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In the present investigation, it seems likely that theophylline activated central respiratory receptors and reversed the hypoxic ventilatory depression 18. This resulted in a more in-phase response water journal ventilation to altered blood gases with consecutive reduction of periodic breathing 19, 20.

The fact that the effects of theophylline observed in this investigation occurred at relatively low serum concentrations, suggests that only little activation of central chemoreceptors is necessary to stabilise the out-of-phase breathing oscillations. This finding is important when theophylline is used in a high-altitude setting, as higher serum levels could result in impaired sleep quality in susceptible individuals.

Although both drugs normalised disturbed breathing patterns, no substantial differences in stages of sleep, arousal indices and sleep efficiency were found. However, in contrast to some previous studies, sleep quality was barely impaired even in the control group 3, 21, 22. The lack of correlation between arousal indices and AHI in this study indicates that the number of arousals was a result of the altitude exposure itself and not secondary to respiratory events 23.

In the second night, there was a trend to lower arousal indices with both active treatments. This is in accordance with the study of Weil et al. As the lowest arousal index was found in the acetazolamide group, this effect may result from increased basal oxygen saturation rather than from reduced periodic breathing.

This study, therefore, provides some evidence that theophylline is effective to reduce high-altitude, disturbed breathing patterns in susceptible subjects. Theophylline how to work in the morning be useful in patients with known sulphonamide intolerance and in those patient groups where the additional properties of this drug, such as antiobstructive how to work in the morning as well as improved diaphragmal contractility preventing failure of respiratory muscles 24, are desirable.

These patient groups include individuals with chronic obstructive pulmonary disease when travelling and staying at higher altitudes. Although acetazolamide remains the standard treatment ofacute mountain sickness and periodic breathing at high altitude, the authors conclude that theophylline is an effective alternative with possible benefits for patients with concomitant respiratory disorders (e.

How to work in the morning criteria were normal weight (body mass index (BMI) Design of the study The double-blind, randomised, placebo-controlled prospective study augmentin bid 1000 performed at the high-alpine research station (3,454 m) of the University of Berne, Switzerland.

View this table:View inlineView popupTable 2 Arterial oxygen tension during how to work in the morning at high altitude View this table:View inlineView popupTable 3 Arterial carbon dioxide tension during stay at high altitude Sleep studies: respiratory patterns The sleep studies of two subjects (one with theophylline, one with acetazolamide) how to work in the morning the second night were lost due to a technical defect.

Channel order is identical to figure 1. View this table:View inlineView popupTable 5 Sleep stage parameters during stay at high altitude Side-effects All the subjects were naive to the drugs employed in this study. Discussion How to work in the morning data demonstrate that nocturnal oxygen desaturations and altered sleep respiratory patterns, reflected in a pathological AHI and DI, occurred with high frequency in healthy volunteers acutely exposed to an altitude of 3,454 m, and that the short-term administration how to work in the morning theophylline or acetazolamide virtually Econazole Nitrate Topical Foam, 1% (Ecoza)- Multum SDB and reduced associated oxyhaemoglobin desaturations.

Operation Everest II: arterial oxygen saturation and sleep at extreme simulated altitude. OpenUrlPubMedWeb of Watch A, Insalaco G, Marrone O, et al. Effects of high-altitude periodic breathing on sleep and arterial oxyhaemoglobin saturation. OpenUrlAbstractZielinski J, Koziej M, Mankowski M, et al.

The quality of sleep and periodic breathing in healthy subjects at an altitude of 3,200 m. OpenUrlCrossRefPubMedKhoo MC, Anholm JD, Ko SW, et al. Dynamics of periodic breathing and arousal during sleep at extreme altitude. OpenUrlCrossRefPubMedWeb of ScienceWeil JV, Kryger MH, Scoggin CH. Sleep and breathing at high altitude In: Guilleminault C, Dement W, editors. Hackett PH, Roach RC, Harrison GL, Schoene RB, Mills WJ Jr.

Respiratory stimulants and sleep periodic breathing at high altitude. OpenUrlPubMedWeb of ScienceFischer R, Lang SM, Steiner U, et al. Theophylline improves acute mountain sickness. Comparison of the effects of acetazolamide and aminophylline on apnea incidence and on ventilatory response to CO2 in preterm infants.

OpenUrlPubMedWeb of ScienceJavaheri S, Parker TJ, Wexler L, Liming JD, Lindower P, Roselle GA. Effect of theophylline on sleep-disordered breathing in heart failure. OpenUrlCrossRefPubMedWeb of ScienceRechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjectsWashington, US Government Printing Office, 1968.

American Sleep Disorders Association. EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. OpenUrlPubMedSeries F, Marc I. Nasal pressure how to work in the morning in the diagnosis of sleep apnoea hypopnoea syndrome. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.

The Report of an American Academy of Sleep Medicine Task Force. OpenUrlPubMedWeb of ScienceWhite DP, Zwillich CW, Pickett CK, Douglas NJ, Findley LJ, Weil JV.

Improvement with acetazolamide therapy. OpenUrlCrossRefPubMedWeb of ScienceKhoo MC, Kronauer RE, Strohl KP, Slutsky AS. Factors inducing periodic breathing in humans: a general model. Aminophylline reduces hypoxic ventilatory depression: possible role of adenosine.

OpenUrlCrossRefPubMedWeb of ScienceJavaheri S, Teppema LJ, Evers JA.

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