Sleep Apnea Syndromes: Teramoto S

Teramoto S, Ishii T, Matsuse T. · Department of Internal Medicine, San-no Hospital, International University of Health and Welfare, Tokyo, Japan. · Dysphagia. · Pubmed #11720400 No free full text.

Abstract: Patients with obstructive sleep apnea syndrome (OSAS) are likely to exhibit an impaired swallowing reflex. However, mechanisms of disturbed swallowing reflex have not been determined. Because the upper-airway function is inhibited by hypoxia and hypercapnia, we examined the relationship between the swallowing function and gas exchange during day and night in patients with OSAS. Twenty-four patients with OSAS and 24 age-matched controls were studied. OSAS was diagnosed from overnight polysomnography. The swallowing reflex was judged by the latent time (LT) for swallowing following bolus injection of distilled water at the suprapharynx, the inspiratory suppression time (IST) from swallowing termination to the next onset of inspiration, and the threshold for evoking the swallowing response in terms of a volume of water (TV). Whereas the LT values are positively correlated with PaCO2 but not with PaO2 during the day, the values of IST and TV were not associated with daytime PaCO2 or PaO2. Nocturnal nadir SaO2 was correlated with LT, IST, and TV. These results indicate that oxyhemoglobin desaturation and hypercapnia may be associated with one of the mechanisms of the impaired swallowing function in patients with OSAS.

Yamamoto H, Teramoto S, Yamaguchi Y, Hanaoka Y, Ishii M, Hibi S, Ouchi Y. · Department of Geriatric Medicine, Faculty of Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. · Sleep Med. · Pubmed #17512795 No free full text.

Abstract: BACKGROUND AND PURPOSE: Obstructive sleep apnea syndrome (OSAS) is recognized as one of the risk factors of hypertension and cardiovascular disorders. In the current study, we hypothesized that the hypoxic stress caused by obstructive sleep apnea would increase circulating adrenomedullin (ADM) levels in untreated OSAS patients compared to an age-matched control group. We further hypothesized that oxygen administration treatment may decrease OSAS-induced hypoxic stress and ADM levels. METHODS: We examined short-term and long-term oxygen administration effects on circulating ADM in 48 OSAS patients. RESULTS: The circulating levels of ADM in untreated OSAS patients were significantly greater than those in the controls. We did not observe a significant effect in 2 weeks of oxygen administration on the circulating ADM in the patients, but we observed a significant effect in long-term oxygen administration for more than 3 months on plasma ADM levels. Long-term oxygen therapy decreased both the magnitude of arterial oxygen desaturation and plasma ADM levels in patients but did not decrease blood pressure. CONCLUSIONS: These observations suggest that long-term oxygen therapy could reduce OSAS-induced nocturnal hypoxemia and plasma ADM levels in patients with OSAS.

Teramoto S. · No affiliation provided · Nippon Ronen Igakkai Zasshi. · Pubmed #17233457 links to  free full text

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Teramoto S, Kume H, Matsuse T, Ishii T, Miyashita A, Akishita M, Toba K, Ouchi Y. · Department of Geriatric Medicine, Tokyo University Hospital, 7-3-1, Hongo Bunkyo-Ku, Tokyo 113-8655, Japan. · Sleep Med. · Pubmed #14592281 No free full text.

Abstract: OBJECTIVES AND BACKGROUND: Nocturnal apnea and hypoxia are implicated in the pathogenesis of pulmonary and systemic hypertension in obstructive sleep apnea syndrome (OSAS). We have hypothesized that vasodilating factors including nitric oxide (NO) are affected by nocturnal apnea and hypoxia in patients with OSAS. METHOD: We examined the serum level of NO production in 24 patients with OSAS (mean age 54.2+/-7.9 years) and 24 age-matched control subjects (53.4+/-8.1 years) and tested the effects of oxygen administration on the production of NO in the patients. RESULTS: The serum level of nitrite/nitrates (NO(x)), which are stable metabolites of NO, was lower in patients with OSAS than in control subjects. Administration of 1-2 l/min of oxygen during night increased the patients' NO(x) level from 35.6+/-7.3 to 57.8+/-11.6 microM. Compressed air administration did not affect the NO(x) level in the patients. CONCLUSION: These results indicate that systemic NO production is impaired in OSAS patients, possibly due to nocturnal hypoxia.

Teramoto S, Kume H, Yamamoto H, Ishii T, Miyashita A, Matsuse T, Akishita M, Toba K, Ouchi Y. · Department of Geriatric Medicine, The University of Tokyo Hospital, Tokyo. · Intern Med. · Pubmed #12924491 links to  free full text

