Effective Diets for Sleep Apnea

Cure Sleep Apnea Without Cpap

In these real-life case studies youll learn in-depth about the lives and treatments of 9 people who have conquered their apnea. Specifically, youll learn: 1. When they first suspected they had sleep apnea. 2. Symptoms that made them first think they had sleep apnea. 3. Steps they took to get diagnosed. 4. How they felt when they were diagnosed (what was going through their mind) 5. The quality of their sleep before their apnea treatment, and how they felt during the day. 6. What they did to try to get a good nights sleep before their successful treatment. 7. What they did to try to overcome fatigue during the day. 8. A description of exactly what their treatment involved. 9. How they found out about the treatment. 10. Side effects of their treatment. 11. Obstacles they encountered during their treatment, and how they overcame those obstacles. 12. How long it took before the quality of their sleep improved. 13. How long it took before they felt better (more rested) during the day. 14. How long its been since they conquered their sleep apnea. 15. Resources they recommend for others who suffer from sleep apnea, and would like to follow their treatment (the name of specific doctors and medical centers) 16. Final words of advice for people who have just been diagnosed with sleep apnea. Here Is a Tiny Sample of What Youll Get When You Download Your Copy Of Cure Your Sleep Apnea Without Cpap: 78 pages of actionable information on alternative, non-Cpap sleep apnea treatments. 9 case studies of men and women who have completely cured their sleep apnea without Cpap. 7 types of alternative treatments that are proven to cure sleep apnea (detailed descriptions) 12 action steps for each alternative treatment, so you know exactly how to take action on each treatment. 7 quick fix sleep treatments that can help you get a better nights sleep Tonight. 69 hand-picked web links for further information on alternative sleep apnea treatments. 31 diagrams explaining alternative sleep apnea treatments Read more...

Cure Sleep Apnea Without Cpap Summary


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Contents: 78 Pages EBook
Author: Marc MacDonald
Price: $47.00

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My Cure Sleep Apnea Without Cpap Review

Highly Recommended

Recently several visitors of blog have asked me about this ebook, which is being advertised quite widely across the Internet. So I purchased a copy myself to find out what all the excitement was about.

In addition to being effective and its great ease of use, this eBook makes worth every penny of its price.

The Sleep Apnea Exercise Program

Here Is a Tiny Sample of What Youll Get When You Register for the Sleep Apnea Exercises Program: 18 step-by-step videos that show you exactly how to do the sleep apnea exercises. A 52-page manual that includes a description of each exercise; illustrations to show you how to do each exercise; an explanation of what each exercise does for your body. The manual includes these sections: Causes of sleep apnea; Relationship between sleep apnea and snoring. Scientific studies backing up sleep apnea exercises. How to test your sleep apnea at home. Daily tasks to keep your sleep apnea at a low level. Names and website addresses of speech language pathologists in the U.S. and U.K. who specialize in sleep apnea, and have agreed to list their contact details in my manual. Names and contact details for obstructive sleep apnea support groups. MP3 (audio) recordings of the exercises that you can download and listen to on your iPod, iPhone, or MP3 device. (This is especially useful for the exercises that youll want to do in front of the mirror) Access to an online Members Area, where youll be able to download the manual, watch the videos, and get the bonuses!

The Sleep Apnea Exercise Program Summary

Contents: 52 Pages EBook, 18 Videos
Author: Marc MacDonald
Official Website: www.sleepapneaexercise.com
Price: $47.00

Obstructive Sleep Apnea

Obese women with PCOS are at increased risk for obstructive sleep apnea (OSA) (56). Based on the increased prevalence of OSA in men, and recent evidence that androgens may play a role in the male predominance, overnight polysomnog-raphy was performed in obese women with PCOS and age weight-matched controls (56). Women with PCOS had a significantly higher apnea-hypopnea index (AHI), and were more likely to suffer from symptomatic OSA syndrome. The AHI correlated with waist-hip ratio, as well as total and free testosterone levels. g Vgontzas et al. (57) also reported that sleep-disordered breathing (SDB) and ex-

