OBJECTS: This study was conducted to investigate the effects of sleep apnea syndromes on the systemic blood pressure. METHODS: The subjects were 140 patients who were consulted to Yon-jung brain auction and sleep research center for polysomnography due to snoring and sleep apnea from Jan. 1st 1995 to Oct. 31st 1995. Twenty-four out of 140 were excluded due to cardiovascular diseases other than systemic hypertension, antihypertensive medication, inadequate data or diagnosis other than sleep apnea syndrome. The remaining 116 were accepted as proper subjects. Using Pearson's correlation and multiple regression analysis, we looked for the relationship between sleep and respiratory variables to systemic blood pressure. RESULTS: The results were as follows : 1) According to the correlation analysis, statistically significant variables to mean systolic and diastolic blood pressure were the total time and total number of sleep apnea, degree of oxygen saturation of total sleep time, apnea index, total time and total number of central apnea, and the total time of obstructive apnea. 2) According to the multiple regression analysis, only the total time of sleep apnea significantly affected mean systolic and diastolic blood pressure, and the degrees of affection were 7.9% and 6.2% respectively. CONCLUSION: These findings showed that sleep apnea syndrome had lower influence over systemic blood pressure than expected and regardless of the type, only the total time of sleep apnea influenced systemic blood pressure. In the case of central apnea, mechanisms other than hypoxemia and the increase of sympathetic activity during arousal may make it possible to increase systemic blood pressure.
Anoxia ; Apnea ; Arousal ; Blood Pressure* ; Brain ; Cardiovascular Diseases ; Diagnosis ; Humans ; Hypertension ; Oxygen ; Polysomnography ; Sleep Apnea Syndromes* ; Sleep Apnea, Central ; Snoring

BACKGROUND: In patients with obstructive sleep apnea syndrome(OSAS),there are several factors increasing upper airway resistance and there is a predisposition to compromised respiratory function during waking and sleep related to constitutional factors including a tendency to obesity. Several recent studies have suggested a possible relationship between sleep apnea(SA) and systemic hypertension. But the possible pathophysiologic link between SA and hypertension is still unclear. In this study, we have examined the relationship among age, body mass index(BMI), pulmonary function parameters and polysomnographic data in patients with OSAS. And also we tried to know the difference among these parameters between hypertensive OSAS and normotensive OSAS patients. METHODS: Patients underwent a full night of polysomnography and measured pulmonary function during waking. OSAS was diagnosed if patients had more than 5 apneas per hour(apnea index, AI). A careful history of previously known or present hypertension was obtained from each patient, and patients with systolic blood pressure > or = 160mmHg and/or diastolic blood pressure > or = 95mmHg were classified as hypertensives. RESULTS: The nocturnal nadir of arterial oxygen saturation(SaO2 nadir) was negatively related to AI and respiratory disturbance index(RDI), and the degree of nocturnal oxygen desaturation(DOD) was positively related to AI and RDI. BMI contributed to AI, RDI, SaO2 nadir and DOD values. And also BMI contributed to FEV1, FEV1/FVC and DLco values. There was a correlation between airway resistance(Raw) and AI, and there was a inverse correlation between DLco and DOD. But there was no difference among these parameters between hypertensive OSAS and normotensive OSAS patients. CONCLUSION: The obesity contributed to the compromised respiratory function and the severity of OSAS. AI and RDI were important factors in the severity of hypoxia during sleep. The measurement of pulmonary function parameters including Raw and DLco may be helpful in the prediction and assessment of OSAS patients. But we could not find clear difference between hypertensive and normotensive OSAS patients.
Airway Resistance ; Anoxia ; Apnea ; Blood Pressure* ; Humans ; Hypertension ; Obesity ; Oxygen ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive*

