Frequency Of Sleep-disordered Breathing Research Articles

The frequency of sleep-disordered breathing in preschool children with asthma and its effects on control of asthma.

The frequency and score of SDB were higher in patients with uncontrolled asthma. Frequency and score of SDB were significantly affected by the severity of asthma. SDB must be evaluated in preschool children with uncontrolled asthma. Sleep-disordered breathing (SDB) is more common in asthmatic patients than in non-asthmatic persons, and SDB affects negatively to control asthma. A limited number of studies are discovered on the effect of SDB in preschool asthmatic children. In this study, we aimed to investigate the prevalence of SDB and its effect on control and severity of asthma in preschool children. A pediatric sleep questionnaire was completed by parents of asthmatic children. Patients who received a score of 0.33 or higher were diagnosed with SDB. Control and severity of asthma was assessed by a pediatric allergy specialist based on the Global Initiative for Asthma (GINA) criteria. The study included 249 patients, with a mean±SD age of 4.37±1.04 (range: 2-5.9) years; 69% were boys; 56.6% children had uncontrolled asthma and 28.7% had SDB. The SDB score was significantly different between controlled and uncontrolled asthma (0.19 vs 0.28; P < 0.001). The frequency of uncontrolled asthma in patients with and without SDB was 74.3% and 49.4%, respectively (P < 0.010). Based on the severity of asthma, the frequency of SDB among patients with mild, moderate, and severe asthma was 23.4%, 35.2%, and 47.4%, respectively (P = 0.010).

Frequency of sleep-disordered breathing in a referral population of Somali-Americans.

To study the frequency of obstructive sleep apnea (OSA) in individuals of Somali ancestry referred to a clinical sleep laboratory. This was a retrospective study using a large registry of patients who underwent diagnostic polysomnography between 17 November 2009 and 15 April 2017. Adult patients self-reporting as being of Somali origin were confirmed using the electronic medical record. Somali-American patients comprised approximately 0.2% of all patients undergoing polysomnography at the Mayo Clinic Center for Sleep Medicine. The median (interquartile range) age was 52.6 (35, 64) years with 66% males and a median (interquartile range) body mass index of 31.2 (27, 34) kg/m². OSA was diagnosed in 77% of patients, with approximately 50% having moderate to severe OSA. OSA was more frequent in older patients and similar between men and women, and only age predicted an OSA diagnosis while sex and body mass index did not. All patients with diabetes mellitus type 2 (n = 7) and all but one of the hypertensive patients (n = 11) had significant OSA. Less than 0.2% of all patients undergoing polysomnography at Mayo Clinic were of Somali origin. Moderate-to-severe OSA was frequent in this select sample of individuals who underwent polysomnography. Hypertension and diabetes were present in most Somali-Americans with OSA. Given the rising prevalence of diabetes and hypertension in Somali-Americans, and the likely high prevalence of undiagnosed OSA, screening Somali-Americans for sleep disorders may contribute importantly to prevention, early detection, and reduction of cardiovascular and metabolic diseases in this population.

0623 Respiratory Profiling of Community-dwelling Individuals Many Years After Polio Infection

Abstract Introduction To determine the presence of respiratory impairment in community-living subjects with a history of poliomyelitis. Methods In a study conducted from July 2013-January 2014, we used a national database to recruit individuals (212 males, 86 females) from north and south provinces in China with a known prior poliomyelitis infection &amp;gt;25 years previously. 298 subjects (96.8%) completed overnight oximetry to collect the number/hr of drops in oxygen saturation &amp;gt;4% (ODI4) and Epworth Sleepiness Scale (ESS); many completed a metabolic and lipid panel, arterial blood gas analysis, chest x-ray (CXR), spirometry and maximal voluntary ventilation (MVV). Some completed risk profiling for OSA. Results Age was 47.8 ± 6.7 years (M±SD) and, when known, the age of infection was 2.3 ± 1.8 yrs. As defined by ODI4 ≥ 5/hr, the frequency of sleep-disordered breathing (SDB) was 37.2%; 9% (n = 27) had an ODI4 ≥15/hr. Those with vs. those without SDB differed by male gender (81% vs 65%, p = 0.004) and BMI (25.9 vs 23.0kg/m2, p &amp;lt; 0.001). ESS was within the normal range, but was higher in those with 6.8 ± 5.0 vs. without 5.2 ± 4.0 (p &amp;lt; 0.01) SDB. Spirometry and MVV revealed no differences among groups. Scoliosis on the CXR was present 26.1% of those with and 14.4% of those without SDB. ODI4 correlated weakly with body mass index (r = 0.40). Glucose levels or hyperglycemia were not different. A triglyceride level &amp;gt; 1.7 mmol/L was present in 47.2% of those with and 21.3% of those without SDB (p &amp;lt; 0.001). Conclusion Mild (28%) and to a smaller extent moderate-severe (9%) SDB is present many years after surviving poliomyelitis in infancy. In most, sleepiness is low but scoliosis is often present, and associations to hyperlipidemia and obesity are not reflected in fasting glucose levels. Support no

