phenylephrine-hydrochloride and Sleep-Apnea-Syndromes

This review aims to provide current knowledge about the efficacy, mechanism, and multidisciplinary collaboration of rapid maxillary expansion (RME) treatment in pediatric obstructive sleep apnea (OSA). OSA is a chronic disease characterized by progressively increasing upper airway resistance, with various symptoms and signs. Increasingly the evidence indicates that RME is a non-invasive and effective therapy option for children with OSA. Besides, the therapeutic mechanism of RME includes increasing upper airway volume, reducing nasal resistance, and changing tongue posture. Recent clinical researches and case reports also show that a multidisciplinary approach improves sleep-disordered breathing in children. Applied with adenotonsillectomy, mandibular advancement, continuous positive airway pressure, and comprehensive orthodontic treatment, RME can be more effective in recurrent or residual OSA.

Topics: Child; Humans; Mandibular Advancement; Nose; Palatal Expansion Technique; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Identification of the obstruction site in the upper airway may help in treatment selection for patients with sleep-disordered breathing. Because of limitations of existing techniques, there is a continuous search for more feasible methods. Snoring sound parameters were hypothesized to be potential predictors of the obstruction site. Therefore, this review aims to i) investigate the association between snoring sound parameters and the obstruction sites; and ii) analyze the methodology of reported prediction models of the obstruction sites.. The literature search was conducted in PubMed, Embase.com, CENTRAL, Web of Science, and Scopus in collaboration with a medical librarian. Studies were eligible if they investigated the associations between snoring sound parameters and the obstruction sites, and/or reported prediction models of the obstruction sites based on snoring sound.. Of the 1016 retrieved references, 28 eligible studies were included. It was found that the characteristic frequency components generated from lower-level obstructions of the upper airway were higher than those generated from upper-level obstructions. Prediction models were built mainly based on snoring sound parameters in frequency domain. The reported accuracies ranged from 60.4% to 92.2%.. Available evidence points toward associations between the snoring sound parameters in the frequency domain and the obstruction sites in the upper airway. It is promising to build a prediction model of the obstruction sites based on snoring sound parameters and participant characteristics, but so far snoring sound analysis does not seem to be a viable diagnostic modality for treatment selection.

Topics: Airway Obstruction; Humans; Nose; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring; Sound

The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 3D Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered breathing for healthcare professionals seeking education in orofacial myology.

Topics: Deglutition; Humans; Malocclusion; Mastication; Mouth Breathing; Myofunctional Therapy; Nose; Patient Care Team; Respiration; Sleep Apnea Syndromes; Tongue Habits

Pediatric sleep-disordered breathing is a continuum, with primary snoring at one end, and complete upper airway obstruction, hypoxemia, and obstructive hypoventilation at the other. The latter gives rise to obstructive sleep apnea. An important predisposing factor in the development and progression of pediatric sleep-disordered breathing might be craniofacial disharmony. The purpose of this systematic review and meta-analysis was to elucidate the association between craniofacial disharmony and pediatric sleep-disordered breathing.. Citations to potentially relevant published trials were located by searching PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials. The MetaRegister of controlled trials database was also searched to identify potentially relevant unpublished trials. Additionally, hand-searching, Google Scholar searches, and contact with experts in the area were undertaken to identify potentially relevant published and unpublished studies. Inclusion criteria were (1) randomized controlled trials, case-control trials, or cohort studies with controls; (2) studies in nonsyndromic children 0 to 18 years of age with a diagnosis of sleep-disordered breathing or obstructive sleep apnea by either a sleep disorders unit, screening questionnaire, or polysomnography; and (3) principal outcome measures of craniofacial or upper airway dimensions or proportions with various modalities of imaging for the craniofacial and neck regions. The quality of the studies selected was evaluated by assessing their methodologies. Treatment effects were combined by meta-analysis with the random-effects method.. Children with obstructive sleep apnea and primary snoring show increased weighted mean differences in the ANB angle of 1.64° (P <0.0001) and 1.54° (P <0.00001), respectively, compared with the controls. An increased ANB angle was primarily due to a decreased SNB angle in children with primary snoring by 1.4° (P = 0.02). Children with obstructive sleep apnea had a distance from the posterior nasal spine to the nearest adenoid tissue measured along the PNS-basion line reduced by 4.17 mm (weighted mean difference) (P <0.00001) and a distance from the posterior nasal spine to the nearest adenoid tissue measured along the line perpendicular to the sella-basion line reduced by 3.12 mm (weighted mean difference) (P <0.0001) compared with the controls.. There is statistical support for an association between craniofacial disharmony and pediatric sleep-disordered breathing. However, an increased ANB angle of less than 2° in children with obstructive sleep apnea and primary snoring, compared with the controls, could be regarded as having marginal clinical significance. Therefore, evidence for a direct causal relationship between craniofacial structure and pediatric sleep-disordered breathing is unsupported by this meta-analysis. There is strong support for reduced upper airway width in children with obstructive sleep apnea. Larger well-controlled trials are required to address the relationship of craniofacial and upper airway morphology to pediatric sleep-disordered breathing in all 3 dimensions.

Topics: Adenoids; Adolescent; Cephalometry; Child; Child, Preschool; Humans; Hypertrophy; Infant; Larynx; Likelihood Functions; Nose; Pharynx; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Imaging plays a role in the anatomic assessment of the airway and adjacent structures. This article discusses the use of 3-dimensional (3D) imaging (cone beam computed tomography [CBCT]) to evaluate the airway and selected regional anatomic variables that may contribute to obstructive sleep-disordered breathing (OSDB) in patients. CBCT technology uses a cone-shaped x-ray beam with a special image intensifier and a solid-state sensor or an amorphous silicon plate for capturing the image. Incorporation of 3D imaging into daily practice will allow practitioners to readily evaluate and screen patients for phenotypes associated with OSDB.

Topics: Airway Obstruction; Cone-Beam Computed Tomography; Epiglottis; Humans; Imaging, Three-Dimensional; Mandible; Maxillofacial Development; Nose; Palate, Soft; Pharynx; Sleep Apnea Syndromes; Temporomandibular Joint Disorders; Tongue

Topics: Humans; Nasal Obstruction; Nose; Sleep Apnea Syndromes

During sleep there is a discrete fall in minute ventilation and an associated increase in upper airway resistance. In normal subjects, the nasal part of the upper airway contributes only little to the elevation of the total resistance, which is mainly the consequence of pharyngeal narrowing. Yet, swelling of the nasal mucosa due to congestion of the submucosal capacitance vessels may significantly affect nasal airflow. In many healthy subjects an alternating pattern of congestion and decongestion of the nasal passages is observed. Some individuals demonstrate congestion of the ipsilateral half of the nasal cavity when lying down on the side. Nasal diseases, including structural anomalies and various forms of rhinitis, tend to increase nasal resistance, which typically impairs breathing via the nasal route in recumbency and during sleep. A role of nasal obstruction in the pathogenesis of sleep-disordered breathing has been implicated by many authors. While it proves difficult to show a relationship between the degree of nasal obstruction and the number of disturbed breathing events, the presence of nasal obstruction will most likely have an impact on the severity of sleep-disordered breathing. Identification of nasal obstruction is important in the diagnostic work-up of patients suffering from snoring and sleep apnea.

Topics: Airway Resistance; Humans; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nose; Posture; Respiratory Mechanics; Sleep; Sleep Apnea Syndromes; Snoring

Radiofrequency volumetric tissue reduction (RFVTR) has been applied to the nose, palate, and tongue as a treatment for sleep-disordered breathing. Data on the outcome of this procedure are very scant. When applied to the palate, RFVTR seems to be moderately effective for simple snoring. It has not been shown to be effective treatment for significant sleep apnea. Application of RFVTR to the tongue and turbinates has not been studied thoroughly enough to assess its efficacy at present.

Topics: Catheter Ablation; Humans; Nose; Palate; Sleep Apnea Syndromes; Tongue

Nasal obstruction whether partial or complete can influence the quality of sleep and has been strongly linked to the genesis of obstructed breathing during sleep (OBS). The relationship between nasal airflow and the process of upper airway collapse is complex. The first part of this article reviews the nasal anatomy with an emphasis on the sites of nasal obstruction, the effect of the nasal reflexes on the pulmonary system, and the pathophysiology of the development of OBS. The second part reviews the common causes of increased nasal resistance, the assessment of nasal passages, and the treatment options. This article also includes literature in support of and refuting the postulated mechanisms by which nasal obstruction can effect the respiratory system during sleep.

Topics: Humans; Nasal Obstruction; Nose; Sleep Apnea Syndromes

The upper airways play a crucial role in respiration, as pathway for gases, modulator for airflow, and filter for particulate matter. This article describes the anatomy and physiology of the trachea and upper airways and imaging of the upper airways in patients with chronic obstructive airway disease.

Topics: Adult; Child; Diagnostic Imaging; Humans; Lung Diseases, Obstructive; Magnetic Resonance Imaging; Nose; Pharynx; Pulmonary Ventilation; Respiration; Sleep Apnea Syndromes; Tomography, X-Ray Computed; Trachea; Tracheal Diseases; Tracheobronchomegaly

This article discusses the history of operative management of obstructive sleep apnea syndrome and reviews a protocol for surgical intervention. An overview of diagnostic procedures and evaluation is also presented, and emerging technology for the management of this disorder is touched on.

Topics: Clinical Trials as Topic; Female; Humans; Male; Nose; Otorhinolaryngologic Surgical Procedures; Palate; Pharynx; Prognosis; Severity of Illness Index; Sleep Apnea Syndromes; Tracheostomy

Obstruction of the upper airway may cause arousals resulting in daytime sleepiness and cardiovascular disturbances. The upper airway resistance syndrome may easily be overlooked because conventional measurements of oronasal airflow and thoracic and abdominal efforts are not sensitive enough. By measuring esophageal pressure even small disturbances can be detected, but the esophageal gauge may disturb sleep. We conclude that other, less invasive methods like measurements of impedance by forced oscillation technique, or flattening of the inspiratory flow contour could be valid alternatives in the diagnosis of the upper airway resistance syndrome. Other methods, such as measurements of the pulse transit time, phase angle, or systolic blood pressure profile are promising, but need further evaluation.

Topics: Airway Obstruction; Airway Resistance; Arousal; Blood Pressure; Electric Impedance; Equipment Design; Esophagus; Hemodynamics; Humans; Inhalation; Mouth; Nose; Oscillometry; Pressure; Pulmonary Ventilation; Pulse; Sleep Apnea Syndromes; Sleep Stages; Syndrome

The authors present the clinical of a male patient aged 45 years whose main complaints were loud snoring and excessive daytime sleepiness. Polysomnographic study revealed a sleep obstructive apnea syndrome with an apnea/hypopnea index of 86.5. After being treated with nasal continuous positive air pressure, (12 cm H2O), the apneas ended and sleep architecture was corrected. Physical examination also indicated the presence of an acromegaly, and therefore, the patient was subjected to endocrinological and cerebral imagiological studies; the diagnosis confirmed it as a predisposing factor to the sleep breathing disorder. A brief literature review about the incidence of sleep apnea syndrome in acromegaly is also made; the authors conclude that there is still the need for a systematic screening of sleep breathing disorders in acromegalic patients in order to optimise the treatment and prognosis of this disorders.

Topics: Acromegaly; Chronic Disease; Humans; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes

Topics: Behavior Therapy; Humans; Nose; Oral Surgical Procedures; Orthodontic Appliances; Positive-Pressure Respiration; Sleep Apnea Syndromes

Research efforts to date have determined that both anatomic and physiologic variables may contribute to the pathophysiology of OSA. Whether specific factors within either of these two categories will be shown to predominate remains to be seen. Surely, experience with sleep apnea patients teaches us that different variables are important in different OSA patients. However, even those patients who initially appear to have predominantly an anatomic or physiologic cause of their OSA often fail to respond to specific treatment. Treatment failure implies the following: (1) The initial impression of the importance of a given variable was wrong. This may happen in the patient who has a narrow transpalatal airway and fails to respond to uvulopalatopharyngoplasty. In this individual, physiologic variables such as pharyngeal collapsibility or periodic breathing may need to be addressed. Of course, the reverse may occur; patients may be treated pharmacologically for an assumed physiologic mechanism and important anatomic factors may have been overlooked. Our ability to differentiate the importance of these different variables is poor. Therefore, our diagnostic acumen needs further refinement. (2) Of course, it is likely that the proper diagnosis was made, but the therapy chosen was imperfect. In the area of anatomy, investigators are just beginning to try surgical approaches designed specifically for the pharyngeal site of obstruction. In other words, uvulopalatopharyngoplasty is not the best approach for everyone. In physiology, treatments beyond continuous positive airway pressure will be needed. It is hoped that advances in the pharmacology of sleep disorders will establish more convenient and successful therapies. It is likely that OSA is a heterogenous disease process. We must realize that a treatment that helps one patient may not be applicable to the next individual. Through a better understanding of the pathophysiology of OSA, better treatment modalities should be developed, resulting in improved quality of life for OSA patients.

Topics: Humans; Nose; Pharynx; Reflex; Respiration; Respiratory Muscles; Respiratory System; Sleep Apnea Syndromes

Recent research, stimulated by the growing awareness of the sleep apnea syndrome, has shown that nasal breathing plays a major role in the regulation of respiration in sleep. These observations are not new; they confirm century-old clinical findings on the importance of nasal breathing in sleep. The earliest account of the deleterious effects of mouth breathing in sleep was made by Lemnious Levinus towards the end of the sixteenth century. Two hundred years later, Catlin dedicated an entire book to the superiority of nasal breathing over mouth breathing in sleep; and in the late 1800's, Cline, Wells, Griffin and others showed that obstructed nasal breathing causes sleep disorders.

Topics: Adult; History, 16th Century; History, 19th Century; History, 20th Century; Humans; Male; Middle Aged; Mouth Breathing; Nose; Respiration; Sleep Apnea Syndromes; United States

Topics: Adult; Aged; Female; Humans; Intubation; Male; Middle Aged; Nose; Pharynx; Sleep Apnea Syndromes

The upper airways are a complex structure with multiple functions; many of the muscles participate in the act of respiration. The neural control of upper airway muscles is distinct from that of chest wall muscles under a variety of circumstances. Coordinated activation of upper airway muscles, both regionally and inter-regionally, results in changes in upper airway size and resistance, alterations in the route of airflow, and increases in the ability of the airways to resist collapse. Several disorders have now been described in which neuromuscular drive abnormalities and/or mechanical dysfunction of the upper airways occur, resulting in clinical disease.

Topics: Afferent Pathways; Behavior; Blood Pressure; Bronchial Spasm; Humans; Hypercapnia; Hypoxia; Laryngeal Diseases; Larynx; Lip; Mechanoreceptors; Muscles; Neuromuscular Diseases; Nose; Palate, Soft; Pharynx; Pulmonary Stretch Receptors; Reflex; Respiration; Respiratory Physiological Phenomena; Respiratory System; Sleep Apnea Syndromes; Vagus Nerve; Vocal Cords

Topics: Breath Tests; Child; Child, Preschool; Choanal Atresia; Fluorometry; Humans; Infant; Infant, Newborn; Lip; Mouth Breathing; Nose; Palate; Physical Exertion; Respiration; Sleep Apnea Syndromes; Smoking; Snoring; Spirometry; Sudden Infant Death; Uvula

Both neural and anatomical factors play an important role in the maintenance of upper airway patency. An abnormality in one or both of these factors is felt to be the underlying cause of obstructive sleep apnea.

Topics: Airway Obstruction; Airway Resistance; Central Nervous System; Humans; Larynx; Mandible; Muscles; Nose; Oropharynx; Pharynx; Positive-Pressure Respiration; Pressure; Respiratory Physiological Phenomena; Respiratory System; Sleep; Sleep Apnea Syndromes; Snoring; Tomography, X-Ray Computed

This study compared the efficacy of three different masks, nasal pillows, nasal masks and full face (oronasal) masks, during a single night of titration with continuous positive airway pressure (CPAP).. Fifty five subjects that included men (n=33) and women (n=22) were randomly assigned to one of three masks and underwent a routine titration with incremental CPAP applied through the different masks.. CPAP applied through the nasal pillows and nasal mask was equally effective in treating mild, moderate, and severe sleep apnea. However, CPAP applied through the oronasal mask required a significantly higher pressure compared to nasal masks to treat moderately severe (2.8 cm of H(2)O ± 2.1 SD) and severe (6.0 cm of H(2)O ± 3.2 SD) obstructive sleep apnea.. CPAP applied with either nasal mask was effective in treating mild, moderate, and severe sleep apnea. The oronasal mask required significantly higher pressures in subjects with moderate to severe disease. Therefore, when changing from a nasal to an oronasal mask, a repeat titration is required to ensure effective treatment of sleep apnea, especially in patients with moderate to severe disease.

Topics: Adult; Aged; Continuous Positive Airway Pressure; Equipment Design; Face; Female; Humans; Male; Masks; Middle Aged; Nose; Oxyhemoglobins; Polysomnography; Pressure; Severity of Illness Index; Sleep Apnea Syndromes; Treatment Outcome

To assess the accuracy of novel algorithms using an oximeter-based finger plethysmographic signal in combination with a nasal cannula for the detection and differentiation of central and obstructive apneas. The validity of single pulse oximetry to detect respiratory disturbance events was also studied.. Patients recruited from four sleep laboratories underwent an ambulatory overnight cardiorespiratory polygraphy recording. The nasal flow and photoplethysmographic signals of the recording were analyzed by automated algorithms. The apnea hypopnea index (AHI(auto)) was calculated using both signals, and a respiratory disturbance index (RDI(auto)) was calculated from photoplethysmography alone. Apnea events were classified into obstructive and central types using the oximeter derived pulse wave signal and compared with manual scoring.. Sixty-six subjects (42 males, age 54 ± 14 yrs, body mass index 28.5 ± 5.9 kg/m(2)) were included in the analysis. AHI(manual) (19.4 ± 18.5 events/h) correlated highly significantly with AHI(auto) (19.9 ± 16.5 events/h) and RDI(auto) (20.4 ± 17.2 events/h); the correlation coefficients were r = 0.94 and 0.95, respectively (p < 0.001) with a mean difference of -0.5 ± 6.6 and -1.0 ± 6.1 events/h. The automatic analysis of AHI(auto) and RDI(auto) detected sleep apnea (cutoff AHI(manual) ≥ 15 events/h) with a sensitivity/specificity of 0.90/0.97 and 0.86/0.94, respectively. The automated obstructive/central apnea indices correlated closely with manually scoring (r = 0.87 and 0.95, p < 0.001) with mean difference of -4.3 ± 7.9 and 0.3 ± 1.5 events/h, respectively.. Automatic analysis based on routine pulse oximetry alone may be used to detect sleep disordered breathing with accuracy. In addition, the combination of photoplethysmographic signals with a nasal flow signal provides an accurate distinction between obstructive and central apneic events during sleep.

Topics: Catheterization; Female; Humans; Male; Middle Aged; Nose; Oximetry; Polysomnography; Reproducibility of Results; ROC Curve; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

While continuous positive airway pressure (CPAP) effectively treats obstructive sleep apnea (OSA), adherence to CPAP is suboptimal. The short-term efficacy of and adherence with a convenient expiratory positive airway pressure (EPAP) nasal device was evaluated in OSA patients non-adherent with CPAP.. Participants were OSA patients who refused CPAP or used CPAP less than 3 h per night. After demonstrating tolerability to the EPAP device during approximately 1 week of home use, patients underwent a screening/baseline polysomnogram (PSG1) and a treatment PSG (PSG2). Patients meeting prespecified efficacy criteria underwent PSG3 after about 5 weeks of EPAP treatment.. Forty-seven of 59 eligible patients (80%) tolerated the device and underwent PSG1. Forty-three patients (27 m, 16f; 53.7±10.9 years) met AHI entry criteria and underwent PSG2. Mean AHI decreased from 43.3±29.0 at baseline to 27.0±26.7 (p<0.001) at PSG2. Twenty-four patients (56%) met efficacy criteria; their mean AHI was 31.9±19.8, 11.0±7.9, 16.4±12.2 at PSG1, PSG2, and PSG3, respectively (p<0.001, PSG1 vs. both PSG2 and PSG3). Mean Epworth Sleepiness Scale (ESS) scores were 12.3±4.8 at baseline, 11.1±5.1 at PSG1, and 8.7±4.4 at PSG3 (p=0.001 compared to baseline). Device use was reported an average of 92% of all sleep hours.. The improvements in AHI and ESS, combined with the high degree of treatment adherence observed, suggest that the convenient EPAP device tested may become a useful therapeutic option for OSA.

Topics: Adult; Aged; Continuous Positive Airway Pressure; Exhalation; Female; Humans; Male; Medical Records; Middle Aged; Nose; Patient Compliance; Patient Satisfaction; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes

This clinical trial was designed to evaluate the efficacy of the external nasal dilator Breathe Right (nasal strip) on snoring. The assessment of snoring intensity and duration as well as the sleep quality without the Breathe Right nasal strip and after application was performed in 30 out-patients with primary habitual snoring. An all-night polysomnographic investigation including registration of a17-channel EEG, EMG, respiration parameters such as breathing efforts and nasal/oral air flow, snoring vibrations, ECG, oxygen saturation, etc. was conducted in the sleep laboratory of Pro Science Private Research Clinic GmbH. The drug-free strip Breathe Right was able to reduce the maximum snoring intensity (maximum snoring vibration) throughout the night (p = 0.02, sign test), especially during the superficial sleep (sleep stage 1 and 2). The snoring intensity remained almost unchanged during slow wave sleep (SWS) and REM. In comparison with the baseline the maximum snoring intensity was reduced during the second treatment night in 22 of the 30 investigated snorers. The differentiation between snorers with and without obstructive sleep apnea and between mild and heavy snorers allowed to state that especially the snorers without apnea and the time in bed, TIB) can achieve a reduction of the maximum snoring intensity using the strip. Moreover, the number of snores per hour TIB (snoring index, SI) was reduced after application of the nasal strip for the snores with an intensity greater than 20 dB (p = 0.02, sign test). The sleep architecture remained almost unchanged, although the nasal strip led subjectively (SF-A questionnaire) to an improvement of sleep quality. The overall estimation of the subjective efficacy rating revealed that 17 of 30 patients (second treatment night) needed a certain period of time to accustom to the nasal strip. After that they could breathe easily, slept well and felt recuperated in the following morning. No adverse events were observed after adhesion of the nasal strip, except for one patient, who had the sensation as if they needed to sneeze for a short time after the first application of the nasal strip. Consequently, Breathe Right is a safe and easily applied noninvasive method to reduce the maximum snoring intensity, especially in habitual mild snorers.

