Apnea obstructive

Antiemetics and antivertigo drag s are used cautiously in patients with glaucoma or obstructive disease of the gastrointestinal or genitourinary system, those with renal or hepatic dysfunction, and in older men with possible prostatic hypertrophy. Piromethazine is used cautiously in patients with hypertension, sleep apnea, or epilepsy. Trimethobenzamide is used cautiously in children with a viral illness because it may increase the risk of Reye s syndrome... 

Scrima L, Hartman PG, Johnson EH, et al The effects of gamma-hydroxybutyrate on the sleep of narcolepsy patients a double blind study. Sleep 13 479 90, 1990 Series F, Series 1, Cormier Y Effects of enhancing slow-wave sleep by gamma-hydroxybutyrate on obstructive sleep apnea. Am Rev Respir Dis 143 1378-1383, 1992 Shannon M Methylenedioxymethamphetamine (MDMA, ecstasy ). Pediatr Emerg Care 16 377-380, 2000... 

Describe the mechanisms of the sleep disorders covered in this chapter, including insomnia, narcolepsy, restless-legs syndrome, obstructive sleep apnea, and parasomnias. 

The main therapy for obstructive sleep apnea is nasal continuous positive airway pressure (CPAP) therapy because of its effectiveness. 

Obstructive sleep apnea (OSA) is a common disorder that is often unrecognized, affecting 4% of middle-aged white men and 2% of middle-aged white women.15 In women, the frequency of OSA increases after menopause. OSA is as common or more common in African Americans and less common in Asian... 

Overnight polysomnogram Frequent obstructive apneas, hypopneas, and leg movements. 

FIGURE 38-1. Primary assessment and initial treatment for complaint of excessive daytime sleepiness. RLS, restless-legs syndrome NPSG, nocturnal polysomnography OSA, obstructive sleep apnea DA, dopamine agonist MSLT, multiple sleep latency test BZDRA, benzodiazepine receptor agonist SNRI, serotonin and norepinephrine reuptake inhibitor TCA, tricyclic antidepressant CPAP, continuous positive airway pressure. 

CH returns to the clinic 3 months later. The physician previously diagnosed him with obstructive sleep apnea and RLS. He received a prescription for CPAP, for OSA and ropinirole 0.5 mg at bedtime for RLS at his last visit. Via phone calls, his ropinirole dose has been increased to 3 mg at bedtime. He has received moderate relief of his RLS symptoms, but on occasion, he still awakens and cannot fall back asleep. His sleepiness and RLS symptoms are improved ESS 13/24. 

OSA obstructive sleep apnea Hening WA, Allen RP, Earley CJ, et al. Restless Legs Syndrome Task... 

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 2006 29 1031-1035. 

Obstructive sleep apnea Potentially Treatable by Drugs... 

Obstructive sleep apnea (a condition where a person may stop breathing for a period of time while sleeping) ... 

The patient experiences anxiety, apathy, bradyphrenia (slowness of thought processes), confusional state, dementia, depression, hallucinosis/psychosis (typically drug-induced), and sleep disorders (excessive daytime sleepiness, insomnia, obstructive sleep apnea, and rapid eye movement sleep behavior disorder). 

Breathing-Reiated Sieep Disorders. The breathing-related sleep disorders include obstructive sleep apnea, central sleep apnea, and alveolar hypoventilation. Of these three, obstructive sleep apnea is by far the most common. The patient with sleep apnea usually breathes normally when awake and only stops breathing while asleep. Occasional episodes of apnea are normal, but five or more episodes of apnea per hour are usually considered diagnostic of the disorder. 

The syndrome is most common in obese males and should be considered when such patients complain of persistent drowsiness. However, the patient s partner provides the key to diagnosis. If the patient s partner reports frequent snoring and gasping for air or has even noticed episodes of apnea, then one should suspect sleep apnea. The final diagnosis is made during a sleep study in which the episodes of apnea can be observed directly. Although obese individuals have an elevated risk for obstructive sleep apnea, there are clearly individuals with sleep apnea who would be considered normal weight. 

Respiratory depression Avoid sedatives and CNS depressants in patients with compromised respiratory function (eg, chronic obstructive pulmonary disease [CORD], sleep apnea). 

Epidural/Intrathecal administration Limit epidural or intrathecal administration of preservative-free morphine and sufentanil to the lumbar area. Intrathecal use has been associated with a higher incidence of respiratory depression than epidural use. Asthma and other respiratory conditions The use of bisulfites is contraindicated in asthmatic patients. Bisulfites and morphine may potentiate each other, preventing use by causing severe adverse reactions. Use with extreme caution in patients having an acute asthmatic attack, bronchial asthma, chronic obstructive pulmonary disease or cor pulmonale, a substantially decreased respiratory reserve, and preexisting respiratory depression, hypoxia, or hypercapnia. Even usual therapeutic doses of narcotics may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. Reserve use for those whose conditions require endotracheal intubation and respiratory support or control of ventilation. In these patients, consider alternative nonopioid analgesics, and employ only under careful medical supervision at the lowest effective dose. 

Obstructive sleep apnea (OSA), which is typically characterized by intermittent hypoxia/reoxygena-tion (IFIR), is a common finding in patients with heart failure and is an independent risk factor for cardiovascular disease [62-64]. OSA has been shown to result in activation of selective markers of inflammation, which could be the basis of the molecular mechanism of the cardiovascular disease seen in these patients [65]. The OSA syndrome has been shown to significantly increase the risk of... 

Sin DD, Fitzgerald F, Parker JD, et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. Oct 1999 160(4) 1101-1106. 

Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation. Oct 25 2005 112(17) 2660-2667. 

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