OBJECTIVE: Uur aim was to investigate the association between OSAHS and mean platelet volume (MPV) value. METHOD: This study included 70 cases with OSAHS in our ward between Jan. 2012 and Jan. 2014, and the OSAHS patients were divided two groups: mild- to moderate group and severe group; 30 age-and sex-matched healthy subjects was in control group. The correlation among the levels of the number of platelets (PLT), MPV, platelet distribution width (PDW) were evaluated in the two groups. RESULT: PLT count was significantly lower in the severe group than the control group [(202. 8 ± 68. 9] × 10(9)/L, (235. 9 ± 65. 2) × 10(9)/L]; MPV and PDW were significantly higher in the severe group [(10. 9 ± 0. 9), (10. 4±0. 8) fL; (12. 9 ± 1. 9) %, (12. 0 ± 1. 4) %]. There was not significantly difference of MPV between the mild to moderate group and the control group [(10. 7 ± 0. 7), (10. 4 ± 0. 8)fL]. CONCLUSION MPV levels are elevated in patients with the severe OSAHS.
Blood Platelets ; Case-Control Studies ; Humans ; Mean Platelet Volume ; Sleep Apnea Syndromes ; blood ; Sleep Apnea, Obstructive ; blood

OBJECTIVES: We investigated difference of parameters of polysomnography, cephalometry and dynamic multi-detector computerized tomography (MD-CT) in wake and sleep states according to obesity. METHODS: We evaluated 93 patients who underwent polysomnography and cephalometry. MD-CT was performed in 68 of these 93 patients. Fifty-nine and 34 patients were classified as obese and non-obese, with obesity defined as BMI > or =25. Cephalometry results were analyzed for 12 variables. Using the MD-CT, we evaluated dynamic upper airway morphology in wake and sleep states and divided the upper airway into four parts named as high retropalatal (HRP), low retropalatal (LRP), high retroglossal (HRG), and low retroglossal (LRG). A minimal cross sectional area (mCSA) and collapsibility index (CI) were calculated for each airway level. RESULTS: Diastolic blood pressure (P=0.0005), neck circumference (P<0.0001), and apnea-hypopnea index (P<0.0001) were statistically significantly different between the obese and non-obese group. Among 12 cephalometric variables, there was a significant difference in only the distance from mandibular plane to hyoid bone (P=0.003). There was statistical difference in CI of HRG and LRG in sleep state (P=0.0449, 0.0281) but no difference in mCSA in wake and sleep states. CONCLUSION: The obese group had more severe sleep apnea than the non-obese group. We believe that the increased severity of apnea in the obese group may be have been due to increased collapsibility of the upper airway rather than decreased size of the upper airway.
Apnea ; Blood Pressure ; Cephalometry ; Humans ; Hyoid Bone ; Neck ; Obesity ; Polysomnography ; Sleep Apnea Syndromes ; Snoring

OBJECTIVE: This study aims to analyze how much heart rate variability (HRV) indices discriminatively respond to age and severity of sleep apnea in the obstructive sleep apnea syndrome (OSAS). METHODS: 176 male OSAS patients were classified into four groups according to their age and apnea-hypopnea index (AHI). The HRV indices were compared via analysis of covariance (ANCOVA). In particular, the partial correlation method was performed to identify the most statistically significant HRV indices in the time and frequency domains. Stepwise multiple linear regressions were further executed to examine the effects of age, AHI, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and sleep parameters on the significant HRV indices. RESULTS: The partial correlation analysis yielded the NN50 count (defined as the number of adjacent R-wave to R-wave intervals differing by more than 50 ms) and low frequency/high frequency (LF/HF) ratio to be two most statistically significant HRV indices in both time and frequency domains. The two indices showed significant differences between the groups. The NN50 count was affected by age (p<0.001) and DBP (p=0.039), while the LF/HF ratio was affected by AHI (p<0.001), the amount of Stage 2 sleep (p=0.005), and age (p=0.021) in the order named in the regression analysis. CONCLUSION: The NN50 count more sensitively responded to age than to AHI, suggesting that the index is mainly associated with an age-related parasympathetic system. On the contrary, the LF/HF ratio responded to AHI more sensitively than to age, suggesting that it is mainly associated with a sympathetic tone likely reflecting the severity of sleep apnea.
Aging ; Blood Pressure ; Body Mass Index ; Heart ; Heart Rate ; Humans ; Linear Models ; Male ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive

OBJECTIVEElderly patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) has a higher risk of cardiovascular and cerebrovascular disease. However, changes of homocysteine (Hcy) as markers of cardiovascular and cerebrovascular disease associated with OSAHS and their mechanism have not been elucidated so far. This study aims to investigate the changes of both serum Hey and oxidative stress and their possible links with OSAHS in elderly patients.