Modulation of Ve by Switching Between Two CPAPLevels

Time cycled switching between two levels of continuous positive airway pressure (CPAP) allows unrestricted spontaneous breathing in any phase of the mechanical ventilatory cycle. Changes in ventilatory demand do not result in any change in the level of mechanical support. Adjusting ventilatory rate and ventilation pressures allows infinitely variable support of spontaneous breathing. This principle is applied during airway pressure release ventilation (APRV) 10, 11 and bilevel positive airway pressure (BiPAP) 12 .

Treatment Of Sleep Apnoea And Snoring

The approach to treatment will vary according to severity of symptoms, severity of hypoxaemia during sleep and cost. In the absence of significant data showing a deleterious effect of asymptomatic sleep apnoea, treatment for prognosis alone is probably A number of studies have demonstrated a reduction in sleep apnoea severity after weight loss, either through caloric restriction or bariatric surgery. However, it is important to reassess patients after weight loss and ensure there is little residual disordered breathing. Most published reports indicate that, although there is a reduction in apnoea index, a significant degree of apnoea persists, which in most cases warrants further treatment (86-88). Weight loss associated with apparently successful bariatric surgery may have limited efficacy in reducing sleep apnoea as many patients also have maxi-llo-facial abnormalities predisposing them to OSA (80). Recent data from the SOS Study show a marked reduction in sleep apnoea...


R randomized NR non randomized PEEP positive end expiratory pressure PSV pressure support ventilation CPAP continous positive airways pressure BiPAP bilevel positive airways pressure NE not evaluated R randomized NR non randomized PEEP positive end expiratory pressure PSV pressure support ventilation CPAP continous positive airways pressure BiPAP bilevel positive airways pressure NE not evaluated Despite the dramatic improvement in the prognosis of HIV-infected patients due to the new anti-retroviral drugs, acute respiratoryfailure due to P. carinii and other opportunistic agents remains the main cause for ICU admission and mortality among patients with AIDS. These patients are generally treated with face-mask CPAP. Two groups have reported the use of non-invasive positive pressure ventilation (NPPV, CPAP + PSV) in patients with AIDS and hypoxemic acute respiratory failure 31-32 . Rabbat etal. 32 reported on 18 patients suffering from acute respiratoryfailure complicating AIDS,...

Sleep Apnea

Obstructive sleep apnea can adversely affect reproductive function (106), and one study found that androgen therapy can precipitate sleep apnea (107). An observational study reported a high prevalence of obstructive sleep apnea in men on hemodialysis and examined whether testosterone ester injections are causative (108). Sleep apnea symptoms were common (12 29, 41 ), particularly in those receiving regular testosterone enanthate injections (250 mg wk) to stimulate erythropoiesis (9 12, 75 ), compared with those not receiving testosterone (6 17, 35 ). However, withdrawal of testosterone did not alter the signs or symptoms of sleep apnea in the five men studied both during and 2 mo after cessation of testosterone treatment. Further surveillance has shown that sleep apnea is common in patients with chronic renal failure even before commencement of dialysis or testosterone treatment (109). Hence, the contribution of pharmacological androgen therapy to breathing while asleep (and...

List of Abbreviations

Britain & Ireland ADH antidiuretic hormone AED automated external defibrillator ALS advanced life support ALT alanine aminotransferase APC activated protein C APPT activated partial thromboplastin time ARDS acute respiratory distress syndrome ASA American Society of Anesthesiologists AST aspartate aminotransferase ATN acute tubular necrosis BLS basic life support BNF British National Formulary CAVH continuous arteriovenous haemofiltration CBF cerebral blood flow CCU coronary care unit CLCR creatinine clearance CNS central nervous system COPD chronic obstructive pulmonary disease COX cyclo-oxygenase enzymes (COX-1, 2) CPAP continuous positive airway pressure CPR cardiopulmonary resuscitation CSF cerebrospinal fluid CT computerized tomography CVP central venous pressure CVS cardiovascular system CVVH venovenous haemofiltration DIC disseminated intravascular coagulation DNAR do not attempt resuscitation ECF extracellular fluid EMLA eutectic mixture of local anaesthetics ENT ear, nose and...

