"At present it appears that stimulation of the self-defense systems in neural cells is a promising strategy in restricting the progression of AD. .... In this review we selectively present data that support the idea that adaptation to hypoxia is a possible non-drug means in the prevention of AD. In our opinion this strategy may provide a break-through in the clinical approach of this disease."

Recognition and management of complex sleep-disordered breathing.
Curr Opin Pulm Med. 2005 Nov;11(6):485-93.
PMID: 16217173 [PubMed - in process]

Gilmartin GS, Daly RW, Thomas RJ.

"PURPOSE OF REVIEW: The recent rapid evolution of our understanding of the mechanisms involved in control of respiration during sleep has yielded new insights to guide our care of difficult-to-treat sleep apnea patients with complex sleep-disordered breathing. This review will describe these recent advances in the literature and suggest a model for their incorporation into clinical practice......."

Relationships Between Sleep Disordered Breathing and Glucose Metabolism in Polycystic Ovary Syndrome.
J Clin Endocrinol Metab. 2005 Oct 11; [Epub ahead of print]
PMID: 16219719 [PubMed - as supplied by publisher]
Tasali E, Van Cauter E, Ehrmann DA.
of Medicine, University of Chicago, Chicago, IL.

“Context: Women with PCOS are insulin resistant and are at increased risk for sleep apnea, which in turn, may contribute to insulin resistance. ...... Conclusion: PCOS is associated with poor sleep quality, daytime sleepiness, and increased risk for OSA. Insulin levels and measures of glucose tolerance in PCOS are strongly correlated with the risk and severity of OSA.”

Association Between Sleep Apnea and Death Points to Need to Examine Treatments, Modify Devices (AScribe - USA)

"ROCHESTER, Minn., Nov. 9 (AScribe Newswire) -- In the current issue of the New England Journal of Medicine, two studies draw attention to the newly recognized association between sleep disorders and heart trouble. The relevance of these studies to patients with sleep apnea is discussed in an accompanying editorial by Virend Somers, M.D., Ph.D., a Mayo Clinic cardiologist."

Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
H. K. Yaggi and Others
N Engl J Med. 2005 Nov 10;353(19):2034-2041.
Abstract  PMID: 16282178

“Background Previous studies have suggested that the obstructive sleep apnea syndrome may be an important risk factor for stroke. It has not been determined, however, whether the syndrome is independently related to the risk of stroke or death from any cause after adjustment for other risk factors, including hypertension. ....

Conclusions The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.”

Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure
T. D. Bradley and Others
N Engl J Med. 2005 Nov 10;353(19):2025-2033.
Abstract |  PMID: 16282177

“Background The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure (CPAP) would improve the survival rate without heart transplantation of patients who have central sleep apnea and heart failure. ....

Conclusions Although CPAP attenuated central sleep apnea, improved nocturnal oxygenation, increased the ejection fraction, lowered norepinephrine levels, and increased the distance walked in six minutes, it did not affect survival. Our data do not support the use of CPAP to extend life in patients who have central sleep apnea and heart failure.”

The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea.
Sleep Breath. 2005 Nov 8;:1-5 [Epub ahead of print]
PMID: 16283228 [PubMed - as supplied by publisher]
Hassaballa HA, Tulaimat A, Herdegen JJ, Mokhlesi B.
Section of Pulmonary/Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA.

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System.
Respiration. 2005 Nov 15; [Epub ahead of print]
PMID: 16293956 [PubMed - as supplied by publisher]
Dincer HE, O'neill W
"Pulmonary, Critical Care and Sleep Medicine, VA Southern Nevada Health Care System, Las Vegas, Nev., USA.

"Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, affecting 5-15% of the population. It is characterized by intermittent episodes of partial or complete obstruction of the upper airway during sleep that disrupts normal ventilation and sleep architecture, and is typically associated with excessive daytime sleepiness, snoring, and witnessed apneas. Patients with obstructive sleep apnea present risk to the general public safety by causing 8-fold increase in vehicle accidents, and they may themselves also suffer from the physiologic consequences of OSA; these include hypertension, coronary artery disease, stroke, congestive heart failure, pulmonary hypertension, and cardiac arrhythmias. Of these possible cardiovascular consequences, the association between OSA and hypertension has been found to be the most convincing. Although the exact mechanism has not been understood, there is some evidence that OSA is associated with frequent apneas causing mechanical effects on intrathoracic pressure, cardiac function, and intermittent hypoxemia, which may in turn cause endothelial dysfunction and increase in sympathetic drive. Therapy with continuous positive airway pressure has been demonstrated to improve cardiopulmonary hemodynamics in patients with OSA and may reverse the endothelial cell dysfunction. Despite the availability of diagnostic measures and effective treatment, many patients with sleep-disordered breathing remain undiagnosed. Therefore, OSA continues to be a significant health risk both for affected individuals and for thegeneral public. Awareness and timely initiation of an effective treatment may prevent potential deleterious cardiovascular effects of OSA. Copyright (c) 2006 S. Karger AG, Basel."

Association of Sleep-disordered Breathing and the Occurrence of Stroke.
Am J Respir Crit Care Med. 2005 Dec 1;172(11):1447-51. Epub 2005 Sep 1.
PMID: 16141444 [PubMed - in process]

Arzt M, Young T, Finn L, Skatrud JB, Bradley TD.