METHODSBased on polysomnogram (PSG) and age, 83 patients with OSAHS were recruited and divided into elderly-OSAHS (n=32) and non-elderly OSAHS groups (n=51). Fifty two subjects without OSAHS were divided into elderly control (n=29) and non-elderly control groups (n=23). A total of 135 subjects were included in the present study. All subjects were recorded for PSG variables and the contents of homocysteine (Hcy), malonaldehyde (MDA), and glutathione (GSH) which were detected after sleep. Serum homocysteine was measured by cyclophorase. MDA and GSH were measured by spectrophotometer.

RESULTS(1) The serum levels of Hcy showed significant difference among the four groups (P < 0.05). The concentrations of Hey in elderly OSAHS patients were higher than in other groups, while those in the elderly control group were higher than in the non-elderly control; the concentrations in the non-elderly OSAHS group were higher than in the non-elderly control. (2) The concentrations of MDA and GSH changed at an equal pace with Hey in the four groups. (3) Multielement linearity regression analysis indicated a statistically significant relationship between Hcy concentration and age, MDA, GSH, and apnea hypopnea index (AHI).

CONCLUSIONS(1) The concentrations of Hey and oxidative stress have increased with advancing age. (2) The concentrations of Hey and oxidative stress have further increased in the elderly patients with OSAHS. (3) Oxidative stress might cause high-level serum Hey in the elderly patients with OSAHS.

Adult ; Aged ; Female ; Homocysteine ; blood ; Humans ; Male ; Middle Aged ; Oxidative Stress ; physiology ; Sleep Apnea Syndromes ; blood

OBJECTIVES: Much attention has been paid to sleep apnea syndrome (SAS) in the elderly because of its high prevalence. It is expected that SAS in the elderly has both similarities and differences compared to SAS in the young or middle-aged populations. The aim of this study was to elucidate the characteristics and consequences of SAS in the elderly. METHODS: In this study we included 210 young or middle-aged adults between 23 and 59 years (20 women and 190 men) and 65 older adults between 60 and 83 years of age (16 women and 49 men). Respiratory disturbance indices (RDIs) of the study subjects were more than 5 in an overnight polysomnography. They completed the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Informations about body mass index (BMI), neck, waist, and hip measurements, and blood pressure were obtained. RESULTS: No difference was observed between older adults with SAS (older SAS) and adults aged under 60 with SAS (SAS aged under 60) in RDI, apnea index, % time of oxygen saturation less than 90%, and PSQI. Obstructive apnea index and oxygen desaturation index (ODI) were lower in older SAS. Compared to SAS aged under 60, lowest oxygen saturation and central apnea index were higher in older SAS, but they were statistically not significant. BMI and neck circumference were significantly lower in older SAS compared to SAS aged under 60. Diastolic blood pressure was lower in older SAS compared to SAS aged under 60 with no difference in systolic blood pressure. Older SAS showed lower scores in ESS than SAS aged under 60. Significant correlation was observed between RDI and BMI in SAS aged under 60, but not in the case of older SAS. The relationships between RDI and neck circumference, systolic and diastolic pressure, and ESS were similar. CONCLUSIONS: The elderly with SAS were not over-weight and there was no relationship between body weight and the severity of SAS. Also, the behavioral and cardiovascular effects of SAS were not marked in the elderly, which might be partly explained by decreased ODI and relatively higher lowest oxygen saturation in older SAS. The normal aging process, aside from increased body weight, might contribute to the development of SAS in the elderly with modest complications.
Adult ; Aged* ; Aging ; Apnea ; Blood Pressure ; Body Mass Index ; Body Weight ; Female ; Hip ; Humans ; Neck ; Oxygen ; Polysomnography ; Prevalence ; Sleep Apnea Syndromes* ; Sleep Apnea, Central

