H F Becker

Asklepios Klinik Barmbek, Hamburg, Hamburg, Germany

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Publications (46)105.55 Total impact

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    ABSTRACT: Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment. In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP. 12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up. CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.
    Full-text · Article · Apr 2011 · European Respiratory Journal
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    ABSTRACT: To investigate the effect of nebivolol, a third generation beta-blocker, on blood pressure (BP) reduction and polysomnographic parameters in hypertensive patients with mild-to-moderate obstructive sleep apnoea (OSA). In this double-blind, parallel group study, patients were randomized to nebivolol 5 mg or valsartan 80 mg once daily following a 14-day, placebo run-in period during which any antihypertensive medication were discontinued. BP and heart rate measurements and overnight polysomnography were performed at baseline and after 6 weeks of treatment. Safety and tolerability were assessed. Thirty-one patients were randomized to nebivolol (n = 16) or valsartan (n = 15). After six weeks both systolic and diastolic BP were effectively reduced by both treatments. Reductions in BP were not statistically significant different between agents, but mean heart rate was significantly decreased with nebivolol (compared with valsartan (p < 0.001). There was no statistically significant difference between both treatments for the change from baseline to treatment end for mean (+/-SD) Apnoea Hypopnoea Index (AHI) (nebivolol: 23.0 +/- 9.2 to 27.9 +/- 21.2 events/h; valsartan: 23.8 +/- 6.6 to 22.5 +/- 18.0 events/h; p = 0.48) or for any other sleep-related parameters. Both agents were well tolerated. Nebivolol has a significant BP reduction effect in patients with OSA that is similar to valsartan and reduces heart rate to a greater extent which may prove beneficial in selected patients.
    No preview · Article · Aug 2010 · Current Medical Research and Opinion
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    ABSTRACT: Cyclic variations of the heart rate as a pathognomonic finding is observed in 80–100% of patients with obstructive sleep apnea (OSA). It is caused by an interaction of parasympathetic and sympathetic activity. Bradycardiac rhythm disorders are predominantly found in obese patients with a frequency of roughly 10%. The most important pathogenetic mechanism is a vagal cardioinhibitory reflex. Apnea-associated variations of the heart rate ongoing with bradycardiac arrhythmias disappear under effective nasal noninvasive ventilatory therapy. In patients with bradyarrhythmias refractory to therapy, pacemaker implantation should be considered. Regarding tachycardiac arrhythmias, both cardiovasculatory morbidity and the extent of apnea-associated hypoxemic events and sympathetic response are relevant for its pathogenesis. Obstructive sleep apnea can lead to an imbalance of the autonomous nervous system by different pathways, implying the risk for (lethal) cardiac arrhythmias. Patients with unclear arrhythmias and hypertension refractory to therapy should be screened for the presence of OSA.
    No preview · Article · Mar 2010 · Somnologie - Schlafforschung und Schlafmedizin

  • No preview · Article · Mar 2009 · Pneumologie
  • G. Mayer · R. Dodel · H. Peter · A. Spottke · A. Althaus · U. Siebert · K. Kesper · H. F. Becker

    No preview · Article · Feb 2007 · Sleep Medicine
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    ABSTRACT: These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985. They have been discussed and accepted in a consensus conference. EN by means of oral nutritional supplements (ONS) or tube feeding (TF) enables nutritional intake to be maintained or increased when normal oral intake is inadequate. No data are yet available concerning the effects of EN on cachexia in CHF patients. However, EN is recommended to stop or reverse weight loss on the basis of physiological plausibility. In COPD patients, EN in combination with exercise and anabolic pharmacotherapy has the potential to improve nutritional status and function. Frequent small amounts of ONS are preferred in order to avoid postprandial dyspnoea and satiety as well as to improve compliance.
    Full-text · Article · May 2006 · Clinical Nutrition
  • R Bals · H F Becker · U Wagner · C Vogelmeier

