News - Part 28

There is some support for this explanation in that we found no difference in survival between UPPP responders and nonresponders. In elderly patients the effect of OSA on longterm survival is less clear. Ancoli-Israel and colleagues showed an association between OSA and decreased survival in elderly women but not in men. Bliwise and coworkers demonstrated no difference in mortality in a group of treated and untreated elderly patients with OSA compared with controls.
The major cause of increased mortality in OSA appears to be cardiovascular in nature. Partinen and associates found an age-adjusted odds ratio of vascular mortality of 4.7. Long-term follow-up of the same patients has shown a relative risk of developing new vascular problems of 2.3 (95 percent confidence interval of 1.5 to 3.6). Obstructive sleep apnea is associated with significant cardiac arrhythmias and cyclical variation of systemic blood pressure during sleep. Both chronic snoring, which usually precedes the onset of florid OSA, and OSA have been shown to be significant risk factors for the development of cardiovascular and cerebrovascular disease. The combined effects of systemic hypertension, hypoxemia, and increased sympathetic activity during sleep are thought to promote the development of atherosclerosis. canadian healthcare mall

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Long-Term Survival of Patients With Obstructive Sleep Apnea Treated by Uvulopalatopharyngoplasty or Nasal CPAP - DiscussionOne hundred forty of the 149 UPPP patients (94 percent) had a follow-up polysomnogram. Eighty-nine of the 140 (63 percent) had a postoperative AI of less than 5 and a further 25 (18 percent) had a greater than 50 percent reduction in AI giving an overall 81 percent response rate. Patients who did not respond well to UPPP ( < 50 percent decrease in AI) tended to be older (mean± SD age, 55±10 years vs 50 ± 11 years, p < 0.02); however, their body mass index and preoperative AI were not significantly different (29.7 ± 4.6 kg/1112 for responders vs 30.8 ±5.7 kg/1112 for nonresponders and 25.6 ± 17.4/h vs 25.0 ± 14.0/h, respectively). All patients with nasal CPAP had an AI less than 5/h on follow-up polysomnography. There was 110 significant difference in posttherapy awake or asleep arterial oxygen saturation between survivors and nonsurvivors in either the patients with UPPP or nasal CPAP. In the UPPP patient group, 3 of the 9 patients (33 percent) without a follow-up polysomnogram died compared with 3 deaths in the 140 patients (2.1 percent) with a follow-up polysomnogram. The follow-up AIs of the 3 patients with UPPP who died and had a follow-up polysomnogram were 23/h, 5/h, and 1/h. The patients in both treatment groups who died were older (mean age, of 60 ±9.3 years, p < 0.001), but initial AI (mean of 34.3 ± 25/h) and body-mass indices (31.1 ± 9.2 kg/m2) were not significantly different from the survivors. my canadian pharmacy online

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One hundred fifty-four patients were treated with UPPP and 208 were treated with nasal CPAP during the 6-year period. Five of the 154 patients treated with UPPP were subsequently treated with nasal CPAP because of an unsuccessful response to surgery, and they were excluded from further analysis. Follow-up was complete in 137 of the remaining 149 patients. Twelve patients were unavailable for follow-up but were were included in the survival analysis. Six deaths occurred among the remaining 137. Eighty-two (40 percent) of the 208 patients initially treated with nasal CPAP were no longer using this form of treatment at the time of follow-up. Forty-four of these 82 elected to have a UPPP, 3 a tracheostomy, 6 an intraoral appliance, and 29 were not using any specific therapy. Thirty-two of the 44 patients going on to UPPP were included in our UPPP group, the other 12 had their surgery after conclusion of the study period or in another center. Only the 126 patients who were using nasal CPAP at the time of contact were included in the initial analysis. Nine were unavailable for follow-up but were included in the survival analysis. Three deaths occurred among patients treated with nasal CPAP.
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Long-Term Survival of Patients With Obstructive Sleep Apnea Treated by Uvulopalatopharyngoplasty or Nasal CPAP - MethodsObstructive sleep apnea (OSA) is a relatively common condition that may affect up to 2 percent of the adult population. There are limited data on the mortality associated with OSA, Ык most studies suggest a decreased long-term survival. Patients with OSA have an increased likelihood of cardiovascular-related death and may be more likely to die in their sleep. In the only study that examined different treatment modalities,2 mortality was decreased in patients treated with nasal continuous positive airway pressure (CPAP) and tracheostomy, but not in those patients treated with uvulopalatopharyngoplasty (UPPP), when compared with untreated patients. Although nasal CPAP is the primary treatment for OSA, some patients cannot tolerate nasal CPAP on a long-term basis.’ Uvulopalatopharyngoplasty continues to be widely performed and it is an effective treatment in selected patients. canadianfamilypharmacy

