Sleep apnea and systemic hypertension: a causal association review

Article Abstract:

Hypertension, or high blood pressure, affects 20 percent of persons and increases the risk of heart disease and circulatory disorders of the brain. However, the mechanism underlying the development of hypertension in many cases is not known. Hypertension has been associated with the sleep apnea syndrome (SAS), a sleep disorder. In SAS, breathing ceases during sleep for at least 10 seconds and this cessation of breathing occurs 30 or more times during the course of sleep. Breathing may cease due to inactivity of the respiratory muscles or blockage of the airways. SAS affects more than one percent of the population. Studies show that circulatory changes occur during apnea and the persistence of such changes may contribute to the development of hypertension and other circulatory disorders. However, more evidence for a role of SAS in causing hypertension is needed to justify the use of costly screening tests for this sleep disorder among hypertensive patients. Hence, the causal relation between SAS and hypertension was assessed by reviewing five epidemiologic studies conducted between 1978 and 1989. The current evidence suggests that SAS is consistently and specifically associated with hypertension. Possible mechanisms underlying the development of both SAS and hypertension are discussed. Although SAS appears to increase the risk of hypertension, the risk relation is not stable and does not justify the need for SAS screening of hypertensive patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Medical examination, Sleep disorders

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Central hemodynamics and 24-hour blood pressure in obstructive sleep apnea syndrome: effects of corrective surgery

Article Abstract:

Sleep apnea is a disorder characterized by cessation of breathing during sleep. Episodes of apnea usually last for 10 seconds and occur 30 or more times during a 7-hour sleep period. The obstructive form of sleep apnea results from inability to breathe due to obstruction of the upper airway. Patients with obstructive sleep apnea are usually middle-aged, obese men with a history of daytime sleepiness and sleep apnea accompanied by snoring and gasping sounds. Obstructive sleep apnea syndrome is associated with insufficient oxygenation of the blood, elevated blood pressure, and respiratory acidosis (excessive acidity of body fluids due to impaired lung function and retention of carbon dioxide). Hypertension or elevated blood pressure is prevalent in more than 60 percent of these patients. Conversely, 25 to 35 percent of patients with hypertension have undiagnosed sleep apnea. Hemodynamic or circulatory abnormalities are greatest when patients with obstructive sleep apnea attempt to inhale against an obstructed airway. Circulation disorders improve with the use of methods or agents that open the airway. A case is described of a hypertensive patient with obstructive sleep apnea, who underwent plastic surgery to reconstruct portions of the oropharynx, or upper airway, in order to improve sleep apnea. Surgical correction of the obstructed upper airway reduced the number of apneic episodes and improved the abnormal elevations of blood pressure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Abnormalities, Surgery, Hemodynamics, Hemodynamic monitoring, Complications

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Diagnostic criteria and technology as sources for changing incidences of pulmonary diseases

Article Abstract:

The effects of changes in diagnostic criteria and new technology on the prevalence of lung disease in 1921, 1941, 1961, and 1982 were evaluated. Medical records of patients with pulmonary tuberculosis or lung cancer, who were discharged from Yale-New Haven Hospital during 1921, 1941, 1961, and 1982, were examined. The clinical course of each patient was reviewed six months before and after hospitalization. According to modern diagnostic criteria, the clinical evidence in the medical records did not justify the diagnosis of either pulmonary tuberculosis or primary lung cancer during each of the four survey years. The percentage of pulmonary tuberculosis cases that were appropriately diagnosed based on clinical evidence was 16 percent in 1921, 42 percent in 1941, 53 percent in 1961, and 86 percent in 1982. The percentage of lung cancer cases that were appropriately diagnosed was 0 percent in 1921, 54 percent in 1941, and 93 percent in 1961 and 1982. The proportion of cases that were correctly diagnosed, based on clinical evidence, increased with time for these pulmonary diseases. Improvements in diagnostic precision may be responsible for the changes in the incidence of pulmonary tuberculosis and lung cancer, in addition to environmental changes and therapeutic advances. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Tuberculosis, Lung cancer

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