Sleep medicine
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Obstructive sleep apnea (OSA) severely impairs sleep architecture. We hypothesized that both intermittent hypoxia (IH) and non-hypoxic arousals of OSA result in significant disruption of non-rapid eye movement sleep (NREMS) and rapid eye movement sleep (REMS). ⋯ Thus, hypoxic exposure, but not arousals, caused overall deficits in the EEG delta power of NREMS and marked deficits in the total amount of REMS. We propose that hypoxic arousals may have a more severe impact on sleep architecture in patients with OSA than non-hypoxic arousals.
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Case Reports
Obstructive sleep apnea syndrome: a potential cause of lower airway obstruction in cystic fibrosis.
A six-year-old healthy female with cystic fibrosis (CF) and pancreatic sufficiency presented with cough, weight loss, and lung function decline. Further history suggested obstructive sleep apnea, and nocturnal polysomnography (NPSG) confirmed this. Adenotonsillectomy resulted in resolution of clinical symptoms with return of normal lung function. This case establishes that obstructive sleep apnea syndrome (OSAS) may be a potential cause of lower airway inflammation and resulting weight loss in the young CF population.
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We previously postulated how evolutionary changes in man's upper respiratory tract to facilitate speech, a phenomenon Jared Diamond calls The Great Leap Forward, have predisposed man to obstructive sleep apnea (OSA) [Diamond J. The Third Chimpanzee: the evolution and future of the human animal. New York: HarperCollins Publishers; 1992. p. 21, 23, 32-54, 54-6; Davidson TM. The Great Leap Forward: the anatomic evolution of obstructive sleep apnea. Sleep Medicine 2003;4:185-94]. We grouped these anatomic changes into four categories: klinorynchy, laryngeal descent, craniobase angulation and supralaryngeal vocal tract (SVT) ratio of SVT(H):SVT(V). This study was designed to investigate the relationship between cephalometric measures corresponding to these anatomic changes and OSA. ⋯ Overall, our data supports the theory that evolutionary anatomic changes to facilitate speech correlate with OSA severity. The cumulative changes in each cephalometric category trended in the directions hypothesized and support the Great Leap theory of OSA evolution.