This study was attempted to observe the rate of oxygen desaturation after full oxygenation in six parturients scheduled for Cesarean sections and six patients scheduled for transabdominal hysterectomies. We calculated the mean rate of fall of arterial saturation (slope of desaturation: less than SaO2 (t2)-SaO2(t1) greater than/t2-t1) and changes in arterial blood gases were observed. All subjects were denitrogenated then a single isolated apnea was carried out. The mean time to obtain 90% saturation was longer in the nonpregnant group (7.5 min vs 3.6 min in parturients). The mean slope of desaturation was steeper in the parturients (-3.34) than the nonpregnant group (-1.52). As far as the oxygen reserve is concerned, the parturients had a lesser margin of safety than the nonpregnant women. It was concluded that the lower the thoracic gas volume (parturients), the lower the alveolar O2 stores and, the more rapidly these stores are depleted.
Adult ; Arteries ; Blood ; Blood Gas Analysis ; Female ; Humans ; Obstetric Labor Complications/*blood ; Oxygen/*blood ; Pregnancy ; Sleep Apnea Syndromes/*blood

BACKGROUND: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these pa tients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. METHODS: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. RESULTS: Forty (85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis (p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis (p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis (p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. Tne obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urae nitrogen, creatinine, potassium and phoshorus was observed after hemodialysis (p<0.05), but the differences of paramenters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two night. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis (p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas anslysis (p<0.05). CONCLUSION: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failre, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.
Apnea ; Blood Gas Analysis ; Creatinine ; Electrolytes ; Gases ; Humans ; Hydrogen-Ion Concentration ; Kidney Failure, Chronic* ; Mortality ; Nitrogen ; Polysomnography ; Potassium ; Surveys and Questionnaires ; Renal Dialysis* ; Respiration ; Sleep Apnea Syndromes* ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep, REM ; Snoring ; Urea

OBJECTIVES: Previous studies have shown that periodic limb movements in sleep (PLMS) could be one of risk factors for cardiovascular morbidity. The purpose of this study was to investigate the association between PLMS and blood pressure changes during sleep. METHODS: We analyzed data from 358 adults (176 men and 182 women) aged 18 years and older who were free from sleep apnea syndrome (Respiratory Disturbance Index < 5) and sleep disorders such as REM sleep behavior disorder or narcolepsy. Demographic characteristics, polysomnography records, and clinical variable data including blood pressure, body mass index, alcohol, smoking, and current medications were collected. In addition, self-report questionnaires including the Beck Depression Index, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index were completed. Blood pressure change from bedtime to awakening was compared between the two periodic limb movement index (PLMI) groups [low PLMI (PLMI ≤ 15) and high PLMI (PLMI > 15)]. Blood pressure change patterns were compared using repeated measures analysis of variance. RESULTS: Systolic blood pressure in the high PLMI group was lower than that in the low PLMI group (p = 0.036). These results were also significant when adjusted for gender and age, but were not statistically significant when adjusted for BMI, alcohol, smoking, anti-hypertension medication use and sleep efficiency (p = 0.098). Systolic blood pressure dropped by 9.7 mm Hg in the low PLMI group, and systolic blood pressure in the high PLMI group dropped by 2.9 mm Hg. There was a significant difference in delta systolic blood pressure after sleep between the two groups in women when adjusted for age, BMI, alcohol, smoking, antihypertensive medication use and sleep efficiency (p = 0.023). CONCLUSION: PLMS was significantly associated with a decreasing pattern in nocturnal BP during sleep, and this association remained significant in women when adjusted for age, BMI, alcohol, smoking, antihypertension medication use and sleep efficiency related to blood pressure. We suggest that PLMS may be associated with cardiovascular morbidity.
Adult ; Blood Pressure ; Body Mass Index ; Depression ; Extremities ; Female ; Humans ; Hypertension ; Male ; Narcolepsy ; Polysomnography ; REM Sleep Behavior Disorder ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Smoke ; Smoking