6 research outputs found
Complete denture wear during sleep in elderly sleep apnea patients-a preliminary study
There is no consensus in the literature about the impact of complete denture wear on obstructive sleep apnea (OSA). The goal of this randomized clinical study was to assess if complete denture wear during sleep interferes with the quality of sleep. Elderly edentulous OSA patients from a complete denture clinic were enrolled and received new complete dentures. An objective sleep analysis was determined with polysomnography performed at the sleep laboratory for all patients who slept either with or without their dentures. Twenty-three patients (74% females) completed the study with a mean age of 69.6 years and a mean body mass index of 26.7 kg/m(2). The apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9 +/- 14.8/h vs. 19.9 +/- 10.2/h; p > 0.005). In the mild OSA group, the AHI was significantly higher when patients slept with the dentures (16.6 +/- 6.9 vs. 8.9 +/- 2.4; p < 0.05), while in moderate to severe OSA patients, the AHI was not significantly different when sleeping with dentures (.30.8 +/- 15.6 vs. 25.7 +/- 7.5; p = 0.2). The supine AHI in mild patients was related to a higher increase in AHI while wearing dentures (12.7 +/- 8.4/h vs. 51.9 +/- 28.6/h; p < 0.001). A limitation of the study is that the mild OSA patients had a higher BMI when compared to the moderate to severe OSA patients. Ten out of 14 patients who preferred to sleep with their upper and lower dentures showed an increase in their AHI while wearing dentures to sleep. Contrary to previous studies, we found that OSA patients may experience more apneic events if they sleep with their dentures in place. Specifically, in mild OSAS patients, the use of dentures substantially increases the AHI especially when in the supine position.Foreign Affairs and International Trade CanadaForeign Affairs and International Trade Canad
HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non-hospital settings in the community
The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD-supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. The expected and non-expected device-related and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD-supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non-LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non-LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast-growing population of LVAD-supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD-supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD-supported patients
HFA of the ESC Position paper on the management of LVAD supported patients for the non LVAD specialist healthcare provider Part 1: Introduction and at the non-hospital settings in the community
The accepted use of left ventricular assist device (LVAD) technology as
a good alternative for the treatment of patients with advanced heart
failure together with the improved survival of the LVAD-supported
patients on the device and the scarcity of donor hearts has
significantly increased the population of LVAD-supported patients. The
expected and non-expected device-related and patient-device interaction
complications impose a significant burden on the medical system
exceeding the capacity of the LVAD implanting centres. The ageing of the
LVAD-supported patients, mainly those supported with the `destination
therapy' indication, increases the risk for those patients to experience
comorbidities common in the older population. The probability of an
LVAD-supported patient presenting with medical emergency to a local
emergency department, internal, or surgical ward of a non-LVAD
implanting centre is increasing. The purpose of this trilogy is to
supply the immediate tools needed by the non-LVAD specialized physician:
ambulance clinicians, emergency ward physicians, general cardiologists,
internists, anaesthesiologists, and surgeons, to comply with the medical
needs of this fast-growing population of LVAD-supported patients. The
different issues discussed will follow the patient's pathway from the
ambulance to the emergency department and from the emergency department
to the internal or surgical wards and eventually to the discharge home
from the hospital back to the general practitioner. In this first part
of the trilogy on the management of LVAD-supported patients for the
non-LVAD specialist healthcare provider, after the introduction on the
assist devices technology in general, definitions and structured
approach to the assessment of the LVAD-supported patient in the
ambulance and emergency department is presented including
cardiopulmonary resuscitation for LVAD-supported patients
Heart Failure Association of the European Society of Cardiology position paper on the management of left ventricular assist device-supported patients for the non-left ventricular assist device specialist healthcare provider: Part 2: at the emergency department
The improvement in left ventricular assist device (LVAD) technology and
scarcity of donor hearts have increased dramatically the population of
the LVAD-supported patients and the probability of those patients to
present to the emergency department with expected and non-expected
device-related and patient-device interaction complications. The ageing
of the LVAD-supported patients, mainly those supported with the
`destination therapy' indication, increases the risk for those patients
to suffer from other co-morbidities common in the older population. In
this second part of the trilogy on the management of LVAD-supported
patients for the non-LVAD specialist healthcare provider, definitions
and structured approach to the LVAD-supported patient presenting to the
emergency department with bleeding, neurological event, pump thrombosis,
chest pain, syncope, and other events are presented. The very
challenging issue of declaring death in an LVAD-supported patient, as
the circulation is artificially preserved by the device despite no other
signs of life, is also discussed in detail