Sleep apnea surgery: putting it all together.

Since the first description of uvulopalatopharyngoplasty (UPPP) in 1972, the surgical management of obstructive sleep apnea syndrome (OSA) has become increasingly popular. This popularity is caused by several reasons. The psychomotor sequelae of OSA, such as excessive daytime sleepiness, daytime fatigue, and poor sleep quality caused by sleep fragmentation, have major deleterious impact on patients' well being, which behooves them to seek treatment.

Reaction time performance in upper airway resistance syndrome versus obstructive sleep apnea syndrome.

Background: Patients with obstructive sleep apnea syndrome (OSAS) are known to have an increased risk for motor vehicle crashes. They suffer from sleep-related respiratory abnormality causing repetitive arousal leading to daytime sleepiness. In turn, it has been demonstrated that sleepiness can impair human psychomotor performance causing slowing of reaction times (RTs).

Hypopharyngeal airway surgery.

Obstructive sleep apnea (OSA) is the result of upper airway obstruction during sleep. Hypopharyngeal airway obstruction can be caused by the prominence or relaxation of the base of the tongue, lateral pharyngeal wall, and occasionally, the aryepiglottic folds or epiglottis. Although nasal continuous positive airway pressure (CPAP) is considered as the first treatment for obstructive sleep apnea, surgery has been shown to be a viable option for patients who are intolerant of positive pressure therapy.

Surgical therapy for obstructive sleep apnea syndrome.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review presents the current state of the art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiography, formulation of a surgical plan with selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

Surgical therapy for adult obstructive sleep apnea.

Despite advances in positive pressure therapy for obstructive sleep apnea, compliance continues to be a problem for many patients. Sleep apnea surgery is a viable option for patients who are intolerant of positive pressure therapy. This review will present the current state of art in sleep apnea surgery, including airway evaluation with fiberoptic nasopharyngoscopy and lateral cephalometric radiograph, formulation of a surgical plan through a selection of procedures to address specific sites of obstruction, as well as discussion of published surgical outcomes.

Sleep extension: getting as much extra sleep as possible.

Nearly all people, whether they consider themselves sleep deprived or not, can initially obtain extra sleep. However, as accumulating extra sleep reduces carryover sleep debt, a point is reached where it is no longer possible to obtain extra sleep. If there were a practical method to make a precise measurement of a person's daily sleep requirement, it may be possible to show that most individuals are carrying a very large sleep debt.

Aging and the role of the HPA axis and rhythm in sleep and memory-consolidation.

Changes in the hypothalamo-pituitary-adrenal (HPA) axis and its rhythm with aging have interesting implications for sleep. Herein, the authors review sleep and HPA changes associated with normal aging and point out the similarities in how they change over time. The authors also discuss the effects of sleep on declarative memory consolidation, in particular.

On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: normal HPA axis activity and circadian rhythm, exemplary sleep disorders.

The hypothalamic-pituitary-adrenal (HPA) axis plays important roles in maintaining alertness and modulating sleep. Dysfunction of this axis at any level (CRH receptor, glucocorticoid receptor, or mineralocorticoid receptor) can disrupt sleep. Herein, we review normal sleep, normal HPA axis physiology and circadian rhythm, the effects of the HPA axis on sleep, as well as the effects of sleep on the HPA axis.

An adjunctive method of radiofrequency volumetric tissue reduction of the tongue for OSAS.

Objectives: Temperature-controlled radiofrequency volumetric reduction (TCRF), a minimally invasive procedure, has been used to treat tongue base obstruction in Obstructive Sleep Apnea Syndrome (OSAS). An adjunctive method was objectively evaluated.

Method: A prospective, nonrandomized clinical study was undertaken on 20 consecutive OSAS patients with isolated tongue base obstruction.

Behavioral parasomnias.

Sleep is not a static state. During the sleep period, physiologic changes occur throughout the body and brain. This complex, dynamic process can, at times, result in episodes of unusual or undesirable behaviors.

Sleep-disordered breathing. A view at the beginning of the new Millennium.