Weight Monitoring for Schizophrenia

Patients with schizophrenia should be given nutritional counseling and recommendations for an exercise regimen, given their propensity for poor dietary habits and sedentary lifestyle. Primary care practitioners, family members, and other caregivers should be alerted to the risk of obesity during treatment with certain novel antipsychotics, as the potential complications of weight gain in patients with schizophrenia can be serious. It is also essential that patients be educated regarding the weight gain liability of their antipsychotic medication to minimize the risks of obesity and its related health consequences. Multiple cases of new-onset diabetes (Wirshing et al. 2001a), hyperlipidemia (Meyer 2001 Wirshing et al. 2001b), and sleep apnea have been reported as potentially associated with antipsy-chotic-related weight gain (Furst et al. 2002), although there may also be effects of certain novel antipsychotics on glucose tolerance and lipids independent of their effects on weight....

Strong Recommendation

Along with COPD exacerbation, cardiogenic pulmonary edema is one of the two most common indications for non-invasive positive pressure techniques in the acute setting 15 . The evidence supporting the use ofpositive pressure in pulmonary edema, however, is stronger for the use of continuous positive airway pressure (CPAP) than for NIV (in which air pressure is increased during inspiration). CPAP has been used for many decades to treat cardiogenic pulmonary edema and the rationale for its application is quite strong. CPAP rapidly improves oxygenation by re-expanding flooded alveoli. It also increases functional residual capacity (FRC), thus more favorably positioning the lung on its compliance curve 16 , reducing the work of breathing. Further, it can improve cardiac performance by raising pericardial pressure 16-18 , lowering transmural pressure and thereby decreasing afterload 19, 20 . This favorable hemodynamic effect is most likely to occur when fillingpressures are high and...

Androgen Replacement Therapy

Testosterone therapy is safely and easily accomplished either by periodic intramuscular injection of testosterone esters or with newer (and more expensive) transdermal patches and gels described in detail elsewhere in this volume (see Chapter 18). Replacement doses for the intramuscular esters of testosterone are 100-200 mg intramuscularly every other week in adults, whereas adolescents are started at lower doses (e.g., 50-100 mg every 2-4 wk) and are gradually increased to adult doses over 2-3 mo (13). Testosterone therapy side effects include weight gain, mostly owing to increases in lean body mass, and acne. In older men, erythrocytosis is seen with some frequency. Induction or a worsening of sleep apnea has also been reported (52). In general, testosterone therapy is both beneficial and well-tolerated by individuals with KS, most of whom continue therapy long-term (54). Twenty-year follow-ups of cohorts of men with KS treated with testosterone have demonstrated marked improvements...

Maintenance of Anesthesia

It is obviously difficult to maintain adequate ventilation under positive pressure in this severely compromised group of patients with end-stage pulmonary disease. One-lung ventilation compromises pulmonary function even further, as there is no ventilatory reserve. In addition, measures usually employed to treat hypoxemia and hypercarbia during one-lung ventilation may worsen the patient's status rather than improve it. Conventional therapy for the treatment ofhypoxia during one-lung ventilation is the application of continuous positive airway pressure (CPAP) to the operative lung and or PEEP to the ventilated lung. Continuous positive pressure applied to the emphysematous lung will result in significant air trapping, a rise in pulmonary artery pressure and decreased venous return resulting in worsening of both pulmonary and cardiovascular function. Hypoxia may worsen, air leaks may develop, hypercarbia may increase, and hypotension can result. For reasons aforementioned, application...

