The effects of arousal accompanying an apneic event on blood pressure and sympathetic nerve activity in severe obstructive sleep apnea.

Purpose: Arousal plays an important protective role against life-threatening events by terminating the apneic events. However, arousal might also be considered as a contributor to obstructive sleep apnea (OSA) pathogenesis since ventilatory overshoot due to arousal leads to irregular breathing. Patients with OSA who have greater upper airway compensation, expressed by relatively high proportion of apneic events without arousal, could have less adverse events or consequences.

Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism.

Study Objectives: Obstructive sleep apnea (OSA) can be severe and present in higher numbers during rapid eye movement (REM) than nonrapid eye movement (NREM) sleep; however, OSA occurs in NREM sleep and can be predominant. In general, ventilation decreases an average 10% to 15% during transition from wakefulness to sleep, and there is variability in just how much ventilation decreases. As dynamic changes in ventilation contribute to irregular breathing and breathing during NREM sleep is mainly under chemical control, our hypothesis is that patients with a more pronounced reduction in ventilation during the transition from wakefulness to NREM sleep will have NREM- predominant rather than REM-predominant OSA.

Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs obstructive-dominant sleep apnea.

Background: Mixed apneas share both central and obstructive components and are often treated as if they are obstructive events. The hypothesis is that patients with obstructive sleep apnea syndrome (OSAS) who exhibit a majority of mixed apneas will differ in ventilatory control from those with predominantly obstructive apneas during wakefulness; moreover, this difference could affect nasal continuous positive airway pressure (CPAP) adherence.

Methods: In a retrospectively derived case-control study, 5 min of respiratory inductance plethysmography signals during wakefulness prior to sleep onset were extracted from a diagnostic polysomnogram in these groups: (1) mixed apnea-dominant OSAS (mix-OSAS) (n = 36), (2) obstructive apnea-dominant OSAS (pure-OSAS) (n = 20), (3) central apnea-dominant sleep apnea syndrome (pure-CSAS) (n = 6), and (4) control subjects (n = 10).

Comparative survey of pain-alleviating effects between ultrasound-guided injection and blind injection of lidocaine alone in patients with painful shoulder.

Background: Complaints of shoulder pain are very frequent in clinical practice. To relieve this type of pain, intra-subacromial bursa (SAB) injection therapy is commonly employed. Injection procedures include blind and ultrasound-guided injection.

Oxidative stress in obstructive sleep apnea.

Study Objectives: To investigate the relationship between the severity of obstructive sleep apnea (OSA) and oxidative stress, which plays an important role in the pathogenesis of cardiovascular disease, and to elucidate the factors contributing to this relationship.

Design: Cross-sectional study.

Participants: A total of 128 consecutive subjects referred to the sleep laboratory of our hospital for screening or treatment of OSA.

Obstructive sleep apnea and carotid-artery intima-media thickness.

Study Objectives: We investigated whether the carotid-artery intimamedia thickness (IMT) measured by ultrasonography, which is regarded as an indicator of atherosclerosis, was associated with the severity of obstructive sleep apnea (OSA).

Design: Cross-sectional study.

Setting: A sleep laboratory in a general hospital in Japan.

[Changes in tracheal and lung sounds before and after resection of adenoid cystic carcinoma of the trachea].

A 79-year-old woman was admitted to our hospital with complaints of wheezing and dyspnea. Adenoid cystic carcinoma was diagnosed from the findings on biopsy specimens obtained by fiberoptic bronchoscopy. The tumor was resected and end-to-end anastomosis was performed.

Double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes: report of a case.

A case of double cancers of the lung and esophagus associated with a sarcoid-like reaction in their regional lymph nodes is reported. A 73-year-old man with hemosputum was found to have a mass in his right lower lung field on a chest X-ray. Based on a diagnosis of lung cancer, a right middle and lower lobectomy with a dissection of the lymph nodes was performed.

[Screening of sleep apnea/hypopnea syndrome by home pulse oximetry].

We evaluated the diagnostic accuracy and reproducibility of results obtained by home oximetry for the screening of sleep apnea/hypopnea syndrome. Our subjects were 40 patients who underwent home oximetry (12 patients for 1 night, 28 patients for 2 nights) followed by all-night polysomnography. Their mean age was 50.

[Automated analysis of all-night records of tracheal sound to detect sleep disordered breathing].

In sleep-disordered breathing, tracheal sounds disappear during apnea and vary cyclicly during hypopnea. We tried to detect these changes in tracheal sounds automatically with a personal computer, and we evaluated the diagnostic accuracy of this system for detecting sleep-disordered breathing. Polysomnography and tracheal sound recording were done in 33 subjects with possible sleep apnea/hypopnea syndrome.

Clinical use of human hepatocyte growth factor in the early detection of HELLP syndrome.

The change in plasma concentration of human hepatocyte growth factor (hHGF) in pregnant women with HELLP (hemolysis, elevated liver enzyme and low platelets) syndrome was investigated, and the following results were obtained. (1) The plasma concentration of hHGF in pregnant women did not change with the gestational stage. (2) The plasma concentration of hHGF in pregnant women with EPH (edema, proteinuria and hypertension) gestosis was 0.

[A case of desmoplastic malignant mesothelioma].

A 43-year-old man was admitted to Nara Medical University Hospital because of right-sided chest pain. Computed tomographic examination revealed a right pleural effusion and diffuse pleural thickening. Malignant mesothelioma was diagnosed from the results of a percutaneous pleural biopsy, and the patient then underwent right pleuro-pneumonectomy.

[Hypopnea according to various definitions and coexisting arousal response in patients with sleep-disordered breathing].

Hypopnea is a type of sleep-disordered breathing, and the apnea plus hypopnea index (AHI) is usually computed to diagnose this condition. Nevertheless, there is no consensus on the definition of hypopnea. To arrive at a reasonable definition, we examined the relationship between arousal response and hypopnea as defined in various ways, in polysomnographs of 20 patients with sleep-disordered breathing.

[Relationship between power spectra of breath sounds and inspiratory flows at different frequencies].

Regional ventilation and changes in airway caliber have been studied by analysis of breath sounds. The aim of this study was to find which frequency band is most suitable for such purposes. The subjects were 19 healthy men.