Annali italiani di medicina interna : organo ufficiale della Società italiana di medicina interna
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Respiratory function undergoes sleep-associated changes which in normal subjects leave it unaffected. However in some cases they may be more marked than usual or may be superimposed on a pre-existing disease, thus giving rise to sleep-related ventilation disorders. These include obstructive sleep apnea syndrome (OSAS), nocturnal desaturation events of chronic obstructive pulmonary disease (COPD) and restrictive syndromes, as well as nocturnal asthmatic attacks. ⋯ Nocturnal asthma is due to circadian changes in hormonal secretion (catecholamines, cortisol), as well as supine posture, reduced muco-ciliary clearance, gastro-esophageal reflux etc. Sleep itself plays some role through a depressed arousal reaction in slow wave sleep, resulting in more marked and prolonged attacks in this stage. Slow-release theophylline or beta-mimetic medications, as well as new chromones and antimuscarinic drugs are therapeutic alternatives.
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Ann. Ital. Med. Int. · Apr 1990
Comparative Study[Plasma beta-endorphin levels in silent or symptomatic myocardial ischemia].
The role of increased beta-endorphin activity in patients with silent myocardial ischemia has been postulated. To further investigate this hypothesis, 13 patients with silent myocardial ischemia (A) and 10 patients with exercise-induced angina (B) were studied. To be entered in groups A and B patients had to fulfill the following criteria: occurrence or not of anginal pain, according to history and clinical data, during a positive exercise ECG and associated imaging of reversible perfusion defect at thallium-201 scintigraphy. ⋯ The patients with silent or symptomatic myocardial ischemia were quite well-matched with regard to age, sex, number and localization of obstructed coronary vessels, positive exercise ECG and imaging of reversible perfusion defect at thallium-201 scintigraphy. The higher basal plasma beta-endorphin levels in patients with painless ischemia, compared to symptomatic patients, suggested that endogenous opioid peptides play a role in the perception of anginal pain during myocardial ischemia. The fact that post-exercise plasma beta-endorphin levels increased in symptomatic patients but remained unchanged in patients with silent myocardial ischemia does not lead to conclusive considerations.