Upper Airway Obstruction

Severe upper airway obstruction from a variety of causes may be complicated by the development of pulmonary hypertension. These include, obstructive sleep apnea which may be associated with the Pickwickian syndrome. Obesity, through the increased work of breathing andC02 production,

Altered States Of Consciousness Internal Influences

Not all people experience smooth patterns of sleeping. Disturbances take several forms, including insomnia, sleep apnea, narcolepsy, and somnambulism (sleepwalking). Insomnia, the inability to fall asleep, is the most common sleep disorder. It may occur at the start of the sleeping period or may be experienced as waking during the night and being unable to fall asleep again. Sleep apnea is marked by complete stoppage of breathing for a few seconds to more than a minute. Associated with obesity and alcohol use in adults, sleep apnea also is thought to be a possible cause of sudden infant death syndrome (SIDS) in children. Sudden, uncontrollable attacks of sleep during the normal waking period mark narcolepsy. A narcoleptic usually sleeps for about 15 to 20 minutes with each incident. Narcolepsy can be dangerous if, for example, the sleeping urge occurs while one is operating machinery. Somnambulism (or sleepwalking) typically occurs during non-REM sleep. Most incidents...

Clinical Trials Using Conventional Mechanical Ventilation

Five different randomized trials were conducted in the 1990s to test modified mechanical ventilation strategies in ARDS patients (Table 1). One of these trials compared clinical outcomes in ARDS patients randomized to receive either a conventional approach with generous Vt and relatively low levels of PEEP to those randomized to receive small Vt and relatively high levels of PEEP 31 . Patients in the small VT higher PEEP group also received recruitment maneuvers (continuous positive pressure airway pressure CPAP of 40 cmH2O for 40 seconds) to reverse atelectasis. Oxygenation was substantially improved with the small VT high PEEP approach. Thus, higher levels of PEEP can compensate for the deleterious effects of the small Vt approach on oxygenation. The small VT higher PEEP approach was also associated with respiratory acidosis, as expected. However, the small VT higher PEEP approach was associated with substantially improved survival. These striking results demonstrated that the...

Case Study for Chapter

This patient is suffering from what has been known as pickwickian syndrome, a disorder that occurs with severely obese individuals because of their excessive weight. The pickwickian syndrome was named after Joe, the fat boy who was always falling asleep in Charles Dickens' novel The Pickwick Papers. Pickwickian patients suffer from hypoventilation and often suffer from sleep apnea as well. Pickwickian syndrome is no longer an appropriate name because it does not indicate what type of sleep disorder is involved. About 80 of sleep apnea patients are obese and 20 are of relatively normal weight. 2. Polycythemia is the result of chronic hypoxemia from hypoventilation, as well as from sleep apnea. 3. An increase in sympathetic discharge is often associated with sleep apnea and is responsible for the accelerated heart rate.

Effects of Blood PO2 on Ventilation

Chemoreceptors Graph Pco2

A variety of disease processes can produce cessation of breathing during sleep, or sleep apnea. Sudden infant death syndrome (SIDS) is an especially tragic condition that claims about I in 1,000 babies under 12 months in the United States annually. Victims are apparently healthy 2-to-5-month-old babies who die in their sleep for no obvious reason hence, the layperson's term crib death. These deaths seem to be caused by failure of the respiratory control mechanisms in the brain stem and or by failure of the carotid bodies to be stimulated by reduced arterial oxygen. Since 1992, when the American Academy of Pediatrics began a campaign recommending that parents put infants to sleep on their backs rather than on their stomachs, the number of infants dying from SIDS has dropped by 38 .