    No preview · Article · Feb 2006 · Pneumologie
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    T Penzel · C-C Lo · P.C. Ivanov · K Kesper · H.F. Becker · C Vogelmeier
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    ABSTRACT: Sleep disorders have a high prevalence. Sleep disorders are recognized first by the complaint of nonrestorative sleep. A quantification of the disorder is done by the investigation in a sleep laboratory. The investigation in the sleep laboratory examines the EEG, EOG and EMG to derive sleep stages. This is a labor intensive sleep scoring after the polysomnography investigation. Usually the time course of the sleep stages is quantified in terms of percentages of stages related to total sleep time and the latencies for the individual stages. The additional feature of transitions between sleep stages and the disruption of sleep, which corresponds to periods of wakefulness during sleep are not evaluated systematically. We have evaluated these transitions using a statistical approach. We have detected systematic differences in the distributions o sleep stages and wake states during sleep. This differences were investigates in normal subjects and patients with sleep apnea. Then these differences were investigated in different species. The difference in the distributions can be explained only by fundamentally different regulation of sleep and wakefulness.
    Full-text · Article · Feb 2005 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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    ABSTRACT: Study Objective: To evaluate the economic burden of patients suffering from narcolepsy. Design: Cross-sectional study. Participants: 75 narcoleptic patients diagnosed at the Hephata Klinik, Germany, who met the International Classification of Sleep Disorders criteria for narcolepsy. Measurements: A standardized telephone interview was used to inquire about the disease and its burden. In addition, health-related quality of life scales (SF-36 and EQ-5D) were mailed to the patients. Complete data were available for 75 patients. Direct and indirect costs were calculated from the societal perspective. All costs (mean +/- SD) were calculated in 2002 Euros. Results: Total annual costs were 14,790 Euro +/- 16,180 (US-$15,410) per patient. Direct costs were 3,180 Euro +/- 3,540 (US-$3,310), which consisted of hospital costs (1,210 Euro +/- 2,210; US-$1,260), drug costs (narcolepsy medication: 1,020 Euro +/- 1,420; US-$1,060), ambulatory care (90 Euro +/- 90; US-$40), and ambulatory diagnostics (20 Euro +/- 30; US-$20). More than 50% of the drug costs were due to the newer wake-promoting drugs. Total annual indirect costs amounted to 11,390 Euro +/- 15,740 (US-$11,860) per patient and were mainly attributable to early retirement due to the disease. Narcolepsy was listed as being the cause of unemployment by 32 patients. In patients with sleep attacks, there was a significant correlation between early retirement and higher indirect costs compared to patients without these attacks. Conclusions: Narcolepsy causes a high socioeconomic burden, which is comparable to other chronic neurologic diseases. Indirect costs are considerably higher than direct costs. Measures should be taken to increase public awareness of this disease. Appropriate treatment must be provided in order to increase quality of life and to assist patients continuing in working life.
    Full-text · Article · Nov 2004 · Value in Health
  • H F Becker
