI analysis was limited by small subsample size and the cross-sectional nature of the AHI assessment.
professionals should look for common sleep symptoms while assessing a
patient due to the measured health risks associated with some symptoms,
the researchers concluded, adding that future research could look at
subjective sleep complaints and psychological factors affecting patients'
poor sleep related to cardiovascular morbidity and mortality.
19/06/2010 - Apnea notturna causa 20% incidenti auto - Fra i sintomi sonnolenza diurna che porta anche a colpi sonno
(ANSA) - ROMA, 19 GIU - Fino al 20% degli incidenti stradali potrebbe essere dovuto all'apnea notturna, patologia dovuta a un'alterazione delle vie respiratorie. Il dato e' emerso a Fiuggi, al simposio sulla 'Sindrome delle apnee ostruttive del Sonno'. Uno dei principali sintomi, spiegano gli esperti, e' la sonnolenza diurna, che puo' condurre nel tempo a disturbi dell'attenzione, deficit cognitivi, scarsa capacita' di concentrazione e colpi di sonno che possono rivelarsi letali quando si e' alla guida.
03/02/2010 - BRAIN GRAY MATTER CONCENTRATIONS IN OSA
Eun Yeon Joo, MD, PhD1; Woo Suk Tae, PhD2; Min Joo Lee, MS1; Jung Woo Kang, MD1; Hwan Seok Park, MD1; Jun Young Lee, MD1; Minah Suh, PhD3; Seung Bong Hong MD, PhD1
1Sleep Center, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; 2Neuroscience Research Institute, Kangwon National University College of Medicine, Chunchon City, Korea; 3Department of Biological Science, Sungkyunkwan University, Suwon, Korea
To investigate differences in brain gray matter concentrations or
volumes in patients with obstructive sleep apnea syndrome (OSA) and
14/02/2009 - Congresso "Schlaf und Krankheit" Lipsia/Halle 12-14 Novembre 2009 in occasione della 17^ Convention annuale della DGSM - Deutschen Gesellschaft für Schlafforschung und Schlafmedizin.
Dental Sleep Medicine
focuses on the management of sleep-related breathing disorders (SBD),
which includes snoring and obstructive sleep apnea (OSA), with oral
appliance therapy (OAT) and upper airway surgery. OAT involves the
customized selection, fabrication, fitting, adjustments, and long-term
follow-up care of specially designed oral devices, worn during sleep,
which reposition the lower jaw and tongue base forward to maintain a
more open upper airway. Surgery may be an effective treatment for SBD if
performed competently and on correctly identified specific anatomic
sites that contribute to upper airway obstruction. The diagnosis of SBD,
particularly the potentially life-threatening medical disorder OSA, must
be determined by sleep physicians. The treatment of selected SBD cases
with OAT should be performed by qualified dentists, and upper airway
surgery by qualified surgeons.
Dental Sleep Medicine focuses on the management of sleep-related breathing disorders (SBD), which includes
the continuum of snoring to obstructive sleep apnea (OSA), with oral
appliance therapy (OAT) and upper airway surgery. OSA is a potentially
life-threatening medical disorder that is more prevalent in males, and
progressively worsens with advancing age and weight gain. It is caused
by repetitive collapse and blockage of the upper airway while asleep
that results in reduced oxygen delivery to body organs, most critically
the heart and brain. Snoring and excessive daytime sleepiness (EDS) are
the two most common symptoms of OSA. It may also cause memory loss,
morning headaches, irritability, depression, decreased sex drive, and
impaired concentration. Left untreated, OSA can result in hypertension,
strokes, heart attacks, and sudden death while asleep, as well as motor
vehicle accidents due to drowsiness while driving.
The dental specialty of oral &
maxillofacial surgery has pioneered the development of jaw, ie.,
maxillomandibular advancement (MMA), which is the most therapeutic
surgery (excluding tracheostomy) for selected cases of moderate to
severe OSA. MMA permanently advances the soft palate and tongue base (suspended
from the maxilla and mandible, respectively) to enlarge and stabilize
the entire velo-oro-hypopharyngeal airway and can be combined safely
with adjunctive extrapharyngeal procedures in a single-staged operation.
There are minimal risks of airway embarrassment due to edema in the
immediate post-operative period or recurrent OSA
American Academy of Dental Sleep
Snoring in children is associated with poor executive function.
Sleep-disordered breathing (SDB) in children has been demonstrated to affect cognition, development, behavior, and school performance negatively. In this study, 39 children ages 3 to 5 years underwent executive-function testing (which evaluated planning, inhibitory control, and working memory); 3 months later, parents completed a sleep questionnaire that elicited parents’ ratings of their children’s snoring as occurring never, rarely, occasionally, frequently, or almost always.
After controlling for age, the authors found that a higher parent-reported risk for SDB was associated with significantly lower executive function. The strongest effect was on inhibition. Children classified as frequent or almost-always snorers performed significantly worse in all three dimensions of executive functioning than did those with less frequent or no snoring.
Comment: This study adds to a growing body of literature implicating childhood SDB in problems with development, cognition, and behavioral function. Although this study did not include polysomnography to determine where on the spectrum of SDB these children lay, previous studies have demonstrated negative developmental and behavioral effects in children who have "only" primary snoring, defined as snoring in the absence of apnea or hypopnea on polysomnography (e.g., Pediatrics 2006; 117:e496). These previous findings raise the issue of whether current standards for performing polysomnography in children and interpreting the results are sufficiently sensitive to identify all those with clinically significant SDB who might benefit from treatment.
— Dennis Rosen, MD
Dr. Rosen is Associate Medical Director of the Sleep Laboratory, Children’s Hospital Boston.
Published in Journal Watch Neurology October 21, 2008
Karpinski AC et al. Risk for sleep-disordered breathing and executive function in preschoolers. Sleep Med 2008 May; 9:418.
Lifestyle intervention with weight reduction: first-line treatment in
mild obstructive sleep apnea.
of Otorhinolaryngology, Institute of Clinical Medicine, University of
Kuopio, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio,
RATIONALE: Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA. OBJECTIVES: The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA. METHODS: Seventy-two consecutive overweight patients (body mass index, 28-40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea-hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements. MEASUREMENTS AND MAIN RESULTS: The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 [mean +/- SD]). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08-0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference. CONCLUSIONS: VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up. [fonte PubMed - indexed for MEDLINE]
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last update: 28 gennaio 2013