Monoaminergic and Cholinergic Interactions and Cataplexy

The BF is anatomically connected with the limbic system, which is regarded as a critical circuit for integrating emotions. Furthermore, BF neurons are known to respond to the arousing property of appetitive stimuli,61 which we use to induce cataplexy in narcoleptic dogs. Considering the fact that emotional excitation is an alerting stimulus in normal animals but induces cataplexy in narcoleptic animals, the BF may be involved in triggering a paradoxical reaction to emotions-atonia rather than wakefulness, in narcoleptic animals. These results also suggest that more global brain structures (than those for REM sleep generation) are involved in the induction of cataplexy. Cataplexy is now demonstrated to be tightly associated with the loss of hypocretin neurotransmission. Global and persistent cholinergic monoaminergic imbalance due to the loss of hypocretin neurotransmission may be required for the occurrence of cataplexy, and cataplexy could not be induced simply by an increase in REM...

Inflation and Pulmonary Vascular Pressure

Lung Capillary Compression

Knowing that the frequency of ventilation was an important determinant of VILI, we reasoned that a lung exposed to pulsatile vascular pressure but not ventilated might experience significant injury, even without fluctuations of airway pressure. In an experiment designed to test this question, we applied a damaging pattern of airway pressure (plateau 30 cmH2O, PEEP 5 cmH2O) to one of three sets of lung preparations and allowed others to remain motionless 26 . In the ventilated group, peak pulmonary artery pressure was allowed to rise to 35 mmHg. Left atrial pressure was held at 10 mmHg and mean airway pressure at 17.5 cmH2O. This set of ventilated preparations was compared to two unventilated groups held without tidal fluctuations of airway pressure (continuous positive airwaypressure CPAP 17.5 cmH2O) in which in which all key hemodynamic pressures - peak, mean and nadir - were identical to their ventilated counterparts. In the latter two groups, a vascular pump applied pulsatile...

Cardiovascular Effects

Picture Mechanical Ventilator Aprv

Periodic reduction of intrathoracic pressure resulting from maintained spontaneous breathing during mechanical ventilatory support promotes the venous return to the heart and right- and left-ventricular filling, thereby increasing cardiac output and DO2 36 . Experimental 27, 29, 37, 38 and clinical 24, 30, 36 studies show that during APRV BiPAP with spontaneous breathing of 10 to 40 of total Ve at unchanged Ve or airway pressure limits results in an increase in cardiac index (Fig. 5). Simultaneous rise in right ventricular end-diastolic volume during spontaneous breathing with APRV BiPAP indicates improved venous return to the heart 24 . In addition, the outflow from the right ventricle which depends mainly on the lung volume which is the major determinant of pulmonary vascular resistance may benefit from a decrease in intrathoracic pressure during APRV BiPAP 24 . In contrast, ventilatory support of each individual inspiration with PSV and identical airway pressures produces no...

Current Limitations Possible Solutions and Enhancement Technologies

In the meantime, clinical applications of electrical brain stimulation have gained world-wide acceptance in the treatment of movement disorders. Indications have been extended and Medtronic Inc., the major manufacturer of such implants, uses its products in clinical tests to pulse the thalamus for the treatment of epilepsy another region of the deep brain to treat migraines, depression, and obsessive-compulsive disorder the hypoglossal nerve in the neck to treat sleep apnea the sacral nerve to treat bowel disorders and the stomach to treat obesity. Parallel to the efforts of modelling and duplicating neural networks, efforts are underway to establish improved connections between electrodes and neurons.

Hypocretin Deficiency In Human Narcolepsy

Despite the lack of an identified genetic cause, hypocretin deficiency as cause of human narcolepsy remained an attractive hypothesis. To further study this an assay for the measurement of hypocretin was developed and cerebrospinal fluid (CSF) hypocretin-1 measurements were performed blindly in a small series of patients and controls.15 The astonishing finding was that 7 out of 9 patients had an undetectable low hypocretin-1 level, in contrast to the control group having levels about 7 times the detection limit, and all in a narrow range. Subsequently, a large extension study was performed to confirm these findings and establish the sensitivity and specificity.16,17 Several hundreds of subjects were included healthy controls, patients with typical narcolepsy, atypical narcolepsy, idiopathic hypersomnia, sleep apnea, restless legs, periodic limb movements disorder, insomnia patients as well as patients suffering from a wide variety of neurological disorders. From these data the...