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    ABSTRACT: Sleep is characterized by a profound change of load and capacity of the respiratory system. Load increases due to a rise in upper and lower airway resistance. Capacity decreases due to reduced chemosensitivity, a decrease in muscle activity and minute ventilation. Whereas these changes do not lead to relevant blood gas changes and do not disturb sleep in healthy subjects, patients with respiratory diseases frequently show the first symptoms of their disease during sleep. Pulmonary diseases in which sleep plays an important role are asthma, COPD, hypercapnic respiratory failure, sleep disordered breathing, the overlap-syndrome and cystic fibrosis. Medical history should include sleep and complaints during the night. In asthmatics peak-flow measurements during the night may provide valuable information. In all other disorders mentioned, nocturnal ambulatory recording of respiration and arterial oxygen saturation often allow the detection of relevant disorders of breathing during sleep. If ambulatory monitoring reveals relevant pathology, then further evaluation and treatment in the sleep laboratory are warranted.
    No preview · Article · Oct 2004 · Der Internist
  • H. F. Becker
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    ABSTRACT: Sleep is characterized by a profound change of load and capacity of the respiratory system. Load increases due to a rise in upper and lower airway resistance. Capacity decreases due to reduced chemosensitivity, a decrease in muscle activity and minute ventilation. Whereas these changes do not lead to relevant blood gas changes and do not disturb sleep in healthy subjects, patients with respiratory diseases frequently show the first symptoms of their disease during sleep. Pulmonary diseases in which sleep plays an important role are asthma, COPD, hypercapnic respiratory failure, sleep disordered breathing, the overlap-syndrome and cystic fibrosis. Medical history should include sleep and complaints during the night. In asthmatics peak-flow measurements during the night may provide valuable information. In all other disorders mentioned, nocturnal ambulatory recording of respiration and arterial oxygen saturation often allow the detection of relevant disorders of breathing during sleep. If ambulatory monitoring reveals relevant pathology, then further evaluation and treatment in the sleep laboratory are warranted.
    No preview · Article · Aug 2004 · Der Internist
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    ABSTRACT: Autotitrating continuous positive airway pressure (CPAP) devices automatically adjust the pressure according to upper airway obstructions. The aim of this study was to compare the treatment effects of different automatic CPAP devices (AutoSet, Horizon and Virtuoso) with conventional CPAP in patients with obstructive sleep apnoea independently of financial manufacturer support. Twelve male patients with obstructive sleep apnoea were submitted to a crossover study protocol with overnight polysomnography for 6 consecutive nights. After diagnostic polysomnography, the CPAP pressure was manually titrated. Over the next 4 nights, the patients were treated with any one of the three automatic CPAP devices or fixed CPAP in random order. The apnoea/hypopnoea index on the diagnostic night was 67.3+/-21.7 events h(-1), and was significantly reduced to 0.7+/-1.2, 3.0+/-2.9, 2.3+/-2.5 and 12.0+/-13.6 events x h(-1) with the fixed CPAP, AutoSet, Horizon and Virtuoso devices respectively. An apnoea/ hypopnoea index of <5 events h(-1), an indicator of optimal treatment, was achieved in all patients with fixed CPAP and in 10 patients using the Autoset and Horizon devices, but in only six of the 12 using the Virtuoso. The mean pressure was significantly lower with the AutoSet and Virtuoso devices, but not with the Horizon as compared to fixed CPAP. The maximum pressure was significantly higher with the Horizon. It is concluded that automatic continuous positive airway pressure devices produce a significant reduction in apnoea/hypopnoea index; however, there is considerable difference in the efficacy of the various devices.
    Full-text · Article · Aug 2004 · European Respiratory Journal
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    H.F. Becker

