The Effects of Nitrazepam and Flunitrazepam on Oxygen Desaturation During Sleep: Respiratory VariablesWe can only speculate that this is due to the fact that the fraction of REM sleep was subnormal already during placebo sleep. Observations on healthy subjects may not be directly applicable to patients with diseases affecting sleep quality.
Another factor contributing to the short total sleeping time may be that all our patients took theophylline during the study. Theophylline, as many other xanthine derivates, affects sleep and may, even in therapeutic concentrations, cause deterioration in the quality of sleep. Acute administration of aminophylline may reverse diazepam-induced sedation, but from our study it seems unlikely that maintenance therapy with theophylline significantly inhibits the hypnotic effects of oral benzodiazepines. Read the rest of this entry »

Apneas were few and their number and duration did not increase after benzodiazepine treatment (Table 3). The patient with an abnormal number of sleep apneas, excluded from the final analysis, had 29 apneas per hour on placebo and 38 and 33 per hour on nitrazepam and flunitrazepam, respectively. The mean duration of his apneas was 17, 19 and 20 s and mean SaOz fell by 2.5, 2.6 and 4.4 percent, respectively. Link
The fall in mean Sa02 from wakefulness to sleep (average for all stages) was small and did not differ significantly between the study nights (Table 3). We also analyzed the fall in mean Sa02 for each sleep stage but found no differences among the study nights (Fig 2). The lowest SaO£ (usually occurring during REM sleep) did not differ between the study nights. There was, however, a small but significant difference in the sleep-induced increase in tcPco2 among the study nights (Table 3). Read the rest of this entry »

The Effects of Nitrazepam and Flunitrazepam on Oxygen Desaturation During Sleep: ResultsThe polygraphic sleep recordings comprised EEG, EMG, EOG, nasal and oral thermistors and thoracic and abdominal strain gauges. Scoring of sleep stage was done according to the criteria of Rechtschaffen and Kales. The sleep recordings were coded and analyzed blindly after the completion of the study of each patient. The Sa02 was monitored with a Biox III ear oximeter and transcu-taneous Pco2 with a Hewlett Packard 47210A cutaneous capnometer. These two variables were recorded separately, coded and analyzed as previously described after the completion of the study of each patient. The drug code was not broken until the whole study was finished. Read the rest of this entry »

We recruited 16 patients with COPD according to clinical history; FEV,/FVC% <0.55 (repeated measurements); and daytime PaO* below 9 kPa (67.5 mm Hg, repeated measurements), ie, low enough to be associated with a reasonable likelihood of desaturation during sleep. One patient was excluded due to intercurrent disease between the second and third study nights and one patient was analyzed separately because he had an abnormal number of sleep apneas. Thus, 14 patients remained for complete evaluation. Read the rest of this entry »

The Effects of Nitrazepam and Flunitrazepam on Oxygen Desaturation During SleepThe severity of oxygen desaturation during sleep in patients with COPD is mainly a function of their position on the oxyhemoglobin dissociation curve. Patients with stable COPD seem not to decrease their ventilation during sleep more than normal subjects. However, due to the shape of the dissociation curve, any factor increasing the hypoventilation during sleep will have more profound effects in COPD patients with hypoxemia already during wakefulness. Read the rest of this entry »

Ventilation-Perfusion Imaging in Evaluating Regional Lung Function in Nonpenetrating Injury to the Chest: ConclusionThe significant morbidity and mortality associated with long-term tracheal intubation and mechanical ventilation” have led investigators to question the routine use of ventilatory support in the treatment of moderate to severe NIC. Noninvasive modes of management such as epidural analgesia in conjunction with vigorous physiotherapy, fluid restriction, diuretics, steroids, and IV albumin, or CPAP by tight-fitting face mask, have been used successfully, mostly in an uncontrolled setting. The extent of lung injury and resulting gas exchange abnormalities, rather than the number of rib fractures or anatomic defects (flail chest) have been emphasized as the important indicators for respiratory support in patients with NIC. Read the rest of this entry »

The tendency for changes on chest x-ray films to lag behind V/Q changes is more difficult to explain. It is known that the radiologic appearance of alveolar opacifications (eg, lobar pneumonia) may lag behind clinical findings and that these opacifications may exist long after clinical recovery. A similar discrepancy between clinical and radiologic findings might be the reason for the observation that chest x-ray film changes worsen, whereas clinical parameters and V/Q abnormalities improve. The sensitivity of supine chest x-ray films to evaluate pulmonary opacifications and lung volumes in patients with a painful chest condition remains questionable. itat on
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