The primary objective of this retrospective study was to compare the long-term survival between patients with OSA treated with UPPP and nasal CPAP. Secondary objectives were to determine the most common cause of death in these patients, to establish whether there is an increased risk of dying during the night, and to examine the impact of follow-up polysomnography on long-term survival after UPPP.
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Therefore, the identification of an accelerated phase of respiratory failure is prog-nostically important. In fact, in this phase, other therapeutic measures (such as some form of intermittent mechanical ventilatory assistance) other than LTOT have been suggested to control the evolution of the disease.
In our patients treated with LTOT, the rate of decline of Pa02 over time as well as the rate of increase of PaC02 were less pronounced than those reported by Cooper and Howard. The life expectancy of our patients was very poor because they had had an episode of ARF requiring mechanical ventilation and also because they subsequently experienced several relapses of ARF. Despite this, the worsening of the respiratory function was relatively slight. One possible explanation is that all of our patients but one stopped smoking at the beginning of the follow-up. It is well known that FEVX is highly correlated with survival and that it decreases faster in smokers than in nonsmokers or ex-smokers. Stopping smoking reduces the decline of FEVX to the level found in nonsmokers. A lower survival rate has been reported in patients with COPD receiving LTOT who continued smoking compared with those who stopped. However, if one compares the survival rate at 2 years of our patients receiving LTOT with that of the nonsmokers of the Swedish study, the difference in favor of our group is considerable (86 percent vs 55 percent). Thus, other factors could have influenced the slight worsening of the respiratory function found in our patients.
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The Effect of Intermittent. Negative Pressure Ventilation and Long-term Oxygen Therapy for Patients With COPD - DiscussionLong-term oxygen therapy has been shown to improve the quality of life and the length of survival of patients with COPD with hypoxemia, even though this form of treatment does not seem to arrest the course of the underlying airway disease. Recendy, Cooper and Howard studied a series of 35 patients with COPD receiving LTOT and observed a worsening of FEVj before death despite the administration of oxygen. This observation suggests that oxygen therapy is ineffective in arresting the progression of the disease and that patients with low FEVj values at the commencement of LTOT are therefore likely to receive a limited benefit from oxygen. Long-term oxygen therapy is generally recognized to improve survival in patients with COPD who present with an acute exacerbation treated with mechanical ventilation. To our knowledge, however, no specific data supporting this conclusion have been published.
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Table 1 shows the anthropometric data, the blood gas analysis measurements, and the spirometric values obtained from the two groups of patients. These data indicate that group A presented a more marked degree of bronchial obstruction and a more severe hypoxemia and hypercapnia at discharge.
Thirty patients (86 percent) of group A and 32 patients (73 percent) of group В presented relapses of ARF during the follow-up with a total number of 1 to 11 episodes per patient in group A (mean ± SD = 3.31 ± 2.86) and 1 to 8 episodes per patient in group В (mean±SD = 1.95 ±2.1). Each episode was treated with our conservative ventilatory method. The values of RM of the two groups were similar (RM = 0.09 ± 0.08 in group A, RM = 0.13 ± 0.22 in group B). The disease-free interval between the beginning of follow-up and the first relapse was 10.616.5 and 12.9 ±12.1 months in groups A and B, respectively. Twenty-one (48 percent) patients of group В and 20 (57 percent) of group A had a relapse of ARF during the first 12 months of follow-up.
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