Topics: Adult; Dilatation; Female; Humans; Leg; Male; Movement; Nose; Polysomnography; Respiratory Mechanics; Sleep; Sleep Apnea Syndromes; Sleep Stages; Snoring; Surveys and Questionnaires; Vibration

Many patients with sleep apnoea/hypopnoea syndrome (SAHS) find nasal continuous positive airway pressure (CPAP) treatment unsatisfactory due to side effects related to mouth air leakage. A study was performed to compare side effects with face mask and nose mask CPAP therapy in patients with SAHS, with and without uvulopalatopharyngoplasty (U3P).. Twenty newly diagnosed patients with SAHS took part in a randomised double limb trial of face or nose mask CPAP therapy (four weeks per limb) in which CPAP compliance in terms of machine run time was measured and patients answered a symptom questionnaire on side effects resulting from the mask. Ten patients with SAHS with U3P (SAHS/U3P) who were already regular users of nasal CPAP were also given a four week trial of face mask CPAP to compare compliance and symptoms. Ten patients with SAHS were matched with the 10 SAHS/U3P patients for body mass index, age, apnoea/hypopnoea index, and CPAP pressure. Long term compliance was estimated one year after the mask comparison studies.. For patients with SAHS nightly compliance was higher with a nose mask (mean (SE) 5.3 (0.4) hours/night CPAP) than with a face mask (4.3 (0.5) hours/night CPAP), p = 0.01 (mean difference 1.0 hour/night, 95% CI 1.8 to 0.3). Nose masks were rated more comfortable by 19 of 20 patients (p < 0.001) despite more mouth leak related symptoms. For SAHS/U3P patients compliance was marginally higher with nose masks (5.1 (0.7) hours/night CPAP) than with face masks (4.0 (0.8) hours/night CPAP), p = 0.07 (mean difference 1.1 hour/night, 95% CI 2.1 to 0.1). Nose masks were rated more comfortable by seven of 10 patients. There were no significant differences in side effect scores with face and nose masks. At one year nine of 10 SAHS patients and nine of 10 SAHS/U3P patients were still using CPAP. Compliance was 5.4 (0.6) hours/night for the SAHS patients and 3.5 (0.4) hours/night for the SAHS/U3P patients, p = 0.02 (mean difference 1.9 hour/night, 95% CI 3.6 to 0.3).. Compliance is greater with nose mask CPAP than with face mask CPAP because the overall comfort is better and compensates for increased symptoms associated with mouth leakage. Improved face mask design is needed.

Topics: Double-Blind Method; Face; Follow-Up Studies; Humans; Masks; Middle Aged; Nose; Patient Compliance; Positive-Pressure Respiration; Sleep Apnea Syndromes

Surgical management of obstructive sleep apnea remains a surgical challenge. Multidisciplinary collaboration is a fundamental element. We report the principles of management as proposed to the patient and preliminary results obtained in a series of 26 patients treated in the phase I of the Stanford protocol. Cure rate after this phase was 50%. Different research projects in this area are discussed.

Topics: Adult; Aged; Airway Obstruction; Facial Muscles; Female; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Nose; Palate, Soft; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes

Knowledge of how dental appliances alter upper airway muscle activity when they are used for the treatment of snoring and/or obstructive sleep apnea (OSA) is very limited. The purpose of this study was to define the effect of a tongue retaining device (TRD) on awake genioglossus (GG) muscle activity in 10 adult subjects with OSA and in 6 age and body mass index (BMI) matched symptom-free control subjects. The TRD is a custom-made appliance designed to allow the tongue to remain in a forward position between the anterior teeth by holding the tongue in an anterior bulb with negative pressure, during sleep. This pulls the tongue forward to enlarge the volume of the upper airway and to reduce upper airway resistance. In this study, two customized TRDs were used for each subject. The TRD-A did not have an anterior bulb but incorporated lingual surface electrodes to record the GG electromyographic (EMG) activity. The TRD-B contained an anterior bulb and two similar electrodes. The GG EMG activity was also recorded while patients used the TRD-B but were instructed to keep their tongue at rest outside the anterior bulb; this condition is hereafter referred to as TRD-X. The GG EMG activity and nasal airflow were simultaneously recorded while subjects used these customized TRDs during spontaneous awake breathing in both the upright and supine position. The following results were obtained and were consistent whether subjects were in the upright or the supine position. The GG EMG activity was greater with the TRD-B than with the TRD-A in control subjects (p < 0.05), whereas the GG EMG activity was less with the TRD-B than with the TRD-A in subjects with OSA (p < 0.01). Furthermore, there was no significant difference between the GG EMG activity of the TRD-A and the TRD-X in control subjects, whereas there was less activity with the TRD-X than with the TRD-A in subjects with OSA (p < 0.05). On the basis of these findings, it was concluded that the TRD has different effects on the awake GG muscle activity in control subjects and patients with OSA. The resultant change in the anatomic configuration of the upper airway caused by the TRD may be important in the treatment of OSA because such a change may alleviate the impaired upper airway function.

Topics: Adult; Aged; Airway Resistance; Body Mass Index; Case-Control Studies; Electromyography; Female; Humans; Male; Middle Aged; Nose; Oropharynx; Orthodontic Appliances; Posture; Pulmonary Ventilation; Sleep Apnea Syndromes; Supine Position; Tongue; Tongue Habits; Wakefulness

We evaluated an auto-nasal continuous positive airway pressure (nCPAP) prototype (MC+; SEFAM, Nancy, France) in which apnoea/hypopnoea detection was disabled and nasal mask pressure vibration detection was the only mode of pressure setting. The device was tested in 15 previously untreated obstructive sleep apnoea patients during a night with polysomnography. We observed that a single night of auto-nCPAP improved the apnoea/hypnoea index (AHI) (12 +/- 21 vs 51 +/- 31 disordered breathing events.h-1 of sleep (mean +/- SD)), the awakening-arousal index (13 +/- 20 vs 40 +/- 26 arousals.h-1 of sleep), and duration of slow wave sleep (102 +/- 49 vs 71 +/- 56 min) but not of rapid eye movement (REM) sleep (55 +/- 31 vs 64 +/- 38 min). Auto-nCPAP was effective (apnoea/hypopnoea and arousal indices < 10 events.h-1) in all but three patients. Auto-nCPAP was ineffective in one patient, whose obstructive respiratory events were not preceded by nasal mask pressure vibration detection, and in two patients who were quasi-permanent mouth breathers. Snoring detection may be effective in sleep apnoea syndrome with heavy snoring and without permanent mouth breathing, during the first night of nasal continuous positive airway pressure treatment.

Topics: Airway Obstruction; Arousal; Awareness; Evaluation Studies as Topic; Humans; Male; Masks; Middle Aged; Mouth Breathing; Nose; Polysomnography; Positive-Pressure Respiration; Pressure; Sleep Apnea Syndromes; Sleep Stages; Sleep, REM; Snoring; Vibration

We hypothesized that (1) patients with congestive heart failure (CHF) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) would have greater nocturnal urinary and daytime plasma norepinephrine concentrations (UNE and PNE, respectively) than those without CSR-CSA because of apneas, hypoxia and arousals from sleep and (2) attenuation of CSR-CSA by nasal continuous positive airway pressure (NCPAP) would reduce UNE and PNE concentrations. Eighteen patients with and 17 without CSR-CSA (Non-CSR-CSA group) were studied. Left ventricular ejection fraction was similar in the two groups, but overnight UNE and awake PNE concentrations were greater in the CSR-CSA group (30.2 +/- 2.5 nmol/mmol creatinine and 3.32 +/- 0.29 nmol/L) than in the Non-CSR-CSA group (15.8 +/- 2.1 nmol/mmol creatinine, p < 0.005, and 2.06 +/- 0.56 nmol/L, p < 0.05, respectively). Patients with CSR-CSA were randomized to a control group or to nightly NCPAP for 1 mo. CSR-CSA was attenuated in the NCPAP but not in the control group. The NCPAP group experienced greater reductions in UNE and PNE concentrations (-12.5 +/- 3.3 nmol/mmol creatinine and -0.74 +/- 0.40 nmol/L) than did the control group (-1.3 +/- 2.8 nmol/mmol creatinine, p < 0.025 and 1.16 +/- 0.66 nmol/L, p < 0.025, respectively). In conclusion, in patients with CHF, CSR-CSA is associated with elevated sympathoneural activity, which can be reduced by NCPAP.

Topics: Adolescent; Adult; Aged; Cheyne-Stokes Respiration; Circadian Rhythm; Creatinine; Epinephrine; Heart Failure; Humans; Hypoxia; Male; Middle Aged; Norepinephrine; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes; Sleep Stages; Stroke Volume; Sympathetic Nervous System; Ventricular Function, Left

Complaints about sleep and daytime alertness are common in ESRD patients. Eight consecutive ESRD patients with a sleep complaint were studied with all-night polysomnography. All were found to have significant sleep apnea with a mean apnea/hypopnea index (AHI) of 64 +/- 41.6 episodes per hour of sleep (range 7.5 to 140/hr of sleep). The majority of apneas were of the central or mixed variety causing severe fragmentation of sleep and frequent awakenings. Treatment was attempted with nasal continuous positive airway pressure (NCPAP). NCPAP was highly successful in six of the eight patients, reducing the mean AHI to normal or near normal levels (6.0 +/- 3.8/hr of sleep, P < 0.02 vs. baseline). The quality of sleep was significantly improved with statistically significant decreases in light stage 1 sleep, and nocturnal oxygenation improved with statistically significant increases in low SaO2 values. Five of six responders reported that they awoke feeling more alert and fewer times from sleep. The etiology of sleep apnea in ESRD is unknown although the frequent central apneas suggest a dysfunction of central respiratory control resulting from the effects of renal failure. Sleep-related complaints in patients with ESRD are likely to result from sleep apnea, a sleep disorder that can be diagnosed with polysomnography and treated with NCPAP.

Topics: Body Weight; Female; Humans; Kidney Failure, Chronic; Leg; Male; Middle Aged; Movement; Nose; Oxygen; Positive-Pressure Respiration; Sleep Apnea Syndromes; Surveys and Questionnaires

The effects of nasal valve dilation on snoring and obstructed breathing were studied in 11 patients with habitual snoring and/or obstructive sleep apnea. The anterior part of the nose, the valve region, was dilated by means of a plastic device. Ten patients underwent polysomnographic investigation including pulse oximetry and measurement of snoring noise with and without the nasal dilator in a randomized manner. Snoring, nocturnal arousals, and daytime hypersomnolence were rated by the patient and partner on a questionnaire before and after a 10-day treatment period with the dilator. The nasal airflow, as assessed by rhinomanometry when awake in the sitting position, increased by 18% (range, 5.5% to 45%) when the nasal dilator was used. The frequency and severity of obstructed breathing decreased significantly with the nasal dilator. The apnea index with and without the nasal dilator was 6.4 (range, 1.3 to 15) and 18 (range, 1.8 to 60), respectively. The mean decrease of the apnea index was 47%. The overnight minimum arterial oxygen saturation (with and without the nasal dilator was 84% (range, 76% to 88%) and 78% (range, 68% to 89%), respectively. There was a substantial decrease in snoring noise (number of epochs with Leq values, equal energy level, above 55 or 60 dB) with the dilator in all patients who presented with snoring noise above these levels during the control night. No subjective effects on arousal frequency or daytime hypersomnolence were reported. Four of 11 patients were positive to continue using the nasal dilator.

Topics: Adult; Dilatation; Equipment Design; Female; Humans; Male; Middle Aged; Nose; Otolaryngology; Sleep Apnea Syndromes; Snoring; Treatment Outcome

1. Sedatives such as the benzodiazepines and alcohol reduce upper airway muscle activity. We hypothesized that a sedating antihypertensive, alpha-methyldopa, might have similar effects. To investigate this hypothesis we studied the effect of alpha-methyldopa on alae nasi electromyographic (EMG) activity during hypercapnia. 2. We studied ten healthy subjects and three subjects with obstructive sleep apnoea during CO2-stimulated breathing. In a preliminary study four subjects demonstrated a fall in alae nasi EMG activity 4 h after the ingestion of 500 mg of alpha-methyldopa during CO2 rebreathing. 3. In six additional normal subjects and three subjects with obstructive sleep apnoea, we studied the alae nasi EMG activity during steady-state hypercapnia with PCO2 held constant 5 torr (0.7 kPa) above baseline. On 2 separate days we studied subjects before and 2 h after they had ingested 750 mg of alpha-methyldopa or placebo. 4. In the normal subjects the mean alae nasi EMG activity fell by 34% 2 h after ingestion of alpha-methyldopa (P less than 0.05) without a change in other ventilatory parameters. 5. In the sleep apnoea group the individual mean alae nasi EMG activity fell 16-49%, with ventilation and tidal volume falling in one patient. 6. We conclude that alpha-methyldopa selectively reduces upper airway motor activity.

Topics: Adolescent; Adult; Electromyography; Female; Humans; Male; Methyldopa; Middle Aged; Muscles; Nose; Respiration; Sleep Apnea Syndromes

Inability to breathe through the nose is an increasingly recognized cause of disordered breathing during sleep. To test the hypothesis that this respiratory dysrhythmia could result from loss of neuronal input to respiration from receptors located in the nose, we anesthetized the nasal passages of 10 normal men during sleep. Each subject spent 4 consecutive nights in the sleep laboratory while sleep stages, breathing patterns, respiratory effort, and arterial oxygen saturation were monitored. Night 1 was for acclimatization with Nights 3 and 4 being randomized to nasal spraying with either 4% lidocaine or placebo. On the lidocaine and placebo nights (Nights 3 and 4) the nasal passages were also sprayed with a decongestant to prevent increased nasal air-flow resistance resulting from mucosal swelling. To control for the possible effects of this decongestant, an additional night (Night 2) was included during which the nasal passages were sprayed with room air. Parallel studies conducted during wakefulness demonstrated low nasal resistance during the lidocaine-decongestant regimen. Because of the short duration of anesthesia with lidocaine, spraying was done at lights out and 2.5 and 5 h later. On the placebo night (decongestant plus saline) there were 6.4 +/- 1.8 (SEM) disordered breathing events (apneas plus hypopneas) per subject, whereas with lidocaine (plus decongestant) this increased fourfold to 25.8 +/- 7.8 events per subject (p less than 0.05). The majority of the disordered breathing events were apneas and were fairly evenly distributed between central and obstructive events. The magnitude of these changes is similar to that previously reported with complete nasal obstruction. These results suggest that nasal receptors sensitive to air flow may be important in maintaining breathing rhythmicity during sleep.

Topics: Adult; Anesthesia, Local; Humans; Lidocaine; Male; Middle Aged; Nose; Respiration; Sleep; Sleep Apnea Syndromes

Apnea during sleep has been associated with both increased pharyngeal resistance and nasal obstruction. Alcohol can worsen obstructive sleep apnea, but its influence on pharyngeal resistance and nasal patency has not been evaluated. Accordingly, we determined the effects of alcohol on pharyngeal and nasal resistances in 11 normal awake subjects on 2 separate days. Baseline pharyngeal resistance prior to placebo and alcohol was not significantly different. After placebo, pharyngeal resistance did not change significantly. However, after alcohol, pharyngeal resistance increased from 1.9 +/- 0.5 (SEM) to 3.3 +/- 0.8 cm H2O/L/s at 45 min (p less than 0.05) and returned to near baseline level by 90 min. Baseline nasal resistance varied considerably within subjects on the 2 days, but the mean values for baseline nasal resistance on alcohol and placebo days were not significantly different. Nasal resistance did not change after placebo, but after alcohol, nasal resistance increased from 2.4 +/- 0.9 at baseline to 3.7 +/- 0.8 at 45 min (NS) and to 4.3 +/- 1.2 cm H2O/L/s at 90 min (p less than 0.05). We conclude that a decrease in pharyngeal airway size and an increase in nasal resistance may account for alcohol's ability to worsen obstructive sleep apnea.

Topics: Adult; Airway Resistance; Ethanol; Humans; Nose; Pharynx; Sleep Apnea Syndromes; Snoring

Anecdotal observations suggested that poor quality of sleep is a frequent complaint during upper respiratory infections (URI). Nasal obstruction occurs frequently during URI and causes sleep apnea in some infants. Sleep apnea disrupts normal sleep and could explain the complaints of poor sleep quality during URI in adults. Accordingly, 10 normal men had full night recordings of sleep stages and breathing rhythm before and during nasal obstruction. The order of obstructed and nonobstructed nights was randomized after a standard acclimatization night. During nasal obstruction, time spent in the deep sleep stages decreased from 90 +/- 11.2 (SEM) to 71 +/- 12.9 min (p less than 0.05), whereas significantly more time was spent in Stage 1 sleep (p less than 0.03). This loss of deep sleep during obstruction was associated with a twofold increase in sleep arousals and awakening (p less than 0.01) resulting from an increased (p less than 0.02) number of apneas (34 +/-19 during control sleep versus 86 +/- 34 during obstructed sleep). Apneas of 20 to 39 s in duration became 2.5 times more frequent (p less than 0.05) during obstruction. Oxygen saturation was studied in the last 4 subjects using an ear oximeter. Desaturation (SaO2 less than 90%) occurred 27 times during control sleep compared with 255 times during obstructed sleep. These desaturation episodes occurred only during apneas. All men complained of poor sleep quality during nasal obstruction. We concluded that apneas, sleep arousals and awakenings, and loss of deep sleep occur during nasal obstruction and may explain complaints of poor sleep quality during URI.

Topics: Adult; Airway Obstruction; Humans; Male; Middle Aged; Nose; Oximetry; Random Allocation; Respiratory Tract Infections; Sleep Apnea Syndromes; Sleep Stages; Sleep Wake Disorders

Sleep-disordered breathing (SDB) is a common disorder in children, characterized by snoring and/or increased breathing force due to narrowing and increased upper airway collapse while sleeping. Over the last decade, it has been recognized that SDB occurs more frequently in children with craniofacial anomalies, but data in Thailand is quite limited. This study retrospective descriptive study aims to find the prevalence of SDB among children with craniofacial anomalies in Thailand and associated risk factors by collecting data among Thai children with congenital craniofacial anomalies younger than 15 years old who visited the Princess Sirindhorn Craniofacial Center at King Chulalongkorn Memorial Hospital between 2016 and 2021. All children were defined into syndromic and nonsyndromic groups. Data collected from the electronic medical record includes baseline characteristics, diagnosis of craniofacial anomalies, associated risk factors, diagnosis of SDB, diagnostic tools, and treatment. Total of 512 children, there were 80 children (15.4%) who had SDB. The most diagnosis was 51 (10%) obstructive sleep apnea followed by 27 (5.3%) primary snoring and 2 (0.4%) obstructive hypoventilation. The prevalence of SDB in the syndromic group was 43 (46.7%) while the nonsyndromic group was 37 (8.6%), ( P <0.001). The risk factors associated with SDB were overweight, allergic rhinitis, tonsillar hypertrophy, high arch palate, micrognathia, and syndromic craniofacial anomalies. The prevalence of SDB is higher in children with syndromic craniofacial anomalies than in the nonsyndromic group. Knowledge of the prevalence and related factors can lead to better care, including early screening and monitoring of SDB in craniofacial patients.

Topics: Adolescent; Child; Humans; Nose; Retrospective Studies; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring

An accurate benchtop model was developed to mimic the different forms of human upper airway collapse in adult sleep apnea patients. This was done via modeling the airway through digital imaging. Airway representative models were then produced in two steps via a customized pneumatic extrusion 3D printing system. This allowed the pressure of collapse and planes of collapse to be manipulated to accurately represent those seen in sleep apnea patients. The pressure flow relationships of the collapsible airways were then studied by inserting the collapsible airways into a module that allowed the chamber pressure (P

Topics: Adult; Humans; Hydrodynamics; Larynx; Models, Anatomic; Nose; Pharynx; Precision Medicine; Printing, Three-Dimensional; Sleep Apnea Syndromes

Sleep apnea is a sleep disorder that occurs when the breathing of a person is interrupted during the sleep. This interruption occurs because of the patient has narrowed airways and the upper airways muscles relax, closes in and blocks the airway. Therefore, any forces or reaction originated by the air flow dynamics over the relaxed upper airways muscles could make to close the upper airways, and consequently the air could not flow into your lungs, provoking sleep apnea. Fully describing the dynamic behavior of the airflow in this area is a severe challenge for the physicians. In this paper we explore the dynamic behavior of airflow in the upper airways of 6 patients suffering obstructive sleep apnea with/without a mandibular advancement device using computational fluid dynamics. The development of flow unsteadiness from a laminar state at entry to the pharynx through to the turbulent character in the soft palate area is resolved using an accurate numerical model. Combining the airflow solution with a geometrical analysis of the upper airways reveals the positive effects of mandibular advance device in the air flow behavior (pressure drop). Improved modeling of airflow and positioning of mandibular advance device could be applied to improve diagnosis and treatment of obstructive sleep apnea.