Abstract: OBJECTIVE: Repeated nocturnal hypoxia is implicated in the pathogenesis of cardiovascular complications in obstructive sleep apnea syndrome (OSAS). We hypothesized that circulating vascular endothelial growth factor (VEGF) levels are affected by nocturnal hypoxemia in patients with OSAS. METHODS: We examined the serum VEGF levels in patients with OSAS and in control subjects. We also tested the effects of oxygen or air administration on the subjects' VEGF levels. PATIENTS AND MATERIALS: Twenty-four OSAS patients (mean age 54.2 +/- 3.6 years) and 24 age-matched control subjects (53.2 +/- 3.6 years). Their serum samples were tested. RESULTS: Serum VEGF levels at 8:00 AM were significantly higher in OSAS patients than in controls (p<0.01). VEGF levels decreased from 515 +/- 31 (pg/ml) to 178 +/- 16 (pg/m) (p<0.01) in OSAS patients whose nocturnal hypoxemia was found to be improved by administration of 2 l/min of oxygen during the night. However, the administration of compressed air affected neither the VEGF level nor nocturnal oxygen desaturation in OSAS patients. CONCLUSION: These results indicate that circulating VEGF levels are elevated in OSAS patients, primarily due to nocturnal hypoxemia.

Okada S, Ouchi Y, Teramoto S. · Department of Geriatric Medicine, Tokyo University Hospital, Tokyo, Japan. · Respiration. · Pubmed #10940807 links to  free full text

Abstract: We have recently reported that swallowing reflex is impaired in patients with obstructive sleep apnea syndrome (OSAS). However, the effects of OSAS treatment on swallowing function in these patients have not been reported. Here we report 2 cases of OSAS in whom swallowing reflex was impaired before the start of nasal continuous positive airway pressure (NCPAP) and improved 1 year after NCPAP. These cases suggest that impaired swallowing reflex may be reversible by OSAS treatment.

Sudo E, Ohga E, Teramoto S, Matsuse T, Nagase T, Toba K, Fukuchi Y, Ouchi Y. · Department of Geriatric Medicine, Tokyo University Hospital. · Nippon Ronen Igakkai Zasshi. · Pubmed #10936927 No free full text.

Abstract: To examine the roles of obstructive apnea (OA) and central apnea (CA) in oxygen desaturation on hypertension and sleep apnea syndrome (SAS), we performed a sleep study on 41 elderly subjects (mean age 69.5 +/- 6.8 years, male:female = 31:10). Nocturnal oxygen desaturation was documented with a pulse oximeter and apneas (OA and CA) were diagnosed on the basis of results of respiratory inductive plethysmography and oronasal flow. Significant desaturation (SDS, greater than 5% drop in SpO2 from baseline value) and desaturation index (DI; epsilon SDS (%) x duration (hour)) were calculated using the continuous nocturnal monitoring system with a pulse oximeter. We defined central type apnea above 50% as the central type group (n = 8, mean age 58.6 +/- 2.9, mean BMI 21.3 +/- 1.0, male:female = 7:1), and obstructive type and mixed type apnea above 50% as the obstructive type group (n = 21, mean age 70.0 +/- 3.2, mean BMI 25.3 +/- 1.0, male:female = 17:4). Other subjects were assigned to the control group (n = 12, mean age 64.3 +/- 2.3, mean BMI 23.8 +/- 1.2, male:female = 7:5). The DI (delta 5%) of the central type was 0.34 +/- 0.17, and that of the obstructive type was 1.78 +/- 0.7 showing a significant increase in the latter compared to the control group (p < 0.02). The DI (< 90%) of the central type was 0.14 +/- 0.07, and that of the obstructive type was 1.72 +/- 0.75, and that of the obstructive type was significantly greater than in the control group (p < 0.05) and central type (p < 0.05). There were 4 cases (33.3%) with hypertension in the control group and 4 cases (50.0%) with hypertension in the central type group, but there were 15 cases (71.4%) with hypertension in the obstructive type group. Hypertensive prevalence in the obstructive group was significantly more than in the control group (p < 0.05). No significant difference in body mass index or age were seen in the obstructive group and control group. There was a significant correlation between mean blood pressure and apnea index (AI). The AI of the hypertensive group was significantly higher than that of the normotensive group (p < 0.001). These results suggest that subjects with significant obstructive apneas may be at greater risk for hypertension than subjects with central apneas and that hypertension in the pathogenesis of SAS may be related to the severity of apneas rather than oxyhemoglobin desaturation.

Teramoto S, Sudo E, Matsuse T, Ohga E, Ishii T, Ouchi Y, Fukuchi Y. · Department of Geriatric Medicine, Tokyo University Hospital, Japan. · Chest. · Pubmed #10424498 links to  free full text

Abstract: BACKGROUND: The swallowing reflex is well coordinated with breathing patterns in normal humans. However, patients with obstructive sleep apnea syndrome (OSAS) may have a swallowing disorder that reflects the abnormal function of nerves and muscles in the suprapharynx. OBJECTIVE: To examine the relationship between the swallowing function and sleep-disordered breathing in patients with OSAS. PARTICIPANTS: Twenty patients with OSAS with a mean (+/-SD) age of 53.4+/-8.9 years old, and 20 age-matched control subjects with a mean age of 51.4+/-9.1 years old. METHODS: OSAS was diagnosed using the recordings of overnight polysomnography. The swallowing function in the subject was tested using a swallowing provocation test. The swallowing reflex was determined according to the following criteria: latent time (LT), the time following a bolus injection of distilled water at the suprapharynx to the onset of swallowing; inspiratory suppression time (IST), the time from the termination of swallowing to the next onset of inspiration; and threshold volume, the minimum volume of water (range, 0.4 to 2 mL) that could evoke the swallowing response. RESULTS: Whereas the LT values in patients with OSAS were larger than the LT values in the control subjects, the IST values (which may reflect the switching mechanism from deglutition apnea to breathing) were actually shorter. In addition, a greater bolus volume was necessary to elicit swallowing in patients with OSAS than was necessary in the control subjects. CONCLUSION: Patients with OSAS are likely to exhibit an impaired swallowing reflex, probably due to the perturbed neural and muscular function of the upper airways.

