Foods to help if you have Sleep Apnea
Respiratory concerns include the potential for a difficult airway, increased incidence of asthma, sleep disordered breathing or obstructive sleep apnea, restrictive lung disease, chronic hypoxia with or without polycythemia, and pulmonary hypertension. Minimal airway intervention, avoiding difficult airway and obstructive sleep apnea (OSA) concerns 12. What is obstructive sleep apnea 13. Is obstructive sleep apnea common The prevalence of adult sleep apnea is approximately 2 in women and 4 in men. The prevalence of childhood sleep apnea is up to 10 . These children are commonly seen on the otolaryngology surgical schedule for tonsillectomy and adenoidectomy this is curative in 75 to 100 of cases, even in the obese population. However, it is estimated that nearly 80 of men and 93 of women with moderate to severe sleep apnea are undiagnosed. Undiagnosed OSA may pose a variety of problems for anesthesiologists. 14. Which techniques can be used to identify patients with obstructive sleep...
Morbidly obese patients have numerous systemic disorders and physiologic challenges, including restrictive lung disease, obstructive sleep apnea, coronary artery disease, diabetes, hypertension, cardiomegaly, pulmonary hypertension, and delayed gastric emptying. Safe anesthetic practice requires preparation for diagnosis, monitoring, and emergent treatment of any of these conditions. 1. American Society of Anesthesiologists Task Force Practice guidelines for the perioperative management of patients with obstructive sleep apnea. Anesthesiology 104 1081-1093, 2006. 3. Chung F, Yegneswaran B, Liao P, et al STOP questionnaire a tool to screen patients for obstructive sleep apnea. Anesthesiology 108 812-821, 2008. 4. Chung F, Yegneswaran B, Liao Pu, et al Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology 108 822-830, 2008.
Obstructive sleep apnea syndrome (OSAS) is one of the many respiratory complications associated with obesity. It is defined as repeated episodes of obstructive apnea and hypopnea during sleep, in association with altered cardiopulmonary function (113). Evidence is emerging that patients with apneic events that occur during sleep have associated acute and chronic hemodynamic changes during waking time, including elevated sympathetic tone, decreased stroke volume (SV) and CO, increased HR, and changes in circulating hormones that regulate BP, fluid volume, vasoconstriction, and vasodilation (114,115). Weight loss is an effective method for reducing the extent of OSAS (116) and associated disruptive symptoms, such as habitual snoring and daytime sleepiness (117).
Weigh loss also improves symptoms associated with obstructive sleep apnea (OSA). The seriousness of this problem is emphasized by the fact that the cost of medical care of obese patients with OSA has been estimated to be twice the cost of similar patients without OS A (45). Recently, Guardiano et al. reported on the effect of significant weight loss in eight subjects showing a mean reduction in respiratory disturbance index (RDI ,the sum of all apneas and hypopneas per hour of sleep) by 75 . The same study reported a 100 reduction in the need for continuous positive airway pressure (CPAP) treatment and the mean oxygen saturation improved by 2 2 (95 to 97 ). The mean nadir oxygen saturation also improved from 74 to 87 (45).
By incorporating sleep montages into the ambulatory digital system and coupling this system with various other physiological recorders such as a portable Sp02 sensor, one can perform ambulatory sleep recordings. The integration of an SpO, measuring transducer into the bedside EEG data acquisition device enables Sp02 to be obtained simultaneously with EEG during seizures or during sleep. 40 One can now measure the depth of a hypopnea related to a stage of sleep or look for apnea during seizures. The recent introduction of a completely integrated, small, portable, and reliable home video EEG recording system has addressed one of the last technical barriers for monitoring in the home. Now it is possible to obtain full EEG video monitoring in the home environment.
Healthy may find that they simply don't need as much sleep as they did when they were younger. Overweight men may have problems getting a good night's sleep. Snoring also may contribute to a loss of sleep. Sleep apnea (a condition characterized by brief episodes of interrupted breathing during sleep) is another common reason for losing sleep. Many people who have sleep apnea find it difficult to stay awake during the day. However, the most common reason for an occasional night of lost sleep is worry or anxiety.