Topics: Adult; Computer Simulation; Female; Humans; Hydrodynamics; Larynx; Male; Mandible; Middle Aged; Nose; Palate, Soft; Pharynx; Polysomnography; Pulmonary Ventilation; Respiration; Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Sleep apnea and hypopnea syndrome (SAHS) seriously affects sleep quality. In recent years, much research has focused on the detection of SAHS using various physiological signals and algorithms. The purpose of this study is to find an efficient model for detection of apnea-hypopnea events based on nasal flow and SpO. A 60-s detector and a 10-s detector were cascaded for precise detection of apnea-hypopnea (AH) events. Random forests were adopted for classification of data segments based on morphological features extracted from nasal flow and arterial blood oxygen saturation (SpO. A retrospective study of 24 subjects' polysomnography recordings was conducted. According to segment analysis, the cascading detection model reached an accuracy of 88.3%. While Pearson's correlation coefficient between estimated AHI and reference AHI was 0.99, in the diagnosis of SAHS severity, the proposed method exhibited a performance with Cohen's kappa coefficient of 0.76.. The cascading detection model is able to detect AH events and provide an estimate of AHI. The results indicate that it has the potential to be a useful tool for SAHS diagnosis.

Topics: Adult; Aged; Algorithms; Humans; Middle Aged; Nose; Oxygen Saturation; Polysomnography; Retrospective Studies; Sleep Apnea Syndromes; Sleep Quality

Evaluation of apnea detection using a tracheal sound (TS) sensor during sleep in patients with obstructive sleep apnea.. Polysomnographic recordings of 32 patients (25 male, mean age 66.7 ± 15.3 years, and mean body mass index 30.1 ± 4.5 kg/m. The number of apneas detected by the thermistor was 4,167. The number of apneas detected using the NP was 5,416 (+29.97%), using the RIPsum was 2,959 (-29.71%) and using the TS was 5,019 (+20.45%). The kappa statistics (95% confidence interval) were 0.72 (0.71 to 0.74) for TS, 0.69 (0.67 to 0.70) for NP, and 0.57 (0.55 to 0.59) for RIPsum. The sensitivity/specificity (%) with respect to the thermistor were 99.23/69.27, 64.07/93.06 and 96.06/76.07 for the NP, RIPsum and TS respectively.. With the sensor placed properly on the suprasternal notch, tracheal sounds could help detecting apneas that are underscored by the RIPsum and identify apneas that may be overscored by the NP sensor due to mouth breathing. In the absence of thermistor, TS sensors can be used for apnea detection.. Registry: German Clinical Trials Register (DRKS), Title: Using the tracheal sound probe of the polygraph CID102 to detect and differentiate obstructive, central, and mixed sleep apneas in patients with sleep disordered breathing, Identifier: DRKS00012795, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012795.

Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Mouth; Nose; Plethysmography; Polysomnography; Pulmonary Ventilation; Respiratory Sounds; Sleep Apnea Syndromes; Trachea; Transducers, Pressure

Patients suspected to have sleep-disordered breathing underwent an overnight polysomnography using a divided nasal cannula to gain additional information about the nasal cycle during sleep.. This was a prospective, observational cohort study replacing the undivided nasal cannula with a divided nasal cannula during routine polysomnography (n = 28).. Integration of the divided nasal cannula pressure transducer system into routine polysomnography was easy and affordable. Most patients (89%) demonstrated nasal cycle changes during the test. Nasal cycle changes tended to occur during body position changes (62%) and transitions from non-rapid eye movement sleep to rapid eye movement sleep (41%). The mean nasal cycle duration was 2.5 ± 2.1 hours. Other sleep study metrics did not reveal statistically significant findings in relation to the nasal cycle.. Replacing an undivided nasal cannula with a divided nasal cannula is easy to implement, adding another physiologic measure to polysomnography. Although the divided nasal cannula did not significantly affect traditional polysomnographic metrics such as the apnea-hypopnea index or periodic limb movement index based on this small pilot study, we were able to replicate past nasal cycle findings that may be of interest to sleep clinicians and researchers. Given the ease with which the divided nasal cannula can be integrated, we encourage other sleep researchers to investigate the utility of using a divided nasal cannula during polysomnography.

Topics: Adult; Cannula; Feasibility Studies; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Posture; Prospective Studies; Sleep Apnea Syndromes; Young Adult

The purpose of this cross-sectional study is to examine the relationship between surgical treatments for sleep-disordered breathing (SDB) and composite measure of surgical complications in a nationally representative sample of hospital discharges among U.S. adults. We performed secondary analyses of 33,679 hospital discharges from the 2002-2012 Nationwide Inpatient Sample that corresponded to U.S. adults (≥18 years) who were free of head-and-neck neoplasms, were diagnosed with SDB and had undergone at least one of seven procedures. Multivariate logistic regression models were constructed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), controlling for age, sex, race/ethnicity, obstructive sleep apnea (OSA) and obesity diagnoses. Positive associations were found between composite measure of surgical complications and specific procedures: palatal procedure (aOR = 12.69, 95% CI: 11.91,13.53), nasal surgery (aOR = 6.47, 95% CI: 5.99,6.99), transoral robotic assist (aOR = 5.06, 95% CI: 4.34-5.88), tongue base/hypopharynx (aOR = 4.24, 95% CI: 3.88,4.62), maxillomandibular advancement (MMA) (aOR = 3.24, 95% CI: 2.74,3.84), supraglottoplasty (aOR = 2.75, 95% CI: 1.81,4.19). By contrast, a negative association was found between composite measures of surgical complications and tracheostomy (aOR = 0.033, 95% CI: 0.031,0.035). In conclusion, most procedures for SDB, except tracheostomy, were positively associated with complications, whereby palatal procedures exhibited the strongest and supraglottoplasty exhibited the weakest association.

Topics: Adolescent; Adult; Aged; Cross-Sectional Studies; Female; Hospitalization; Humans; Logistic Models; Male; Mandibular Advancement; Middle Aged; Nose; Obesity; Odds Ratio; Palate; Postoperative Complications; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Tongue; Tracheostomy; United States; Young Adult

Inspiratory Flow Limitation (IFL) is a phenomenon associated with narrowing of the upper airway, preventing an increase in inspiratory airflow despite an elevation in intrathoracic pressure. It has been shown that quantification of IFL might complement information provided by standard indices such as the apnea-hypopnea index (AHI) in characterizing sleep disordered breathing and identifying subclinical disease. Defining guidelines for visual scoring of IFL has been of increasing interest, and automated methods are desirable to avoid inter-scorer variability and allow analysis of large datasets. In addition, as recording instrumentation and practices may vary across hospitals and laboratories, it is useful to assess the influence of the recording parameters on the accuracy of the automated classification. We employed nasal pressure signals recorded as part of polysomnography (PSG) studies in 7 patients. Two experts independently classified approximately 2000 breaths per subject as IFL or non-IFL, and we used the consensus scoring as the gold standard. For each breath, we derived features indicative of the shape and frequency content of the signals and used them to train and validate a Support Vector Machine (SVM) to distinguish IFL from non-IFL breaths. We also assessed the effect of signal filtering (down-sampling and baseline-removal) on classification performance. The performance of the classifier was excellent (accuracy ~93%) for the raw signals (collected at 125 Hz with no filtering), and decreased for increasing high-pass cut-off frequencies (fc = [0.05, 0.1, 0.15, 0.2] Hz) down to 84% for fc= 0.2 Hz and for decreasing sampling rate (fs = [20, 50, 75, 100] Hz) down to ~85% for fs=20 Hz. Loss of performance was minimized when the classifier was re-trained using data with matched filtering characteristics (accuracy > 89%). We can conclude that the SVM feature-based algorithm provides a reliable and efficient tool for breath-by-breath classification.

Topics: Algorithms; Automation; Humans; Nose; Polysomnography; Records; Sleep Apnea Syndromes

Sleep disordered breathing a very common disorder with prevalence rates of up to 49% in large epidemiological studies on subjects older than 40 years. A recent study showed that applying CPAP treatment to patients with sleep disordered breathing recruited by their number of apnea and hypopnea events alone, does improve sleepiness but does not improve overall cardiovascular mortality. Based on older large studies however it is knownthat sleep disordered breathing is a cardiovascular risk and that treatment lowers mortality and morbidity. These results appear to be contradictory. However, they might be explained if patient population investigated are carefully reviewed further, and if sleep apnea severity metrics are reconsidered. According to this, it appears that studies speak of different populations. Whereas epidemiological studies use sampled subjects willing to participate, earlier studies used patients contacting a sleep center with complaints and symptoms. In this paper two studies are presented with an assessment of anatomical metrics for upper airway morphology in order to derive parameters for better prediction. Different phenotypes can explain why some people benefit from treatment and others do not benefit equally. Therefore more than just counting apnea and hypopnea events is needed in order to identify patients at risk and patients who have a lower risk when treated. This will require large data set evaluations with hard outcome data.

Topics: Continuous Positive Airway Pressure; Humans; Nose; Phenotype; Prevalence; Sleep Apnea Syndromes

Topics: Case-Control Studies; Child; Humans; Inflammation; Nitric Oxide; Nose; Polysomnography; Respiratory System; Sleep Apnea Syndromes

Partial pressure of end-tidal carbon dioxide (P. Two sizes of redesigned face masks (small for 7-20 kg, medium for 10-40 kg) were evaluated. Initial bench testing used a simulator modeling a spontaneously breathing infant and child with a natural airway. An infant/child manikin head was connected to the breathing lung simulator. A mass flow controller provided expiratory CO. Bench testing revealed a P. P

Topics: Breath Tests; Capnography; Carbon Dioxide; Child; Child, Preschool; Computer Simulation; Equipment Design; Female; Humans; Infant; Lung; Male; Manikins; Masks; Models, Biological; Nose; Oxygen; Partial Pressure; Sleep Apnea Syndromes; Trachea

Topics: Adult; Child; Dilatation; Equipment Design; Eustachian Tube; Exercise; Humans; Musculoskeletal Diseases; Nose; Occupational Diseases; Otitis Media with Effusion; Otolaryngology; Sleep Apnea Syndromes

Inspiratory flow limitation (IFL) is defined as a "flattened shape" of inspiratory airflow contour detected by nasal cannula pressure during sleep and can indicate increased upper airway resistance especially in mild sleep-related breathing disorders (SRBD). The objective of this study was to investigate the association between upper airway abnormalities and IFL in patients with mild SRBD.. This study was derived from a general population study consisting of selected individuals with apnea-hypopnea index (AHI) below 5 events/h of sleep, ("no obstructive sleep apnea" group) and individuals with AHI between 5 and 15 events/h ("mild obstructive sleep apnea" group). A total of 754 individuals were divided into four groups: group 1: AHI <5/h and <30 % of total sleep time (TST) with IFL (515 individuals), group 2: AHI <5/h and >30 % of TST with IFL (46 individuals), group 3: AHI: 5-15/h and <30 % of TST with IFL (168 individuals), and group 4: AHI: 5-15/h and >30 % of TST with IFL (25 individuals).. Individuals with complains of oral breathing demonstrated a risk 2.7-fold larger of being group 4 compared with group 3. Abnormal nasal structure increased the chances of being in group 4 3.2-fold in comparison to group 1. Individuals with voluminous lateral wall demonstrated a risk 4.2-fold larger of being group 4 compared with group 3.. More than 30 % of TST with IFL detected in sleep studies was associated with nasal and palatal anatomical abnormalities in mild SRBD patients.

Topics: Adult; Aged; Aged, 80 and over; Airway Resistance; Brazil; Catheterization; Craniofacial Abnormalities; Female; Humans; Inhalation; Lung; Male; Middle Aged; Nose; Palate; Polysomnography; Respiratory Function Tests; Risk Factors; Severity of Illness Index; Sleep; Sleep Apnea Syndromes; Time Factors; Young Adult

To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs.. The present study sample consisted of 382 children 6-8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile.. The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000-0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951-0.992.. In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Topics: Anatomic Landmarks; Cephalometry; Child; Chin; Face; Feasibility Studies; Female; Forehead; Humans; Male; Mouth Breathing; Nose; Observer Variation; Photography; Reproducibility of Results; Risk Factors; Sleep Apnea Syndromes; Snoring

To explore the change of nasal ventilation function in a group of SDB patients and its relationship to PSG parameters.. One hundred twenty-eight controls, 11 habitual snorers, 33 cases of mild-moderate OSAHS and 33 cases of severe OSAHS were examined. NN1 Rhinospirometer was used to measure unilateral nasal respiratory capacity (NC(un)) and bilateral nasal respiratory capacity (NC(bi)), and the nasal partitioning ratio (NPR) can be calculated. NR6 Rhinomanometry was used to measure total nasal inspiratory and expiratory resistance (TNRi, TNRe). A1 acoustic rhinometry was used to measure distances of the two notches to the nostril (MD1, MD2), cross-sectional areas of the two notches (MCA1, MCA2) and nasal volume from 0-5 cm (NV(0-5)). Moreover, make the correlational analysis on different index of nasal functional tests and PSG.. (1) Significant group differences were shown in NPR (P < 0.01). (2) TNRi and TNRe were statistical different among the groups (P < 0.01 or P < 0.05). (3) There are significant difference on MD1, MCA1, MCA2, NV(0-5) in male, but just on MD1 in female. (4) There was no correlation between PSG parameters and nasal functional parameters in SDB patients. But for certain subgroup analysis in female patients with a body mass index below 25, minimum oxygen saturation correlated significantly with MCA2 (r = 0.688, P < 0.05), arousal index correlated significantly with MCA1 (r = 0.543, P < 0.05).. The nasal anatomical structure and physiological function contribute to the pathogenesis of OSAHS, which may play a larger role in non-obese female patients.

Topics: Adult; Aged; Case-Control Studies; Female; Humans; Male; Middle Aged; Nose; Rhinomanometry; Rhinometry, Acoustic; Sleep Apnea Syndromes; Young Adult

Topics: Aged; Continuous Positive Airway Pressure; Face; Female; Humans; Male; Masks; Middle Aged; Nose; Retrospective Studies; Sleep Apnea Syndromes; Time Factors; Treatment Outcome

The association between pediatric sleep-disordered breathing caused by upper airway obstruction and craniofacial morphology is poorly understood and contradictory. The aims of this study were to evaluate the prevalence of children at risk for sleep-disordered breathing, as identified in an orthodontic setting by validated screening questionnaires, and to examine associations with their craniofacial and upper airway morphologies. A further aim was to assess the change in quality of life related to sleep-disordered breathing for affected children undergoing rapid maxillary expansion to correct a palatal crossbite or widen a narrow maxilla.. A prospective case-control study with children between 8 and 17 years of age (n = 81) at an orthodontic clinic was undertaken. The subjects were grouped as high risk or low risk for sleep-disordered breathing based on the scores from a validated 22-item Pediatric Sleep Questionnaire and the Obstructive Sleep Apnea-18 Quality of Life Questionnaire. Variables pertaining to a screening clinical examination, cephalometric assessment, and dental cast analysis were tested for differences between the 2 groups at baseline. Ten children who underwent rapid maxillary expansion were followed longitudinally until removal of the appliance approximately 9 months later with a repeated Obstructive Sleep Apnea-18 Quality of Life Questionnaire. All data were collected blinded to the questionnaire results.. The frequency of palatal crossbite involving at least 3 teeth was significantly higher in the high-risk group at 68.2%, compared with the low-risk group at 23.2% (P <0.0001). Average quality of life scores in the high-risk group indicated reduced quality of life related to sleep-disordered breathing by 16% compared with children in the low-risk group at baseline (P <0.0001). Cephalometrically, mean inferior airway space, posterior nasal spine to adenoidal mass distance, and adenoidal mass to soft palate distance were reduced in the high-risk group compared with the low-risk group by 1.87 mm (P <0.03), 2.82 mm (P <0.04), and 2.13 mm (P <0.03), respectively. The mean maxillary intercanine, maxillary interfirst premolar, maxillary interfirst molar, mandibular intercanine, and mandibular interfirst premolar widths were reduced in the high-risk group compared with the low-risk group by 4.22 mm (P <0.0001), 3.92 mm (P <0.0001), 4.24 mm (P <0.0001), 1.50 mm (P <0.01), and 1.84 mm (P <0.01), respectively. Children treated with rapid maxillary expansion showed an average improvement of 14% in quality of life scores in the high-risk group compared with the low-risk group, which showed a slight worsening in quality of life related to sleep-disordered breathing by an average of 1% (P <0.04), normalizing the quality of life scores in the high-risk children to the baseline scores compared with the low-risk group.. Children at high risk for sleep-disordered breathing are characterized by reduced quality of life, reduced nasopharyngeal and oropharyngeal sagittal dimensions, palatal crossbite, and reduced dentoalveolar transverse widths in the maxillary and mandibular arches. No sagittal or vertical craniofacial skeletal cephalometric predictors were identified for children at high risk for sleep-disordered breathing. In the short term, rapid maxillary expansion might aid in improvement of the quality of life for children with a narrow maxilla in the milder end of the sleep-disordered breathing spectrum.

Topics: Adolescent; Case-Control Studies; Cephalometry; Child; Female; Humans; Male; Malocclusion; Maxilla; Nose; Palatal Expansion Technique; Palate; Pharynx; Prevalence; Prospective Studies; Quality of Life; Risk Factors; Sleep Apnea Syndromes; Surveys and Questionnaires

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that rapidly involves the respiratory system, leading to persistent respiratory insufficiency. Neuromuscular respiratory weakness is also responsible for sleep disordered breathing (SDB), which occurs at an early stage of ALS. Maximal sniff nasal-inspiratory pressure (SNIP) is a sensitive test to early disclose respiratory muscle decline. The aim of this study was to evaluate the role of the SNIP test, compared to FVC, as a marker of SDB in ALS. We studied 31 (18 males) patients with ALS, who were divided into two groups according to the SNIP test value. Ten patients who showed a SNIP value higher than 60 cmH(2)O were considered as group 1. Twenty-one patients exhibited a SNIP lower than 60 cmH(2)O and were included in group 2. Both groups of patients were also investigated with nocturnal sleep study. A linear correlation between lower SNIP value and reduced nocturnal SaO(2) in patients with a SNIP value less than 60 cmH(2)O (n = 21; r = 0.449; p = 0.04) was found. A negative correlation between SNIP and time spent in SaO(2) below 90% (TST90) (n = 21; r = -0.584; p = 0.0054), and between SNIP and oxyhaemoglobin desaturation index (ODI, events/hour) (n = 21; r = -0.458; p = 0.0368) was also established in all the patients of group 2, while, in this group, FVC did not correlate with any nocturnal parameter observed. A positive correlation between SNIP and PaO(2) at baseline of the entire population of patients (n = 31; r = 0.614; p < 0.001) was also seen. In conclusion, the results of this preliminary study show that SNIP < 60 cmH(2)O might be considered an early predictor of SDB in ALS.

Topics: Aged; Amyotrophic Lateral Sclerosis; Female; Humans; Inhalation; Male; Middle Aged; Nose; Oxygen; Pressure; Respiratory Function Tests; Sleep Apnea Syndromes

Nasal expiratory positive airway pressure (nEPAP) delivered with a disposable device (Provent, Ventus Medical) has been shown to improve sleep-disordered breathing (SDB) in some subjects. Possible mechanisms of action are 1) increased functional residual capacity (FRC), producing tracheal traction and reducing upper airway (UA) collapsibility, and 2) passive dilatation of the airway by the expiratory pressure, carrying over into inspiration. Using MRI, we estimated change in FRC and ventilation, as well as UA cross-sectional area (CSA), in awake patients breathing on and off the nEPAP device. Ten patients with SDB underwent nocturnal polysomnography and MRI with and without nEPAP. Simultaneous images of the lung and UA were obtained at 6 images/s. Image sequences were obtained during mouth and nose breathing with and without the nEPAP device. The nEPAP device produced an end-expiratory pressure of 4-17 cmH(2)O. End-tidal Pco(2) rose from 39.7 ± 5.3 to 47.1 ± 6.0 Torr (P < 0.01). Lung volume changes were estimated from sagittal MRI of the right lung. Changes in UA CSA were calculated from transverse MRI at the level of the pharynx above the epiglottis. FRC determined by MRI was well correlated to FRC determined by N(2) washout (r = 0.76, P = 0.03). nEPAP resulted in a consistent increase in FRC (46 ± 29%, P < 0.001) and decrease in ventilation (50 ± 15%, P < 0.001), with no change in respiratory frequency. UA CSA at end expiration showed a trend to increase. During wakefulness, nEPAP caused significant hyperinflation, consistent with an increase in tracheal traction and a decrease in UA collapsibility. Direct imaging effects on the UA were less consistent, but there was a trend to dilatation. Finally, we showed significant hypoventilation and rise in Pco(2) during use of the nEPAP device during wakefulness and sleep. Thus, at least three mechanisms of action have the potential to contribute to the therapeutic effect of nEPAP on SDB.

Topics: Adult; Carbon Dioxide; Epiglottis; Exhalation; Female; Functional Residual Capacity; Humans; Intermittent Positive-Pressure Ventilation; Lung; Magnetic Resonance Imaging; Male; Middle Aged; Mouth; Nitrogen; Nose; Pharynx; Polysomnography; Respiration; Respiratory Mechanics; Sleep; Sleep Apnea Syndromes; Tidal Volume; Trachea; Wakefulness

Studies have shown that algorithms based on single-channel airflow records are effective in screening for sleep-disordered breathing diseases (SDB). In this study, we investigate the diagnostic effectiveness of a classifier trained on a set of features derived from single-channel airflow measurements. The features considered are based on recurrence quantification analysis (RQA) of the measurement time series and are optionally augmented with single measurements of neck circumference and body mass index. The airflow measurement utilized is the nasal pressure (NP). The study used an overnight recording from each of 77 patients undergoing PSG testing. Mixture discriminant analysis was used to obtain a classifier, which predicts whether or not a measurement segment contains an SDB event. Patients were diagnosed as having SDB disease if the recording contained measurement segments predicted to include an SDB event at a rate exceeding a threshold value. A patient can be diagnosed as having SDB disease if the rate of SDB events per hour of sleep, the respiratory disturbance index (RDI), is > or = 15 or sometimes > or = 5. Here we trained and evaluated the classifier under each assumption, obtaining areas under receiver operating curves using fivefold cross-validation of 0.96 and 0.93, respectively. We used a two-layer structure to select the optimal operating point and assess the resulting classifier to avoid unbiased estimates. The resulting estimates for diagnostic sensitivity/specificity were 71.5%/89.5% for disease classification when RDI > or = 15 and 63.3%/100% for RDI > or = 5. These results were found assuming that the costs of misclassifying healthy and diseased subjects are equal, but we provide a framework to vary these costs. The results suggest that a classifier based on RQA features derived from NP measurements could be used in an automated SDB screening device.

