A day vs. night comparison of type and frequency of cardiac arrhythmias documented by long-term ECG was done in 30 patients with nocturnal respiratory disorders in the form of the sleep apnoea syndrome. The commonest nocturnal arrhythmia was pronounced sinus arrhythmia during the apnoeic phases with variations of cardiac frequency between 40 and 120/min. Supraventricular and ventricular extrasystoles occurred significantly more frequently during the night than during the day. In three patients bradycardiac arrhythmias presenting as sinoauricular and atrioventricular blockades of the 3rd degree with node or ventricular substitute rhythm were seen during the sleep apnoea which could not be demonstrated during the day. Predominantly nightly occurrence of cardiac arrhythmias should lead to differential diagnostic consideration of the sleep apnoea syndrome.

BACKGROUND:Noninvasive pressure support ventilation (NPSV) demands triggering with each breath. This study investigates the effects of NPSV via face mask on breathing pattern, ventilation and respiratory muscle loading in patients with hypercapnic stable COPD.METHODS:7 patients (age 66 +/- 9 years; FEV1 43 +/- 13% predicted; PaO2 52 +/- 19 mmHg; PaCO2 58 +/- 12 mmHg) were included. The physiologic variables were evaluated during spontaneous breathing and at the end of a 60 minutes period with NPSV. Inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) were adjusted to 12-14 cm H2O and 3 cm H2O, respectively. Respiratory muscle activity was measured as esophageal and transdiaphragmatic pressure time product (PTPes and PTPdi).RESULTS:Non-triggering was observed only occasionally. Compared to unsupported spontaneous breathing NPSV improved ventilation: PaCO2 was reduced from 58 +/- 11 mmHg to 50 +/- 14 mmHg (p +/- 0.05). Respiratory muscles were unloaded by 30% (p +/- 0.05). Breathing frequency and breathing pattern did not change.CONCLUSIONS:In patients with hypercapnic stable COPD NPSV effectively recognizes and supports breathing efforts. As a result ventilation is improved and respiratory muscles are unloaded.

Zusammenfassung: Hintergrund: Die nicht-invasive druckunterstützte Spontanatmung (¹pressure support ventilationª, NPSV) erfordert das aktive Auslösen der Beatmung bei jedem Atemzug.Die Studie sollte ermitteln, wie sich NPSV, auf das Atemmuster, die Ventilation und die Belastung der Atemmuskulatur bei Patienten mit stabiler hyperkapnischer chronischobstruktiver Lungenerkrankung (COPD) auswirkt.Methode: 7 Patienten (Alter 66 9 Jahre; FEV 1 43 13 % Soll; PaO 2 52 19 mmHg; PaCO 2 58 12 mmHg) nahmen an der Studie teil.Die physiologischen Variablen wurden bei Spontanatmung und am Ende einer 60-minütigen NPSV-Beatmung ermittelt.Die Beatmung erfolge über eine Gesichtsmaske.Der Inspirationsdruck (IPAP) wurde auf 12 ± 14 cm H 2 O, der Exspirationsdruck (EPAP) auf 3 cm H 2 O eingestellt.Die Aktivität der Atemmuskeln wurde als ösophageales und transdiaphragmales Druck-Zeit-Produkt (PTPes und PTPdi) gemessen.Ergebnisse: Ineffiziente Atemmuskeltätigkeit (Non-triggering) wurde nur sporadisch beobachtet.NPSV verbesserte die Ventilation im Vergleich zur nicht-unterstützten Spontanatmung: der PaCO 2 sank von 58 11 mmHg auf 50 14 mmHg (p < 0,05).Gleichzeitig wurde die Atemmuskulatur um 30 % entlastet (p < 0,05).Die Atemfrequenz und das Atemmuster änderten sich nicht.Schlussfolgerungen: Bei klinisch stabilen

OBJECTIVE:Hypertension is often seen in obstructive sleep apnea (OSA) and is characterized by increased sympathetic activity, depressed baroreflex and accentuated vascular responsiveness. The objective of this study was to investigate the effects of the new T-selective calcium channel blocker mibefradil on invasively measured blood pressure (BP) and heart rate in hypertensive patients with OSA.METHODS:The present study was a double-blind, randomized and placebo-controlled before and after trial in two parallel groups. Fifty-three men aged 23 69 years with systemic hypertension and OSA were recruited from the Outpatient Department of the Marburg University Sleep Laboratory and hospitalized for 10 days. Mibefradil (50 mg) or placebo were given orally in the morning for 8 days. The main outcome measure was the mean arterial (radial) BP monitored continuously during nocturnal sleep and during standardized daytime physical and psychological performance testing.RESULTS:Mibefradil lowered mean arterial BP and heart rate with (SD) during the entire measurement period compared with placebo: -7.25 (9.59) vs -2.11 (8.43) mmHg (P=0.039) and -4.83 (5.94) vs -1.34 (4.13) bpm (P=0.022), respectively. Both effects were observed during nocturnal sleep and performance testing, including graded exercise. Adverse events did not differ compared with placebo.CONCLUSION:Mibefradil is an effective but well-tolerated antihypertensive that also lowers heart rate over 24 h in OSA, in conditions known to increase BP.

