Obstructive Sleep Apnoea: Another Burden on Cirrhotic Liver
Aliae AR Mohamed-Hussein,
Mohamed-Eltaher AA Ibrahim
Issue:
Volume 4, Issue 2-1, April 2016
Pages:
1-5
Received:
4 July 2015
Accepted:
6 July 2015
Published:
8 September 2015
Abstract: Obstructive sleep apnea syndrome (OSAS) may cause aggressive deterioration in the course of liver cirrhosis and may have an impact on the development of hepatic cell failure in patients with concomitant diseases. Patients and Methods: 34 patients with OSAS and compensated cirrhosis as well as 30 compensated cirrhotic patients were followed for 1 year to demonstrate the effect of hypoxia and body mass index (BMI) on their prognosis. Polysomnography, abdominal sonography, liver function tests and portal venous pressure were assessed on inclusion. Parameters of hepatic de-compensation (HD) as ascites, hepatic encephalopathy and bleeding esophageal varices (variceal hemorrhage) were recorded. Results: BMI was significantly higher in patients with concomitant OSAS and cirrhosis (p<0.01), and manifestations of hepatic de-compensation occurred in 32.3% of those cases compared to 10% in patients with cirrhosis alone (p<0.01) in one year. Positive correlations were recorded between BMI, desaturation index, sleep duration SpO2<90% and predictors of HD. Multivariate analysis showed that BMI, AHI, sleep duration SpO2< 90%, desaturation index were independent predictors of de-compensation, together with high portal venous pressure and lower serum albumin. Conclusion: Obesity and intermittent hypoxemia in OSAS may have deleterious effect on the natural history of compensated cirrhosis independent of portal venous pressure and liver function. Treatment of OSAS and weight reduction may decrease considerable burden on cirrhosis.
Abstract: Obstructive sleep apnea syndrome (OSAS) may cause aggressive deterioration in the course of liver cirrhosis and may have an impact on the development of hepatic cell failure in patients with concomitant diseases. Patients and Methods: 34 patients with OSAS and compensated cirrhosis as well as 30 compensated cirrhotic patients were followed for 1 ye...
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Sleep Related Conditions with Myasthenia Gravis: Evidence, Causes and Implications
Issue:
Volume 4, Issue 2-1, April 2016
Pages:
6-16
Received:
15 August 2015
Accepted:
17 August 2015
Published:
8 September 2015
Abstract: Myasthenia gravis (MG) is an autoimmune disease caused mainly by antibodies against skeletal muscle nicotinic acetylcholine receptors (nAChRs) at the postsynaptic membrane resulting in depletion of acetylcholine at the neuromuscular junction (NMJ). Muscle fatigue is the cardinal symptom of MG. Respiratory muscle weakness and breathing problems are manifestations of MG even in mild stages of the disease resulting in significant morbidity and mortality. Also sleep related conditions are among the manifestations of MG which include sleep disordered breathing (SDB) [i.e. central (CSA) and obstructive (OSA) sleep apneas, hypoventilation or hypoxemic syndromes], reduced sleep efficiency and quality, increased number of nocturnal awakenings, excessive daytime sleepiness, reduced rapid eye movement sleep and altered sleep perception and dreaming. On the other hand, sleep abnormalities may result in lack of concentration, cognitive impairments and mood disturbances as depression and anxiety. Central and peripheral mechanisms have been suggested for the association between MG and central nervous system manifestations and sleep abnormalities. Neurologists and sleep medicine professionals should be aware of the associations between OSA/CSA, hypoventilation and other sleep related conditions with MG and consider systematic investigations including polysomnography and ventilatory support. This will reduce morbidity and mortality and improve quality of lives of patients with MG.
Abstract: Myasthenia gravis (MG) is an autoimmune disease caused mainly by antibodies against skeletal muscle nicotinic acetylcholine receptors (nAChRs) at the postsynaptic membrane resulting in depletion of acetylcholine at the neuromuscular junction (NMJ). Muscle fatigue is the cardinal symptom of MG. Respiratory muscle weakness and breathing problems are ...
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