Ohga E, Nagase T, Tomita T, Teramoto S, Matsuse T, Katayama H, Ouchi Y. · Department of Geriatric Medicine, Faculty of Medicine, University of Tokyo, Tokyo 113, Japan. · J Appl Physiol. · Pubmed #10409552 links to  free full text

Abstract: Obstructive sleep apnea syndrome (OSAS) may be one of the most important risk factors of cardiovascular disorders, although the exact mechanism remains to be elucidated. In the present study, we hypothesized that OSAS-induced hypoxic stress might be involved in the etiology of cardiovascular disorders by activating adhesion molecules, including intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and L-selectin. To examine this hypothesis, we measured circulating ICAM-1, VCAM-1, and L-selectin levels before and after sleep in OSAS patients and age-matched controls. The circulating ICAM-1, VCAM-1, and L-selectin levels increased in the OSAS patients before sleep compared with the normal subjects (ICAM-1: 392.9 +/- 48.5 vs. 201.2 +/- 55.0 ng/ml, P < 0.05; VCAM-1: 811.0 +/- 87.8 vs. 574.2 +/- 42.7 ng/ml, P < 0.05; L-selectin: 1,386.6 +/- 77.9 vs. 1,038.8 +/- 78.6 ng/ml, P < 0.01, respectively). After sleep, significantly greater levels of ICAM-1 and L-selectin, but not VCAM-1, were observed in the OSAS group. These observations suggest that OSAS-induced hypoxia activates adhesion molecules, resulting in the important risk factor of cardiovascular disorders. Treatment of OSAS can be, therefore, a potential approach to prevention of cardiovascular events.

Teramoto S, Yamaguchi Y, Yamamoto H, Hanaoka Y, Ishii M, Shinichiro H, Kume H, Akishita M, Ouchi Y. · No affiliation provided · J Am Geriatr Soc. · Pubmed #18315673 No free full text.

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Teramoto S, Yamaguchi Y, Yamamoto H, Hanaoka Y, Ishii M, Hibi S, Ishii T, Kume H, Ouchi Y. · No affiliation provided · Eur Respir J. · Pubmed #18166604 links to  free full text

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Teramoto S, Yamaguchi Y, Yamamoto H, Hanaoka Y, Ishii M, Hibi S, Kume H, Akishita M, Ouchi Y. · No affiliation provided · J Am Geriatr Soc. · Pubmed #17979911 No free full text.

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Teramoto S, Kume H, Yamaguchi Y, Yamamoto H, Hanaoka Y, Ishii M, Ishii T, Ouchi Y. · No affiliation provided · Eur Respir J. · Pubmed #17197486 links to  free full text

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Teramoto S, Kume H, Yamaguchi Y, Yamamoto H, Ishii M, Ishii T, Ouchi Y. · No affiliation provided · Eur Respir J. · Pubmed #16880376 links to  free full text

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Teramoto S, Yamamoto H, Yamaguchi Y, Namba R, Ouchi Y. · No affiliation provided · Chest. · Pubmed #15764798 links to  free full text

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Teramoto S, Yamamoto H, Ouchi Y. · No affiliation provided · Chest. · Pubmed #15136420 links to  free full text

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Teramoto S, Yamamoto H, Ouchi Y. · No affiliation provided · Chest. · Pubmed #12907575 links to  free full text

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Teramoto S, Yamamoto H, Ouchi Y. · No affiliation provided · Circulation. · Pubmed #12578892 links to  free full text

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Teramoto S, Kume H, Ouchi Y. · No affiliation provided · Chest. · Pubmed #12475880 links to  free full text

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Teramoto S, Kume H, Matsuse T. · No affiliation provided · Lancet. · Pubmed #12147401 No free full text.

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Teramoto S, Kume H, Matsuse T, Ishii T, Inoue Y. · No affiliation provided · Eur Respir J. · Pubmed #11829091 links to  free full text

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Teramoto S, Ishii T, Matsuse T. · No affiliation provided · Lancet. · Pubmed #11458935 No free full text.

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Teramoto S, Kume H, Matsuse T, Fukuchi Y. · No affiliation provided · Eur Respir J. · Pubmed #11405539 links to  free full text

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Teramoto S, Ouchi Y. · No affiliation provided · Chest. · Pubmed #10767272 links to  free full text

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Teramoto S, Ouchi Y. · No affiliation provided · Arch Intern Med. · Pubmed #10724059 No free full text.

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