Prevalence of Sleep-Disordered Breathing During Routine Electroencephalogram (EEG): A Hospital-Based Descriptive Study

Sleep-disordered breathing (SDB) in adults is a common condition that is associated with a range of medical problems including hypertension, cardiovascular complications, and increase of seizure frequency in susceptible individuals. Polysomnography (PSG) is considered the gold standard measure in the diagnosis of SDB. This is an observational study on the frequency of SDB in adult patients referred for routine EEG. We found that routine EEG was capable of detecting moderate to severe symptoms of SDB in 14% of adult patients (95% confidence interval = 8.1–19.9%). The state of sleep during a routine EEG recording could help in assessing a SDB pattern and could provide an opportunity for further diagnostic sleep consultation if the patient has not previously reported problems with sleep or if SDB was not considered by the referring physician. This study underscores the need for a practice approach to ensure that patients suffering from SDB are properly referred to a sleep specialist. In the context of this report, some training and experience in PSG can be an added advantage for EEG technologists in the detection of SDB.

The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control

ABSTRACTBackground: The presence of sleep-disordered breathing (SDB) in children with asthma may cause difficult to control asthma. Objectives: The aim of this study was to determine the frequency of SDB in children with asthma, to evaluate its effects on asthma control and to assess the risk factors associated with the presence of SDB. Methods: Parents of children who Sleep Questionnaire (PSQ) and the Childhood Asthma Control Test (C-ACT). Asthma control level was assessed according to Global Initiative for Asthma (GINA). Same ear–nose–throat (ENT) specialist evaluated all patients. A 4-point tonsil grading method and adenoid-nasopharynx ratio were used to categorize tonsil and adenoid size, respectively. Results: A total of 408 children (275 male, 67.4%) with a mean age of 8.1 ± 3.2 years were included. Nearly 40% of asthmatic children were not-well-controlled according to GINA and 34.6% of all patients had SDB according to PSQ. Multivariate logistic regression analysis revealed that coexistence of SDB [OR: 6.62, 95% CI (4.21–10.41); p < 0.001)] and tonsillar hypertrophy [OR: 3.47; 95% CI (1.05–11.5); p < 0.041] were independent risk factors for not-well-controlled asthma in asthmatic children after other established contributors to asthma control were adjusted. Conclusions: Our study showed that SDB is a strong risk factor for not-well-controlled asthma in asthmatic children independent of other confounders. In addition, tonsillar hypertrophy may have a role in the association between SDB and not-well-controlled asthma in childhood.

Abstract T P263: Screening Practices for Sleep-Disordered Breathing in Stroke Medical Community

Background: Frequency of sleep-disordered breathing (SDB) among stroke and TIA patients ranges from 50% to 94%, and is associated with poor neurological outcomes. Per current stroke prevention guidelines from American Stroke Association, SDB is included in the list of modifiable risk factors for stroke and TIA prevention. The goal of our study was to determine screening practices for SDB in stroke medical community. Methods: A web-based survey was conducted between 12/2013 to 7/2014 among practitioners taking care of stroke patients across United States and Europe. Results: Among 112 total responses (18%), 91 were stroke physicians (81.25%), 9 were general neurologist (8.04%), 3 were sleep medicine physicians (2.68%) and 9 were other specialty (8.04%). Majority of practitioners (72%, n= 81) do not use SDB screening questionnaires in their stroke patients. Epworth sleepiness scale is the most used among SDB questionnaires (24%), followed by Berlin sleep questionnaire (9.5%) and STOP-BANG questionnaire (7%). Only 12% of practitioners use screening questionnaires in both in-patients and out- patients, where as 20% use only in out- patients and 5% use only in acute stroke setting. Only 50% of practitioners would refer their stroke patients to a sleep medicine specialist when patients were screened positive for SDB on questionnaires. Conclusion: Despite being an independent risk factor for stroke and TIA, majority of practitioners do not screen stroke and TIA patients for SDB. Further work is needed to improve screening practices for SDB in stroke medical community.