Evaluation includes careful personal and familial history, complete physical examination, ECG, chest Rx, transesophageal echocardiogram, pulmonary function test with arterial blood gas tension, and additional sleep studies when sleep apnea may be suspected, routine blood tests, liver function tests, complete autoantibody screening including aPL, HIV serology, and either pulmonary angiogram or helicoidal chest CT scan that should be preferred to ventilation-perfusion isotopic scan.
Dyslipidemia, obstructive sleep apnea, liver disease, and degenerative joint disease. A subset of obese patients demonstrate abdominal obesity or adiposity which is defined by increasing waist circumference, sagittal abdominal diameter, and waist-to-hip ratio. Waist circumference and sagittal abdominal diameter have been shown to correlate best with intra-abdominal adiposity which is a risk factor for cardiovascular disease as well as for dyslipidemia and diabetes18. The definition for abdominal adiposity varies between different ethnic populations as well as within the current literature. A recent study revealed that 36.9 of men and 55.1 of women in the US met the definition of abdominal adiposity based on high-risk waist circumference (waist circumference of greater than 102 cm in men and greater than 88 cm in women)19.
Sleep-disordered breathing (SDB) is a continuum that ranges from normal breathing and oxygenation to chronic intermittent desaturation (CIND) and obstructive sleep apnea (OSA). Obstructive sleep apnea is known to be associated with decreased CO2 response curve and a higher incidence of perioperative respiratory problems such as desaturation, obstruction, apnea, and increased opioid sensitivity. It is important to assess the severity and comorbidities present in each particular patient.
Patients should be questioned about adverse events related to previous airway management episodes. For instance, have they ever been informed by an anesthesiologist thatthey had an airway management problem (e.g., difficult to ventilate, difficult to intubate ) Have they had a tracheostomy or other surgery or radiation about the face and neck Have they sustained significant burns to these areas Do they have obstructive sleep apnea, snoring, or temporomandibular joint (TMJ) dysfunction Review of prior anesthetic records is always helpful.
Between 1 and 2 of patients will be difficult to ventilate. Predictors of difficult mask ventilation include limitations in mandibular protrusion a thyromental distance less than 6 cm advanced age (older than 57 years in one study) abnormal neck anatomy sleep apnea, snoring body mass index of 30 kg m2 or greater and the presence of a beard. A beard may in of itself make mask ventilation difficult, but it may also hide a small thyromental distance. Some men may choose to wear a beard because they don't care for their weak chin facies, which is another way of saying that they have a small thyromental distance.
Introduction - The prevalence of obesity worldwide has increased dramatically during the last several decades, and today has reached epidemic proportions in Western society (1, 2). The causes of obesity are varied, but clearly both genetic and environmental factors are responsible. This increased incidence has had an associated rise in co-morbidities linked with obesity. Indeed, the significant medical risks of obesity have led to the more appropriate clinical view of obesity as a medical condition rather than simply a cosmetic issue. An association clearly exists between obesity and Type-2 diabetes, coronary heart disease, hypertension, cholelithiasis, sleep apnea, osteoarthritis and certain forms of cancer (1, 3). The incidence of these co-morbidities increases linearly with the Body Mass Index (BMI) (defined as weight kg height m 2) and are greatly increased for individuals with a BMI 30 (ca. 208 lbs. at 5'10 height). Even modest long-term weight reduction (5-8 ) may produce...
Depending on the clinical trial evaluated, but significant improvements are reported at 4 and 8mg 30 . Most common adverse effects noted to date appear minor, i.e., headache (7 ), dizziness (5 ) and somnolence (5 ). The last published clinical trials evaluated the potential effects of ramelteon 16 mg on apenic and hypopneic events in individuals with obstructive sleep apnea, due to the lack of depressant effects on nervous system, demonstrating no worsening of sleep apnea 31 .