Newly Identified Risks

Cases and respiratory arrests in sleep apnea patients after postoperative narcotics. Sleep Apnea and Narcotic Postoperative Pain Medication A number of malpractice cases reviewed by TDC involved postoperative respiratory arrests in patients with obstructive sleep apnea (OSA) who had received parenteral narcotics (11). Sleep apnea is a common disorder, with a prevalence of 1 to 4 in the middle-aged population (12,13). Affected patients are more likely to be obese, and there is a predominance of male OSA patients. Patients with sleep apnea have narrower upper airways that tend to collapse with normal rapid eye movement sleep. This tendency to obstruction is markedly increased by narcotic pain medication. OSA patients are much more sensitive to narcotic sedation than normal individuals (12,13). The effect of the narcotics on obstruction can be out of proportion to the level of sedation achieved (14). Many of these patients were described by nurses as complaining vociferously of pain...

Recommended with Caution

Decompensated Obstructive Sleep Apnea or Obesity-Hypoventilation Syndrome Patients with acute on chronic respiratory failure caused by sleep apnea syndrome have been treated with NIV and transitioned to CPAP once stabilized 77 , but no controlled trials have evaluated this application. NIV is indicated for such patients if they have acute worsening of CO2 retention and are otherwise good candidates for NIV. Indications for NIV in the acute setting have been broadening over the past decade, based on accumulating evidence and experience. The best-established indications remain acute exacerbations of COPD and acute pulmonary edema, with non-invasive CPAP being the positive pressure mode supported by the strongest evidence for the latter diagnosis. However, NIV can be used for numerous other diagnoses, as long as selection guidelines are observed. Strong evidence supports the use of NIV for immunocompromised patients with acute respiratory failure, largely because of the risk of invasive...

Perioperative Anesthetic Management

It must be remembered that all sedative drugs exacerbate obstructive sleep apnea and should be avoided in those patients suspected of having the condition. It is common practice to administer hydrocortisone (100 mg) on induction of anesthesia, although the need for this is being increasingly questioned.

Setting Ventilation Pressures and Tidal Volumes

Mechanical ventilation with PEEP titrated above the lower inflection pressure of a static pressure-volume (V P) curve and low Vt has been suggested to prevent tidal alveolar collapse at end-expiration and overdistension of lung units at end-inspiration during ARDS 58 . This lung-protective ventilatory strategy has been found to improve lung compliance, venous admixture, and PaO2 without causing cardiovascular impairment in ARDS 58 . Recently, a lung protective mechanical ventilation using Vt of not more than 6 ml kg ideal body weight has been shown in large-scale clinical trials to improve outcome in patients with ARDS 58,59 . Based on these results the CPAP levels during APRV BiPAP should be titrated to prevent end-expiratory alveolar collapse and tidal alveolar overdistension 58, 59 . In our investigations, CPAP levels were always adjusted. When CPAP levels during APRV BiPAP were adjusted according to a lung-protective ventilatory strategy occurrence of spontaneous breathing...

Health Impact of Obesity in Childhood

Obese children and adolescents are at increased risk of developing a number of health problems. The most significant long-term consequence is the persistence of obesity and its associated health risks into adulthood. Some 30 of obese children become obese adults. This is more likely when the onset of obesity is in late childhood or adolescence and when the obesity is severe. Other obesity-related symptoms include psychosocial problems, raised blood pressure and serum triglycerides, abnormal glucose metabolism, hepatic gastrointestinal disturbances, sleep apnoea and orthopaedic complications.