Obstructed sleep apnea syndrome and UARS are often missed in clinical practice. The pediatric population presenting with UARS or mild OSAS is the most commonly ignored because the symptoms are insidious. Often, their craniofacial morphology is not as altered as in the adult population because the effects of airway obstruction may not have been fully established.

Sleep and wakefulness in somnambulism: a spectral analysis study.

Objective: The sleep structure and the dynamics of EEG slow-wave activity (SWA) were investigated in 12 young adults and age- and gender-matched controls.

Methods: Polysomnography was performed in subjects with well-documented chronic sleepwalking and in matched controls. Blinded visual scoring was performed using the international criteria from the Rechtschaffen and Kales atlas [A manual of standardized technology, techniques and scoring systems for sleep stages of human subjects.

Problems associated with switch to modafinil - a novel alerting agent in narcolepsy.

Modafinil is a novel medication recently approved for the treatment of narcolepsy and idiopathic hypersomnia. Commonly, patients had already been prescribed medications for their syndrome. This report outlines difficulties encountered in the clinical practice of switching patients to modafinil.

Central sleep apnea.

A central sleep apnea is the absence of respiratory effect, and, this, the absence of airflow during sleep. Central hypopnea, a related disorder, is also discussed. The sensory component of central sleep apnea; defects involving the integrative and executive neurons; non-neurologic causes of central sleep apneas, including chronic obstructive pulmonary disease and congestive heart failure; diagnosis; treatment; and other topics are reviewed.

Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease.

Objective: Investigation of the therapeutic effects of bilevel positive airway pressure delivered by nasal mask in patients with neuromuscular disease.

Methods: 20 patients with neuromuscular disease were evaluated for symptoms of nocturnal sleep disruption. These symptoms included daytime tiredness, fatigue, sleepiness, and complaints of insomnia.

Narcolepsy and idiopathic hypersomnolence.

Narcolepsy is among the leading causes of excessive daytime sleepiness. Its classic form associates daytime sleepiness with cataplexy, sleep paralysis, hypnopompic hallucinations, and nocturnal disrupted sleep. This form is associated with HLA DQ betal-0602 in about 85% to 90% of affected subjects, independently of their ethnicity.

Nasal obstruction and obstructive sleep apnea: a review.

Several groups of investigators have assessed the impact of nasal obstruction on the obstructive sleep apnea syndrome. These studies evaluated patients with either naturally occurring partial nasal obstruction (e.g.

Central sleep apnea.

A central sleep apnea is the absence of respiratory effect, and, thus, the absence of airflow during sleep. Central hypopnea, a related disorder, is also discussed. The sensory component of central sleep apnea; defects involving the integrative and executive neurons; non-neurologic causes of central sleep apneas, including chronic obstructive pulmonary disease and congestive heart failure; diagnosis; treatment; and other topics are reviewed in detail.

Familial aggregates in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) was diagnosed in157 subjects based on clinical symptoms, physical evaluation, cephalometric x-ray films, and polysomnography. These index cases identified 844 living first-degree relatives. Mailings were sent to 792 (94%).

Sleep and sleep-disordered breathing in commercial long-haul truck drivers.

We have performed a study assessing the prevalence of sleep-disordered breathing in a large US trucking company using a validated portable monitor (MESAM-4) and a validated symptom questionnaire. Three hundred eighty-eight drivers with a mean age of 36 years filled out the questionnaire. One hundred fifty-nine drivers with a mean age of 35 years spent the night at the terminal hub where they underwent monitoring for identification of sleep-disordered breathing.

Upper airway sleep-disordered breathing in women.

Objective: To investigate the various clinical presentations of sleep-disordered breathing in women.

Design: A retrospective case-control study.

Setting: A sleep disorders clinic.

Obstructive sleep apnea and the hyoid: a revised surgical procedure.

Obstructive sleep apnea syndrome results from a loss of muscular activity of pharyngeal dilators and airway collapse at the hypopharynx-base of tongue or the oropharynx-soft palate. The hyoid arch and its muscle attachments strongly affect hypopharyngeal airway patency and resistance. On the basis of these concepts and previous experience, a modified hyoid suspension procedure is presented.