Obesity is defined as an unhealthy excess of body fat that increases the risk of morbidity and premature mortality. Unfortunately, accurate measures of actual fat mass require sophisticated technologies that are not typically available in clinical settings. The BMI (weight in kg height in m2) has become the method of obesity classification used by the World Health Organization (WHO) and the National Institutes of Health (NIH) (1). This index provides a simple measure of the relation between height and weight that correlates with percentage body fat in young and middle-aged adults (2). Increased morbidity and mortality from hypertension, stroke, coronary artery disease, type 2 diabetes, sleep apnea, and some cancers increases as BMI rises above 25 kg m2, and a sharp increase occurs when BMI exceeds 30 kg m2 (1) (Fig. 1).
There has been a threefold increase in childhood obesity in the United States in the past three decades (12). Coinciding with this increase has been an increase in prevalence for type 2 diabetes, hypertension, gallbladder disease, hyperlipidemia, orthopedic complications, sleep apnea, and nonalcoholic steatohepatitis in children. Obese children are predisposed to adult obesity and have increased risks for adult obesity-related diseases (19). Approximately 30 of obese adults became obese during childhood, and 80 of obese adolescents become obese adults (20).
Other treatable comorbid illnesses must also be considered, most notably infections (e.g., pneumonia and urinary tract infections), psychiatric disorders, and sleep disorders. Although psychotic features rarely occur in the CBS, depression evolves in essentially every patient, likely owing in part to the preserved insight that is also characteristic of the disorder. Sleep disorders such as obstructive sleep apnea, central sleep apnea, restless legs syndrome, periodic limb movement disorder, etc. occur with some frequency in the CBS, and treatment can improve quality of life (100). REM sleep behavior disorder is very rare in the CBS in fact if it is present, one must suspect some contribution of synucleinopathy pathology (101). Despite the difficulties of manipulating the headgear as part of nasal continuous positive airway pressure (CPAP) therapy owing to the limb apraxia, CPAP therapy for obstructive sleep apnea can be tolerated and used effectively in many patients. Patients and...
In the association between obesity and asthma, potential misclassifications of wheeze and asthma must be considered. Obstructive sleep apnea or hypoventilation are frequent among obese patients (5,9). However, it seems unlikely that these symptoms are mis-classified as asthma in longitudinal surveys. As previously stated, all the existing prospective epidemiological studies show a consistent positive association of obesity with both incidence and prevalence of asthma in children and adults. Obesity precedes asthma and predicts the development of asthma and the effect persists after controlling for diet and physical activity. The dose-response relationship is demonstrated by the finding that the greater the obesity, the greater the observed effect on asthma (10-12,21). The effects of obesity seem greater for asthma and airway responsiveness than they do for other allergy phenotypes, although these effects have not been assessed as frequently. From these observations, studies suggest...
Obesity may lead to asthma not directly, but through its role in other disease processes. For example, obesity increases the risk of both gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDR). An increased prevalence of asthma has been observed in subjects with each of these conditions furthermore, subjects undergoing surgical induced weight loss showed improvements not only in asthma but also in GERD and sleep apnea. Consequently, there has been speculation that obesity leads to asthma through its effects on these other conditions. Two recent studies have examined the interrelationships between these conditions. Multivariate logistic regression in data
Methods to improve oxygenation during one-lung ventilation include increasing FiO2, adding PEEP to the dependent lung, adding continuous positive airway pressure to the nondependent lung, adjusting tidal volumes, and clamping the blood supply to the nonventilated lung.
In this section, we will outline important information that the medical history will elicit concerning the features of PCOS, including the presenting complaint, the onset and progression of hyperandrogenic signs and symptoms, menstrual dysfunction and irregularity, weight gain, symptoms of obstructive sleep apnea, and the family history. Weight gain that is primarily centripetal, especially if associated with extremity wasting, purple striae, easy bruisability, moon facies, and rubor, suggests the presence of Cushing's syndrome, and these patients should be appropriately screened using 24-hour urinary-free cortisol levels or a cortisol level following an overnight dexamethasone suppression test. Other information that should be sought includes the patient's awareness of her body fat distribution, as women with PCOS have a greater prevalence of abdominal obesity (29). Weight gain may also be associated with carbohydrate craving and evidence of postprandial reactive hypoglycemia,...
Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?