Effect of upper airway obstruction on blood pressure variability after stroke

2004 ◽  
Vol 107 (1) ◽  
pp. 75-79 ◽  
Author(s):  
Peter M. TURKINGTON ◽  
John BAMFORD ◽  
Peter WANKLYN ◽  
Mark W. ELLIOTT
Keyword(s):  
Blood Pressure ◽  
Airway Obstruction ◽  
Acute Stroke ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Stroke Patients ◽  
Sleep Study ◽  
Ischaemic Brain ◽  
Respiratory Disturbance ◽  
The Impact

Approx. 60% of acute stroke patients have periods of significant UAO (upper airway obstruction) and this is associated with a worse outcome. UAO is associated with repeated fluctuation in BP (blood pressure) and increased BP variability is also associated with a poor outcome in patients with acute stroke. UAO-induced changes in BP, at a time when regional cerebral perfusion is pressure-dependent in areas of critically ischaemic brain, could explain the detrimental effect of UAO on outcome in these patients. The aim of the present study was to examine the relationship between UAO and BP variability in patients with acute stroke. Twelve acute stroke patients and 12 age-, sex- and BMI (body mass index)-matched controls underwent a sleep study with non-invasive continuous monitoring of BP to assess the impact of UAO on BP control after stroke. Stroke patients had significantly more 15 mmHg dips in BP/h than the controls (51 compared with 6.7 respectively; P<0.004). Stroke patients also demonstrated significantly higher BP variability than the controls (26.8 compared with 14.4 mmHg; P<0.001). There were significantly more 15 mmHg dips in BP/h in stroke patients who had significant UAO than those who did not (85.7 compared with 29.5 respectively; P<0.032). Furthermore, stroke patients without UAO (RDI <10, where RDI is respiratory disturbance index) had significantly more 15 mmHg dips in BP/h than the controls (29.5 compared with 6.7 respectively; P<0.037). There was a positive correlation between the severity of UAO (RDI) and 15 mmHg dips in BP/h (r=0.574, P<0.005) in stroke patients. Our results suggest that UAO alone does not explain BP variation post-stroke, but it does play an important role, particularly in determining the severity of the BP fluctuation.

scholarly journals 1244 A Curious Case of ASV Failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A474
Author(s):  
Nishant Chaudhary ◽  
Mirna Ayache ◽  
John Carter
Keyword(s):  
Sleep Apnea ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Central Sleep Apnea ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Neck Extension ◽  
Sleep Study ◽  
Obstructive Sleep

Abstract Introduction Positive airway pressure-induced upper airway obstruction has been reported with the treatment of obstructive sleep apnea (OSA) using continuous positive airway pressure (CPAP) along with an oronasal interface. Here we describe a case of persistent treatment emergent central sleep apnea (TECSA) inadequately treated with adaptive servo ventilation (ASV), with an airflow pattern suggestive of ASV-induced upper airway obstruction. Report of Case A 32-year-old male, with severe OSA (apnea hypopnea index: 52.4) and no other significant past medical history, was treated with CPAP and required higher pressures during titration sleep studies to alleviate obstructive events, despite a Mallampati Class II airway and a normal body mass index. Drug-Induced Sleep Endoscopy (DISE) showed a complete velopharynx and oropharynx anterior posterior (AP) collapse, long soft palate, which improved with neck extension. CPAP therapy, however, did not result in any symptomatic benefit and compliance reports revealed high residual AHI and persistent TECSA. He underwent an ASV titration sleep study up to a final setting of expiratory positive airway pressure 9 cm H2O, pressure support 6-15 cm H2O (auto-rate), with a full-face mask due to high oral leak associated with the nasal interface. The ASV device detected central apneas and provided mandatory breaths, but did not capture the thorax or abdomen, despite normal mask pressure tracings. Several such apneas occurred, with significant oxyhemoglobin desaturation. Conclusion We postulate that the ASV failure to correct central sleep apnea as evidenced by the absence of thoracoabdominal inspiratory effort, occurred due to ASV-induced upper airway obstruction. Further treatment options for this ASV phenomenon are to pursue an ASV-assisted DISE and determine the effectiveness of adjunctive therapy including neck extension, nasal mask with a mouth closing device and a mandibular assist device.

