Pneumologie
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Continuous positive airway pressure (CPAP) therapy reduces sleeping time per day and daytime sleepiness in obstructive sleep apnoea (OSA) and heavy snoring. Due to sleep fragmentation the OSA and heavy snoring are associated with a daytime sleepiness and increased necessity of sleep. In this pilot study the effect of CPAP-therapy on daytime sleepiness and sleep time during 24 hours were assessed in patients with OSA or heavy snoring (daytime sleepiness, none or slight apnoea with AHI < 10/h and benefit of CPAP). ⋯ In respect of the change of sleeping time/day and of the sleepiness score there was no significant difference between the OSA and heavy snoring group. With CPAP the AHI in OSA patients was reduced from 34.5 +/- 23.6/h to 3.2 +/- 3.2/h. Due to the improvement of sleep-related breathing disorders CPAP therapy reduced the mean sleeping time/day by approximately 10% and the daytime sleepiness score both in patients with OSA and heavy snoring compared to the pretreatment period.
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Noninvasive mechanical ventilation with nasal or face mask using either BiPAP or IPPV (intermittent positive pressure ventilation) modes is meanwhile the standard type of mechanical ventilation instead of endotracheal intubation or tracheostomy in many patients with chronic and acute respiratory failure. However, problems occur very often in noninvasive mechanical ventilation due to mask problems with leakage of air out of the mask or erasions and necrosis of the skin by constant pressure through the mask frame. Hence, some clinical work groups developed customized molded masks mostly in cooperation with dentistry labs. These masks, however, are often very expensive and take several weeks to be manufactured. Our aim was to develop an inexpensive (less than 600 USS) and easy-(in one day)-to-produce customized nasal mask, the so-called "Freiburg nasal mask". We wish to show by a case report the clinical efficacy of this customized mask in severe respiratory failure. ⋯ This case shows that sometimes due to leakage of air in standard nasal masks noninvasive mechanical ventilation may fail in patients with severe respiratory failure. Therefore, in these patients customized moulded nasal or face masks should be used instead of standard masks. We think that the Freiburg nasal mask is an example of an easy to produce and nonexpensive customized mask and may be used in such patients, as this case report shows.
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Biography Historical Article
[Gustav Killian Memorial Lecture. 100 years bronchoscopy--early history and subsequent development].
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Patients with untreated sleep apnea syndrome have a higher cardiovascular mortality. It is not known which mechanisms lead to this increase in mortality and whether it is independent from the often associated coronary heart disease and systemic hypertension. In 48 consecutive patients with coronary heart disease confirmed by angiography, exercise-ECG, Holter-ECG, echocardiography, spirometric tests, analysis of ventricular late potentials, heart rate variability and a test for sleep-disordered breathing with a screening device were performed. ⋯ There are no significant differences in age (58.9 +/- 6.1 vs. 59.7 +/- 7.6 years), body-mass-index (28.6 +/- 3.7 vs. 27.7 +/- 3.3 kg/m2), left ventricular ejection fraction (57.2 +/- 13.6 vs. 64.0 +/- 14.6%), forced expiratory volume in 1 second/vital capacity 95.4 +/- 13.9 vs. 92.9 +/- 11.2% predicted, heart rate variability (standard deviation of the RR-intervals 39.4 +/- 29.4 vs. 37.2 +/- 17.0 ms), the frequency of premature ventricular beats over 24 h and at night, the frequency of multivessel disease (71 vs. 68%), additional hypertension 53 vs. 48%), status postmyocardial infarction (47 vs. 48%) and positive late potential analysis (24 vs. 13%). There were no ST segment depressions during the night. Patients with coronary heart disease and mild sleep-disordered breathing show no significant differences in the investigated parameters compared with patients without obstructive sleep apnea or sleep-disordered breathing.