Dysarthria plus dysphagia is associated with severe sleep‐disordered breathing in patients with acute intracerebral hemorrhage

Sleep-disordered breathing (SDB) is a risk factor for stroke. The frequency of SDB in Japanese patients with acute intracerebral hemorrhage (ICH) was investigated, as well as factors associated with SDB severity. Between April 2010 and April 2013, patients with ICH within 24 h of onset were prospectively enrolled to participate in a sleep study within 7 days of admission. SDB was defined as a respiratory disturbance index (RDI: apnea or hypopnea events per hour) of ≥ 5. Patients were assigned to groups based on RDI values of ≥ 30 (severe SDB) and <30 (absent or not severe SDB). The frequency of SDB and factors associated with its severity were investigated using multivariate logistic regression analysis. Of 97 patients (55 males; mean age 68.1 years) enrolled in the study, 91 (94%) had SDB. Severe SDB was evident in 29 (30%) patients. Compared with the RDI< 30 group, the RDI ≥ 30 group had a higher frequency of dysarthria plus dysphagia (76% vs. 47%, P = 0.008), larger waist circumference [86 (84-92) vs. 84 (78-88) cm, P = 0.019] and a greater body mass index [23.8 (21.1-26.8) vs. 21.5 (19.4-25.0) kg/m(2), P = 0.046]. Multivariate logistic regression analysis showed that dysarthria plus dysphagia was independently associated with severe SDB (odds ratio 3.4; 95% confidence interval 1.250-9.252, P = 0.017). Most Japanese patients with acute ICH had SDB, and dysarthria plus dysphagia was associated with severe SDB.

Atrial fibrillation is associated with severe sleep‐disordered breathing in patients with ischaemic stroke and transient ischaemic attack

Sleep-disordered breathing (SDB) is a risk factor for cerebrovascular disease. We investigated the frequency of SDB in Japanese patients with acute ischaemic stroke and transient ischaemic attack (TIA), as well as factors associated with SDB severity. Between April 2010 and March 2011, we prospectively enrolled patients with ischaemic stroke and TIA within 24 h of onset to participate in a sleep study within 7 days of admission. We defined SDB as a respiratory disturbance index (RDI) (number of apnoeas or hypopnoeas per hour) of ≥ 5. Patients were assigned to groups based on RDI values of ≥ 30 (severe) and <30 (absent or not severe). The frequency of SDB and factors associated with severity were investigated using multivariate regression analysis. We enrolled 150 patients amongst whom 126 (84%) had SDB. The frequencies of SDB were 21 (75%) patients with TIA, 105 (86%) with ischaemic stroke, 8/10 (80%) with large artery atherosclerosis, 14/14 (100%) with small vessel occlusion, 37/41 (90%) with cardioembolism and 46/57 (81%) with other causes of stroke/undetermined. Severe SDB was evident in 44 (29%) patients. The frequency of males (75% vs. 56%, P = 0.027), atrial fibrillation (AF) (39% vs. 23%, P = 0.045), higher body mass index (23.8 ± 3.8 vs. 22.3 ± 3.8, P = 0.043) and a larger neck circumference (37.8 ± 4.3 vs. 35.8 ± 4.2, P = 0.012) was significantly higher in the group with severe SDB. Multivariate regression analysis found that AF (OR 2.4; 95% CI 1.079-5.836, P = 0.0359) was independently associated with severe SDB. Most Japanese patients with acute ischaemic stroke and TIA had SDB, and AF was associated with SDB.

303 Sleep-disordered Breathing in Obese and Eutrophic Adolescents, Asthmatics and not Asthmatics, in the Hospital Infantil of Mexico Federico Gómez

