Posted by writermd on May 13, 2002 at 07:21:14:Below are three journal abstracts copied from Medline. None are new but I found all interesting. I would welcome comments, by anyone interested, on the utility of these approaches. Thank you.
1. Am J Rhinol 2001 Sep-Oct;15(5):311-3
Treatment of hypoxemia in obstructive sleep apnea.
Friedman M, Landsberg R, Ascher-Landsberg J.Department of Otolaryngology, Illinois Masonic Medical Center, Chicago,USA.
Many patients suffering from obstructive sleep apnea (OSA) have intermittent oxygen desaturation associated with periods of apnea or hypopnea. Oxygen saturation levels below 90% are considered harmful. Usually, treatment is directed at correcting the apnea, which will in turn prevent hypoxemia. Unfortunately, many patients fail or are not candidates for nasal continuous positive airway pressure (CPAP) or surgical correction of their OSA. Forty-three patients with persistent OSA and nocturnal hypoxemia below 90% who were not candidates for additional surgical or CPAP therapy were treated with nocturnal oxygen supplementation. Standard symptoms associated with OSA and the Epworth Sleepiness Scale (ESS) were recorded before treatment and 30 days after the start of the treatment. In 21 patients, polysomnography studies were performed to compare the Respiratory Disturbance Index (RDI) score and minimum oxygen saturation levels when the patients were breathing room air or breathing 4 L/minute of oxygen by nasal cannula. Subjective symptoms of obstructive sleep apnea improved, and the ESS score significantly decreased after a 30-night treatment with oxygen. Split-night polysomnography showed a significant increase in minimum oxygen saturation during oxygen administration. The RDI did not significantly change with treatment. Oxygen administration for the correction of OSA-related nocturnal hypoxemia was both safe and effective in alleviation of OSA-related symptoms. It also appeared to have a beneficial effect on minimum oxygen saturation levels. Thus, oxygen therapy may be considered a treatment option in patients who fail to comply with CPAP and are not candidates for a surgical procedure.
2. Psychiatry Clin Neurosci 1999 Apr;53(2):321-2Clinical efficacy and indication of acetazolamide treatment on sleep apnea syndrome.
Inoue Y, Takata K, Sakamoto I, Hazama H, Kawahara R.
Department of Neuropsychiatry, Faculty of Medicine, Tottori University, Yonago, Japan.
The efficacy and indication of acetazolamide treatment on patients with sleep apnea syndrome (SAS) were discussed from assessing the changes of polysomnographic findings with the treatment in 75 SAS patients. For the patients as a whole, respiratory disorder variables improved significantly during the treatment. However, the number of acetazolamide treatment responders who showed a decrease of apnea hypopnea index (AHI) to 50% or less of the pretreatment value numbered only 34 (45.3%). The lower values of body mass index and AHI in the responder group indicated that monotherapy with acetazolamide is the treatment choice only for mild SAS cases without obesity. However, combined treatment with acetazolamide and uvulopalatopharyngoplasty was thought to be beneficial for severe cases.
PMID: 10459724 [PubMed - indexed for MEDLINE]
3. Psychiatry Clin Neurosci 1998 Apr;52(2):222-3 RelatedEffectiveness of tonsillectomy in adult sleep apnea syndrome.
Miyazaki S, Itasaka Y, Tada H, Ishikawa K, Togawa K.Department of Otolaryngology, Akita University School of Medicine, Hondo, Japan.
Tonsillectomy was performed on 10 adult sleep apnea patients (five males, five females; average age, 39 years old; average body mass index, 24.8 kg/m2). Tonsillectomy alone was indicated if tonsillar hypertrophy was moderate to severe and the length of the soft palate was less than 35 mm according to cephalometry. Remarkable improvements were observed in all cases following surgery. The average weight of the resected tonsils was 11 g. The patients demonstrated a preoperative apnea + hypopnea index (AHI) of 14.4/h. This decreased to 2.9/h postoperatively. The intraesophageal pressure change improved from -36.6 to -15.7 cmH2O following surgery. A significant correlation between preoperative AHI and the degree of obesity (r=0.684, P < 0.05) was found. Although uvulopalatopharyngoplasty has been used extensively to treat sleep apnea, the present results suggests that certain subjects can be effectively treated through only tonsillectomy.
PMID: 9628163 [PubMed - indexed for MEDLINE]
- Re: Comments Solicited on these 3 Journal Abstracts Patricia 13:30 10/19/02 (0)
- Re: Comments Solicited on these 3 Journal Abstracts technician 07:45 5/31/02 (1)
- Re: Comments Solicited on these 3 Journal Abstracts John Hey MD 20:31 6/21/02 (0)