"Conclusions: These data demonstrate a strong association between moderate to severe sleep-disordered breathing and prevalent stroke, independent of confounding factors. They also provide the first prospective evidence that sleep-disordered breathing precedes stroke and may contribute to the development of stroke."

Sleep Apnea Increases Stroke Risk (MedPage)

"In the four years after diagnosis people with moderate to severe sleep-disordered breathing have nearly 4.5 times the risk of stroke as do people without the condition, according to Douglas Bradley, M.D., director of Toronto General Hospital's Sleep Research Laboratory here."

"The researchers found:

      Without adjustment for other risk factors, the odds ratio for stroke among those with the worst disorder -- compared to the reference group -- was 4.31 (with a 95% confidence interval from 1.31 to 14.15) over any four-year period.

      When age and sex were accounted for, the odds ratio became 4.48 (with the 95% confidence interval from 1.31 to 15.33.)

      Both results were statistically significant at p=0.02."

Researchers link sleep apnea to risk of strokes (CTV.ca, Canada)

"We showed for the first time that if you have sleep apnea, your chance of having a stroke is four times greater than if you have no sleep apnea," Dr. Douglas Bradley, director of the Sleep Research Laboratory at the Toronto Rehabilitation Institute, told CTV News.

The researchers found that interrupted sleep increases blood pressure, which makes blood more prone to the clots that cause strokes. More than 70 per cent of stroke patients are later found to have sleep apnea."

Sleep apnea linked to higher stroke risk(United Press International)

Study links sleep disorder, stroke (Globe and Mail)

Influence of cardiac function and failure on sleep-disordered breathing: evidence for a causative role.
J Appl Physiol. 2005 Dec;99(6):2433-9. PMID: 16288101 [PubMed - in process]
Caples SM, Wolk R, Somers VK.
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St., SW, Rochester, MN 55905. somers.virend@mayo.edu).

"Heart failure is an increasingly common public health problem that is strongly linked to both central and obstructive sleep apnea, collectively referred to as sleep-disordered breathing. Much attention has been given to the deleterious effects of sleep-disordered breathing on the failing heart and potential mechanisms by which treatment of sleep-disordered breathing may result in improved cardiac performance and long-term outcomes. However, there is compelling evidence that cardiac dysfunction may contribute to sleep-disordered breathing. Although there is recognized overlap between pathophysiological mechanisms in central sleep apnea and obstructive sleep apnea, data supporting the role of cardiac function are certain forms of central sleep apnea are well established, whereas investigation into the relationship with obstructive sleep apnea is less mature but continues to evolve. This review will examine experimental and observational data that explore possible pathophysiological mechanisms and potential targets for therapy in heart failure and sleep-disordered breathing."

‘Silent’ nighttime acid reflux symptoms can cause poor sleep and sleep apnea October 31, 2005

"HONOLULU — Patients with sleep complaints but no heartburn symptoms suffered episodes of nighttime acid reflux according to research presented at the 70th Annual Scientific Meeting of the American College of Gastroenterology. In a separate study, researchers found that symptoms of gastroesophageal reflux (GER) are common and frequently severe in patients with obstructive sleep apnea."

Most GERD symptoms are not due to acid reflux in patients with very low 24-hour acid contact times.
Dig Dis Sci. 2004 Aug;49(7-8):1084-7.
PMID: 15387325 [PubMed - indexed for MEDLINE]

Green BT, O'Connor JB.

"In patients with very low total acid contact times, only 12% of symptoms (typical or atypical) are associated with acid reflux, compared to 86% in patients with very high acid contact times. Younger females are overrepresented in the very low reflux, low SI group."

Causal relationship suggested between reflux and sleep apnea

"The results of a recent study to be presented at the 68th Annual Scientific Meeting of the American College of Gastroenterology suggest that gastroesophageal reflux (GER) of any sort -- not just acid reflux -- may contribute to sleep apnea arousals.   Causal relationship suggested between reflux and sleep apneaOctober 14, 2003 BALTIMORE - The results of ... of Gastroenterology suggest that gastroesophageal reflux (GER) of any sort -- not just acid reflux..."

Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airway pressure.
Arch Intern Med. 2003 Jan 13;163(1):41-5.
PMID: 12523915 [PubMed - indexed for MEDLINE]
Green BT, Broughton WA, O'Connor JB.

"CONCLUSIONS: Nocturnal GER is common in patients with OSA. Treatment with nasal CPAP decreases the frequency of nGER symptoms by 48%. Higher nasal CPAP pressures are associated with greater improvement in nGER."

Predictors of heartburn during sleep in a large prospective cohort study.
Chest. 2005 May;127(5):1658-66.
PMID: 15888843 [PubMed - indexed for MEDLINE]

Fass R, Quan SF, O'Connor GT, Ervin A, Iber C.

"CONCLUSIONS: Heartburn during sleep is very common in the general population. Reports of this type of symptom of GERD are strongly associated with increased BMI, carbonated soft drink consumption, snoring and daytime sleepiness, insomnia, hypertension, asthma, and usage of benzodiazepines. Overall, heartburn during sleep may be associated with sleep complaints and excessive daytime sleepiness."