Topics: Algorithms; Body Mass Index; Female; Humans; Male; Multivariate Analysis; Neck; Nonlinear Dynamics; Nose; Pattern Recognition, Automated; Polysomnography; Pressure; Pulmonary Ventilation; Reproducibility of Results; Respiration; ROC Curve; Sleep Apnea Syndromes

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep and is associated with increasing respiratory efforts, with a consequent oxyhemoglobin desaturation, sleep fragmentation, and daytime symptoms, most commonly excessive sleepiness. The effectiveness of continuous positive airway pressure (CPAP) is undoubtedly high in treating those patients who use it regularly, but for those who refuse it, the success rate is 0. It is for this subset of patients that surgical therapy can be useful. The purpose of this study was to evaluate the effects of nasal surgery on nasal resistance, sleep apnea, sleep quality, and nasal volumetric measurement in adult male patients with OSAS.. Twenty male patients with complaints of hypersomnia and snoring were included in the study. Polysomnography of patients with the prediagnosis of OSAS was planned. All patients underwent CPAP treatment before and after surgery. Patients, who had anatomic structural defects causing nasal valve shrinkage, were operated on at the Plastic Reconstructive and Aesthetic Department. Volumetric measurements of the nose were obtained before and after the operation.. In our study, it was observed that respiratory tract space of patients increased subsequent to the surgery, and thereby OSAS level decreased, and tolerating CPAP device was easier. Measurements of internal nasal valve vertex and fields and external nasal valve fields before and after operation were significant.. Surgical relief of this nasal obstruction may improve quality of life in patients with OSAS.

Topics: Adult; Airway Resistance; Anatomy, Cross-Sectional; Cephalometry; Continuous Positive Airway Pressure; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nasal Obstruction; Nose; Oxygen; Polysomnography; Pulmonary Ventilation; Quality of Life; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Stages; Snoring; Time Factors; Treatment Outcome

To investigate the relationship between nasal cavity dimensions and airflow based on measures of acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF) in a very large sample of mixed rhinologic and nonrhinologic patients.. Clinical survey conducted between 2001 and 2007.. Secondary referral ambulatory center and hospital.. The study population comprised 2523 consecutive adult patients, mainly white, referred to the Department of Otolaryngology-Head and Neck Surgery, Sørlandet Hospital, Kristiansand, Norway, for evaluation of sleep-related disorders (eg, snoring, sleep apnea) or chronic nasal complaints.. The subjects underwent AR and PNIF at baseline and after decongestion of the nasal mucosa with xylometazoline hydrochloride. Questionnaires and height and weight measurements were obtained prior to the nasal recordings.. Associations between measures of AR (volume and area) and PNIF.. Nearly linear relationships were found between PNIF in 4 categories and nasal cavity volumes and minimal cross-sectional areas (analysis of variance, P < .001; post hoc analysis, P < .01). Adjusted associations between 5 of 6 AR measures and PNIF both at baseline and after decongestion were significant (P < .001 in 9 cases and P = .03 in 1 case).. Our study indicates statistically significant associations between nasal cavity dimensions and PNIF. The most important structural determinant for PNIF is the minimal cross-sectional area of the nasal cavity.

Topics: Adrenergic alpha-Agonists; Adult; Airway Resistance; Comorbidity; Female; Humans; Imidazoles; Male; Nasal Cavity; Nasal Mucosa; Nose; Rhinometry, Acoustic; Sleep Apnea Syndromes; Smoking; Snoring

Topics: Airway Resistance; Body Mass Index; Humans; Mouth; Mouth Breathing; Nose; Obesity; Otorhinolaryngologic Diseases; Polysomnography; Sleep Apnea Syndromes

To validate the technique of sleep nasendoscopy using target controlled infusion in symptomatic patients and a control group of asymptomatic individuals.. Prospective cohort study.. Department of otolaryngology-head and neck surgery and anesthesia in a teaching hospital.. Two groups of patients were compared and matched for their body mass index. The first group consisted of 53 patients with a history suggestive of obstructive sleep apnea. The second group consisted of 54 patients with partner-confirmed history of no snoring. These patients were undergoing anesthesia for other reasons. Both groups of patients were free of associated otorhinolaryngologic symptoms.. Assessment of production of snoring or obstruction in patients with no documented history of snoring when sedation was administered as part of general anesthesia using target controlled infusion with propofol.. None of the patients in the asymptomatic group snored or obstructed at any level of propofol, and this was clearly significant on comparison with the symptomatic group (P < .001). All of the symptomatic patients were induced to become symptomatic (snoring/obstruction).

Topics: Body Mass Index; Case-Control Studies; Endoscopy; Female; Humans; Hypnotics and Sedatives; Male; Middle Aged; Nose; Propofol; Prospective Studies; Reproducibility of Results; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Snoring

Although it is known that after surgery of the nose and/or the paranasal sinuses serious complications can arise for patients suffering from Sleep-Apnea-Syndrome (SAS), there exists no general recommendation for postoperative care of these patients. This retrospective analysis is dealing with the question whether it is generally necessary to observe SAS-patients after nasal surgery including intubation in an Intensive Care Unit (ICU).. 24 Patients of the ORL-Dept., Marienkrankenhaus Hamburg, suffering from SAS underwent surgery of the nose, the paranasal sinuses and/or the pharynx including total intravenous anesthesia (TIVA) during the period of 1. 10. 2000 until 1. 5. 2004. SAS was diagnosed in 6 cases due to defined clinical criteria and in 18 cases due to the polysomnographic findings in the sleeping laboratory's examination. All patients were observed postoperatively for one night in an ICU. The anesthesia protocol and the intensive care curve of each patient were systematically evaluated with special regard of the following parameters: Risk factors (Body Mass Index; other diseases, ASA-classification), premedication drugs, duration of the surgery, drugs for pain relief, lowest O2-saturation of blood, lowest heartrate, highest systolic blood pressure, adverse effects, intensive care interventions.. Intensive care interventions were never needed. 2 patients received a low dosage of oxygeninsufflation via a face mask, in 5 cases calcium-antagonist drugs were administered due to high blood pressure and in 1 case Metamizole administration was necessary due to high temperatures. An accompanying bradycardia of the same patient was treated by administration of Atropine. The lower average O2-saturation was 93.6 +/- 1.7 % (Minimum value: 89 %). The maximum systolic blood pressure was 165.8 +/- 21.2 mm Hg and the lowest average heart rate was 65.4 +/- 13.2 bpm.. Patients suffering from a mild to moderate SAS do not need a general postoperative surveillance in an ICU if the chosen form of anesthesia is considered concerning this sickness.

Topics: Adult; Aged; Anesthesia, General; Female; Humans; Intensive Care Units; Laser Therapy; Male; Middle Aged; Nose; Palate, Soft; Paranasal Sinuses; Postoperative Care; Postoperative Complications; Retrospective Studies; Risk Factors; Sleep Apnea Syndromes

Topics: Humans; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes; Stroke

We evaluated tolerance of nasal cannula (NC) by 14 infants (median age, 2.6 months) and 16 children (median age, 5.5 years) with suspected obstructive sleep apnea syndrome and compared the efficacy of the NC with that of a nasobuccal thermistor in detecting obstructive apneas (OA) and obstructive hypopneas (OH) on polysomnography traces. The relationship between cannula flow and esophageal pressure was assessed in six patients. Time spent with an uninterpretable flow signal was longer when using a cannula than when using a thermistor in infants (p < 0.05) and children (p < 0.01), and it was longer in the younger patients (p < 0.05). Among the 650 OA-OH detected by either method, only 38% were detected by both, and 58% were detected by the cannula and missed by the thermistor, so that the apnea-hypopnea index was higher with cannula than with thermistor in each age group (p < 0.01). More hypopneas than apneas were detected by the cannula and missed by the thermistor (p < 0.001). Out-of-phase thoracic and abdominal motions and/or changes in the end-tidal CO(2) signal shape were associated with 86% of OH identified by cannula. In the six patients whose esophageal pressure was measured, all respiratory events identified using a cannula were associated with increased "airway resistance." Thus, the NC is more likely than the thermistor to detect OA and OH in infants and children, and this superiority is particularly marked for hypopneas.

Topics: Adolescent; Age Factors; Airway Resistance; Catheterization; Cheek; Child, Preschool; Esophagus; Humans; Infant; Nose; Polysomnography; Pressure; Pulmonary Ventilation; Severity of Illness Index; Signal Processing, Computer-Assisted; Sleep Apnea Syndromes; Transducers, Pressure

The purpose of this article was to compare the craniofacial morphology and hyoid bone position of preschool girls and boys with sleep-related breathing disorder (SBD).. The control groups consisted of girls and boys without ear, nose, and throat disorders. After lateral cephalometric radiographs were taken, the children were selected on the basis of the head position in relation to the true horizontal. Thirty-eight cephalometric variables were determined. RESULTS The findings indicate that boys with SBD had a larger anterior lower facial height and a more anterior hyoid bone position than girls with SBD. However, the distance between the third cervical vertebra and the hyoid bone was a constant value among girls and boys with SBD. Girls with SBD had a sagittally narrower pharyngeal airway space than boys with SBD.. These findings suggest that boys with SBD have a skeletal risk factor, whereas girls with SBD have an airway risk factor. In conclusion, the difference in risk factors may have some bearing on the greater incidence of SBD in both boys and men.

Topics: Adenoids; Cephalometry; Cervical Vertebrae; Chi-Square Distribution; Child, Preschool; Chin; Facial Bones; Female; Humans; Hyoid Bone; Incisor; Male; Mandible; Maxilla; Nose; Palate; Palate, Soft; Pharynx; Risk Factors; Sex Factors; Skull; Sleep Apnea Syndromes; Statistics, Nonparametric; Vertical Dimension

Our study was undertaken to determine whether increased platelet activation occurs in patients with obstructive sleep apnea syndrome (OSAS) and whether a therapy with nasal-continuous positive airway pressure (N-CPAP) alters this activation.. We measured the positive rate of activated platelets using activation-dependent monoclonal antibodies (MoAb) and flow cytometry in whole blood from 94 patients with OSAS, and from 31 age-matched controls. Thrombotic vascular diseases were surveyed as a background of alternative of platelet activation.. The positive rate for activated platelets was significantly higher in patients with OSAS ( PAC1 52.6 +/- 22.9 %, CD62P 6.8 +/- 7.1%, mean +/- SD), as compared with healthy control subjects ( PAC1 16.7 +/- 8.6 %, CD62P 0.7 +/- 0.5 %, p < 0.001). The activation indexes were significantly reduced after 1 month with N-CPAP treatment as a whole (PAC1; from 52.6 +/- 22.9 to 44.2 +/- 22.4, p < 0.05, CD62P; from 6.8 +/- 7.1 to 5.3 +/- 5.5, p < 0.05). In nearly 60 % of patients, platelets activation remained high despite significant improvement of sleep apnea-episodes after N-CPAP. These patients had significantly higher incidence of previous myocardial infarction and/or cerebral infarction and abnormalities of head MRI and carotid sonograpy; indicating that the platelet activation appears to be induced by existing atheroma plaque and not by sympathetic activity in OSAS.. In conclusion, patients with OSAS have increased percentages of activated platelets as assessed by flow cytometrical analysis of activation dependent surface markers, and were divided into two groups, one group with response to N-CPAP treatment in the reduction of platelet activation and the other without. One possible reason of no response to N-CPAP treatment in the reduction of platelet activation was suggested to be thrombotic diseases.

Topics: Adult; Aged; Biomarkers; Female; Flow Cytometry; Humans; Male; Middle Aged; Nose; Platelet Activation; Positive-Pressure Respiration; Reference Values; Sleep Apnea Syndromes

The sensitivity of a simplified variant of forced oscillation technique (FOT) was studied for assessment of dynamic upper airway obstruction during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA). The airway impedance P[FOT] was measured by FOT and the oesophageal pressure (P(oes)) was recorded during stable stage II sleep in 11 patients with OSA. The CPAP level was initially set high enough to completely abolish upper airway obstruction. To induce gradually increasing upper airway re-obstruction, the CPAP pressure was then lowered stepwise. Thirty six such manoeuvres were analysed, blind, to define the first inspiration at which upper airway re-obstruction was detectable by analysis of P[FOT](t(FOT)) and by P(oes)(t(oes)), respectively. On seven occasions t(FOT) and t(oes) occurred together, in the remaining 29 cases t(FOT) preceded t(oes) with a mean latency of 6.0+/-7.7 (0-32) breath cycles. In no case did t(oes) preceed t(FOT). FOT is a highly sensitive tool for the assessment of incipient upper airway obstruction during nCPAP therapy.

Topics: Aged; Airway Obstruction; Esophagus; Humans; Middle Aged; Nose; Oscillometry; Positive-Pressure Respiration; Pressure; Reaction Time; Sensitivity and Specificity; Single-Blind Method; Sleep Apnea Syndromes

The aim of this study was to examine an acoustic reflection method using a flexible tube for identifying the obstructive site of the upper airway in snorers and patients with obstructive sleep apnoea (OSA). As a preliminary study it was performed n models and subjects in the awake state. Flextube narrowing was produced in a model of the nose and pharynx and three blinded observers assessed the obstructive level. The correlation between pharyngeal narrowing assessed by endoscopy and by acoustic measurement during Müller manoeuvres was also examined in 10 OSA patients and 11 healthy non-snoring, adults. Three blinded observers dentified the level of 176 of 180 random cases of flextube narrowing in a polycarbonate model correctly The level of narrowing was always correctly evaluated within 1.9 mm. Pharyngeal area decrease was measured by the flextube method during the Müller manoeuvre but it was not closely related to the findings by endoscopy. In conclusion the flextube reflectometry method was able to demonstrate narrowng in a model of the nose and pharynx in a precise way. Narrowing was also observed during Müller manoeuvres. Flextube reflectometry may be a promising method to detect upper airway narrowing but further evaluation during sleep is required.

Topics: Adult; Awareness; Endoscopy; Humans; Middle Aged; Models, Anatomic; Nose; Pharynx; Sensitivity and Specificity; Sleep Apnea Syndromes; Sound Spectrography

The aim of this study was to examine a new technique based on sound reflections in a flexible tube for identifying obstructive sites of the upper airway during sleep. There was no significant difference between two nights in seven obstructive sleep apnoea (OSA) patients regarding the level distribution of pharyngeal narrowings, when the pharynx was divided into two segments (retropalatal and retrolingual). We also compared the level distribution determined by magnetic resonance imaging (MRI) with the level distribution found by flextube reflectometry in seven OSA patients. There was no significant difference between flextube and MRI level distributions during obstructive events, but due to few subjects the power of the test was limited. We found a statistically significant correlation between the number of flextube narrowings per hour of sleep and the number of obstructive apnoeas and hypopnoeas per hour of sleep determined by polysomnography (PSG) in 21 subjects (Spearman's correlation coefficient r = 0.79, P < 0.001). In conclusion, the flextube reflectometry system seems to be useful for level diagnosis in OSA before and after treatment.

Topics: Adult; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nose; Pharynx; Polysomnography; Reproducibility of Results; Sleep; Sleep Apnea Syndromes; Sound Spectrography

To determine the diagnostic utility of a nasal cannula/pressure transducer (NC), in comparison to thermistor (TH), during routine, clinical nocturnal polysomnography (NPSG).. We analyzed the respiratory arousal index (RAI) using TH (RAI-TH) or NC (RAI-NC) in patients with suspected sleep-disordered breathing (SDB).. Sleep disorders center of a university-affiliated teaching hospital.. Fifty consecutive, nonselected patients referred for evaluation of suspected SDB.. Twenty patients were found to have obstructive sleep apnea/hypopnea syndrome (OSA), 25 had upper airway resistance syndrome (UARS), and 5 had primary snoring (PS). Mean RAI-NC was greater than the mean RAI-TH by 25%, 302%, and 500% in OSA, UARS, and PS, respectively. RAI-NC was >/= 14 (mean, 25.2) in UARS and < 14 (mean, 9) in PS. Mean RAI-TH was 8.4 in UARS and 1.8 in PS, with significant overlap between the two groups.. NC is more sensitive than TH in detecting respiratory events during NPSG and may represent a simple, objective means to identify UARS among patients with a range of SDB.

Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Airway Resistance; Catheterization; Circadian Rhythm; Female; Humans; Male; Middle Aged; Nose; Polysomnography; Retrospective Studies; Sensitivity and Specificity; Sleep Apnea Syndromes; Snoring; Syndrome; Transducers, Pressure

The aim of this preliminary work is to determine an easy method to diagnose "buccal breather" children and "nasal breather" children. Then, to establish a possible connection with the syndrome of obstructive sleep apnea. 22 children agreed to participate. Clinical, orthophonic, orthodontic, postural and polysomnographical exams have been carried out. The proposed clinical exam turns out to be a good means of diagnosing between buccal breathers and nasal breathers. The aerophonoscope reveals velar inadequacies in buccal breathers. The latter also present osseous discrepancies mainly in the mandible. The polysomnography reveals a higher apnea/hypopnea index and more agitated sleep in buccal breathers. Mandibular lowering movements are more frequent and similar to those of adults suffering from apnea. These elements similar to those encountered in adults suffering from apnea make us think that buccal breathing could be the origin of obstructive sleep apnea, several decades later.

Topics: Adolescent; Adult; Cephalometry; Child; Dental Occlusion; Female; Head; Humans; Male; Mandible; Mouth Breathing; Movement; Nose; Palate, Soft; Polysomnography; Posture; Respiration; Sleep Apnea Syndromes; Speech

Topics: Humans; Hypoxia; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

The aim of this study was to investigate whether nasal prongs, which have been proposed to assess nasal flow during sleep, affect nasal airflow resistance (NR).. NR was estimated by posterior rhinomanometry at a 0.5 L/s flow, under eight conditions: in the basal state, and with seven different nasal prongs.. The study was performed in 17 healthy supine subjects, 8 of whom had basal NR values within the normal range (< or = 2 cm H(2)O.L(-1).s, group 1), and 9 had increased basal NR values (> 2.5 cm H(2)O.L(-1).s, group 2), because of nare narrowness and/or deviated nasal septum.. NR increased significantly while breathing with nasal prongs (p < 0.0001 in both groups). The changes in NR (DeltaNR) induced by the different nasal prongs were characterized by large intersubject and intrasubject variability, with a maximum DeltaNR of 24.2 cm H(2)O.L(-1).s. Significant differences were found between the DeltaNR induced by the different nasal prongs (p < 0.001 in group 1, and p < 0.0003 in group 2), and for six of them, DeltaNR was significantly higher in group 1 than in group 2 (p < 0.02).. This study demonstrates that nasal prongs can markedly increase NR in subjects presenting with nare narrowness and/or deviated nasal septum. Further investigations that would include nocturnal polysomnography are still required to evaluate the possible influence of nasal prongs on the diagnosis of obstructive sleep apnea syndrome and its severity.

Topics: Adult; Airway Resistance; Diagnosis, Differential; Equipment Design; Female; Humans; Male; Manometry; Middle Aged; Monitoring, Physiologic; Nasal Obstruction; Nose; Polysomnography; Pressure; Reference Values; Sleep Apnea Syndromes

A high incidence of nocturnal cardiac rhythm disturbances among patients with obstructive sleep apnea (OSA) syndrome has been described in some reports, but not in others. We wished to examine the prevalence of significant cardiac rhythm disturbance in patients with established moderate to severe OSA syndrome and, in particular, to assess the impact of nasal continuous positive airway pressure (nCPAP) therapy.. A prospective study of consecutive eligible patients in a dedicated sleep disorders unit of a university teaching hospital.. Holter monitoring was performed for 18 h in 45 patients with previously diagnosed OSA syndrome (mean [SD] apnea/hypopnea frequency [AHI] of 50 [23]/h) and repeated within 2 to 3 days after institution of nCPAP therapy. Investigators were blinded to the patients' treatments during data analysis. Thirty-five patients were found to have some cardiac rhythm disturbance, but only 8 had pathologically significant disturbances (ventricular tachycardia or fibrillation, complex ventricular ectopy, new-onset supraventricular tachycardia other than sinus tachycardia, pauses of > 2 s, and second- or third-degree heart block). Significant rhythm disturbances occurred only during the nighttime, and there was a significant correlation between OSA severity and the severity of rhythm disturbance (p = 0.04, r = 0.301). No significant correlation was found between OSA severity and any other anthropometric parameter measured. nCPAP therapy resulted in abolition of rhythm disturbance in seven of these eight patients; the eighth patient was found to have coexisting severe aortic valve disease requiring valve replacement.. The data indicate that OSA syndrome predisposes to clinically significant cardiac rhythm disturbances that can be successfully controlled by nCPAP therapy.

Topics: Body Mass Index; Circadian Rhythm; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Prospective Studies; Severity of Illness Index; Sleep Apnea Syndromes; Tachycardia, Ventricular

This prospective open study was performed to examine the relation between pathologic findings of the upper respiratory tract and the types of noncentral sleep disorders (rhonchopathy, obstructive sleep apnea). 312 men and 274 women aged between 35-75 years attended our outpatient department for relief of their nocturnal breathing disorder. About 1/3 of the patients suffered only of habitual rhonchopathy and 2/3 were obstructive. No findings of the head and neck examination could predict the degree of oxygen desaturation, although pathologies of the nose (73.68%), the soft palate (94.1%) and narrowing of the oro- and hypopharynx (74.19%) were very common in patients with sleep disorder. At least one pathology could be found in every patients. The more pathologies were found the higher was the risk of obstructive sleep apnoea with desaturation below 70%. Unrelated tonsillectomy (51.36%) did not prevent nocturnal breathing disorders.