BackgroundSleep-disordered breathing (SDB) has been studied in obese adults but there are few studies on adolescents. This study analyzed the frequency of SDB in obese adolescents and controls with and without asthma.MethodsA cross-sectional comparative study, 27 obese adolescents 10 to 18 years old with body mass index (BMI) ≥ 95th percentile, of whom 17 (43%) had mild intermittent asthma (MIA) according to GINA 2005 guidelines and 23 (57%) without asthma, plus a group of 20 eutrophics adolescents (BMI = percentile 50th–84th), 50% (n = 10) with MIA and 50% (n = 10) healthy. All patients underwent overnight polysomnography, primary snoring (PS) was diagnosed with recording of snoring and apnea/hypopnea index (AHI) <1 and sleep apnea /hypopnea syndrome (SAHS) with an AHI ≥ 1 plus oxygen desaturations >4% baseline, bradycardia or tachycardia. We obtained measures of central tendency, dispersion and t student test for different groups.ResultsIn obese adolescents with and without asthma SAHS was found in 72.5% (n = 29), PS was diagnosed in 20% (n = 8) and the subgroup analysis of obese show that same number of asthmatic and non asthmatic had SAHS (70.5%, 74%, respectively). The subgroup analysis of asthmatics and healthy eutrophic had SAHS (60% (n = 6), 0% (n = 0) respectively. Globally AHI in the obese group was 2.05 ± 3.48 compared to healthy eutrophic (0.40 ± 0.26) with P = 0.0016, significant differences were obtained in the analysis of subgroups: the IAH in obese adolescents with asthma (3.41 ± 3.47) and obese without asthma (2.60 ± 2.55) with P = 0.7017. In the eutrophic group differences there were significant differences: eutrophic asthmatics (IAH: 2.15 ± 0.26) and 0.40 ± 0.26 healthy eutrophic P = 0.0047.ConclusionsSDB is more common in obese adolescents. In eutrophic asthmatic adolescents SAHS was more frequent than in healthy, probably by the presence of co-morbidities such as rhinitis, hypertrophy of tonsils and all patients were classified as MIA. Adolescents who are obese have an increased risk of SDB compared with the group of healthy adolescents.

Cerebrovascular Diseases and Sleep-Disordered Breathing

Sleep-disordered breathing (SDB) is more probably the cause rather than the consequence of stroke because: apneas are essentially obstructive rather than central; the frequency of SDB is not different between transient ischemic attack and cerebral infarction; and previous excessive daytime sleepiness is significantly more frequent among stroke patients with SDB than those without. The presence of SDB in stroke patients could lead to a poor outcome. Pathophysiological relationships between strokes and SDB are multiple. Experimental and clinical studies have shown that both short- and long-term factors may play a role in increasing the susceptibility to stroke in patients with obstructive sleep apnea syndrome. The former include changes in cerebral hemodynamics, hematologic alterations, and cardiocirculatory dysfunctions that typically and repeatedly occur during apnea episodes and also may persist during wakefulness. Regarding long-term factors, some changes in the anatomical characteristics of carotid arteries wall have been recognized in SDB patients. This finding seems to suggest that the link between SDB and cerebrovascular disease might be explained, at least in part, by an increase in the progression of the atherosclerosis process involving cerebral vessels.There are several practical implications from the demonstrated significant role of sleep apnea in increasing the predisposition to developing stroke. Specific investigation is fundamental in the presence of a clinical suspect of SDB, especially in patients with history of transient ischemic attacks and stroke. Specific treatment of SDB may reduce the possibility of further cerebrovascular disturbances.

Relationship between Sleep-Disordered Breathing and Lifestyle-related Illnesses in Subjects Who Have Undergone Health-screening

Simplified sleep polysomnography was performed in 207 adult men to examine the relationship between the frequency of sleep-disordered breathing (SDB) and lifestyle-related illness. Each subject was checked for SDB using a simplified sleep polysomnograph (Auto-Set Portable; Teijin Limited, Tokyo, Japan). Apnea and hypopnea were detected with a nasal cannula type airflow sensor. Hypoxemia was checked with a percutaneous oxygen saturation (SpO2) monitor. We analyzed the relationships between SDB and body mass index (BMI) and hypertension, hyperlipidemia, liver dysfunction, fatty liver, and abnormal glucose metabolism. Fifty-nine subjects (29%) showed SDB with apnea hypopnea index (AHI) over 15 times/h. The frequency of obesity (BMI > or = 25), hypertension, hypercholesterolemia, fasting blood glucose level, and HbA1c were significantly higher in patients with SDB than in normal individuals (AHI < 5 times/h). The frequencies of hypertension, hyperlipidemia, and abnormal glucose metabolism were compared between the obesity-free normal AHI group and the SDB group, and only that of hypertension was significantly different between the two groups. The present study revealed a high frequency of SDB among Japanese individuals. The results also suggest that as SDB becomes severe, it becomes more closely linked to the onset of lifestyle-related illnesses, such as hypertension, hypercholesterolemia and abnormal glucose metabolism.

