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February 21, 1986, Vol 255, No. 7 >
ARTICLE | February 21, 1986

The Cardiopulmonary Failure of Sleep-Disordered Breathing FREE

Jesse B. Hall, MD
[+] Author Affiliations

Reprint requests to the Medical Intensive Care Unit, Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 (Dr Hall).


JAMA. 1986;255(7):930-933. doi:10.1001/jama.1986.03370070084031
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References

SLIGHTLY more than 100 years following the publication of the Pick-wick Papers, wherein Charles Dickens described the hypersomnolent and obese character Joe, the term pickwickian syndrome was applied to a group of patients exhibiting obesity, hypersomnolence, hypoventilation, and erythrocytosis.1 Since this descriptive report, a large amount of information regarding the clinical spectrum, pathophysiology, and treatment of various forms of sleep-induced breathing disorders has been generated,2 requiring increased clinical awareness of methods of diagnosis and treatment. Sleep-induced breathing disorders include the following: sleep apnea syndromes, such as central, obstructive, and mixed apnea; primary alveolar hypoventilation; periodic or irregular breathing patterns; and nocturnal hypoxemia in chronic obstructive pulmonary disease (COPD) or neuromuscular disorders (NMD).

Apneas are defined as the complete cessation of ventilation and may be analyzed by polysomnography3—the simultaneous recording during sleep of an electroencephalogram (to characterize sleep stage and pattern), measures of airflow (by means of