Topics: Adult; Aged; Airway Resistance; Body Mass Index; Data Interpretation, Statistical; Female; Hemodynamics; Humans; Hypopharynx; Male; Manometry; Middle Aged; Nose; Oropharynx; Oximetry; Oxygen; Palate; Prospective Studies; Pulmonary Ventilation; Sleep Apnea Syndromes; Snoring

In a significant proportion of individuals, the physiologic decrease of muscle tone during sleep results in increased collapsibility of the upper respiratory airway. At peak inspiratory flow, the pharyngeal soft tissues may collapse and cause airflow limitation or even complete occlusion of the upper airway (sleep apnea). While there are plenty of methods to detect sleep apnea, only a few can be used to monitor flow limitation in sleeping individuals. Nasal prongs connected to pressure sensor provide information of the nasal airflow over time. This paper documents a method to automatically classify each nasal inspiratory pressure profile into one without flow limitation or six flow-limited ones. The recognition of the sample signals consists of three phases: preprocessing, primitive extraction, and word parsing phases. In the last one, a sequence of signal primitives is treated as a word and we test its membership in the attribute grammars constructed to the signal categories. The method gave in practical tests surprisingly high performance. Classifying 94;pc of the inspiratory profiles in agreement with the visual judgment of an expert physician, the performance of the method was considered good enough to warrant further testing in well-defined patient populations to determine the pressure profile distributions of different subject classes.

Topics: Algorithms; Diagnosis, Computer-Assisted; Humans; Monitoring, Physiologic; Nose; Pattern Recognition, Automated; Respiratory Mechanics; Signal Processing, Computer-Assisted; Sleep Apnea Syndromes

Recent progress in the physiology of the upper airways has led to significant advances in evaluating the dynamics of upper airway occlusion during sleep. Measuring the collapsibility of the upper airways and localizing the site of obstruction should theoretically lead to efficacious non-mechanical treatment and enable selection of patients susceptible of benefiting from surgical procedures. From a diagnostic point of view, fluctuations in the nasal pressure curve appear to give more precise information on ventilatory changes and their association with disrupted sleep pattern than conventional parameters such as thermistance signals or induction plethysmography. Again, from a pathophysiological point of view, little is known about the role or tissue inflammation and repeated upper airway trauma in the transition from simple snoring to sleep apnea syndrome. Current studies lead to the conclusion that the dilatroy muscles of the upper airways in the apneic subject are the target for adaptive trophic, immunohistochemical and metabolic phenomena in response to stimulation comparable to training against resistance. Although there is no evidence that sleep affects neuromuscular activity in apneic subjects, the disappearance of compensatory hyperactivity on awakening and the reduction of muscle contraction efficacy (transmission of the dilatory force to soft tissues) observed in patients may explain the greater instability of the upper airways characteristic of sleep apnea syndrome.

Topics: Humans; Larynx; Nose; Pharynx; Sleep Apnea Syndromes

A Spanish version of the Epworth Sleepiness Scale (ESS-Sp) was developed by translation, back-translation, formal discussion, and a meeting of researchers with a group of patients with sleep apnea syndrome (SAS). The translated questionnaire was then tested in 345 patients, 275 with SAS at various levels of severity and 70 without SAS. Significant differences existed between the two groups as to age (53 +/- 11 years versus 47 +/- 13, p < 0.001) and BMI (32 +/- 5 versus 29.5 +/- 5, p < 0.001). Patients with SAS had significantly higher scores (14 +/- 5) than did those without SAS (10 +/- 5) (p < 0.001). Reproducibility was tested in 146 patients (113 SAS and 33 non-SAS), with no significant differences found among patients with SAS (14.9 +/- 5 versus 14.2 +/- 5, p = n.s.); significant differences in BMI were found, however, among the 33 non-SAS patients (12 +/- 5 versus 10 +/- 5, p < 0.01). Total scores and individual item scores were related in both groups. Likewise, each item was related to total score in patients with SAS. Sensitivity to post-treatment changes was assessed in 77 SAS patients, with initial scores of 16 +/- 4 seen to decrease to 4 +/- 3 after continuous positive airway pressure. ESS-Sp scores over 10 were recorded for 85% of patients with SAS: 78% of those with mild SAS, 85% of those with moderate disease and 92% of those whose SAS was severe. Significant inter-group differences were found upon applying a test of variance (p < 0.001). Differences continued to be detected when multiple correlations were looked for, with differences increasing with severity. SAS patients with ESS-Sp level one scores (< 10) had lower apnea-hypopnea indices (AHI) (35 +/- 18 versus 42 +/- 20, p < 0.05), lower desaturation levels (21 +/- 21 versus 34 +/- 28, p < 0.01) and higher minimum saturation (80 +/- 10 versus 75 +/- 12, p < 0.05), with no differences in age or BMI. A significant correlation was found between ESS-Sp score and respiratory variables recorded during polysomnography: AHI, r = 0.23 (p < 0.001); percent time in apnea-hypopnea, r = 0.18 (p < 0.01); desaturation index, r = 0.27 (p < 0.01) and minimum saturation (r = -0.14, p < 0.05). We conclude that the Spanish version of the ESS is equivalent to the original, is reproducible in patients with SAS, sensitive to post-treatment changes and seems to discriminate level of severity, showing correlation with polysomnograph variables.

Topics: Adult; Analysis of Variance; Evaluation Studies as Topic; Humans; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Reproducibility of Results; Sensitivity and Specificity; Sleep Apnea Syndromes; Spain; Statistics, Nonparametric; Surveys and Questionnaires; Translations

To select patients with sleep apnoea hypopnoea syndrome (SAHS) who will benefit from surgery, we use information from four different pressure sensors in the upper airways and oesophagus during polysomnography (PSG). These pressure sensors also have the ability to act as internal thermistors and can hence indirectly measure flow as well as pressure. This new method for measuring flow has proven to be very accurate for scoring hypopnoeas as well as apnoeas. The aim of this study was to determine whether the flow and pressure sensors located in the epipharynx, oropharynx and hypopharynx could differentiate between nasal and oral breathing. The design was a prospective cross-over study in 124 patients referred to the hospital for SAHS diagnosis. The awake patients were asked to breathe first through the nose and then through the mouth while the nose was blocked with a clip. A standard nocturnal PSG with pressure and flow measurement in the upper airways was performed in all patients. The procedure was repeated in a lateral position, and again the next morning in 32 of the patients. Reduction in flow signals from the nose was calculated, and a paired t-test was performed for statistical analysis. The difference between nasal and oral breathing was quite distinct in the flow tracings from the internal thermistors. The mean reduction in nasal flow signals when changing from nasal to oral breathing was 83.7% (SD 14.5, p < 0.0001). The same was seen in a lateral position, 82.2% (SD 16.4, p < 0.0001). Testing for changes in properties of the internal thermistors revealed no significant difference between the reduction in flow when the test started and after the patients had slept the whole night (p > 0.1). It is possible to differentiate between nasal and oral breathing using internal thermistors.

Topics: Female; Humans; Male; Middle Aged; Mouth Breathing; Nose; Polysomnography; Pulmonary Ventilation; Respiration; Sleep Apnea Syndromes; Thermometers

Nasal airway obstruction may exacerbate sleep apnea and is difficult to quantify on clinical examination. In this study, we examined the relationship among nasal patency, the frequency of sleep apnea events, and effective nasal continuous positive air pressures. Acoustic rhinometry was used as an objective measurement of nasal cross-sectional areas in 76 patients without nasal symptoms who underwent study with diagnostic polysomnography because of obstructive sleep apnea. Patients with persistent obstructive sleep apnea were titrated to nasal continuous positive air pressure in a split night study. All subjects had a mean apnea/hypopnea index of 28, and those with obstructive sleep apnea had a mean apnea/hypopnea index of 43. Mean cross-sectional areas 1 to 4 cm into the nose were 1.7, 1.1, 2.1, and 2.8 cm2, respectively (F = 39, p < 0.001). However, there was no correlation between the apnea/hypopnea index and the cross-sectional area at the four distances (r = 0.03, 0.06, 0.02, and 0.02, respectively, p = not significant). Correlations between nasal continuous positive air pressures and cross-sectional areas did not reveal a significant relationship at any of the four sites (r = 0.09, 0.07, -0.03, 0.00, respectively). Findings in patients with apnea were also compared with those in patients without apnea and significant differences were not found (F = 0.019, p = not significant). Although it would seem intuitive that increased nasal obstruction is associated with the severity of obstructive sleep apnea and difficulty with the use of nasal continuous positive air pressure, this study shows that nasal patency, as measured by acoustic rhinometry, does not correlate with the severity of obstructive sleep apnea, as determined by the apnea/hypopnea index or the effective nasal continuous positive air pressure.

Topics: Adult; Age Factors; Anatomy, Cross-Sectional; Body Mass Index; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Positive-Pressure Respiration; Pulmonary Ventilation; Sex Factors; Sleep Apnea Syndromes; Sound; Treatment Outcome

We previously showed that upper airway resistance can be inferred from the inspiratory flow contour during continuous positive airway pressure (CPAP) titration in obstructive sleep apnea syndrome (OSAS). The present study examines whether similar information can be obtained from inspiratory flow measured by a nasal cannula/pressure transducer. Ten symptomatic patients (snoring, upper airway resistance syndrome [UARS], or OSAS) and four asymptomatic subjects underwent nocturnal polysomnography (NPSG) with monitoring of flow (nasal cannula) and respiratory driving pressure (esophageal or supraglottic catheter). For each breath the inspiratory flow signal was classified as normal, flattened, or intermediate by custom software. "Resistance" was calculated from peak inspiratory flow and pressure, and normalized to the resistance during quiet wakefulness. Resistance in all stages of sleep was increased for breaths with flattened (387 +/- 188%) or intermediate (292 +/- 163%) flow contour. In combination with apnea-hypopnea index (AHI), identification of "respiratory events," consisting of consecutive breaths with a flattened contour, allowed differentiation of symptomatic from asymptomatic subjects. Our data show that development of a plateau on the inspiratory flow signal from a nasal cannula identifies increased upper airway resistance and the presence of flow limitation. In patients with symptoms of excessive daytime somnolence and low AHI this may help diagnose the UARS and separate it from nonrespiratory causes of sleep fragmentation.

Topics: Adult; Aged; Airway Resistance; Humans; Intubation; Middle Aged; Nose; Polysomnography; Respiratory Function Tests; Sleep Apnea Syndromes; Snoring; Transducers, Pressure

Conventional systems to monitor oronasal flow in sleep studies have traditionally relied on a thermistor signal. Our study was designed to verify whether nasal prongs (NP) connected to a pressure transducer could improve respiratory events detection in patients with sleep apnoea/hypopnoea syndrome (SAHS) compared to traditional systems. Sleep episodes from a 2 h conventional polysomnographic record plus NP signal obtained at random from eight patients (age: mean(+/-SD) 53(+/-12) yrs; body mass index (BMI): 29(+/-6) kg x m(-2); apnoea/hypopnoea index (AHI): 27(+/-20) events x h(-1)) were identified and used for analysis. An abnormal change in the pattern of any of the respiratory or neurological variables occurring during the observation period was defined as an episode. Each episode was registered and scored with concomitant scoring of the remaining variables. According to the episode definition three different profiles were established: 1) periods of reduction of ventilation in either variable without an arousal or cyclical desaturation, named nonpathological episode (NPE); 2) an idiopathic or nonrespiratory arousal (IA); and 3) a true respiratory event (TRE) defined as reduction or absence of flow demonstrated by either thermistor, thoraco-abdominal bands or NP accompanied by cyclical desaturation and/or arousal. For each TRE, its detection by thermistor, thoraco-abdominal bands or NP was established. A total of 877 sleep episodes were observed (42 NPE, 30 IA and 805 TRE). When compared to single or combined thermistor and bands approach, NP had the highest respiratory events detection rate, 779 (96.8%) versus 673 events (83.6%), respectively. Detection of respiratory-related arousals was also improved by NP and only 3% could account for mouth breathing respiration. It is concluded that nasal prongs improve the detection of respiratory events in patients with sleep respiratory disorders.

Topics: Adult; Aged; Child; Electroencephalography; Electromyography; Electrooculography; Humans; Middle Aged; Monitoring, Physiologic; Nose; Pulmonary Medicine; Sleep Apnea Syndromes

Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.

Topics: Acidosis, Respiratory; Adult; Age Factors; Aged; Body Mass Index; Carbon Dioxide; Female; Humans; Hypoventilation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Obesity; Oxygen; Oxygen Inhalation Therapy; Peak Expiratory Flow Rate; Polysomnography; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes

The purpose of our study was to introduce an ultrafast MR imaging technique of the pharynx as a diagnostic tool for viewing the mechanism of obstruction in patients with obstructive sleep apnea.. Six healthy volunteers and 16 patients with obstructive sleep apnea were examined on a 1.5-T whole-body imager using a circular polarized head coil. Ultrafast two-dimensional fast low-angle shot sequences were obtained in midsagittal and axial projections during transnasal shallow respiration at rest, during simulation of snoring, and during performance of the Müller maneuver. All patients underwent physical examination, transnasal fiberoptic endoscopy, and polysomnography.. Five to six images were obtained per second with an in-plane resolution of 2.67 x 1.8 mm and 2.68 x 2.34 mm, allowing visualization of motion of the tongue, soft palate, uvula, and posterior pharyngeal surface. MR findings correlated well with results of clinical examination. The length of obstruction in the oropharynx, which cannot be ascertained by transnasal endoscopy of the pharynx, was clearly visible MR images. Differences between patients with obstructive sleep apnea and healthy subjects in terms of the degree of obstruction in the velopharynx and oropharynx depicted on MR images during the Müller maneuver were highly significant.. We believe that ultrafast MR imaging is a reliable noninvasive method for use in the evaluation of obstructive sleep apnea.

Topics: Airway Obstruction; Endoscopy; Evaluation Studies as Topic; Fluoroscopy; Humans; Image Enhancement; Inhalation; Magnetic Resonance Imaging; Middle Aged; Nose; Oropharynx; Palate, Soft; Pharynx; Physical Examination; Polysomnography; Reproducibility of Results; Respiration; Rest; Sleep Apnea Syndromes; Snoring; Tongue; Uvula

Masticatory and tongue muscle activity was examined polysomnographically in 14 patients with sleep apnea syndrome and six snorers. The all-night polysomnographic recordings included electromyograms (EMG) of the genioglossal, the masseter and the inferior head of the lateral pterygoid muscles, nasal airflow and thoracoabdominal respiratory effort. The apneas were defined and classified into three types (obstructive, central and mixed). EMG amplitudes of each muscle were measured before, during and after the obstructive and central apneas. In the apnea patients the three muscles showed significantly lower EMG amplitudes during the obstructive apnea than before the apnea, and then significantly higher amplitudes after the apnea. These findings indicate that the hypotonia of the muscles during sleep can result in obstructive apnea. There was no significant difference in the pattern of muscle activity during obstructive apnea between the apnea patients and the snorers. On the other hand, a decrease in the mean EMG amplitude during the central apnea was not observed. It is suggested that central apnea occurs independently of masticatory and tongue muscle activity.

Topics: Abdomen; Adult; Aged; Electromyography; Female; Humans; Male; Masseter Muscle; Middle Aged; Muscle Hypotonia; Nose; Polysomnography; Pterygoid Muscles; Pulmonary Ventilation; Respiratory Mechanics; Sleep Apnea Syndromes; Snoring; Thorax; Tongue

Esophageal pressure amplitude (DeltaPes), inspiratory pulmonary resistance (RLI) and inspiratory flow limitation score (FS) are used as indices of upper airway obstruction for the titration of nasal continuous positive airway pressure (nCPAP) in patients with obstructive sleep apnea syndrome (OSAS). This study was designed to determine whether oscillatory respiratory resistive impedance at 16 Hz (RFO) might be proposed as an alternative index. Eleven OSAS patients were studied during a night of polysomnography-controlled nCPAP titration. Nasal flow (V) and airway opening and esophageal pressures (Pao and Pes, respectively) were continuously measured during nasal breathing, and forced-flow oscillations (FO) were applied for 5 min at each nCPAP level. RLI was calculated by linear regression analysis of resistive pressure versus V over inspiration. R FO was obtained by linear regression analysis of respiratory resistive impedance versus frequency. Application of FO affected neither sleep nor pulmonary mechanics. RFO correlated with RLI in all patients. RFO did not correlate with DeltaPes in two patients, and was not significantly related to FS in five patients. This study demonstrates the applicability of the FO technique in sleeping patients receiving nCPAP, and the reliability of RFO for assessing pulmonary resistance. RFO might therefore be proposed as a quantitative index of airway obstruction for nCPAP titration.

Topics: Aged; Airway Obstruction; Airway Resistance; Analysis of Variance; Esophagus; Humans; Inspiratory Capacity; Linear Models; Lung; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Pressure; Pulmonary Ventilation; Reproducibility of Results; Respiration; Respiratory Mechanics; Sleep Apnea Syndromes

Since the final common pathway for obstructive sleep apnea is obstruction of the upper airway during nocturnal respiration, examination and assessment of the anatomy of the upper airway plays a central role in patient evaluation. Since the upper airway begins at the nose and lips and ends at the larynx, a complete assessment of the upper airway evaluates this entire length of this anatomic region including the bony framework and soft tissue. Though office assessment of these structures does not necessarily mimic the appearance of behavior of these structures during physiologic sleep, the office examination can give important information as to the site of obstruction during sleep that can help direct therapy.

Topics: Airway Obstruction; Body Mass Index; Endoscopy; Facial Bones; Humans; Larynx; Lip; Mouth; Neck; Nose; Oropharynx; Pharynx; Physical Examination; Pulmonary Ventilation; Sleep Apnea Syndromes

Topics: Aged; Humans; Male; Masks; Nose; Pneumothorax; Positive-Pressure Respiration; Sleep Apnea Syndromes; Time Factors; Tomography, X-Ray Computed

Adenoidal hypertrophy is the commonest cause of nasal obstruction in the pediatric population. It may cause marked morbidity as regards respiratory physiology, facial growth and middle ear function. Determination of adenoidal presence and size is not easy. Nasal endoscopy and radiology are the most accepted modes of diagnosis and each has its disadvantages. We have used acoustic rhinometry to determine the size of adenoids. Changes in nasal volume and resistance were recorded and an easy formula was devised to determined adenoid size. This technique is easy, non-invasive and reproducible with a 93.5% predictive value.

Topics: Acoustics; Adenoidectomy; Adenoids; Airway Resistance; Cephalometry; Child; Child, Preschool; Ear, Middle; Endoscopy; Female; Humans; Hypertrophy; Male; Manometry; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Otitis Media with Effusion; Otitis Media, Suppurative; Predictive Value of Tests; Radiography; Reproducibility of Results; Respiration; Sleep Apnea Syndromes; Snoring

This study aimed to evaluate the effects of nasal continuous positive airway pressure (nCPAP) therapy on sleep and daytime symptoms of bed partners and patients with obstructive sleep apnea (OSA).. A cross-sectional questionnaire survey.. The sleep laboratory of a university teaching hospital.. Ninety-one consecutive OSA patients within 2 to 12 months of being prescribed nCPAP.. Eighty-five replies (93% of sample population) were received. Twelve patients (14% of replies) had discontinued nCPAP therapy; two patients had not yet been supplied with an nCPAP device. Seventy-one patients continued nightly nCPAP therapy. Bed partners of these patients (n = 55) answered a separate questionnaire assessing improvements in their own sleep quality, daytime alertness, mood and quality of life (questions 1 to 4), and evaluated the same parameters for the patients (questions 5 to 8). Possible scores ranged from -1 (worse) to +3 (marked improvement). Questions 1 to 4 yielded median scores of 2, 1, 1, and 2, respectively, and scores of 3, 3, 2, and 3 for questions 5 to 8. A ninth question addressing perceived changes in the quality of their relationship resulted in a median score of 2. Mean (SD) Epworth sleepiness scores improved from 14.3 (5.8) to 5.2 (4.3) in patients receiving therapy (p < 0.005).. These data indicate that bed partners of OSA patients treated with nCPAP experience important improvements in symptoms and personal relationships. The findings are of practical clinical use when counseling patients with OSA and their partners on the likely impact of nCPAP therapy on their quality of life.

Topics: Affect; Attitude to Health; Counseling; Cross-Sectional Studies; Female; Humans; Interpersonal Relations; Male; Middle Aged; Nose; Positive-Pressure Respiration; Prospective Studies; Quality of Life; Sleep; Sleep Apnea Syndromes; Sleep Stages; Surveys and Questionnaires; Wakefulness

To determine an effective means of improving compliance with nasal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA).. Retrospective chart review.. An outpatient clinic at a Veterans Affairs Medical Center.. Seventy-three patients with OSA.. Hour meters on CPAP machines provided documentation of nightly machine use. A 2-h group CPAP clinic, scheduled every 6 months, provided education, support, symptom treatment, and equipment monitoring for all CPAP patients.. Twenty-five patients had hour meter readings taken at their first CPAP clinic. In these patients, nightly CPAP use increased from 5.2 +/- 0.6 to 6.3 +/- 0.6 h per night after attendance at one CPAP clinic (p < 0.05). CPAP use increased from 5.2 +/- 0.5 before CPAP clinic to 6.3 +/- 0.6 h per night after attendance at all subsequent CPAP clinics for 34 patients (p < 0.05), an improvement that was sustained over 605 +/- 34 days. Twenty-nine percent of patients increased nightly CPAP use by at least 2 h, while only 6% decreased by > or = 2 h (p < 0.025). Patients receiving supplemental oxygen had higher CPAP use prior to CPAP clinic compared to patients not receiving oxygen (p < 0.05).. Attendance in a group clinic designed to encourage patient compliance with CPAP therapy provided a simple and effective means of improving treatment of OSA.

