Apnoea

Edling C, Lindberg A, Ulfberg J. 1993. Occupational exposure to organic solvents as a cause of sleep apnoea. Br J Ind Med 50 276-279. 

Monstad P, Mellgren SI, Sulg lA. 1992. The clinical significance of sleep apnoea in workers exposure to organic solvents implications for the diagnosis of organic solvent encephalopathy. J Neurol 239 195-198. 

Monstad P, Nissen T, Sulg lA, et al. 1987. Sleep apnoea and organic solvent exposure. J Neurol 234 152-154. 

Bardwell W. A., Ziegler M. G., Ancoli-Israel S. et at (2000). Does caffeine confound relationships among adrenergic tone, blood pressure and sleep apnoea J. Sleep Res. 9, 269-72. 

Morisson F, Lavigne G, Petit D, Nielsen T, Malo J, Montplaisir J. (1998). Spectral analysis of wakefulness and REM sleep EEG in patients with sleep apnoea syndrome. Eur RespirJ. 11(5) 1135-40. 

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

Desflurane is a rapid-acting, volatile, liquid anaesthetic. Hov/ever, compared v/ith isoflurane, it has a lower potency. Desflurane is not used for the induction of anaesthesia, as it is irritant to the upper respiratory tract leading to cough, apnoea, laryngospasm and increased secretions. 

Adverse effects include local effects like redness and phlebitis, apnoea (usually seen on IV administration). Rarely nausea, vomiting, headache, drowsiness, hiccups and retrograde amnesia may occur. 

Adverse effects include respiratory depression (death from hypoventilation), dependence, apnoea, muscle rigidity, bradycardia, arrhythmia, chest pain, GI symptoms, haemoptysis, abdominal pain, headache, sorrmolence, confusion and hallucinations. 

It is indicated in all types of depression, nocturnal enuresis, intractable chronic pain, narcolepsy, chorea, cachexia, mood disturbances and sleep apnoea syndrome. 

Desflurane does not have a marked bronchodilator effect and in cigarette smokers it is associated with significant bronchoconstriction. In clinical practice, both humidification of inspired gases and opioids are thought to reduce airway irritability but even at moderate concentrations (2 MAC), desflurane is more likely to cause coughing than sevoflurane. In common with other volatile agents, desflurane causes dose-related respiratory depression. Tidal volume is reduced and respiratory rate increases, initially. As inspired concentrations of desflurane increase, the trend is to hypoventilation and hypercardia and apnoea is to be expected at concentrations of 1.5 MAC or greater. 

Enflurane is a potent respiratory depressant and apnoea may occur at inspired... 

Thiopentone has a potent dose-dependent, depressant effect on both respiratory rate and depth and depresses the sensitivity of the respiratory centre to carbon dioxide. A short period of apnoea is common, frequently preceded by a few deep breaths. Respiratory depression is influenced by premedication and is more pronounced in the presence of opioids and in patients with chronic obstructive pulmonary disease. 

Respiratory depression and duration of apnoea are of a lesser magnitude with methohexitone than with thiopentone. 

Those related to the respiratory apparatus are of special interest DPDPE causes a dose dependent increase in foetal respiratory activity which was blocked by administration of naloxone (Cheng et al., 1992). These stimulatory effects of selective 5 agonists may be of clinical value in treating respiratory disorders such as apnoea. 

Hardinge FM, Pitson DJ, Stradling JR. Use of Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous airway pressure in patients with obstructive sleep apnoea. RespirMed 1995 89 617-620. 

Ficker JH, Dertinger SH, Siegfried W, Konig HJ, Pentz M, Sailer D, Katalinic A, Hahn EG. Obstructive sleep apnoea and diabetes mellitus the role of cardiovascular autonomic neuropathy. Eur Respir J 1998 11 14—19. 

Rees PJ, Prior JG, Cochrane GM, Clark TJ. Sleep apnoea in diabetic patients with autonomic neuropathy. J Roy Soc Med 1981 74 192-195. 

Conti M, Izzo V, Muggiasca ML, Tiengo M. Sleep apnoea syndrome in pregnancy a case report. Eur J Anaesthesiol 1988 5 151-154. 

Taibah K, Ahmed M, Baessa E, Saleem M, Rifai A, Al-arifi A. An unusual cause of obstructive sleep apnoea presenting during pregnancy. J Laryngol Otol 1998 112 1189-1191. 

Brain K, Thornton JG, Sarkar A, Johnson AOC. Obstructive sleep apnoea and fetal death successful treatment with continuous positive airway pressure. Br J Obstet Gynecol 2001 108 543-544. 

Hastie S, Prowse K, Perks WH, Atkins J, Blunt VAW. Obstructive sleep apnoea during pregnancy requiring tracheostomy. Aust NZ J Obstet Gynaecol 1989 29 365-367. 

George CF. Reduction in motor vehicle colhsions following treatment of sleep apnoea with nasal CPAP. Thorax 2001 56(7) 508-512. 

McArdle N, Kingshott R, Engleman HM, Mackay TW, Douglas NJ. Partners of patients with sleep apnoea/hypopnoea syndrome effect of CPAP treatment on sleep quality and quality of life. Thorax 2001 56(7) 513—518. 

Chakravorty I, Cayton RM, Szczepura A. Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome. Eur Respir J 2002 20(5) 1233-1238. 

Lloberes P, Levy G, Deseals C, et al. Self-reported sleepiness while driving as a risk factor for traffic accidents in patients with obstructive sleep apnoea syndrome and in non-apnoeic snorers. Respir Med 2000 94 971-976. 

Hack MA, Choi SJ, Vijayapalan P, Davies RJ, Stradling JR. Comparison of the effects of sleep deprivation, alcohol and obstructive sleep apnoea (OSA) on simulated steering performance. Respir Med 2001 95 594-601. 

Villaneuva AT, Buchanan PR, Yee BJ, Grunstein RR (2005) Ethnicity and obstructive sleep apnoea. Sleep Medicine Reviews, doi 10.1016/j.smrv.2005.04.005... 

Marin JM, Carrizo SJ, Vicente E, Agusti AGN (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure an observational study. The Lancet 365(9464) 1046-1053... 

Malhotra A, White DP (2002) Obstructive sleep apnoea. The Lancet 360(9328) 237... 

Sutton PM (1981) The interaction between reflex apnoea and bradycardia produced by injecting 5-HT into the nodose ganglion of the cat. Pflugers Arch 389 181-187... 

Stradling J, Smith D, Radulovacki M, Carley D (2003) Effect of ondansetron on moderate obstructive sleep apnoea, a single night, placebo-controlled trial. J Sleep Res 12 169-170... 

Smith I, Lasserson T, Wright J (2002) Drug treatments for obstructive sleep apnoea. Cochrane Database Syst Rev 2 CD003002... 

Grunstein RR, Hedner J, L Grote (2001) Treatment options for sleep apnoea. Drugs 61 237-251... 

CistulliPA, Barnes DJ, Grunstein RR, Sullivan CE (1994) Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women. Thorax 49 699-702... 

Fletcher EC, Munafo DA (1990) Role of nocturnal oxygen therapy in obstructive sleep apnoea. Chest 98 1497-1505... 

One commonly administered drug in these infants is theophylline which is used in the treatment of apnoea. In order to examine the feasibility of delivering this drug, a simple gel formulation containing 15J theophylline sodium glycinate in 5% hydroxymethyl cellulose was prepared [JJ2,]. This formulation was chosen using the kinetic model such that the input rate of theophylline produced plasma levels in the therapeutic range 4 to 12 mg/1. Thirteen infants were studied and in all but two cases therapeutic levels... 

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