117th ENMC Workshop: Ventilatory Support in Congenital Neuromuscular Disorders — Congenital Myopathies, Congenital Muscular Dystrophies, Congenital Myotonic Dystrophy and SMA (II) 4–6 April 2003, Naarden, The Netherlands

Eighteen participants from Australia, Austria, Denmark, Finland, France, Germany, The Netherlands, the UK, and the USA met in Naarden, representing a variety of disciplines with experience in the respiratory management of patients with neuromuscular disorders (NMD). The aims of the workshop were to agree upon and report minimum recommendations for the investigation and treatment of respiratory involvement in congenital muscular disorders, and to identify areas where further research is needed. The workshop specifically excluded patients with Duchenne muscular dystrophy where evidence for the need for and efficacy of the treatment of respiratory failure is better established. All participants contributed to the review and assessment of published evidence in the field, and current practice amongst the group was also compared. Despite the individual rarity of the conditions under consideration in this workshop, the accumulated experience of the group represented the care of more than 545 patients with these disorders, of whom around one-third were receiving mechanical ventilation.

Sleep-Disordered Breathing and Symptoms of ADHD

The frequency of sleep-disordered breathing (SDB) among children with inattention and hyperactivity was determined in 866 patients, aged 2.0 to 13.9 years (mean; 6.8 yrs), evaluated in two general pediatric clinics at the University of Michigan and University of Pittsburg.

Assessment of Sleep Complaints and Sleep-Disordered Breathing in a Consecutive Series of Obese Patients

Background/Objective: The prevalence of sleep-related complaints (SRC) and the frequency of sleep-disordered breathing (SDB) in obese patients has not been studied extensively. We investigated SRC and SDB in a group of obese persons as part of a preoperative workup for weight reduction (bariatric) surgery. Methods: All consecutive patients attending a weight-loss clinic for evaluation for bariatric surgery were asked to complete a questionnaire. The questionnaire consisted of a section on SRC and a validated general sleep questionnaire (Sleep Wake Experience List). The patients underwent sleep studies in which an Edentrace recorder registered heart rate, chest wall movements by impedance, airflow and oxygen saturation. Results: Fifty-one patients (14 men, 37 women) were evaluated. Mean body mass index (BMI) was 45 kg/m² (range 33–61). Eighteen patients (35%) demonstrated SDB, defined as (a) an apnea/hypopnea index ≥5, and/or (b) more than 2% of registration time with an oxygen saturation below 90%. There was no difference between these 18 patients and patients who did not exhibit SDB in age, sex, BMI or SRC. Seven patients had SDB of a severity warranting closer investigation and perioperative monitoring. Conclusion: Both SRC and SDB are common in obese patients. Limited nocturnal respiratory monitoring is indicated as part of the preoperative workup for weight reduction surgery.

Neuropsychological function in obstructive sleep apnoea.

Patients with obstructive sleep apnoea (OSA) experience neuropsychological deficits falling broadly into the four areas of daytime sleepiness, cognitive deficits, reduced driving competence and impaired psychosocial well-being. Case-control studies of daytime function in OSA patients generally indicate moderate to severe daytime sleepiness using polysomnographic or self-rating assessments. Cognitive performance on tests of attention and concentration ability, visuomotor and constructional skills, verbal fluency, planning and problem-solving, memory and executive function may be mildly to moderately impaired. These two symptoms may contribute to a road traffic accident rate in OSA between two and seven times higher than that of normals, and to the high prevalence of minor psychiatric morbidity, and reductions in functional and health status, among patients. The daytime impairments associated with OSA are improved by continuous positive airway pressure (CPAP) therapy, although a lack of complete normalization has been suggested for objective sleepiness and some areas of cognitive function. The severity of sleepiness and cognitive impairments show weak and moderate correlations with frequency of sleep-disordered breathing in clinical and epidemiological studies. Experimental and clinical evidence supports a role for nocturnal physiological events of OSA, arousals and hypoxaemia, in directly or indirectly producing neuropsychological deficits, particularly those of sleepiness and cognitive deterioration.