REFERENCES

1 +
Burwell CS, Robin ED, Whaley RD, et al:  Extreme obesity associated with alveolar hypoventilation: A pickwickian syndrome . Am J Med 1956;;21:811-818.
2 +
Saunders NA, Sullivan CE: Sleep and Breathing , ed 2. New York, Marcel Dekker Inc, 1984;.
3 +
Tobin MT, Cohn MA, Sakner MA:  Breathing abnormalities during sleep . Arch Intern Med 1983;;143:1221-1228.
4 +
Farmer WC, Glenn WWL, Gee JB:  Alveolar hypoventilation syndrome: Studies of ventilatory control in patients selected for diaphragm pacing . Am J Med 1978;;64:39-60.
5 +
Guilleminault C, Cummiskey J:  Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome . Am Rev Respir Dis 1982;;126:14-20.
6 +
Bradley TD, Day A, Hyland RH, et al:  Chronic ventilatory failure caused by abnormal respiratory pattern generation during sleep . Am Rev Respir Dis 1984;;130:678-680.
7 +
Findley LJ, Blackburn MR, Goldberger AL, et al:  Apneas and oscillation of cardiac ectopy in Cheyne-Stokes breathing during sleep . Am Rev Respir Dis 1984;;130:937-939.
8 +
Boysen PG, Block AJ, Wynne JW, et al:  Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease . Chest 1979;;76:536-542.
9 +
Bradley TD, Rutherford R, Grossman RF, et al:  Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome . Am Rev Respir Dis 1985;;131:835-838.
10 +
Fletcher EC, DeBehnke RD, Lovoi MS, et al:  Undiagnosed sleep apnea in patients with essential hypertension . Ann Intern Med 1985;; 103:190-195.
11 +
Orr WC, Martin RJ:  Obstructive sleep apnea associated with tonsillar hypertrophy in adults . Arch Intern Med 1981;;141:990-992.
12 +
Coccagna G, Di Domato G, Veruchi P, et al:  Hypersomnia with periodic apneas in acquired micrognathia . Arch Neurol 1976;;33:769-776.
13 +
Remmers JE, DeGroot WJ, Sauerland FK, et al:  Pathogenesis of upper airway obstruction during sleep . J Appl Physiol 1978;;44:931-938.
14 +
Sullivan CE, Berthon-Jones M, Issa Faiq G, et al:  Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nose . Lancet 1981;;1:862-866.
15 +
Guilleminault C, Connolly SJ, Winkle RA:  Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome . Am J Cardiol 1983;;52:490-494.
16 +
Millman RP, Bevilacqua J, Peterson DD, et al:  Central sleep apnea in hypothyroidism . Am Rev Respir Dis 1983;;127:504-507.
17 +
Orr WC, Males JL, Imes NK:  Myxedema and obstructive sleep apnea . Am J Med 1981;; 70:1061-1066.
18 +
Zwillich CW, Pierson DJ, Hofeldt FD, et al:  Ventilatory control in myxedema and hypothyroidism . N Engl J Med 1975;;292:662-665.
19 +
Remmers JE:  Obstructive sleep apnea: A common disorder exacerbated by alcohol . Am Rev Respir Dis 1984;;130:153-155.
20 +
Martin RJ, Sanders MH, Gray BA, et al:  Acute and long-term ventilatory effects of hyperoxia in the adult sleep apnea syndrome . Am Rev Respir Dis 1982;;125:175-180.
21 +
Motta J, Guilleminault C, Schroeder JS, et al:  Tracheostomy and hemodynamic changes in sleep-induced apnea . Ann Intern Med 1979;; 89:454-458.
22 +
Conway WA, Victor LD, Magilligan DJ Jr, et al:  Adverse effects of tracheostomy for sleep apnea . JAMA 1981;;246:347-350.
23 +
Fujita S, Conway W, Zorick F, et al:  Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: Uvolo-palatopharyngoplasty . Otolaryngol Head Neck Surg 1981;;39:923-934.
24 +
Cartwright RD, Samelson CF:  The effects of a nonsurgical treatment for obstructive sleep apnea: The tongue-retaining device . JAMA 1982;; 248:705-709.
25 +
Brownell LG, West P, Sweatman P, et al:  Protriptyline in obstructive sleep apnea: A double-blind trial . N Engl J Med 1982;;307:1037-1042.
26 +
Sutton FD, Zwillich CW, Creagh CD, et al:  Progesterone for outpatient treatment of pick-wickian syndrome . Ann Intern Med 1975;;83:476-479.
27 +
Smith PL, Haponik EF, Allen RP, et al:  The effects of protriptyline in sleep-disordered breathing . Am Rev Respir Dis 1983;;127:8-13.
28 +
Owens GR, Rogers RM:  Managing respiratory failure in chronic airflow obstruction . J Respir Dis 1982;;3:24-37.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Burwell CS, Robin ED, Whaley RD, et al:  Extreme obesity associated with alveolar hypoventilation: A pickwickian syndrome . Am J Med 1956;;21:811-818.
2 +
Saunders NA, Sullivan CE: Sleep and Breathing , ed 2. New York, Marcel Dekker Inc, 1984;.
3 +
Tobin MT, Cohn MA, Sakner MA:  Breathing abnormalities during sleep . Arch Intern Med 1983;;143:1221-1228.
4 +
Farmer WC, Glenn WWL, Gee JB:  Alveolar hypoventilation syndrome: Studies of ventilatory control in patients selected for diaphragm pacing . Am J Med 1978;;64:39-60.
5 +
Guilleminault C, Cummiskey J:  Progressive improvement of apnea index and ventilatory response to CO2 after tracheostomy in obstructive sleep apnea syndrome . Am Rev Respir Dis 1982;;126:14-20.
6 +
Bradley TD, Day A, Hyland RH, et al:  Chronic ventilatory failure caused by abnormal respiratory pattern generation during sleep . Am Rev Respir Dis 1984;;130:678-680.
7 +
Findley LJ, Blackburn MR, Goldberger AL, et al:  Apneas and oscillation of cardiac ectopy in Cheyne-Stokes breathing during sleep . Am Rev Respir Dis 1984;;130:937-939.
8 +
Boysen PG, Block AJ, Wynne JW, et al:  Nocturnal pulmonary hypertension in patients with chronic obstructive pulmonary disease . Chest 1979;;76:536-542.
9 +
Bradley TD, Rutherford R, Grossman RF, et al:  Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome . Am Rev Respir Dis 1985;;131:835-838.
10 +
Fletcher EC, DeBehnke RD, Lovoi MS, et al:  Undiagnosed sleep apnea in patients with essential hypertension . Ann Intern Med 1985;; 103:190-195.
11 +
Orr WC, Martin RJ:  Obstructive sleep apnea associated with tonsillar hypertrophy in adults . Arch Intern Med 1981;;141:990-992.
12 +
Coccagna G, Di Domato G, Veruchi P, et al:  Hypersomnia with periodic apneas in acquired micrognathia . Arch Neurol 1976;;33:769-776.
13 +
Remmers JE, DeGroot WJ, Sauerland FK, et al:  Pathogenesis of upper airway obstruction during sleep . J Appl Physiol 1978;;44:931-938.
14 +
Sullivan CE, Berthon-Jones M, Issa Faiq G, et al:  Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nose . Lancet 1981;;1:862-866.
15 +
Guilleminault C, Connolly SJ, Winkle RA:  Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome . Am J Cardiol 1983;;52:490-494.
16 +
Millman RP, Bevilacqua J, Peterson DD, et al:  Central sleep apnea in hypothyroidism . Am Rev Respir Dis 1983;;127:504-507.
17 +
Orr WC, Males JL, Imes NK:  Myxedema and obstructive sleep apnea . Am J Med 1981;; 70:1061-1066.
18 +
Zwillich CW, Pierson DJ, Hofeldt FD, et al:  Ventilatory control in myxedema and hypothyroidism . N Engl J Med 1975;;292:662-665.
19 +
Remmers JE:  Obstructive sleep apnea: A common disorder exacerbated by alcohol . Am Rev Respir Dis 1984;;130:153-155.
20 +
Martin RJ, Sanders MH, Gray BA, et al:  Acute and long-term ventilatory effects of hyperoxia in the adult sleep apnea syndrome . Am Rev Respir Dis 1982;;125:175-180.
21 +
Motta J, Guilleminault C, Schroeder JS, et al:  Tracheostomy and hemodynamic changes in sleep-induced apnea . Ann Intern Med 1979;; 89:454-458.
22 +
Conway WA, Victor LD, Magilligan DJ Jr, et al:  Adverse effects of tracheostomy for sleep apnea . JAMA 1981;;246:347-350.
23 +
Fujita S, Conway W, Zorick F, et al:  Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: Uvolo-palatopharyngoplasty . Otolaryngol Head Neck Surg 1981;;39:923-934.
24 +
Cartwright RD, Samelson CF:  The effects of a nonsurgical treatment for obstructive sleep apnea: The tongue-retaining device . JAMA 1982;; 248:705-709.
25 +
Brownell LG, West P, Sweatman P, et al:  Protriptyline in obstructive sleep apnea: A double-blind trial . N Engl J Med 1982;;307:1037-1042.
26 +
Sutton FD, Zwillich CW, Creagh CD, et al:  Progesterone for outpatient treatment of pick-wickian syndrome . Ann Intern Med 1975;;83:476-479.
27 +
Smith PL, Haponik EF, Allen RP, et al:  The effects of protriptyline in sleep-disordered breathing . Am Rev Respir Dis 1983;;127:8-13.
28 +
Owens GR, Rogers RM:  Managing respiratory failure in chronic airflow obstruction . J Respir Dis 1982;;3:24-37.

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