Topics: Adult; Aged; Ambulatory Care; Documentation; Follow-Up Studies; Humans; Male; Middle Aged; Monitoring, Ambulatory; Nose; Oxygen Inhalation Therapy; Patient Compliance; Patient Education as Topic; Positive-Pressure Respiration; Regression Analysis; Retrospective Studies; Sleep Apnea Syndromes; Social Support

A cephalometric analysis according to Hasund, supplemented by special obstructive sleep apnoea syndrome (OSAS) parameters, was performed on 169 patients who had been referred from the sleep laboratory. Statistical analysis showed a correlation between specific cephalometric landmarks including posterior airway space (PAS), a soft palate length, hyoid position and posterior growth development of the mandible and OSAS severity. A principal component analysis differentiated between four subgroups of OSAS patients: (1) orthognathic obese subjects; (2) patients with a long soft palate and low-positioned hyoid; (3) retrognathic patients with narrow PAS; and (4) prognathic ones. Lateral cephalometry is an important contribution to OSAS diagnostics and oral and maxillofacial therapy procedures.

Topics: Adult; Age Factors; Aged; Cephalometry; Female; Humans; Hyoid Bone; Hyperplasia; Male; Mandible; Maxilla; Middle Aged; Nasopharynx; Nose; Obesity; Palate, Soft; Palatine Tonsil; Prognathism; Retrognathia; Sleep Apnea Syndromes

A new noninvasive method to detect obstructive and central sleep apnea [(OSA) and (CSA)] events is described. Data were collected from ten volunteer subjects with a previous diagnosis of OSA while they were titrated for continuous positive airway pressure (CPAP) therapy. Apneic events were identify by analyzing of estimated airway impedance determined from pressure and airflow signals delivered from CPAP. To enhance performance of this technique, a single-frequency (5 Hz with 0.5 cmH2O peak-to-peak amplitude) probing signal was superimposed on the applied CPAP pressure. The results indicated that estimated airway impedance during OSA (mean: 17.9, SD: 3.4, N = 50) was significantly higher then during CSA (mean: 4.1, SD: 1.7, N = 50). When the estimated impedance of OSA and CSA events were compared to a fixed threshold, 100% of all events can be correctly categorized. These results indicate that it may be possible to diagnose OSA and CSA noninvasively based upon this technique. The instrument and the algorithm required are relatively simple and can be incorporated in a home-based device. If this method was used for prescreening apnea patients, it could reduce cost, waiting time, and discomfort associated with traditional diagnostic procedures.

Topics: Airway Resistance; Algorithms; Female; Humans; Male; Middle Aged; Models, Biological; Nose; Polysomnography; Positive-Pressure Respiration; Random Allocation; Respiratory System; Sleep Apnea Syndromes

Many studies have shown a relationship between obstructive sleep apnea (OSA) and accidents, but to our knowledge, none have investigated prospectively the effects of treatment with nasal continuous positive airway pressure (CPAP). CPAP was proposed to 973 patients, of whom 893 patients actually underwent CPAP. These patients were consecutively invited to enter a prospective follow-up study including a questionnaire before treatment and after 6 and 12 months of treatment; 547 patients completed the study (153 left the study, and only partial data were available for 193). The baseline questionnaire included questions concerning accidents in the previous 12 months, asking whether patients had had an accident and, if so, whether they felt that the accident(s) were related to sleepiness, and whether the patients felt that they had had near-miss accidents due to sleepiness. The questionnaires at 6 and 12 months included the same questions referring to the previous 6 months; the accidents reported on each follow-up questionnaire were cumulated and compared with the accidents during the 1-year period before treatment. The number of patients having an accident decreased with treatment for real accidents (from 60 to 36; p<0.01), as well as for near-miss accidents (from 151 to 32; p<0.01). The average number of accidents per patient also decreased, for real accidents (from 1.6+/-1.3 to 1.1+/-0.3; p<0.01) and for near-miss accidents (from 4.5+/-6.5 to 1.8+/-1.4; p<0.01). The cost, in terms of days in hospital related to accidents, decreased from 885 to 84 days. With caution due to the absence of a control group, it is suggested that treatment with CPAP decreases the number of accidents occurring in OSA patients. This result may have important implications in the evaluation of the cost/benefit ratio when treating OSA patients.

Topics: Accidents; Aged; Female; Follow-Up Studies; France; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Prospective Studies; Sleep Apnea Syndromes; Statistics, Nonparametric; Surveys and Questionnaires; Time Factors

The purpose of this study was to examine the behavior of the glottis during intermittent positive-pressure ventilation (nIPPV) using a two-level positive-pressure ventilator and to compare the glottic adaptation to this ventilatory mode with the one observed using volumetric ventilators, recently reported by us. Six healthy subjects were studied during both wakefulness and sleep. Their glottis was continuously monitored through a fiberoptic bronchoscope. We measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure, the corresponding tidal volume, and other indices. We used the controlled ventilatory mode. The expiratory pressure was kept at 4 cm H2O, and the inspiratory pressure was increased by steps from 10 to 15 to 20 cm H2O. Increases in inspiratory pressure did not always lead to increases in effective ventilation reaching the lungs. This was due to a significant narrowing of the glottis by adduction of the vocal cords in all subjects. Periodic breathing with or without apneas were common during wakefulness, but especially during sleep, representing 10.5 +/- 11% (SD) of total sleep time. We conclude that effective ventilation during nIPPV using a two-level positive-pressure ventilator in the controlled mode is less predictable and less stable than during nIPPV using volumetric ventilators.

Topics: Adaptation, Physiological; Adult; Apnea; Bronchoscopes; Equipment Design; Female; Fiber Optic Technology; Glottis; Humans; Inhalation; Intermittent Positive-Pressure Ventilation; Lung; Male; Monitoring, Ambulatory; Nose; Pressure; Pulmonary Ventilation; Respiration; Sleep; Sleep Apnea Syndromes; Tidal Volume; Ventilators, Mechanical; Vocal Cords; Wakefulness

Interactions between upper airway structure and posture in relation to obesity were studied in a sample of 61 adult Class I skeletal type male patients with obstructive sleep apnea (OSA) and 10 homologous control subjects. A pair of upright and supine lateral cephalometric films were taken for each subject. A Pearson correlation analysis identified significant r values for several demographic variables in patients with OSA such as apnea and hypopnea index, percentage of predicted neck circumference, minimum arterial oxygen saturation, and body mass index (BMI). The difference between cephalometric variables identified in upright and supine subjects was calculated. When patients with OSA changed their posture from upright to supine, significant correlations were observed between the cranial base to upper cervical column angle and the hypopharynx cross-sectional area and BMI. Moreover, the mandibular plane angle and the sella-nasion plane was significantly correlated with BMI. This occurred along with a significant positive correlation between the sella-nasion plane angle and BMI and a significant inverse correlation between the mandibular plane angle in reference to the absolute vertical and horizontal planes, with BMI after the positional change. Such correlations were not observed in control subjects. No correlations were observed between the variables related to the position of the hyoid bone with BMI in either patients with OSA or control subjects after the change in posture. On the basis of these findings, we propose that when patients with OSA change their body position from upright to supine (1) the patient's neck is more extended, and (2) the hyoid bone moves more anterosuperiorly in conjunction with an upward and forward rotation of the mandible. This change in craniofacial structure may be a compensatory geometrical change in the upper airway to secure its patency.

Topics: Adult; Airway Obstruction; Body Mass Index; Cephalometry; Cervical Vertebrae; Humans; Hyoid Bone; Hypopharynx; Male; Malocclusion; Mandible; Mouth; Neck; Nose; Obesity; Oxygen; Pharynx; Posture; Sella Turcica; Skull; Sleep Apnea Syndromes; Supine Position; Vertical Dimension

In patients with obstructive sleep apnea syndrome (OSAS), the blood coagulation system may contribute to an increased risk of cardiovascular events, which occur most frequently in the morning. Nasal continuous positive airway pressure (NCPAP) treatment can improve the mortality of patients with OSAS. We measured the plasma fibrinogen concentration, which is an independent risk factor for cardiovascular events, in the afternoon (3:30 P.M.) and the next morning upon awakening (8:30 A.M.) in 11 patients with OSAS (apnea and hypopnea index > 20) before and after NCPAP therapy. We also measured the hematocrit, the C-reactive protein, and the total plasma protein at the same time. The plasma fibrinogen and hematocrit levels in the morning (298 +/- 16 mg/dl and 48.5 +/- 1.5%, mean +/- SEM) were significantly higher than on the previous afternoon (275 +/- 14 mg/dl and 46.6 +/- 1.3%) (fibrinogen, p < 0.02; hematocrit, p < 0.005). The whole blood viscosity (WBV) at a shear rate of 208 inverse seconds, which can be predicted based on the hematocrit and total plasma protein, was also significantly higher in the morning (4.98 +/- 0.20/s) than in the afternoon (4.73 +/- 0.17/s) (p < 0.005). These increases in the plasma fibrinogen concentration and the WBV in the morning disappeared after NCPAP treatment. The attenuation of morning increases in the plasma fibrinogen concentration and WBV induced by NCPAP treatment may contribute to an overall improvement in the mortality from cardiovascular events in patients with OSAS.

Topics: Adult; Aged; Cardiovascular Diseases; Female; Fibrinogen; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Predictive Value of Tests; Risk Factors; Sleep Apnea Syndromes; Syndrome

Topics: Expert Testimony; Follow-Up Studies; Humans; Male; Malpractice; Middle Aged; Nasal Obstruction; Nasal Septum; Nose; Postoperative Complications; Reoperation; Rhinoplasty; Sleep Apnea Syndromes

Ten subjects known to suffer from heavy snoring but not obstructive sleep apnoea were studied using the technique of sleep nasendoscopy. The mechanism of snoring was noted for each and sound recordings of the snoring noise were made. Six subjects were observed to snore using their soft palate only, three snored using only their tongue base and one snored using a combination of palate and tongue base. The sound recordings were subjected to computer analysis of waveform and frequency. Palatal flutter snoring and tongue base snoring appear to have distinct waveform and frequency patterns which allows them to be differentiated from each other.

Topics: Confounding Factors, Epidemiologic; Endoscopy; Humans; Noise; Nose; Oximetry; Palate, Soft; Pharynx; Saliva; Signal Processing, Computer-Assisted; Sleep; Sleep Apnea Syndromes; Snoring; Sound Spectrography; Tongue; Video Recording

The incidence and pathogenesis of right ventricular dysfunction in obstructive sleep apnoea (OSA) remains controversial. Using nuclear ventriculography, the prevalence of right ventricular dysfunction (RVD) was therefore determined in obese patients with OSA, as well as their clinical characteristics, arterial blood gas values, spirometry and sleep parameters. The reversibility of RVD was evaluated after long-term use of nasal continuous positive airway pressure (nCPAP). We studied 112 obese patients with OSA by nuclear ventriculography, 35 with RVD (Group 1), 77 without RVD (Group 2), and 14 patients without OSA as controls (Group 3). Repeat nuclear ventriculography was performed in seven patients who used nCPAP nightly for 6-24 months. The mean right ventricular ejection fractions (RVEF) were 31%, 47% and 44% in Groups 1, 2 and 3, respectively. Group 1 also had a lower left ventricular ejection fraction (LVEF) of 55 vs 63% in Group 2. The OSA groups did not differ in mean spirometric or arterial blood gas values. Group 1 had a lower mean nocturnal arterial oxygen saturation (Sa,O2) of 82 vs 87% in Group 2, and a longer apnoea duration of 22.3 vs 19.2 s. All but two patients in Group 1 had either awake alveolar hypoventilation or an apnoea + hypopnoea index > 40 disordered breathing events.h-1. Repeat nuclear ventriculography after nCPAP revealed an increase in RVEF from 30 to 39%. In conclusion, right ventricular dysfunction is common in obstructive sleep apnoea, but it is reversible with nasal continuous positive airway pressure treatment and appears to be related to nocturnal oxygen desaturation.

Topics: Adult; Blood Gas Analysis; Female; Humans; Incidence; Male; Middle Aged; Nose; Obesity; Positive-Pressure Respiration; Prospective Studies; Radionuclide Ventriculography; Respiratory Function Tests; Risk Factors; Sex Distribution; Sleep Apnea Syndromes; Ventricular Dysfunction, Right

Previous studies have generally shown poor effective long-term compliance with nasal continuous positive airway pressure (nCPAP) in patients with obstructive sleep apnoea syndrome (OSAS). We performed a retrospective study of patients treated with nCPAP for more than one year. Compliance was defined as the average number of hours of nCPAP use per day, where hours of use were obtained from the built-in time counter of the nCPAP device, after deduction of the 10% difference between effective use and time counters previously shown by others. We present data on the first 95 patients for whom results were available. The follow-up period was 784 +/- 366 (mean +/- SD) days for the whole group. Compliance was 5 +/- 1.8 h. For a subgroup of 36 patients, we had data on two consecutive follow-up periods (673 +/- 235 and 390 +/- 147 days for the first and second period, respectively). Compliance remained stable (5.2 +/- 1.5 and 5 +/- 2.3 h, respectively). For the whole group, a significant correlation was found between compliance and sleep fragmentation expressed as the movement arousal index (r = 0.226). During a similar 3 year period, 155 patients with a confirmed diagnosis of OSAS were offered a nCPAP trial. CPAP was actually delivered for home use to 117 patients (76%). During this same 3 year period, only 21 patients out of a total of 192 followed-up in our institution quit treatment, mainly due to intolerance or cure. These results indicate that in a nonselected group of obstructive sleep apnoea syndrome patients a high and stable compliance with nasal continuous positive pressure can be achieved, contradicting recent results of other series.

Topics: Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Patient Compliance; Positive-Pressure Respiration; Prognosis; Respiratory Mechanics; Retrospective Studies; Sleep Apnea Syndromes

This article evaluates the long-term clinical and physiologic effects of nocturnal nasal intermittent positive-pressure ventilation (NIPPV) in patients with neuromuscular disease.. Before and after 18 +/- 2 months of NIPPV, we measured during the daytime arterial blood gases, lung mechanics, and respiratory muscle strength in 8 patients (51 +/- 5 years; mean +/- SEM). Sleep parameters were also evaluated at 10 +/- 2 months.. All patients tolerated NIPPV and none required hospitalization during follow-up. After NIPPV, daytime arterial PO2 increased (71 +/- 4 to 81 +/- 2 mm Hg; p < 0.05) and arterial PCO2 decreased (46 +/- 3 to 41 +/- 1 mm Hg; p < 0.05). The change of PaO2 after NIPPV was related to its baseline value (r2 = 0.78, p < 0.05). Vital capacity (50 +/- 6% predicted), total lung capacity (63 +/- 4% predicted), alveolar-arterial oxygen gradient (20 +/- 3 mm Hg), and maximal inspiratory (39 +/- 9% predicted) or expiratory (32 +/- 5% predicted) pressures did not change after NIPPV. The apnea-hypopnea index fell from 22 +/- 6 to 1 +/- 1 (p < 0.05), and both sleep architecture and sleep efficiency (from 59 +/- 8% to 83 +/- 5%; p < 0.05) were enhanced. The time spent with an arterial oxygen saturation (SaO2) value below 90% decreased from 160 +/- 53 min to 8 +/- 4 min (p < 0.05). Mean (88 +/- 3 to 95 +/- 1%; p < 0.05) and minimal nocturnal SaO2 (67 +/- 5 to 89 +/- 1%; p < 0.001) improved after NIPPV.. In patients with neuromuscular disease, long-term NIPPV is well tolerated and easy to implement clinically. In these patients, long-term NIPPV improves daytime arterial blood gas values and sleep-disordered breathing. However, it does not modify lung mechanics or respiratory muscle strength.

Topics: Adult; Aged; Carbon Dioxide; Circadian Rhythm; Female; Follow-Up Studies; Humans; Intermittent Positive-Pressure Ventilation; Longitudinal Studies; Lung; Male; Middle Aged; Muscle Contraction; Neuromuscular Diseases; Nose; Oxygen; Partial Pressure; Pressure; Pulmonary Diffusing Capacity; Pulmonary Ventilation; Respiratory Mechanics; Respiratory Muscles; Sleep; Sleep Apnea Syndromes; Total Lung Capacity; Vital Capacity

Marfan's syndrome is associated with a high prevalence of obstructive sleep apnea (OSA). As this syndrome is associated with a characteristic constricted maxilla and high-arched palate, we reasoned that nasal airway constriction and resultant high nasal airway resistance (NAR) may contribute to the development of OSA. Therefore, the aim of this study was to measure NAR in patients with Marfan's syndrome. In addition, we aimed to examine the influence of maxillary morphology on both NAR and the severity of OSA.. We measured NAR in 13 consecutive patients with Marfan's syndrome and 13 control subjects. NAR was measured by posterior rhinomanometry, and expressed as the inspiratory resistance at a flow of 0.5 L/s. Dental impressions were taken to evaluate maxillary arch morphology, allowing measurement of the following distances: intercuspid (ICD), interpremolar (IPD), intermolar (IMD), and maximum hard palate height (MPH). Ten of the patients and four of the control subjects had previously undergone nocturnal polysomnography.. Mean NAR for the Marfan group was more than twice that in the control group (7.7 +/- 1.2 vs 2.9 +/- 0.4 cm H2O/L/s; p < 0.005). The patients also had marked constriction of the maxillary arch compared with control subjects. Two of the lateral maxillary measurements were significantly inversely correlated with NAR. There were significant correlations between various maxillary arch measurements (MPH/ICD, MPH/IPD, MPH/IMD) and the apnea/hypopnea index.. These data suggest that high NAR is a common feature of Marfan's syndrome. Maxillary constriction with a relatively high hard palate appears to be a major reason for the high NAR. The significant correlations between indexes of maxillary constriction and sleep apnea severity suggest that maxillary morphology may play an important role in the pathophysiology of OSA in Marfan's syndrome.

Topics: Adult; Airway Resistance; Bicuspid; Cephalometry; Cuspid; Dental Arch; Female; Follow-Up Studies; Humans; Inhalation; Male; Manometry; Marfan Syndrome; Maxilla; Molar; Nose; Palate; Polysomnography; Pulmonary Ventilation; Sleep Apnea Syndromes

Topics: Humans; Male; Middle Aged; Nasal Septum; Nose; Shock, Septic; Silicones; Sleep Apnea Syndromes; Splints; Staphylococcal Infections; Surgical Wound Infection

The purpose of this investigation was to determine if there are cranial base differences in adults with obstructive sleep apnea (without identifiable craniofacial abnormalities) when compared with those of adults without airway problems.. Cephalometric analysis of the cranial base of 52 patients with documented sleep apnea were compared with 96 normal adult patients. Each of the groups was subdivided based on skeletal profiles (Class I, II, III). Cephalometric measurements included cranial base flexure angle and anterior and posterior cranial base lengths. Standard analysis of variance and Students' t test were used to determine level of significance.. The cranial base flexure angle in patients with documented sleep apnea was significantly more acute than that found in the nonapnea group. Patients with a skeletal Class III profile had the most acute cranial base flexure whereas those with Class II profiles had the most obtuse angles. This pattern was true for apnea and nonapnea groups. No cranial base length differences could be found in either group.. The results of this study demonstrate that there were abnormalities of the cranial base in patients with obstructive sleep apnea. Abnormalities of the cranial base seen in "nonsyndrome" obstructive sleep apnea patients are similar to those seen in patients with certain identifiable syndromes. This may suggest that sleep apnea is a reflection of a form of craniofacial syndrome.

Topics: Adult; Analysis of Variance; Cephalometry; Cohort Studies; Female; Humans; Male; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Nose; Sella Turcica; Skull; Sleep Apnea Syndromes

As an initial step in simplifying the diagnosis of sleep apnea with a view toward using portable equipment in the home setting, we examined the efficacy of a portable transducer catheter that measures intrathoracic pressure. This catheter, connected to a miniature data-logger, can be introduced nasally into the airway, and the data so collected can be acquired, stored, and analyzed off-line. We tested this catheter against standard nocturnal polysomnography in 10 patients suffering from obstructive sleep apnea. We found that by using a combination of the raw pressure signal and an envelope pressure signal, we accurately identified apneas and hypopneas, and classified them as obstructive, central, and mixed. For the 10 subjects studied, the polysomnographic apnea/hypopnea index was 34 + 30, versus 32 + 28 obtained by analysis of the pressure tracings. Analysis of 200 respiratory events identified one-by-one from polysomnograms and pressure tracings revealed close correspondence between the two methods. The average duration of apneas was 22.1 + 6.7 s as measured by polysomnography, versus 21.9 + 6.6 s as measured from pressure tracings. Furthermore, there was excellent agreement between the two methods (kappa = 0.89, 95% confidence limits = 0.84 to 0.94). We conclude that our technique for identifying apnea based on measurements of intrathoracic pressure using a thin, portable transducer catheter is a promising method for simplifying the diagnosis of this disorder.