Sleep-Disordered Breathing in Healthy, Aged Persons: Fifth and Final Year Follow-up

The frequency of sleep-disordered breathing (SDB) events increases dramatically with age, although the clinical significance of this phenomenon is uncertain. We report herein on data from the fifth follow-up observation of a cohort of healthy elderly which we selected, evaluated, and followed up in an effort to address this issue. Baseline observations on this group of 95 normal older persons medically screened for good health included standard nocturnal polysomnograms and daytime assessment of medical, sleep/wake, and psychological variables. At fifth-year follow-up, 42 subjects returned for assessment. Comparison of returning vs nonreturning subjects indicated no significant differences in baseline characteristics between these groups. Division of returning subjects into moderate (apnea-hypopnea index [AHI] > or = 5) vs low (AHI < 5) SDB at baseline resulted in 10 subjects in the moderate group and 32 subjects in the low group. The two groups were comparable with regard to sex, weight, and education, although the moderate SDB group was significantly older (70.4 years) than the low SDB group (64.8 years). Follow-up medical, sleep/wake, and psychological data were contrasted for the two groups using a mixed design multivariate analysis of variance (repeated measures factor-time-6 observations; between-subjects factor SDB level, 2 groups). There were no statistically significant effects of SDB or interactions of SDB and time across this 5-year follow-up. These results confirm observations from the third-year follow-up. We conclude that observation of a moderate level of SDB in an otherwise healthy older person is apparently not a significant risk across a 5-year follow-up period and therefore does not seem to warrant investigation beyond a thorough medical history and physical examination to rule out other disorders.

Nasal and Oral Flow-Volume Loops in Normal Subjects and Patients with Obstructive Sleep Apnea

Because flow-volume loops (FVLs) are clinically useful in evaluating upper airway (UA) obstruction and the fact that patency of the nasopharyngeal ventilatory pathway is important to the prevention of obstructive sleep apnea (OSA), the present study examined the role of nasal compared with oral FVLs in evaluating patients with OSA. Fourteen obese male patients 56 +/- 3 yr of age with a mean apnea plus hypopnea index (AHI) of 51 +/- 9/h were studied along with 14 nonobese, healthy, age- and sex-matched control subjects whose mean AHI was 6 +/- 1/h. Nasal and oral FVLs obtained in the normal subjects indicated the nose behaved like a variable resistor, with flow limitation during inspiration but not during expiration. In the patient group, flow limitation was observed during expiration as well as inspiration indicating nondistensibility of the nasopharyngeal ventilatory pathway in the patients compared to the control subjects. A change in body position from upright to supine in the OSA group was associated with small reductions in expiratory but not inspiratory flow rates. The area under the nasal supine flow-volume loop (FVLANaSup) was found to be highly correlated with awake resting PaO2 (r = 0.80) and PaCO2 (r = -0.83) in the patient group. In addition, multiple linear regression analysis revealed that PaO2 and the area under the nasal FVLs independently contributed to the prediction of AHI with a multiple R of 0.89. These results suggest that limitations to ventilation via the nasopharynx may significantly influence both gas exchange and the frequency of sleep-disordered breathing in patients with OSA.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of protriptyline in sleep-disordered breathing.

The effects of therapy with the tricyclic antidepressant protriptyline were studied in 12 patients with hypersomnolence and moderately severe sleep apnea. After treatment there was no significant change in the duration or frequency of sleep-disordered breathing (SDB) during non-REM sleep, but there was an alteration in the breathing pattern characterized by a decrease in the amount of apnea during SDB events. Apnea, as a percent of disordered breathing time, fell from 60.4 +/- 27.2% to 35.5 +/- 26.7% (p less than 0.01) and was accompanied by a reduction in the peak fall in oxygen saturation from 16.2 +/- 6.2% to 9.2 +/- 4.7% (p less than 0.01). During REM sleep there was no change in the pattern, duration, or frequency of SDB, or reduction in the peak fall in oxygen saturation. However, there was a reduction in the amount of Stage REM sleep, thereby reducing the more severe SDB events (p less than 0.01) and further improving nocturnal oxygenation. In 10 of 12 patients, there was subjective improvement in daytime hypersomnolence, which was associated with an increase in median sleep onset time from 3.3 +/- 2.2 to 5.1 +/- 2.1 min (p less than 0.01). Although all patients developed mild side effects from the anticholinergic properties of protriptyline manifested by a dry mouth, 4 patients noted additional side effects including urinary hesitancy, mild constipation, and difficulty in maintaining an erection. One patient developed intolerable constipation that necessitated discontinuation of the drug. We conclude that protriptyline reduced daytime hypersomnolence and altered the pattern of SDB, thus improving gas exchange and oxygenation during sleep. Therefore, in selected patients with moderately severe obstructive sleep apnea, therapy with protriptyline is an alternative to surgical treatment with a tracheostomy.