Publications (99) View all
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Article: Sleep apnea in precapillary pulmonary hypertension.
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ABSTRACT: OBJECTIVES: Pilot studies have described the occurrence of sleep apnea in patients with precapillary pulmonary hypertension (PH). However, there are no data on the prevalence of sleep-related breathing disorders in larger patient cohorts with PH. METHODS: 169 patients with a diagnosis of PH confirmed by right heart catheterisation and clinically stable in NYHA classes II or III were prospectively investigated by polygraphy (n=105 females, mean age: 61.3years, mean body mass index: 27.2kg/m(2)). Recruitment was independent of sleep-related symptoms and the use of vasodilator drugs or nasal oxygen. RESULTS: 45 patients (i.e. 26.6%) had an apnea-hypopnea-index (AHI) >10/h. Of these, 27 patients (i.e. 16%) had obstructive sleep apnea (OSA) and 18 patients (i.e. 10.6%) had central sleep apnea (CSA). The mean AHI was 20/hour. As a polygraphy had been performed with nasal oxygen in half of the patients without evidence for sleep apnea, the frequency of CSA was probably underestimated. Patients with OSA were characterized by male gender and higher body mass index whereas, those with CSA were older and hypocapnic. CONCLUSIONS: At least every fourth patient with PH suffers from mild-to-moderate sleep apnea. Considering the anthropometric characteristics of the patients studied, the prevalence of both OSA and CSA seem to be higher in PH than in the general population.Sleep Medicine 01/2013; · 3.40 Impact Factor -
Article: Effects of anti-inflammatory vagus nerve stimulation on the cerebral microcirculation in endotoxinemic rats.
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ABSTRACT: In sepsis syndromes the severity of the inflammation triggers microvascular dysfunction and early organ failure. We studied the effects of anti-inflammatory vagus nerve stimulation on the cerebral microcirculatory integrity in an endotoxinemic rat model. In both control and endotoxinemic (5 mg/kg lipopolysaccharide i.v.) rats, the effect of cervical bilateral vagotomy with or without left-sided distal vagus nerve stimulation were compared to non-vagotomized, nonstimulated group (sham). Neurovascular coupling was analyzed by electrical forepaw stimulation, EEG, and cortical laser-Doppler flow recording. Resting cerebral blood flow, evoked potentials and hemodynamic responses, were obtained over a period of 4.5 hours. Regulation of the nitric oxide system (iNOS expression and nitrite/nitrate measurements), cytokines (IFN-γ, TNF-α, IL-6, IL-10), hypoxic and apoptosis signaling molecules (HIF-2α, Bax) were measured at the end of experiments. In endotoxinemic rats, vagus nerve stimulation tended to increase anti-inflammatory cytokine levels and resulted in a stabile hemodynamic response (28 ± 13%; versus baseline). Vagotomized animals incurred a pro-inflammatory response (7 ± 4%; P < 0.0001 versus baseline) and produced more HIF-2α than vagotomized vagus nerve stimulated (VNS) animals. Evoked potential amplitudes were stabilized in VNS (15 ± 7 μV; n.s. versus baseline) as compared to vagotomised rats (8 ± 5 μV; P < 0.001 versus baseline). However, no effects were observed on apoptosis markers or nitric oxide levels. Vagus nerve stimulation in endotoxinemic rats had a positive effect on neurovascular coupling and stabilized evoked potentials.Journal of Neuroinflammation 07/2012; 9:183. · 3.83 Impact Factor -
Article: Quality of life in clinically stable adult cystic fibrosis out-patients: associations with daytime sleepiness and sleep quality.
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ABSTRACT: Patients with cystic fibrosis (CF) may suffer from sleep disturbances and reduced health-related quality of life (HRQoL). However, the relationships of daytime sleepiness and sleep quality to HRQoL in CF have not yet been investigated. 55 adult CF out-patients free from a pulmonary exacerbation were prospectively enrolled in this study. Questionnaires were used to assess disease-specific HRQoL (German version of the revised Cystic Fibrosis Questionnaire for adults, CFQ18 + R), daytime sleepiness (Epworth Sleepiness Scale, ESS) and sleep quality (Pittsburgh Sleep Quality Index, PSQI). 30 age- and sex-matched healthy volunteers served as a control group. The prevalence of daytime sleepiness was higher in the CF than in the control group (ESS > 10; n = 11 [20%] vs. n = 2 [6.7%]; p < 0.01) as was reduced sleep quality (PSQI > 5; n = 21 [38.2%] vs. n = 1 [3.3%]; p < 0.01). Multiple regression analysis including age, gender, body mass index, lung function and pseudomonas status showed that higher PSQI scores significantly correlated with lower CFQ18 + R scores for vitality, emotional functioning, social, role, eating disturbances and digestive symptoms. In clinically stable adult CF out-patients self-reported daytime sleepiness and poor sleep quality are more common than in age and sex-matched healthy controls. In addition, impaired sleep quality is related to reduced disease-specific HRQoL in CF.Respiratory medicine 07/2012; 106(9):1244-9. · 2.33 Impact Factor -
Article: Supplementation in acute lung injury.
JAMA The Journal of the American Medical Association 01/2012; 307(2):144; author reply 145-6. · 30.03 Impact Factor -
Article: Early or late parenteral nutrition in critically ill adults.
New England Journal of Medicine 11/2011; 365(19):1839; author reply 1841-2. · 53.30 Impact Factor
