Roger J. Cadieux

Severe obstructive sleep apnea—I: Onset, clinical course, and characteristics

The clinical course and characteristics of severe obstructive sleep apnea are described for 50 adults whose condition warranted recommendation for tracheostomy. All patients had a history of snoring, excessive daytime sleepiness and sleep attacks, nocturnal snorting and gasping sounds and observer-noted nocturnal breath cessations. Generally, these symptoms became manifest before age 40, their appearance tended to cluster together within only a few years and, invariably, they were chronic. Aside from snoring, excessive daytime sleepiness was on average often the first symptom and began at a mean age of 36 years. However, in half of the patients either hypertension or overweight preceded excessive daytime sleepiness by at least 1 year. Physicians in the office setting should suspect severe obstructive sleep apnea in patients who have loud snoring and either excessive daytime sleepiness, hypertension, or obesity. Further evidence of apnea can be obtained by determining the presence of the additional signs of loud nocturnal snorting and gasping sounds and nocturnal breath cessations.

Biopsychobehavioral correlates of insomnia, part 1: Role of sleep apnea and nocturnal myoclonus

Abstract In the first such comparative study, the prevalence of sleep apnea, sleep apneic activity, nocturnal myoclonus, and nocturnal myoclonic activity proved quite similar in 200 insomniac patients and 100 normal controls. None of the 300 subjects manifested the clinical condition of sleep apnea, while similar percentages (5% to 6%) of insomniacs and normal controls displayed nocturnal myoclonus. Thus, the claim that these conditions are common causes of insomnia is not substantiated by this controlled study. However, the presence of psychopathology clearly differentiated between the insomniacs and the controls. The authors conclude that the psychiatrist can thoroughly evaluate the insomniac patient by combining psychiatric assessment with a complete sleep history.

Propranolol in the Treatment of Narcolepsy

Excerpt Narcolepsy is being treated with stimulant drugs (amphetamines or methylphenidate) to control the excessive daytime sleepiness and sleep attacks, and imipramine to manage auxiliary symptoms...

Clinical Experience with the Silicone Tracheal Cannula in Obstructive Sleep Apnea

The surgical and postoperative course was evaluated in 20 patients with severe obstructive sleep apnea who underwent tracheostomy in which a silicone tracheal cannula was used. The cannula has been introduced recently by Dr. William Montgomery for use in a variety of clinical settings. Our findings indicate that the silicone tracheal cannula is a simple and reliable method of maintaining the tracheal airway in patients with severe sleep apnea. There were infrequent complications and a high degree of patient acceptance with this surgical procedure. Advantages of the silicone tracheal cannula include ease of insertion (especially in the often obese neck of the patient with sleep apnea), the inconspicuous nature of the cannula itself, the ease of care, and the maintenance of speech. Thus our clinical experience with this new tracheal cannula in the treatment of certain types of sleep-related breathing disorders indicates that it has a number of advantages as well as infrequent complications.

Narcolepsy/cataplexy. IV: Diagnostic value of daytime nap recordings

ABSTRACT— Sleep and wakefulness patterns in daytime naps of 50 patients with narcolepsy/cataplexy were compared with those of 50 controls. Each subject was monitored polygraphically during 2 one‐hour nap periods. A sleep‐onset REM period in either of the 2 daytime naps was observed to have a higher diagnostic sensitivity (78%) than an abnormally shortened sleep latency (68%). However, the specificities of a sleep‐onset REM period (88%) of abnormally shortened sleep latency (90%) were quite similar. When the occurrence of either a sleep‐onset REM period or a shortened sleep latency was evaluated in either of the two naps, the overall sensitivity was increased to 84% while the specificity was decreased only to 80%. The limitations of and indications for the use of testing for sleep and REM latencies in the diagnosis of narcolepsy in clinical practice are discussed.

Effects of nadolol on blood pressure, sleep efficiency, and sleep stages

The effects of nadolol (20 and 80 mg) on blood pressure and sleep parameters were assessed in six patients with mild hypertension. A 32‐night experimental protocol in the sleep laboratory was instituted consisting of four placebo‐baseline nights followed by 4 weeks of drug administration. Both doses of nadolol had a clear‐cut and consistent lowering effect on blood pressure throughout the night and during the day, with a greater reduction noted with the 80 mg dose. In fact, blood pressure values were reduced to normotensive levels. Neither dose had a disrupting effect on sleep, whereas the 80 mg dose improved sleep efficiency and also had a rapid eye movement‐enhancing effect. This absence of sleep‐disrupting effects is attributed to nadolols low level of lipophilicity and lack of intrinsic sympathomimetic activity. The clinical significance of the lack of sleep disruption and possible improvement of sleep with nadolol is discussed in light of the well‐recognized sleep disturbances produced by other β‐blockers.

Uvulopalatopharyngoplasty as a treatment of obstructive sleep apnea precipitated by uvular prolapse.

Two patients are discussed in whom obstructive sleep apnea was precipitated by uvular prolapse into the larynx and successfully treated by uvulopalatopharyngoplasty. Although tracheostomy has been the definitive treatment for obstructive sleep apnea, uvulopalatopharyngoplasty has also been used as an alternative surgical procedure. However, indications for its successful use have not been clearly defined. Our experience illustrates that the surgical approach to obstructive sleep apnea is dependent on a thorough diagnostic evaluation that includes a sleep history, head and neck examination, hypnopolygraphic recording and, if indicated, nocturnal fiberoptic endoscopy.