DOZ047.107: Increased quality of life burden related to obstructive sleep apnea in children with aerodigestive disease

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
C T Wootten ◽  
B Lipscomb ◽  
S Acra ◽  
M Fazili
Keyword(s):  
Quality Of Life ◽  
Airway Obstruction ◽  
Sleep Disturbance ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Systematic Screening ◽  
Obstructive Sleep ◽  
Physical Suffering ◽  
The Impact

Abstract Objective The aim of this study was to determine the impact of sleep-disordered breathing on quality of life (QOL) in children with aerodigestive disease compared to children without aerodigestive disease. Methods Retrospective, IRB-approved, single-institution review of OSA-18 survey results administered to an unselected population of pediatric otolaryngology patients, some of whom had also been seen in the multidisciplinary aerodigestive clinic, was carried out. Results 476 non-aerodigestive patients and 43 aerodigestive patients were compared using total OSA-18 score and the summed scores from the 5 domains that comprise the OSA-18: (1) sleep disturbance, (2) physical suffering, (3) emotional distress, (4) daytime problems, and (5) caregiver concern. Sleep-related QOL was significantly worse for children with aerodigestive disease compared to those without aerodigestive disease across domains of sleep disturbance (P = 0.011), physical suffering (P = 0.028), and caregiver concern (P = 0.016). Total OSA-18 scores were in the mild impact range, and they did not differ significantly between the two populations. Conclusion While the focus of many aerodigestive programs is on the pathophysiological relationship between the upper digestive tract, the laryngotracheal airway, and the lungs, the present study elucidates a significant impact of upper airway obstruction during sleep on the QOL of children with aerodigestive disease. In recognition of this impact, certain airway centers have added a multidisciplinary approach to upper airway obstruction to their aerodigestive treatment armamentarium. At the minimum, airway treatment centers should consider systematic screening of all children with aerodigestive disease for QOL burden related to OSA.

scholarly journals ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

2017 ◽  
Vol 50 (6) ◽  
pp. 1700985 ◽  
Author(s):  
Athanasios G. Kaditis ◽  
Maria Luz Alonso Alvarez ◽  
An Boudewyns ◽  
Francois Abel ◽  
Emmanouel I. Alexopoulos ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Sleep Disordered Breathing ◽  
Objective Assessment ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Sleep Study ◽  
Mandibular Hypoplasia ◽  
Obstructive Sleep ◽  
Obstructive Sleep Disordered Breathing ◽  
Disordered Breathing

The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1–23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g.snoring) and/or conditions predisposing to SDB (e.g.mandibular hypoplasia) as well as children with SDB and complex conditions (e.g.Down syndrome, Prader–Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g.supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1–23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.

scholarly journals Pengaruh tonsilektomi terhadap ukuran dan ekspresi IL-6 tonsil lingualis pada pasien OSA

2012 ◽  
Vol 42 (2) ◽  
Author(s):  
Sally Mahdiani ◽  
Teti Madiadipoera ◽  
Iwin Sumarman ◽  
Bambang Purwanto
Keyword(s):  
Airway Obstruction ◽  
Epworth Sleepiness Scale ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Test Design ◽  
Open Label ◽  
Lingual Tonsil ◽  
Obstructive Sleep ◽  
Post Test ◽  
The Impact

