barbecue java barcode generator SLEEP-RELATED BREATHING DISORDERS in Objective-C

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SLEEP-RELATED BREATHING DISORDERS
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Abnormal ventilation during sleep is manifested by apnea (breath cessation for at least 10 seconds) or hypopnea (decrement in airflow with drop in hemoglobin saturation of at least 4%) Episodes of apnea are central if ventilatory effort is absent for the duration of the apneic episode, obstructive if ventilatory effort persists throughout the apneic episode but no airflow occurs because of transient obstruction of the upper airway, and mixed if absent ventilatory effort precedes upper airway obstruction during the apneic episode Pure central sleep apnea
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Clinical Findings
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A Symptoms and Signs
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Most patients with obstructive or mixed sleep apnea are obese, middle-aged men Systemic hypertension is common Patients may complain of excessive daytime somnolence, morning sluggishness and headaches, daytime fatigue, cognitive impairment, recent weight gain, and impotence Bed partners usually report loud cyclical snoring, breath cessation, witnessed apneas, restlessness,
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deformity is present Tracheotomy relieves upper airway obstruction and its physiologic consequences and represents the definitive treatment for obstructive sleep apnea However, it has numerous adverse effects, including granuloma formation, difficulty with speech, and stoma and airway infection Furthermore, the long-term care of the tracheotomy, especially in obese patients, can be difficult Tracheotomy and other maxillofacial surgery approaches are reserved for patients with lifethreatening arrhythmias or severe disability who have not responded to conservative therapy Some patients with sleep apnea have nocturnal bradycardia A pilot study in 15 patients with either central or obstructive sleep apnea showed some improvement in oxygen saturation with atrial pacing This single study must be considered preliminary
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Bao G et al Upper airway resistance syndrome one decade later Curr Opin Pulm Med 2004 Nov;10(6):461 7 [PMID: 15510051] Caples SM et al Obstructive sleep apnea Ann Intern Med 2005 Feb 1;142(3):187 97 [PMID: 15684207] Pack AI Advances in sleep-disordered breathing Am J Respir Crit Care Med 2006 Jan 1;173(1):7 15 [PMID: 16284108] White DP Pathogenesis of obstructive and central sleep apnea Am J Respir Crit Care Med 2005 Dec 1;172(11):1363 70 [PMID: 16100008]
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and thrashing movements of the extremities during sleep Personality changes, poor judgment, work-related problems, depression, and intellectual deterioration (memory impairment, inability to concentrate) may also be observed Physical examination may be normal or may reveal systemic and pulmonary hypertension with cor pulmonale The patient may appear sleepy or even fall asleep during the evaluation The oropharynx is frequently found to be narrowed by excessive soft tissue folds, large tonsils, pendulous uvula, or prominent tongue Nasal obstruction by a deviated nasal septum, poor nasal airflow, and a nasal twang to the speech may be observed A bull neck appearance is common
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B Laboratory Findings
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Erythrocytosis is common A hemoglobin level and thyroid function tests should be obtained Observation of the sleeping patient reveals loud snoring interrupted by episodes of increasingly strong ventilatory effort that fail to produce airflow A loud snort often accompanies the first breath following an apneic episode Polysomnography reveals apneic episodes lasting as long as 60 seconds Oxygen saturation falls, often to very low levels Bradydysrhythmias such as sinus bradycardia, sinus arrest, or atrioventricular block may occur Tachydysrhythmias, including paroxysmal supraventricular tachycardia, atrial fibrillation, and ventricular tachycardia, may be seen once airflow is reestablished
ACUTE RESPIRATORY FAILURE
Respiratory failure is defined as respiratory dysfunction resulting in abnormalities of oxygenation or ventilation (CO2 elimination) severe enough to threaten the function of vital organs Arterial blood gas criteria for respiratory failure are not absolute but may be arbitrarily established as a PO2 under 60 mm Hg or a PCO2 over 50 mm Hg Acute respiratory failure may occur in a variety of pulmonary and nonpulmonary disorders (Table 9 29) A complete discussion of treatment of acute respiratory failure is beyond the scope of this chapter Only a few selected general principles of management will be reviewed here
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