We investigated the efficacy of an Angiotensin Converting Enzyme [ACE] inhibitor on daytime and night-time blood pressure in 55 male hypertensive patients with moderately severe to severe obstructive sleep apnea. We resolved to determine if treatment oriented towards the reduction of hypertension would be successful, despite persistent repetitive hypoxemia and sleep-disordered breathing. The study was a randomized, double-blind, single daily dose, placebo-controlled protocol, with 8 days drug intake (placebo or 2.5 mg Cilazapril) and monitoring on the final day of drug administration. Subjects underwent continuous 24-h arterial blood pressure monitoring during baseline and treatment conditions. Polysomnography was performed at night during the 24-h arterial monitoring period. Cilazapril (2.5 mg) lowered systolic, diastolic and mean blood pressure, despite persistence of repetitive obstructive apneas during sleep and the associated repetitive hypoxemia. The lowering of blood pressure occurred without a significant change in heart rate, and was noted during nocturnal sleep, performance testing and graded exercise.

In 5-10% of patients with sleep apnoea, AV conduction block or sinus arrest up to several seconds can be demonstrated. We studied the effect of nCPAP treatment on apnoea-associated heart blocks. 10 consecutive patients (9 m, 1 f) between 28-56 years of age (mean value 43.4 y) were studied. The diagnosis of sleep apnoea and nocturnal heart blocks during the first visit at the outpatient department were the only selection criteria. A standard polysomnography before and during nCPAP was performed. Mean pretreatment RDI was 91/h. Repetitive II degrees and III degrees AV conduction blocks were diagnosed in 2 patients (pts) and sinus arrest of 2 to 11 s in 8 pts at the study without therapy. 89.2% of heart blocks occurred during REM-sleep. In 8 pts a complete reversal of heart blocks could be demonstrated during nCPAP. In 2 pts heart blocks persisted at a reduced number during REM-sleep, mainly during ineffective nCPAP. In 80% of our pts nCPAP leads to a complete reversal of heart blocks. The indication for pacemaker implantation must be established on an individual basis.

The clinical features of Posner-Schlossman syndrome and the various differential diagnoses are described in a 20-year-old patient. Additional to Posner-Schlossman syndrome this patient showed signs of Axenfeld's anomaly. He also presented symptoms of a status-dysrhaphicus-like state after atrial septal defect and the ability to overstrain the distal finger joints. Posner-Schlossman syndrome, heterochromic cyclitis, anterior-chamber cleavage syndrome and ICE syndrome (iridocorneal-endothelial syndrome: Chandler's, Cogan-Reese syndrome and progressive essential iris atrophy) often produce similar effects at the Descemet membrane, the anterior chamber angle and the iris. Because of the same mesodermal origin of these tissues we suggest that all the diseases mentioned above are merely different clinical expressions of one main disease.

: Former investigations concerning muscular eyelid strength with dynamic registration revealed great inter- and intraindividual variations. We tried to minimize these influences by using an electronic power register with isometric registration. This is important because lid closing is a complex mechanism of horizontal and vertical movements with continuously changing power vectors. Our new apparatus reduces false results. A normal collective of 114 persons was examined. The results show no statistically significant age- or sex-related differences in lid strength.

Two cases of optic pit associated with macular edema detected by fluorescein fundus angiography are described; the edema was most probably caused by pathologic vessels.

Patients with sleep apnea syndrome (SAS) have an increased incidence of cardiovascular diseases, e.g., arterial hypertension [1, 2]. Especially the physiological decrease in systemic blood pressure at night is often missing in patients with obstructive sleep apnea [2]. This is possibly produced by an increased sympathetic activity in response to hypoxemia during apnea. The urinary excretion of catecholamines is also increased in patients with SAS [2, 3] and the diurnal rhythm of excretion is lost [2]. Hitherto there have been no reports about the pattern of the plasma catecholamines in patients with SAS during sleep.

The formerly accepted view that snoring is, at worst, an annoying or irritating factor in human sleep can no longer be maintained in the light of recent medical evidence. Snoring has been discovered to be an important pathophysiological and pathogenic factor, particularly in two fields: sleep apnea (SA) syndromes and essential hypertension. For patients with SA, histories of many years or even decades of loud and irregular snoring have been described [1]. Habitual snoring must be evaluated as an early symptom of obstructive SA [2, 3].