Background: Obstructive sleep apnea (OSA) is a sleep breathing disorder caused by upper airway  obstruction. It occurs on 51% adult and could cause systemic side effects. Hypertrophy of the palatine  and lingual tonsils cause upper airway obstruction and increasing cytokine IL-6 production. Obstruction and inflammation products have an important role in causing OSA. Inflammation of the palatine tonsil causes lingual tonsil to be inflamed. Purpose: To find out the impact of tonsillectomy on size and IL-6 expression of lingual tonsil. Method:The quasiexperimental open label pre and post test design was done on August 2010 – October 2011. There were 20 adult subjects with snoring, palatine and lingual tonsil hypertrophy. All subjects filled the Epworth Sleepiness Scale (ESS) questionnaire, underwent ENT examination and biopsy using fiber optic rhinolaryngoscope. Immunohistochemistry examination for IL-6  were performed on all biopsy specimens. Results: There is highly significant improvement on lingual  tonsil size score from 3 to 1 after tonsillectomy. IL-6 expression was significantly decreased from 12 to 2 after tonsillectomy. ESS score was also significantly decreased from 16 to 5. The reducing size of lingual tonsil correlates with decreasing of IL-6 expressions. Conclusion:Tonsillectomy on OSA patients reduced the IL-6 expression of the lingual tonsil and that cause the reducing of its size. Decreasing of obstruction and inflammation could lead to the decrease of the ESS score. Keywords: OSA, tonsillectomy, Epworth Sleepiness Scale, lingual tonsil size, IL-6 expression    Abstrak :  Latar belakang: Henti napas obstruktif saat tidur (OSA) merupakan gangguan napas saat tidur yang terjadi karena obstruksi saluran napas atas. Keluhan ini terjadi pada 51% orang dewasa dan menimbulkan efek samping sistemik berat. Pembesaran ukuran tonsil palatina dan tonsil lingualis akan menyebabkan obstruksi saluran napas atas dan mengakibatkan peningkatan produksi IL-6, sehingga akan menyebabkan OSA. Inflamasi yang terjadi pada tonsil palatina membuat tonsil lingualis mengalami inflamasi. Tujuan: Untuk melihat pengaruh tonsilektomi terhadap ukuran dan ekspresi IL-6 tonsil lingulis. Metode: Penelitian quasiexperimental open label pre and post test design di Poliklinik IK. THT-KL RSHS Bandung sejak Agustus 2010 – Oktober 2011. Subjek 20 orang dewasa dengan keluhan mendengkur, pembesaran tonsil palatina dan tonsil lingualis. Seluruh subjek mengisi kuesioner skala kekantukan Epworth (Epworth Sleepiness Scale/ESS), biopsi tonsil lingualis dengan rinolaringoskopi serat optik lentur dan imunohistokimia IL-6 jaringan biopsi. Hasil: Didapatkan perbaikan yang sangat bermakna skor ukuran tonsil lingualis sebelum tonsilektomi (3) dibandingkan setelah tonsilektomi (1). Nilai ekspresi IL-6 menurun sangat bermakna dari 12 menjadi 2. Skor ESS menurun secara bermakna dari 16 menjadi 5. Pengecilan ukuran tonsil lingualis berhubungan dengan penurunan ekspresi IL-6. Kesimpulan: Tonsilektomi pada pasien OSA dapat menurunkan ekspresi IL-6 pada tonsil lingualis, sehingga ukuran tonsil lingualis mengecil. Hilangnya obstruksi dan inflamasi mengakibatkan skor ESS menurun. Kata kunci: henti napas obstruktif saat tidur, tonsilektomi, Epworth Sleepiness Scale, ukuran tonsil lingualis, ekspresi IL-6

scholarly journals Prevalence and Predictors of Upper Airway Obstruction in the First 24 Hours After Acute Stroke

Stroke ◽  
2002 ◽  
Vol 33 (8) ◽  
pp. 2037-2042 ◽  
Author(s):  
P.M. Turkington ◽  
J. Bamford ◽  
P. Wanklyn ◽  
M.W. Elliott
Keyword(s):  
Airway Obstruction ◽  
Acute Stroke ◽  
Upper Airway ◽  
Upper Airway Obstruction
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