Faculty Bibliography

A study was undertaken to determine whether topographic brain mapping of standard EEG and cognitive evoked potentials would provide additional information for the detection of subtle brain abnormalities associated with obstructive sleep apnea. During nocturnal sleep, significant brain activity was detected in frontal regions not usually monitored with standard sleep recordings. Moreover, preliminary results suggest that total brain activity decreased in association with apneic events and depth of O2 desaturation. Also, component asymmetry in the P300 waveform observed in brain areas not typically recorded improved with treatment. We conclude that the use of topographic mapping adds important information to the study of brain function during sleep and sleep apnea

Defense of ventilatory homeostasis against recurrent hypercapnia, hypoxia, and acidosis resulting from apnea in obstructive sleep apnea syndrome (OSAS) is dependent on compensatory mechanisms operative between episodes of airway obstruction. This investigation was designed to examine whether endogenous opiate activity modulates the compensatory ventilatory response to apnea in OSAS. Polysomnography and quantitative measurement of tidal volume was performed in 12 patients with moderate to severe OSAS during a morning nap study before and after intravenous administration of 10 mg of naloxone. Apnea index was not significantly altered. There was a small but significant shortening of apneas (postnaloxone apnea duration, 91.2% of prenaloxone; p = 0.002 by ANOVA). Tidal volume of the first postapnea breath and minute ventilation extrapolated from the first two postapnea breaths, but not frequency, increased significantly after naloxone (postnaloxone first breath volume, 112.7% of prenaloxone value [p = 0.03], with a similar increase for minute ventilation, 115.1% [p = 0.007]). The volume of the first postapnea breath was correlated with the duration of the previous apnea, both before (r = 0.59, p = 0.0001) and after naloxone. Despite this, analysis of covariance with apnea duration as the covariate confirmed a significant independent increase in postapnea breath volume after naloxone (p = 0.001). Naloxone also altered sleep architecture, increasing percent time awake during the study period (prenaloxone, 36.3 +/- 15.6%; postnaloxone, 56.7 +/- 22.4%; p = 0.0003) and decreasing total sleep time and percent time in Stage 1. Furthermore, naloxone increased continuity of awake periods (mean length of awake periods increased from 27.0 +/- 8.4 to 66.0 +/- 66.6 s after naloxone, p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

A new technique of measurement--Scoliotic Index(SI)--was devised to obtain more accurate determination of the spinal curvature. In comparison with previously established methods (Ferguson, Cobb), the SI is a more comprehensive and accurate representation of the scoliotic curve. It measures that the deviation of each involved vertebral segment from the vertical spinal lines with multiple points taken along the scoliotic curve. The development of this technique proved by serendipity that the Ferguson and Cobb measurements of the angle of scoliosis are reliable and comparable at all degrees of curvature