Evidence and Limitations of Recent Clinical Trials


The recent randomized clinical studies 1,2,46-48 on lung protective ventilation gave rise to much debate. Some important aspects require further comment in this chapter. Although the five studies addressed the consequences of the 'baby lung theory' by limiting the end-inspiratory pressure, only the Brazilian study applied a first-intention strategy to prevent cyclic collapse and reopening 1 . The chosen PEEP-titration method at the time was the inspiratorypressure volume curve. PEEP was set at 2 cmH2O above the LIP (Pflex) ofa pressure volume curve obtained before randomization. This PEEP strategy was applied on the protective ventilation arm after a recruitment maneuver with continous positive airways pressure (CPAP) of 35 to 40 cmH2O for 40 seconds. On that occasion, we believed that nearly maximal recruitment and aeration could be achieved with this strategy. Later investigation suggested, however, that the term 'open lung approach' needed some review. The theoretical limitations...

Gastric Bypass Complications

At the FDA Advisory Panel session23 only 115 patients had been followed for three years following the procedure. Patients lost approximately one-third of excess weight and one-third of patients required either revision or removal of the device. In a series of international patients presented from Europe and Australia, surgical revision or repair of tubing or removal of the device has been necessary in 28 , the most common problem being prolapse. The mean EWL following the procedure was 38 . In these patients, diabetes, sleep apnea, and hypertension resolved in only 22 , 40 and 55 respectively. In the Swedish Obese Subjects study,11 most patients had either vertical-banded gastroplasty or implantation of the so-called Swedish band (which differs from the current device in design, introduction method, and reported results) and had only 23 loss of body weight despite a rather low average preoperative BMI of 42 kg m2. The authors also noted a rather disappointing 47 reduction in diabetes...

Other Possible Adverse Effects

Sleep-related breathing disorders may be aggravated by testosterone replacement (72). Thus, a detailed history for symptoms of sleep apnea before and during testosterone treatment must be obtained. Patients at high risk for sleep apnea (obese and elderly) should be investigated and treated for sleep apnea before beginning androgen-replacement therapy.

Replacement Therapy In Hypogonadal

The absolute contraindications to androgen replacement therapy are carcinoma of the prostate and breast. These are androgen-dependent tumors. Another contraindication includes an elevated hematocrit or hemoglobulin level (e.g., hematocrit 53 ). Androgen treatment may cause fluid retention and, in unusual circumstances, may precipitate or aggravate heart failure. In older patients with symptoms or signs of moderate or severe of congestive heart failure, androgens should not be used until the heart failure has been treated. Although there is minimal evidence to implicate testosterone in the development or aggravation of benign prostate hyperplasia (BPH), if a patient has lower urinary tract obstructive symptoms of BPH, then the symptoms should be controlled before institution of testosterone replacement. Obese and older subjects who may be at risk of sleep apnea should be carefully questioned about their ventilatory disturbances during sleep. Such symptoms should be appropriately...

Pulmonary Function and Mechanics

Dyspnoea than those without OSA (22). Weight loss following bariatric surgery results in significant relief of these symptoms (23), with an independent association between the reduction in sleep-disordered breathing and relief of breathlessness and chest pain. This suggests that OSA is implicated in the genesis of these symptoms in subjects with obesity, possibly through effects on respiratory control with relative daytime hypoventilation and resulting mild hypoxaemia. In the absence of weight loss, continuous positive airway pressure (CPAP) therapy can improve daytime gas exchange and respiratory control (24,25) in patients with OSA and so may also reduce the incidence of daytime respiratory symptoms in obese subjects with OSA. What is Sleep Apnoea Sleep-disordered breathing encompasses a spectrum of conditions ranging from snoring through to profound nocturnal hypoventilation and respiratory failure. Obstructive sleep apnoea (OSA) is characterized by repetitive cessation of airflow...

Screening For Obesity

Although obesity should be regarded as a disease entity of its own, many of its more serious consequences are due to the strong relations that exist between obesity and some common chronic diseases. Obesity is an important risk factor for type 2 diabetes, cardiovascular disease, sleep apnoea, gallbladder disease and certain types of cancer.