Topics: Adult; Aged; Catheterization; Equipment Design; Esophagus; Female; Humans; Information Storage and Retrieval; Intubation; Male; Middle Aged; Monitoring, Ambulatory; Nasopharynx; Nose; Polysomnography; Pressure; Pulmonary Ventilation; Signal Processing, Computer-Assisted; Sleep Apnea Syndromes; Thorax; Tongue; Transducers, Pressure; Vocal Cords

This is a retrospective review of children 15 years of age or younger, who underwent overnight sleep studies between 1980 and 1993. All were diagnosed and treated for obstructive sleep apnea (OSA). Overnight studies were performed for OSA in 413 children. One hundred seventy-five (42.4%) children were treated with adenotonsillectomy and 80 (19.4%) with nasal mask continuous positive airway pressure (nCPAP). The proportion of male children was greater than expected in both the entire study group (69%, p < 0.001) and in those treated with nCPAP for OSA (71% p < 0.001). There was no significant difference between the mean age of the children treated with nCPAP (5.7 +/- 0.5 yr) and the entire group studied (5.04 +/- 0.21 yr). A greater proportion of the children who received nCPAP therapy had a congenital syndrome or malformation than in the group with OSA as a whole; 27.7% of children assessed for OSA were affected, and 53% of those children with OSA who received treatment with nCPAP (p < 0.001). Therapy with nCPAP (mean duration 15 +/- 3 mo, mean pressure 7.9 cm H2O) eliminated the signs of OSA in 72 children (90%). Respiratory disturbance index fell from a mean of 27.3 +/- 20.2 to 2.55 +/- 2.74 (p < 0.001). Eight of 32 children who underwent pressure determination studies could not tolerate nCPAP above an upper limit because of hypoventilation or frequent central apneas. Nevertheless, we conclude that nCPAP is an effective and generally well-tolerated therapy for treatment of OSA in infants and children.

Topics: Adenoidectomy; Adolescent; Airway Obstruction; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Infant; Male; Masks; Nose; Polysomnography; Positive-Pressure Respiration; Pulmonary Ventilation; Respiratory Insufficiency; Retrospective Studies; Sleep Apnea Syndromes; Sleep Stages; Tonsillectomy; Treatment Outcome

Topics: Humans; Nose; Self-Help Devices; Sleep Apnea Syndromes

Twenty-one patients were examined, of whom 18 suffered from obstructive sleep apnea syndrome and 3 were heavy snorers. The diagnosis was established by a combination of medical history, clinical examination and standard nocturnal polysomnography. Five pressure transducers were used in the pharynx and one in the esophagus, in addition to monitors for oxygen saturation and oro-nasal airflow. A clinically significant obstruction was defined as occurring when the pressure difference between two transducers was higher than 50% of the more caudal of the two pressures. In the 20 patients having obstructions during sleep, 7 had obstruction in only one segment of the airway, 9 in two segments and 4 in three segments. All but 2 patients had obstructions in the velopharyngeal region. Since the effect of uvulopalatopharyngoplasty (UPPP) is best during the first few months after surgery, 10 patients were re-examined after only 3 months in order to record optimal results sequentially. Of these, 6 still had obstructions involving the velopalatine segments and only 4 had none. This may explain why UPPP has a success rate of only 50-70% in most publications, depending on the definitions of success.

Topics: Airway Obstruction; Airway Resistance; Esophagus; Follow-Up Studies; Humans; Mouth; Nose; Oxygen Consumption; Palate, Soft; Pharynx; Polysomnography; Pressure; Pulmonary Ventilation; Sleep; Sleep Apnea Syndromes; Snoring; Transducers, Pressure; Uvula

Sinus arrest and atrioventricular (AV) block have been demonstrated in as much as 30% of patients with sleep apnea (SA). The reversal of heart block after tracheostomy has been shown. Nasal continuous positive airway pressure (nCPAP) now is widely used as the treatment of SA, but little data are available on the effect of nCPAP on heart block in patients with SA. During a 17-mo period 239 patients were found to have SA in an ambulatory study. Heart block was identified in 17 (16 male, one female) of these patients. Standard polysomnography and two-channel long-term ECG before and during nCPAP therapy were performed in order to assess the effect of nCPAP on SA and heart block. Mean age of the 17 patients was 50.7 yr (range, 27 to 78 yr), mean respiratory disturbance index (RDI) was 90/h (SD +/- 36.1) before nCPAP and 6/h (SD +/- 6.2) on the second treatment night. The number of episodes of heart block during sleep decreased significantly (p < 0.001) from 1,575 before therapy to 165 during nCPAP. In 12 patients (70.6%) heart block was totally prevented by nCPAP. In another three patients, there was a 71 to 97% reduction in the number of episodes of heart block on the second treatment night, and in two of them a complete reversal occurred thereafter. Two patients exhibited an increase in block frequency during nCPAP, which was reversed after 4 wk of nCPAP in one but persisted in the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Electrocardiography; Female; Heart Block; Humans; Male; Middle Aged; Nose; Polysomnography; Positive-Pressure Respiration; Sinoatrial Block; Sleep Apnea Syndromes

To determine the mechanism for obstructive sleep apnea in two patients with clinical abnormalities of laryngeal function, airflow dynamics during sleep were analyzed. The site of airway obstruction was assessed by examining pressure gradients across specific airway segments. The relation between maximal inspiratory airflow and nasal pressure was analyzed to determine (1) the critical pressure, a measure of the collapsibility of the laryngeal airway, and (2) the effect of nasal continuous positive airway pressure on airflow during sleep. Large inspiratory pressure gradients developed during sleep between the supraglottic and pleural spaces, indicating that collapse had occurred in the larynx. Elevated critical pressures of -6.4 and +1.2 cm H2O, respectively, occurred in the two patients. When the nasal pressure was raised to 10 cm H2O, normal levels of tidal airflow occurred, and obstructive apneas were eliminated. These findings indicate that sleep apnea was caused by laryngeal airflow obstruction that resulted from elevations in the collapsibility of the larynx. The response to nasal continuous positive airway pressure suggested that laryngeal sleep apnea was similar to pharyngeal sleep apnea in pathophysiologic characteristic and response to treatment.

Topics: Adult; Airway Obstruction; Arnold-Chiari Malformation; Humans; Inhalation; Laryngeal Diseases; Male; Middle Aged; Nose; Positive-Pressure Respiration; Pressure; Pulmonary Ventilation; Respiratory Sounds; Shy-Drager Syndrome; Sleep Apnea Syndromes; Sleep Stages; Tidal Volume

History of a middle aged obese male, presenting with severe obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is described. Provisionally patient was started on CPAP and long-term domiciliary oxygen therapy (LTOT). OSA was successfully treated by surgical repair of nasal patency and partial uvulectomy. There was also remarkable improvement in ventilatory indices after steroid therapy. There was no further need for CPAP and LTOT.

Topics: Humans; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Oxygen; Positive-Pressure Respiration; Remission Induction; Sleep Apnea Syndromes

Nasal continuous positive airway pressure (NCPAP) improves sleepiness and prognosis in obstructive sleep apnea (OSA). Our objective was to document NCPAP compliance and the percentage of time that the effective pressure shown to eliminate 95% of the obstructive apneas and hypopneas was maintained. We built and covertly installed an elapsed timer and mask pressure transducer recorder in NCPAP units of 47 OSA patients. Subjects were seen at 2- to 8-wk intervals over 6 months. Group mean age was 51 yr; 38 males, with mean body mass index of 42; all complained of daytime sleepiness. Initial full night polysomnography demonstrated a mean apnea-hypopnea index (AHI) of 58 +/- 2.6 SEM (range, 10 to 115). Nine subjects discontinued therapy within 3 months for various reasons. In the remaining subjects (n = 38) the actual mean nightly hours of use was 4.7 which represents 68% of the stated total sleep time (compliance). However, effective mean hours of use was 4.3 which represents 91% of the time that prescribed effective pressure was maintained at the mask. The AHI did not correlate with compliance, but did correlate with effective use (R = 0.27048, p = 0.0006). Subjective initial complaints of daytime sleepiness correlated with compliance only during the first visit (R = 0.38590, p = 0.05). No predictors for compliance were found.

Topics: Adult; Aged; Evaluation Studies as Topic; Female; Home Care Services; Humans; Male; Masks; Middle Aged; Nose; Patient Compliance; Polysomnography; Positive-Pressure Respiration; Prognosis; Severity of Illness Index; Sleep Apnea Syndromes; Sleep Stages; Time Factors; Treatment Failure

Twenty two patients with obstructive sleep apnea syndrome were examined by nocturnal polysomnography (n-PSG), and the obstructive sites in the upper airway were observed by nasendoscopic diurnal polysomnography using diazepam (n-d-PSGD). The types of apnea were divided into three groups according to the obstructive sites in the upper airway: soft palate apnea, tongue base apnea, and combined type apnea. Among the 22 patients, there were 17 soft palate apneas, 3 tongue base apneas and 2 combined type apneas. All patients underwent uvulopalatopharyngoplasty (UPPP). Preoperative values of AI, AR, DI and mean sleep SaO2 were 37.2, 24.5%, 31.4 and 92.5%, and the postoperative values were 10.4, 7.3%, 6.8 and 94.8%, respectively. Criteria were established to define UPPP responders, as follows: 50% or more reduction in AI and postoperative AI less than 20. The overall improvement rate was 81.0%. The improvement rates for soft palate apnea, combined type apnea and tongue base apnea were 93.8%, 50.0%, and 0%, respectively. In 15 of the 22 patients, measurements of mesopharyngeal and esophageal pressures were performed simultaneously with n-d-PSGD. In these 15 patients, 12 soft palate apneas, 2 combined type apneas and 3 tongue base apneas were observed with n-d-PSGD, while 7 soft palate apneas, 3 combined type apneas and 5 tongue base apneas were detected by measuring the pressures. The results of these two methods concurred in only nine of fifteen patients. It was suspected that the obstructive sites in the upper airway were identified by tissues with n-d-PSGD, but by region with the pressure measuring method. It was suggested that UPPP is the most suitable treatment for patients with soft palate type apnea, without pathologic obesity.. n-d-PSGD is a useful method of evaluating respiratory status during sleep, can be performed in a few hours, and can simultaneously identify the obstructive site in the upper airway, so as to allow treatment planning.

Topics: Diazepam; Endoscopy; Humans; Nose; Palate, Soft; Pharynx; Polysomnography; Respiration; Sleep Apnea Syndromes; Uvula

Snoring is a common disorder usually presenting to otolaryngologists. Most patients who have any nasal symptoms would normally be offered nasal surgery, but there is a significant incidence of failure to control the snoring (approximately 25%). We analysed a group of patients, all having nasal surgery for snoring, with the aim of assessing whether any pre-operative factors would predict success or failure of the surgery. We found symptoms of excessively loud snoring, witnessed apnoeic episodes and hypersomnolence, or obstructive sleep apnoea diagnosed by overnight oxygen saturation measurements to be statistically associated with failure of nasal surgery to improve snoring.

Topics: Adult; Aged; Airway Resistance; Apnea; Endoscopy; Female; Fiber Optic Technology; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Polysomnography; Sleep Apnea Syndromes; Sleep Stages; Snoring; Sound; Treatment Failure; Treatment Outcome

This study was designed to test the hypothesis that nasal dilation reduces snoring. To achieve this we performed nocturnal polysomnography, including measurement of snoring, in 15 patients without nasal pathology before and after insertion of a nasal dilator (NOZOVENT). Snoring was quantified for each sleep stage by recording the number of snores per minute of sleep, number of snores per minute of snoring time and nocturnal sound intensities (maximum, average and minimum). We found that nasal dilation had no effect on the number of apneas, hypopneas or oxygen saturation. Snoring parameters were unaffected by NOZOVENT during stages I, II and REM sleep, but were all significantly reduced during slow wave sleep. We conclude that dilation of the anterior nares in patients without nasal pathology has a relatively weak effect on snoring, and routine use of nasal dilating appliances is not recommended for treatment of snoring.

Topics: Adult; Aged; Airway Obstruction; Dilatation; Equipment Design; Female; Humans; Male; Middle Aged; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages; Snoring

We report a 71-year-old female patient with primary alveolar hypoventilation syndrome who received diaphragm pacing (DP) and developed obstructive sleep apnea syndrome (OSAS). Application of nCPAP markedly improved her nocturnal hypoxemia. The monitored polygrams before and after the application strongly suggested that the main mechanism of OSAS was an imbalance of activity between upper airway dilator muscles and pump muscles. Moreover, paradoxical movement of the rib cage is not necessarily due to upper airway obstruction. Monitoring of tidal volume and arterial oxygen saturation is essential for the diagnosis of DP-induced OSAS.

Topics: Aged; Diaphragm; Electric Stimulation Therapy; Female; Humans; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

In order to investigate respiratory failure during sleep in patients with Duchenne muscular dystrophy (DMD), overnight arterial oxygen saturation (SaO2) and end-tidal CO2 (EtCO2) monitoring by capnographoximeter was performed. We supposed that average of EtCO2 over 60 mmHg documented by continuous overnight capnograph study indicated the need for introducing nocturnal respiratory assistance. Accordingly, four patients who showed EtCO2 over 60 mmHg were initiated to treat with nocturnal nasal intermittent positive pressure ventilation (NIPPV). The first ventilator settings were adjusted for patient comfort and to attain near normal arterial blood gas values while the patients were awake on NIPPV. After the patients were able to tolerate NIPPV for the whole night, overnight recording of SaO2 and EtCO2 on nocturnal NIPPV were made to assure the adequacy of ventilation and to provide basis for adjusting ventilator settings. Subsequently, appropriate nocturnal NIPPV could normalize overnight SaO2 and EtCO2, improve daytime arterial PO2 and PCO2, and reverse symptoms of chronic alveolar hypoventilation in these patients. According to further decline in pulmonary function, efficacy of NIPPV must be checked periodically by overnight monitoring, and ventilator resettings should be done if necessary. We believe that early awareness and appropriate management of respiratory failure during sleep by NIPPV are important to postpone tracheostomy for patients with DMD.

Topics: Adolescent; Adult; Humans; Intermittent Positive-Pressure Ventilation; Muscular Dystrophies; Nose; Respiratory Insufficiency; Sleep Apnea Syndromes

The aim of this study was to evaluate the right ventricular function in the obstructive apnea sleep syndrome (OSAS) and to determine the effect of the continuous use of a continuous positive pressure nasal device on the airway (CPSPn) produces on this aspect of the disease.. Forty patients were diagnosed of OSAS by study of spontaneous night sleep. A functional respiratory study was performed in all the patients as was a calculation of the index of body mass (IBM) and isotopic ventriculography for the calculation of the right and left ventricular ejection fractions (RVEF and LVEF). Twenty-six patients were followed after 8.4 +/- 3.3 months of home treatment with CPAPn in which these studies were repeated.. Twenty-four of the 40 patients (60%) had RVEF lower than 0.45. These 24 patients had paO2 in vigil state (69.9 +/- 13.6 mmHg) than those with a normal RVEF (80.1 +/- 8.7 mmHg) (p < 0.05). After treatment with CPAPn an elevation was observed in the RVEF in the group which was followed. This increase was significant in the subgroup sharing low RVEF (n = 16) prior to starting treatment upon passing from 0.39 (+/- 0.02) to 0.45 (+/- 0.04) (p < 0.001).. Right ventricular dysfunction in frequent in patients with the obstructive apnea sleep syndrome and is more frequent in patients maintaining hypoxemia in vigil. The continual use of continuous positive pressure in the nasal airway produces improvement in right ventricular function particularly in those in whom this was most disturbed.

Topics: Adult; Body Mass Index; Female; Follow-Up Studies; Forced Expiratory Volume; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes; Stroke Volume; Ventricular Function, Right; Vital Capacity

Topics: Aged; Carcinoma, Basal Cell; Female; Home Nursing; Humans; Male; Middle Aged; Nose; Respiratory Insufficiency; Respiratory Protective Devices; Skin Neoplasms; Sleep Apnea Syndromes

Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.

Topics: Airway Obstruction; Endoscopy; Humans; Hypopharynx; Nose; Oropharynx; Palate, Soft; Pharynx; Respiration; Sleep Apnea Syndromes; Snoring

Topics: Adult; Blood Pressure; Body Mass Index; Humans; Hypertension; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Cineradiography of the pharynx during simulated snoring was done in 6 healthy volunteers, and supraglottic pressure and flow rate were recorded in 12 others. We observed, immediately before snoring, a decrease in the sagittal diameter of the oropharynx followed, during snoring, by high-frequency oscillations of soft palate and pharyngeal walls. The pattern of soft palate oscillations was different while snoring through the nose or mouth. During inspiratory snoring through the nose, the soft palate remained in close contact with the back of the tongue and only the uvula presented high-frequency oscillations. Snoring through the mouth resulted in ample high-frequency oscillations of the whole soft palate. Frequency of airflow and supraglottic pressure oscillations was less (P less than 0.05) during mouth (28.2 +/- 7.5 Hz) than during nasal snoring (77.8 +/- 36.7 Hz). This difference may be related to the smaller oscillating mass (i.e., uvula) during nasal snoring. At variance with our previous data, which showed that snoring during sleep, in both heavy (nonapneic) snorers and obstructive sleep apnea patients, was systematically preceded by flow limitation, this was not true during simulated snoring.

Topics: Adult; Airway Resistance; Female; Glottis; Humans; Male; Mouth; Nose; Oropharynx; Palate, Soft; Pressure; Respiratory Mechanics; Sleep Apnea Syndromes; Snoring; Uvula

The modifications in the ventilation pattern when a continuous positive pressure is applied through the nose (CPAPn) in an acute form or by increasing pressures is evaluated in 13 normal subjects and 8 individuals presenting obstructive sleep apnea syndrome (OSAS). No significant modifications are observed in breathing frequency or breathing time when 5 and 10 cm of H2 are applied. It is concluded that this mechanism does not seem to be involved in the disappearance of hypercapnia which occurs in some patients with OSAS.

Topics: Humans; Nose; Positive-Pressure Respiration; Respiration; Respiratory Mechanics; Sleep Apnea Syndromes; Time Factors

Snoring is a common disorder, and may be associated with obstructive sleep apnoea, although there is little published information on the incidence of apnoea in snorers. This study aimed to assess the upper airway and to relate the findings to sleep study data in a population of patients referred by their general practitioners with loud snoring. Each patient had a full history, weight and height measurements, nasal examination, rhinomanometry, peroral grading of the oropharyngeal features, and fibreoptic pharyngoscopy with a modified Muller manoeuvre, followed by a sleep study. The results in our group of 35 patients demonstrate a high incidence of obstructive sleep apnoea (46%). Factors which correlated well with apnoea were excessively loud snoring, a narrow oropharynx, and marked obesity; 94% of patients with one or more of these features had evidence of sleep apnoea.

Topics: Adult; Aged; Airway Resistance; Endoscopy; Female; Humans; Male; Manometry; Middle Aged; Nose; Pharynx; Sleep Apnea Syndromes; Snoring

This report describes the polysomnographic findings and the respiratory alterations during sleep in a 20-year-old patient with the Prader-Willi syndrome. Nocturnal recordings and a variant of the multiple sleep latency test showed excessive daytime sleepiness, sleep onset rapid eye movement episodes, snoring and sleep apnea. Treatment with nasal continuous positive airway pressure normalized the respiratory pattern and the sleep structure, except for rapid eye movement sleep onset. Whereas upper airway obstruction and obesity may explain the respiratory disorders, as shown by their resolution with continuous positive airway pressure treatment, hypothalamic dysfunction could play a role in the disruption of the normal nonrapid eye movement/rapid eye movement sleep periodicity.

Topics: Adult; Airway Obstruction; Heart Rate; Humans; Hypothalamus; Male; Nose; Positive-Pressure Respiration; Prader-Willi Syndrome; Sleep Apnea Syndromes; Sleep Wake Disorders; Sleep, REM; Snoring

To examine if gender and airway resistance (nasal and pulmonary) influence the loudness and intensity of snoring, we prospectively studied 370 unselected patients referred to our sleep clinic because of heavy snoring and a possibility of sleep apnea. All patients had full nocturnal polysomnography, including measurements of snoring using a calibrated microphone-sound meter system, and determination of pulmonary (Raw) and nasal resistance (Rna). Snoring was quantified by reporting the number of snores per hour of sleep (snoring index--SI) and the maximum nocturnal sound intensity (dBmax). The patient population comprised 77 females and 293 males, ranging in age from 12 to 80 years. Based on the apnea/hypopnea index (AHI) we separated all patients into the apneic and non-apneic groups. There were 201 non-apneic snorers (AHI less than or equal to 10) and 160 apneic snorers (AHI greater than 10). There was no significant difference in snoring frequency, maximum nocturnal sound intensity, nasal and pulmonary resistance between men and women or between apneic and non-apneic snorers. Stepwise, forward, multiple linear regression analysis showed that body mass index and nasal resistance correlate significantly with the snoring index (R2 = 0.29, p less than 0.005), while age and body mass index correlate only weakly, but significantly, with the maximum nocturnal sound intensity. We conclude that (1) men snore similarly to women, and (2) obesity and nasal resistance are important determinants of the frequency of snoring. It follows that measures taken to reduce weight and decrease nasal resistance may be of benefit in reducing snoring.

Topics: Adolescent; Adult; Age Factors; Aged; Airway Resistance; Analysis of Variance; Child; Female; Humans; Linear Models; Lung; Male; Middle Aged; Nasal Obstruction; Nose; Obesity; Prospective Studies; Sex Factors; Sleep Apnea Syndromes; Snoring; Sound

Topics: Humans; Nasal Obstruction; Nose; Sleep Apnea Syndromes; Stents

The Nasal Spray Test, as herein described, is a simple, reliable, no-cost, self-administered test for assessment of the nasal component in several combined etiologies of snoring and obstructive sleep apnea. A topical decongestant is sprayed into the nose on alternate nights for one week. Spray-nights are compared to non-spray nights for the severity of snoring and apnea. Improvement on the spray-nights implies that nasal obstruction is a causative factor in snoring and that relief of that obstruction will also improve the snoring problem. The test helps the physician decide when nasal surgery should or should not be performed for the complaint of snoring.

Topics: Administration, Intranasal; Adult; Aged; Female; Humans; Male; Methods; Middle Aged; Nasal Obstruction; Nose; Oxymetazoline; Sleep Apnea Syndromes; Snoring

Topics: Adolescent; Female; Home Care Services; Humans; Hypoventilation; Infant; Masks; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Topics: Child; Equipment Design; Evaluation Studies as Topic; Female; Humans; Masks; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

We evaluated the activity of dilator nasalis+ EMG (Electro-Myo-Graphy) and submental EMG during sleep in three patients with obstructive sleep apnea syndrome. Both EMG activities involved periodic changes which proved to be correlated with each other (r = 0.85). Apnea and hypopnea episodes always occurred at the nadir of these periodic changes. The activity of dilator nasalis+ EMG, as well as submental EMG, at the nadir of these periodic changes was significantly lower during REM (Rapid Eye Movement) sleep than non-REM sleep and also significantly lower during severe airway obstruction accompanied by paradoxical movements of thorax and abdomen. The correlation of this EMG activity with SaO2 or the duration of obstructive apnea was more remarkable in submental EMG than dilator nasalis+ EMG in the observed patients.