    Preview · Article · Jun 2004 · European Respiratory Journal
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    ABSTRACT: There is increasing evidence that nasal continuous positive airway pressure (nCPAP) lowers blood pressure in obstructive sleep apnoea (OSA) patients, not only during sleep but also in the daytime. However, both the mechanisms of blood pressure reduction and the considerable differences in the magnitude of the effect in the studies presented to date are not fully understood. Therefore, the authors prospectively studied the effect of nCPAP on noradrenaline plasma levels (NApl), blood pressure and heart rate (HR) in 10 normotensive and eight hypertensive OSA patients before and after 41.6 +/- 16.9 days of nCPAP therapy. Polysomnography and invasive blood pressure were continuously monitored over 24 h in the supine position before and with nCPAP. NApl were analysed every 15 min. In hypertensives, nCPAP reduced NApl by 36 +/- 25%, lowered mean arterial blood pressure substantially (night-time: -8.89 +/- 14.09 mmHg; daytime: -7.94 +/- 10.47 mmHg) and decreased HR by 6.6 +/- 5.4 beats x min(-1), whereas in normotensives there were only minor changes. The decrease in heart rate was associated with a decrease in mean arterial blood pressure and noradrenaline plasma levels, suggesting a causal effect of nasal continuous positive airway pressure therapy. This nasal continuous positive airway pressure effect occurs mainly in hypertensive obstructive sleep apnoea patients, whereas the effect is small in normotensives. This may explain, at least in part, some of the discrepant results in previous treatment studies.
    Full-text · Article · Mar 2004 · European Respiratory Journal
  • H F Becker · G Mayer · T Penzel
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    ABSTRACT: Normal sleep consists of 4-5 sleep cycles including light-, deep- and rapid eye-movement sleep. Restoration of physical and psychological function are the main effects of sleep. In most cases, disturbances of normal sleep become clinically evident as problems of initiating and maintaining sleep and/or as increased daytime sleepiness. Approximately 10% of adults suffer from pronounced insomnia, a similar percentage from markedly increased daytime sleepiness. Sleep disorders cause high socio-economic costs due to increased accident risk, cardiovascular sequelae and sick leave. Most of the 88 distinct diagnoses summarized in the international classification of sleep disorders can be differentiated and managed according to patients history. In patients with severe daytime sleepiness - sleep disordered breathing being the most frequent cause - the diagnostic evaluation and treatment in the sleep laboratory is required. Effective therapeutic strategies are available for many sleep disorders. According to the underlying disorder, treatment includes a variety of measures like life style changes, differentiated medical treatment and the use of nasally applied positive pressure in patients suffering from sleep disordered breathing.
    No preview · Article · Feb 2004 · Der Internist
  • T Penzel · K Kesper · T Ploch · H F Becker · C Vogelmeier
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    ABSTRACT: Sleep related breathing disorders are common. A reliable diagnosis with relatively simple and portable methods is still needed. One approach is to make use of autonomous nervous system changes which accompany disordered breathing during sleep. The peripheral arterial tonometry (PAT) determines the peripheral arterial vascular tone using a plethysmographic method on the finger. The peripheral arterial tone is modulated by sympathetic activity, by peripheral blood pressure, and by the peripheral resistance of the vessels. We investigate a new ambulatory recording device which uses PAT, oximetry and actigraphy in order to detect sleep apnea. For this purpose we performed a comparative study on 21 patients referred to our sleep laboratory due to suspected sleep apnea. Of these 17 valid recordings were compared. The Watch-PAT was used in parallel with cardiorespiratory polysomnography and the validity was determined. The new system is able to detect apneas and hypopneas with a high reliability (r=0.89). It is very sensitive to arousals (r=0.77). Since arousal are not specific to sleep apnea the specificity of the new system could not be finally clarified in this study. We conclude that the new system is very well suited to perform control studies in patients with sleep apnea which are under therapy and require regular follow-up investigations to maintain a high CPAP compliance.
    No preview · Article · Feb 2004 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
  • U Koehler · H F Becker · V Gross · C Reinke · T Penzel · H Schäfer · C Vogelmeier
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    ABSTRACT: Patients with obstructive sleep apnea (OSA) frequently suffer from cardiovascular diseases. Mechanisms like intrathoracic pressure variations, changes in blood gases (hypoxia), arousals and neurohumeral adaptation mechanisms, combined with breathing disorders are causing these cardiovascular sequelae. In particular repetitive hypoxemia and activation of the sympathetic nervous system have to be considered as stressors for the cardiovascular system. Special clinical findings should take OSA into consideration as a differential diagnosis. A systematic anamnesis with questions to daytime conditions (hypersomnia, decrease of performance), snoring and apneas while sleeping is easy to ascertain, and will lead to the correct diagnosis in more than 90% of cases. The extent and need for therapy should be assessed by three criteria: 1) daytime symptoms, 2) the extent of breathing disorder and 3) cardiovascular comorbidity.