Proteomic Analysis of Renal Kallikrein Pathway in Hypoxia Induced Hypertension

Obstructive sleep apnea syndrome (OSAS), a disorder characterized by episodic hypoxia (EH), is a major public health problem. OSAS affects 4-5 of the general adult population and 1-2 of children in the United States. One of the major consequences of untreated OSAS is systemic hypertension. In addition to hypertension, OSAS has also been associated with both proteinuria and end-stage renal disease. A rat model of EH was used to obtain proteins from the kidney after EH induction, which were resolved by two-dimensional PAGE and then identified by MALDI-MS (72). Proteomic analysis showed that EH induces changes in renal protein expression consistent with the impairment of vasodilation mediated by kallikrein-kallistatin pathway. However, transgenic rats expressing human tissue kallikrein were protected from EH-induced hypertension. The results obtained from kallikrein transgenic rats reinforce the proteomic data. Therefore, EH-induced hypertension may result, in part, from altered...

Physiologic Anemia

If on CPAP or mechanical ventilation with mean airway pressure 6 cm H2O Abbreviation CPAP, continuous positive airway pressure by nasal or endotracheal route. Modified from Hume, H. Red blood cell transfusions for preterm infants the role of evidence-based medicine. Semin Perinatol 1997 21 8-19, with permission.

Navigator Pitfalls

Identification of the dome on 2 orthogonal planes is advised. Localization of the navigator with 1 3 above the lung-liver interface and 2 3 below is recommended. Caudal 'drift' of the end-expiratory diaphragmatic position is sometimes observed which may adversely affect the efficiency of the scan. However, this is often related to sleep apnea or a low frequency pattern overlaid to the respiration, and in most cases the end-expiratory diaphragmatic position returns to its original position. On average, the navigator efficiency should approach 50 which prolongs the nominal scanning time by a factor of 2. Navigator efficiencies below 20 and above 80 are suboptimal meaning that the localization of the navigator may need to be adapted. Stopping and restarting the scan may help in some cases. General patient motion can be minimized by specifically informing the patient that changing the position of the legs (crossed vs. non-crossed) should be avoided during the scan session. Asking the...


Pharmacological androgen therapy in chronic renal failure has a proven indication only for treatment of renal anemia, where it has been widely applied for more than three decades before being largely supplanted by recombinant human EPO. Although EPO is highly effective and widely used (including for women and children where androgens are best avoided), it is much more expensive. Recent studies suggest pharmacological androgen therapy is as effective as EPO in older men, and has synergistic, EPO dose- (and cost-) sparing effects in conjunction with low-dose EPO therapy. This suggests a diminished but continuing role of pharmacological androgen therapy for renal anemia. The potential for pharmacological androgen therapy to improve nutritional status and nonreproductive functions has long been considered, but the overall benefits on quality of life and survival remain to be well established. Such potential benefits would have to be weighed against potential adverse effects, including...

Sleep Disturbances

Sleep apnea refers to failure to breathe for brief periods during sleep. It usually results from upper airway obstruction, as is seen in obesity, alcohol consumption, or weakened throat muscles, and is usually accompanied by loud snoring with brief periods of silence. Dental appliances that move the tongue and jaw forward may help to prevent sleep apnea. Other options are surgery to correct obstruction or positive air pressure delivered through a mask.

Future Developments

PSV may greatly benefit by technological improvement. Most innovations are being introduced in the patient-ventilator synchronization. Messinger et al. performed a tracheal pressure triggered CPAP, demonstrating that by moving the triggering site at the carinal end of endotracheal tube, WOB is reduced. This result is achieved by avoiding the additional work to overcome the resistance of the

Sleep Apnea

Sleep Apnea

Have You Been Told Over And Over Again That You Snore A Lot, But You Choose To Ignore It? Have you been experiencing lack of sleep at night and find yourself waking up in the wee hours of the morning to find yourself gasping for air?

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