In this report we describe the case of a 69-year-old woman, with a medical history of onset of asthenia, worsening of dyspnoea for mild efforts (class NYHA II) and events of nocturnal dyspnoea ...(without orthopnea or edema of lower limbs). The patient presents hypertension, dyslipedaemia and obesity (BMI 38 kg/m²) as cardiovascular risk factor. A previous 24-h Holter monitoring documents bradycardic events and sinusal pauses. The ergometric test and the echocardiogram do not show particulary pathological features. After a careful anamnesis about nocturnal events of dyspnoea and about daytime tiredness, and the Epworth questionnaire regarding the relationship between sleep-related breathing disorder and cardiovascular disease, we perform cardiorespiratory sleep study that shows a diagnosis of obstructive sleep apnea syndrome (OSAS). The patient begins therapy with continuous positive airway pressure (CPAP) during the night. It is shown a considerably decrease of bradycardic events during the night after a period of this treatment.
Objectives: The purpose of this study was to examine the relationship between pathological patterns and hyperventilation syndrome, using pathological pattern and Nijmegen questionnaires. Methods: 33 ...healthy adults were asked to complete the Cold-Heat-, Phlegm-, Yin deficiency, and Lao Juan (勞倦)-pattern questionnaires, the Chalder fatigue scale, and the Nijmegen questionnaire at Kyung Hee University Hospital. We performed Pearson correlation analyses between the pathological pattern questionnaires and the Nijmegen questionnaire. The questionnaires were composed of several factors. Therefore, each factor and Nijmegen questionnaire score were also analyzed. Results: All of the pattern questionnaire scores had a positive correlation with the Nijmegen ques-tionnaire score. The phlegm pattern, in particular, and the LaoJuan (勞倦) questionnaire scores had high correlation coefficients. The coefficient for the phlegm pattern was 0.856 and the coefficient for the LaoJuan (勞倦) pattern questionnaire was 0.855. Conclusions: The results mean that the pathological pattern questionnaires could be one of the refer-ence materials to evaluate hyperventilation syndrome. Furthermore, improvement of pathological patterns may be helpful for treating hyperventilation syndrome, together with conventional therapies including breathing training.
Both the influence of comorbid obstructive sleep apnea–hypopnea syndrome (OSAHS) on daytime sleepiness and its pathological mechanism in 10 narcoleptic patients was studied. Mild elevation of ...esophageal negative pressure and obstruction in the velopharyngeal area, as observed by upper airway magnetic resonance imaging, during apneic episodes was observed in the subjects. Severity of the disorder was correlated positively with body mass index, and the latencies of the multiple sleep latency tests were not improved with nasal continuous positive airway pressure treatment in subjects. Pathogenesis of OSAHS in narcolepsy was thought to be almost similar to typical OSAHS, and that the disorder seemed to lack a pathological influence on daytime sleepiness.
The objective of this study was to investigate whether injections of botulinum toxin into the soft palate reduce snoring in a subgroup of patients that present an active process causing habitual ...snoring. The study was conducted in eight patients with habitual snoring but without evidence of obstructive sleep apnea. Polysomnography was performed for diagnostic purposes and to monitor sleep quality before and after treatment. The patients and their partners completed a questionnaire before and after treatment. Recordings of snoring noise before and after treatment were evaluated on a visual analog scale by a blinded assessor. Doses of 20 U of botulinum toxin type A (Dysport®) were injected unilaterally into the muscles of the soft palate. Snoring was reduced in eight cases. The patients reported no major adverse effects. These results justify further studies of botulinum toxin therapy in patients with habitual snoring. The scheme presented for injections of botulinum toxin into the levator veli palatini muscle provides a rational basis for the design of such studies. Therapy with botulinum toxin for habitual snoring is safe, non-invasive, easy to perform, fully reversible, and thus warrants investigation under placebo-controlled, double-blind conditions. This treatment is appropriate for a disorder that is of paramount social importance but does not pose a medical threat to the individuals affected.
Multiple system atrophy (MSA) is a sporadic, adult-onset progressive neurodegenerative disease characterized by autonomic dysfunction, parkinsonism, and cerebellar ataxia in various combinations. ...Sleep-related disorders such as insomnia with sleep fragmentation, sleep-related breathing disorder (SRBD), REM sleep behavior disorder (RBD), and periodic leg movements are common in MSA. SRBD in MSA may manifest as obstructive (e.g., stridor, snoring, obstructive sleep apnea) and central (e.g., central sleep apnea, dysrhythmic breathing) patterns. In particular, stridor reflects upper airway obstruction at the level of the larynx and initially presents during sleep. In later stages, stridor occurs during wakefulness. Stridor should alert the clinician to the risk of sudden death during sleep. Video-polysomnographic recording or laryngeal fiberscopy during wakefulness or sleep are useful to confirm diagnoses of RBD and laryngeal stridor, respectively. In cases of stridor occurring only during sleep, CPAP therapy may be indicated initially. When CPAP is not tolerated or stridor also appears during wakefulness, tracheostomy needs to be considered. Accurate diagnosis or treatment planning for MSA can contribute to an improved prognosis and quality of life of patients and their caregivers.
Autonomic dysfunction in multiple system atrophy (MSA) is mainly caused by the accumulation of α-synuclein, mainly in the central nervous system, and partly in post-sympathetic ganglion fibers. ...Typical autonomic dysfunctions are urinary dysfunction, impaired orthostatic blood pressure regulation, and sleep-related breathing disorders, which also affect life prognosis. Urinary incontinence and orthostatic decrease of blood pressure are included in the diagnostic criteria for probable MSA, but assessment of residual urine volume and active standing and/or prolonged standing time might improve the sensitivity and specificity of the diagnosis. Since it is difficult to predict sudden death in MSA during sleep, periodical evaluation of respiratory function during natural and drug-induced sleep is warranted.