    No preview · Article · Jan 2004 · Zeitschrift für Kardiologie
  • H.F. Becker · G. Mayer · T. Penzel
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    ABSTRACT: Normal sleep consists of 4–5 sleep cycles including light-, deep- and rapid eye-movement sleep. Restoration of physical and psychological function are the main effects of sleep. In most cases, disturbances of normal sleep become clinically evident as problems of initiating and maintaining sleep and/or as increased daytime sleepiness. Approximately 10% of adults suffer from pronounced insomnia, a similar percentage from markedly increased daytime sleepiness. Sleep disorders cause high socio-economic costs due to the increased accident risk, cardiovascular sequelae and sick leave. Most of the 88 distinct diagnoses summarised in the international classification of sleep disorders can be differentiated and managed according to the patients history. In patients with severe daytime sleepiness—sleep disordered breathing being the most frequent cause—diagnostic evaluation and treatment in the sleep laboratory is required. Effective therapeutic strategies are available for many sleep disorders. According to the underlying disorder, treatment includes a variety of measures like life style changes, differentiated medical treatment and the use of nasally applied positive pressure in patients suffering from sleep disordered breathing.
    No preview · Article · Dec 2003 · Der Internist
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    ABSTRACT: Bei Patienten mit obstruktiver Schlafapnoe (OSA) werden Erkrankungen des kardiovaskulren Systems gehuft gefunden. Die an die Atmungsstrung gekoppelten Mechanismen wie intrathorakale Druckschwankungen, Vernderungen der Blutgase (Hypoxie), Arousalreaktionen sowie neurohumoral vermittelte Adaptationsvorgnge sind als urschlich fr die kardiovaskulren Folgeschden anzusehen. Vor allem die repetierenden Hypoxmien sowie die Sympathicotonusaktivierungen mssen als Schdigungskontinuum des arteriellen Gefsystems angesehen werden. Spezielle klinische Symptome und Befunde sollten die OSA in der Differenzialdiagnose bercksichtigen. Eine zielgerichtete Anamnese mit Fragen nach Tagesbefindlichkeit (Hypersomnie, Leistungsminderung), Schnarchen und Atemstillstnden im Schlaf ist einfach zu erheben und in ber 90% der Flle richtungsweisend. Schweregrad und Therapiebedrftigkeit lassen sich mithilfe von drei Kriterien abschtzen: 1. der klinischen Beschwerdesymptomatik (Tagesbefindlichkeitsstrung), 2. dem Ausma pathologischer Atmungsstrungen und 3. der kardiovaskulren Komorbiditt.Patients with obstructive sleep apnea (OSA) frequently suffer from cardiovascular diseases. Mechanisms like intrathoracic pressure variations, changes in blood gases (hypoxia), arousals and neurohumeral adaption mechanisms, combined with breathing disorders are causing these cardiovascular sequelae. In particular repetitive hypoxemia and activation of the sympathetic nervous system have to be considered as stressors for the cardiovascular system. Special clinical findings should take OSA into consideration as a differential diagnosis. A systematic anamnesis with questions to daytime conditions (hypersomnia, decrease of performance), snoring and apneas while sleeping is easy to ascertain, and will lead to the correct diagnosis in more than 90% of cases. The extent and need for therapy should be assessed by three criteria: 1) daytime symptoms, 2) the extent of breathing disorder and 3) cardiovascular comorbidity.
    No preview · Article · Nov 2003 · Zeitschrift für Kardiologie
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    T. Penzel · J.W. Kantelhardt · H.F. Becker · J.H. Peter · A. Bunde
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    ABSTRACT: In a systematic study we compared the performance of spectral analysis and detrended fluctuation analysis (DFA) to discriminate sleep stages and sleep apnea. We investigated 14 healthy subjects, 33 patients with moderate, and 31 patients with severe sleep apnea with polysomnography. Discriminance analysis was used on a person and sleep stage basis to determine the best method for the separation of sleep stages and sleep apnea severity. Using spectral parameters 69.7% of the apnea severity assignments and 54.6% of the sleep stage assignments were correct, while using scaling analysis these numbers increased to 74.4% and 85.0%, respectively. Changes in heart rate variability are better quantified by scaling analysis than by spectral analysis.
    Full-text · Conference Paper · Oct 2003

Publication Stats

844 Citations
105.55 Total Impact Points

Institutions

  • 2010-2011
    • Asklepios Klinik Barmbek
      Hamburg, Hamburg, Germany
  • 2006
    • Sapienza University of Rome
      Roma, Latium, Italy
  • 1997-2006
    • Philipps University of Marburg
      • Faculty of Medicine
      Marburg, Hesse, Germany