Topics: Adult; Chin; Electromyography; Electrooculography; Humans; Monitoring, Physiologic; Muscles; Nose; Sleep Apnea Syndromes

Snorers represent a heterogenous group that require adequate assessment before recommending surgical treatment. There are unfortunately no specific features either in the history or physical examination that might predict those chronic snorers with obstructive sleep apnoea. We have used trained observation together with pulse oximetry ('sleep screening') and fibreoptic nasendoscopy with Muller manoeuvre in our unit to assess snorers. This combination is a reliable means of distinguishing apnoeic patients from simple snorers and determining the level of the obstructing segment. We report our experience in using these methods in the management of 71 chronic snorers. We stress the value of conservative management, and emphasize that obesity, habitual alcohol ingestion and nasal obstruction should be corrected before embarking on pharyngeal surgery.

Topics: Adult; Aged; Body Weight; Chronic Disease; Female; Humans; Male; Middle Aged; Nasal Obstruction; Nose; Sleep Apnea Syndromes; Snoring

Nasal obstruction is a cause of disordered breathing during sleep. Our previous study demonstrated diminished end-tidal PCO2 with nose obstruction while subjects were awake. If this is also the cause during sleep, decreased CO2 stimulus may easily induce apnea, hypopnea, and disordered breathing. To test this hypothesis, six male volunteers were examined to compare sleep disorders during both nose-open and nose-obstructed conditions. End-tidal PCO2 during nose-obstructed sleep was lower than that during nose-open sleep in all of the subjects. Furthermore apnea during nasal obstruction occurred most frequently shortly after transition to a deeper sleep stage. These results suggest that diminished PCO2 stimulus combined with depressed behavioral activity play an important role for disordered breathing in nose-obstructed sleep.

Topics: Adult; Airway Obstruction; Carbon Dioxide; Humans; Male; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages

We compared the changes in nasal and pharyngeal resistance induced by modifications in the central respiratory drive in 8 patients with sleep apnea syndrome (SAS) with the results of 10 normal men. Upper airway pressures were measured with two low-bias flow catheters; one was placed at the tip of the epiglottis and the other above the uvula. Nasal and pharyngeal resistances were calculated at isoflow. During CO2 rebreathing and during the 2 min after maximal voluntary hyperventilation, we continuously recorded upper airway pressures, airflow, end-tidal CO2, and the mean inspiratory flow (VT/TI); inspiratory pressure generated at 0.1 s after the onset of inspiration (P0.1) was measured every 15-20 s. In both groups upper airway resistance decreased as P0.1 increased during CO2 rebreathing. When P0.1 increased by 500%, pharyngeal resistance decreased to 17.8 +/- 3.1% of base-line values in SAS patients and to 34.9 +/- 3.4% in normal subjects (mean +/- SE). During the posthyperventilation period the VT/TI fell below the base-line level in seven SAS patients and in seven normal subjects. The decrease in VT/TI was accompanied by an increase in upper airway resistance. When the VT/TI decreased by 30% of its base-line level, pharyngeal resistance increased to 319.1 +/- 50.9% in SAS and 138.5 +/- 4.7% in normal subjects (P less than 0.05). We conclude that 1) in SAS patients, as in normal subjects, the activation of upper airway dilators is reflected by indexes that quantify the central inspiratory drive and 2) the pharyngeal patency is more sensitive to the decrease of the central respiratory drive in SAS patients than in normal subjects.

Topics: Adult; Airway Resistance; Carbon Dioxide; Humans; Hyperventilation; Male; Middle Aged; Nose; Pharynx; Respiration; Respiratory Muscles; Sleep Apnea Syndromes

1. Plasma levels of atrial natriuretic peptide (ANP) were measured in seven patients with obstructive sleep apnoea (OSA) while they were awake, during repetitive apnoea and during treatment with nasal continuous positive airway pressure (CPAP). 2. ANP levels in both pulmonary artery and peripheral venous samples were elevated during apnoeic sleep and reduced when apnoea was prevented by nasal CPAP. Mean values of pulmonary artery ANP were 116.3 +/- 17.9 pg/ml during apnoea and 64.8 +/- 15.2 pg/ml (P less than 0.05) on nasal CPAP. 3. It is concluded that there is increased ANP release during sleep in patients with OSA and that CPAP treatment normalizes ANP secretion. These findings may explain previously identified urinary abnormalities in OSA.

Topics: Atrial Natriuretic Factor; Humans; Male; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

A 75-year-old man with obstructive sleep apnea and secondary right heart failure was started on nasal CPAP therapy. Shortly thereafter he experienced massive life-threatening epistaxis requiring nasal packing and hospitalization. The epistaxis was thought to be due to the drying effect of nasal CPAP.

Topics: Aged; Epistaxis; Humans; Humidity; Male; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Topics: Adult; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

We examined interactions between inspiratory duration (TI), expiratory duration (TE), and inspiratory (esophageal) pressure (Pes) generation in seven subjects with confirmed occlusive sleep apnea. Breath-by-breath values of TI, TE, and Pes were identified by digital computer during 21 260-s epochs of repetitive occlusive apnea during non-rapid-eye-movement sleep. The control theory of interacting nonlinear oscillators was used to categorize the interaction between TI and TE for each epoch as either 1) synchronization, the strongest possible interaction between biological oscillators; 2) relative entrainment, a moderate interaction between oscillators; or 3) relative coordination, a weak interaction. The latter two interactions were characterized by systemic oscillations in the moving cross-correlation between TI and TE. The relationship between TI and Pes was analyzed in a similar fashion. Significant oscillations were present in all three parameters (P less than 0.0001 for each). We observed significant negative correlations between TI and TE and between TI and Pes (P less than 0.001 for each) when all breaths for all epochs were pooled. In no epoch was there a significant positive correlation between TI and TE or Pes. All three interactions were observed between TI and TE: five epochs of synchronization, nine of relative entrainment, and seven of relative coordination. In contrast, 19 of 21 epochs exhibited synchronization between TI and Pes, with 2 epochs of relative entrainment. The relative frequency of TI vs. Pes synchronization was significantly greater than TI vs. TE synchronization (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Computers; Humans; Inhalation; Male; Mouth; Nose; Respiration; Sleep Apnea Syndromes

The effect of nasal airway positive pressure (NAPP) on upper airway size and configuration during wakefulness was studied by computerized tomography in 12 obese subjects with obstructive sleep apnea (OSA), seven weight- and age-matched subjects without OSA, and 12 normal subjects. NAPP of 10 to 12 cm H2O was associated with a significant increase in airway area throughout the upper airway in all three groups. The change in airway area per cm H2O NAPP increased from nasopharynx to hypopharynx. The change in airway area per cm H2O NAPP was significantly smaller in the OSA than in the normal subjects in the region of the soft palate. Electromyographic recordings of the genioglossus and alae nasi muscles with and without NAPP during wakefulness in five of the OSA and five of the normal subjects showed either a decrease or no change in phasic and tonic activity with NAPP. In a separate series of experiments in an additional five OSA and five normal subjects, NAPP of zero, 5, 10, and 15 cm H2O was associated with a linear increase in airway area at a given airway level. These results indicate that (1) the increase in pharyngeal cross-sectional area with application of NAPP during wakefulness is smaller in OSA than in normal subjects in the region of the soft palate and (2) changes in upper airway muscle activity may accompany changes in upper airway size and configuration.

Topics: Electromyography; Humans; Hypopharynx; Male; Mouth; Nasopharynx; Nose; Plethysmography, Impedance; Positive-Pressure Respiration; Reference Values; Respiratory System; Sleep Apnea Syndromes; Tomography, X-Ray Computed

We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Müller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.

Topics: Adolescent; Adult; Asthma; Humans; Male; Middle Aged; Nose; Pharynx; Positive-Pressure Respiration; Prospective Studies; Sleep Apnea Syndromes; Snoring; Time Factors

We have developed a portable home sleep monitoring system using nasal airflow (NA), tracheal sound recordings (TSR), and electrocardiogram (ECG). NA was recorded by two thermisters. TSR was recorded by a microphone attached to the skin overlying the cervical trachea. Three kinds of signals were recorded with a cassette recorder. Thirty-seven outpatients who had sleep complaints were monitored during sleep at home using this recorder. Attachment of the pickups was performed by the patients themselves. Recordings were played back and analyzed by a personal computer to evaluate apnea episodes from TSR and R-R intervals beat by beat. This home monitoring system had labor-saving and cost-saving benefits and seemed to be a satisfactory technique for screening.

Topics: Ambulatory Care; Electrocardiography; Humans; Monitoring, Physiologic; Nose; Pulmonary Ventilation; Respiratory Sounds; Sleep Apnea Syndromes; Trachea

Nineteen subjects with the obstructive sleep apnea syndrome (10 with daytime arterial CO2 tension 44 mm Hg or higher) were treated with long-term nocturnal continuous positive airway pressure. The ventilatory response to CO2 (Read's method) was measured in triplicate prior to treatment and after 1, 2, 3, 7, and 14 or more nights of therapy. Seven subjects were tested on at least 4 occasions. For each test, slope of the response line and position of the response line (ventilation at a PCO2 of 60 mm Hg) were calculated. The subjects with initial high daytime CO2 showed no change in slope of response with treatment but showed a progressive increase in ventilation at any given degree of PCO2. Ventilation at a PCO2 of 60 mm Hg increased from a mean of 20.0 +/- 1.3 SEM L/min by 8.0 +/- 2.5 SEM L/min after 2 nights of therapy (p less than 0.05, two-way analysis of variance), and by 16.2 +/- 1.9 L/min after 2 wk or more (p less than 0.01). On average, there was no significant change in either slope or position of response in the subjects with initially normal daytime PCO2. We conclude that airway obstruction in sleep (in obstructive sleep apnea syndrome) leads in some subjects to respiratory failure in the daytime, with a left shift in the ventilatory response to CO2, and that this changes is usually reversible during the next several days.

Topics: Blood Gas Analysis; Carbon Dioxide; Humans; Hypercapnia; Masks; Nose; Partial Pressure; Positive-Pressure Respiration; Respiration; Sleep Apnea Syndromes; Sleep, REM; Time Factors

Topics: Aged; Humans; Middle Aged; Nose; Positive-Pressure Respiration; Respiration; Sleep Apnea Syndromes

Severe nocturnal hypoxemia may occur in patients with respiratory muscle weakness caused by neuromuscular disorders. Negative pressure ventilators may be partially effective in these patients but can cause upper airway obstructive apneas. We examined the effectiveness of positive pressure ventilation through a nose mask in preventing nocturnal hypoxemia and compared it with negative pressure systems. We reasoned that nasal positive pressure would provide stability for the upper airway. Five patients with neuromuscular disorders underwent a series of all-night sleep studies under control conditions, negative pressure ventilation, and positive pressure ventilation through a comfortable nose mask. Sleep staging and respiratory variables were monitored during all studies. Daytime awake lung function, respiratory muscle strength, and arterial blood gases were also measured. The severe hypoxemia and hypercapnia that occurred under control conditions were prevented by positive pressure ventilation through a nose mask. Negative pressure ventilation improved NREM ventilation in all patients, but did not prevent severe oxyhemoglobin desaturation, which occurred during REM sleep. Negative pressure ventilation appears to contribute to upper airways obstruction during REM sleep as evidenced by cessation of air flow, reduced chest wall movements, falls in arterial oxyhemoglobin saturation, and hypercapnia. With treatment, daytime PaO2 improved from a mean of 70 to 83 mm Hg, and PaCO2 decreased from a mean of 61 to 46 mm Hg. We conclude that nasally applied positive pressure ventilation is a highly effective method of providing nocturnal assisted ventilation because it stabilizes the oropharyngeal airway.

Topics: Evaluation Studies as Topic; Humans; Hypercapnia; Hypoxia; Masks; Neuromuscular Diseases; Nose; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes; Sleep, REM

This study explores the role of the nose in obstructive sleep apnea. If the nose acts as a Starling resistor, elevated nasal resistance may result in negative pharyngeal pressure that is of greater magnitude than the situation with normal nasal resistance. Large negative pharyngeal pressures could cause obstructive apnea. To test this hypothesis, nasal resistance studies were performed on 37 normal subjects and 53 patients with proven obstructive sleep apnea. The results suggest that although the patients had a significantly elevated nasal resistance, the increased nasal resistance did not correlate with parameters that predict the severity of obstructive sleep apnea. Although the nose probably contributes to sleep apnea, we conclude that nasal resistance is not a major factor in severe obstructive apnea.

Topics: Adult; Airway Resistance; Female; Humans; Male; Manometry; Middle Aged; Nose; Sleep Apnea Syndromes

The interaction between airway and tongue structures in a sample of 25 adult men with obstructive sleep apnea was quantified on the basis of a series of preoperative CT slices obtained for each subject. Tracings were completed for tongue, and right and left nasal, nasopharynx, oropharynx, and hypopharynx structures; computer graphics were used to obtain superior and lateral three-dimensional reconstructions of all structures for each subject. In addition, cross-sectional areas of specific sites of airway constriction, surface area, volume, and ratio calculations were completed. The majority of the constrictions occurred in the oropharynx (0.52 +/- 0.18 cm2), but six subjects had two constrictions--one in the oropharynx and one in the hypopharynx. The airway had a mean volume of 13.89 +/- 5.33 cm3, whereas tongue volume ranged from 44.03 to 99.56 cm3 with a mean of 71.96 +/- 13.41 cm3. Subjects with more severe obstructive sleep apnea tended to have larger tongue and smaller airway volumes. The more obese subjects showed larger tongue surface areas and smaller airway surface areas. To determine the structural relationships between airway and tongue variables, a series of logarithmic plots was determined. An isometric relationship characterized tongue surface area and tongue volume. A logarithmic plot of oropharyngeal airway vs. tongue volume showed a negative allometric relationship. Tongue volume increased more rapidly than airway volume in subjects with obstructive sleep apnea. Subjects with large tongue volumes were observed to experience significant complications at the time of surgical treatment. Quantification of the volume of the oropharynx and its relationship to tongue volume provide an overview of the interaction between these structures.

Topics: Adult; Blood Gas Monitoring, Transcutaneous; Computer Graphics; Humans; Hypopharynx; Male; Middle Aged; Nasopharynx; Nose; Oropharynx; Pharynx; Pulmonary Ventilation; Sleep Apnea Syndromes; Tomography, X-Ray Computed; Tongue

In treating obstructive sleep apnea, positive pressure applied through the nose (CPAP) might cause a reflex increase in upper airway muscle activity or might enlarge the airway passively. We studied the effect of CPAP applied by a nasal mask on the electromyographic (EMG) activation of the alae nasi and genioglossal muscles in 8 patients with obstructive apneas during sleep, and correlated EMG activity with concentrations of oxygenation by ear oximeter, and with the end-expiratory position of the rib cage and abdomen by DC-coupled inductance plethysmography. One to 3 cm H2O of CPAP did not eliminate the cyclic occurrence of obstructive apneas. The greatest tonic and phasic EMG activity occurred at apnea termination; the least occurred at apnea onset. With 13 to 15 cm H2O CPAP, apneas were eliminated; mean oxygen saturation rose from 84 +/- 6% (mean +/- SD) to 92 +/- 2%, and EMG activity was reduced or eliminated. With abrupt lowering of CPAP, end-expiratory positions fell, and an obstructive apnea ensued; however, EMG activity did not immediately return. We conclude that the elimination of apneas with CPAP is not attributed to increased EMG activity in the upper airway. The reduction in EMG activity observed with nasal CPAP was closely related to the improvement in hemoglobin oxygen saturation. Therefore, CPAP may act as a pneumatic splint and passively open the upper airway to prevent obstructive apnea.

Topics: Electromyography; Male; Muscles; Nose; Oxygen; Positive-Pressure Respiration; Pressure; Sleep Apnea Syndromes; Tongue

32 patients with habitual snoring and 2 patients with obstructive sleep apnea syndrome underwent nasal and/or palatopharyngeal surgery. 12 patients with combined nasal septoplasty, submucous resection of the inferior turbinate bones and palatopharyngoplasty gained total relief from snoring. The same result was achieved in 10 children with removal of extremes of tonsillar and adenoid enlargement. From 7 patients with nasal surgery alone 4 experienced total improvement in the snoring, 3 perceived no long-term relief. 3 adults with PPP alone gained some change in their snoring. Uvulectomy in 2 adults had no influence on the snoring situation.

Topics: Adenoidectomy; Adolescent; Adult; Airway Obstruction; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Nose; Palate; Pharynx; Sleep Apnea Syndromes; Snoring; Suture Techniques; Tonsillectomy; Uvula

Topics: Airway Obstruction; Airway Resistance; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Maxillofacial Development; Nasal Mucosa; Nose; Nose Diseases; Respiratory Tract Infections; Sleep Apnea Syndromes

Nasal obstruction has been shown to increase the number of apneas during sleep in normal subjects and in some may actually cause the sleep apnea syndrome. We postulated that the pharynx may act as a Starling resistor, where increases in negative inspiratory pressure result in elevated resistance across a collapsible pharyngeal segment. To test this theory in normal subjects we studied 10 men and 10 women during wakefulness. Pharyngeal resistance (the resistance across the airway segment between the choanae and the epiglottis) was determined in the normal state and with three inspiratory loads added externally. Flow was measured using a pneumotachometer and a sealed face mask; epiglottic pressure by a latex balloon placed just above the epiglottis and choanal pressure by anterior rhinometry. Pharyngeal resistance (measured at 300 ml/s) could thus be determined. Base-line inspiratory pharnygeal resistance was 1.6 +/- 0.2 cmH2O . l-1 . s. This increased to 2.3 +/- 0.3, 2.8 +/- 0.4, and 2.9 +/- 0.4 cmH2O . l-1 . s, respectively, with the addition of 1.3, 2.7, and 6.7 cmH2O . l-1 . s inspiratory load. The resistance at each level of load was significantly different from the base-line resistance determination (P less than 0.05) but not different from each other. We conclude that added nasal resistive loads during inspiration cause an increase in pharyngeal resistance during wakefulness but that this resistance does not increase further with additional increments of load.

Topics: Adult; Airway Obstruction; Airway Resistance; Female; Humans; Male; Middle Aged; Nose; Pharynx; Sleep Apnea Syndromes; Work of Breathing

Partial nasal obstruction was performed during a morning of quiet sleep (QS: non-REM) and active sleep (AS: REM) at ages 1 week, 2 weeks, 1, 2, 3, 4 and 6 months on 12 normal infants, 15 subsequent siblings of victims of the Sudden Infant Death Syndrome (SIDS) and 12 infants admitted for investigation of infant apnoea ('near-miss' SIDS). In all three groups the numbers failing to arouse after 240 s (FTA-240) in QS were significantly greater than those in AS. After 2 months of age all groups showed a decrease in the number FTA-240 in AS, whereas in QS the number did not change significantly. Subsequent siblings of SIDS had a significantly higher number FTA-240 in QS than controls. There was no significant difference in FTA-240 in QS between controls and infant apnoeas, although there was a trend for this to be higher in subsequent siblings of SIDS than infant apnoeas. It was concluded that arousal from AS is more marked than from QS, that after 2 months of age the ability to arouse from AS increases, and that in relation to SIDS, QS is the sleep state in which the infant is less able to arouse. Furthermore, subsequent siblings of SIDS differ from normal infants in their ability to arouse from QS.

Topics: Airway Obstruction; Arousal; Electrocardiography; Female; Heart Rate; Humans; Infant; Infant, Newborn; Male; Monitoring, Physiologic; Nose; Respiration; Sleep; Sleep Apnea Syndromes; Sleep, REM; Sudden Infant Death; Time Factors

The alae nasi is an accessible dilator muscle of the upper airway located in the nose. We measured electromyograms (EMG) of the alae nasi to determine the relationship between their activity and timing to contraction of the rib cage muscles and diaphragm during obstructive apnea in nine patients. Alae nasi EMG were measured with surface electrodes and processed to obtain a moving time average. Contraction of the rib cage and diaphragm during apneas was detected with esophageal pressure. During non-rapid-eye-movement (NREM) sleep, there was a significant correlation in each patient between alae nasi EMG activity and the change in esophageal pressure. During rapid-eye-movement (REM) sleep, correlations were significantly lower than during NREM sleep. As the duration of each apnea increased, the activation of alae nasi EMG occurred progressively earlier than the change in esophageal pressure. We conclude that during obstructive apneas in NREM sleep, activity of the alae nasi increases when diaphragm and rib cage muscle force increases and the activation occurs earlier as each apneic episode progresses.

Topics: Electromyography; Esophagus; Humans; Male; Muscles; Nose; Pressure; Sleep; Sleep Apnea Syndromes; Sleep, REM; Time Factors

Nine patients with severe, predominantly obstructive sleep apnoea syndromes were treated during one night by continuous positive pressure under polygraphic monitoring. Three patients did not tolerate the treatment for either mechanical reasons (2 cases) or ventilatory reasons (1 case). In the remaining 6 patients, continuous positive pressure resulted in reorganization of sleep and disappearance of obstructive and central apnoeic episodes. This effect was incomplete at low pressure (2 cm H2O) and complete at pressures of 6 to 10 cm H2O. The fact that continuous positive pressure was effective against both obstructive and central apnoea suggests that its mode of action is not purely mechanical but involves the central ventilatory control, probably by a reflex mechanism. In view of its effectiveness, continuous positive pressure appears to be the treatment of choice for sleep apnoea syndromes.

Topics: Aged; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

To evaluate the effect of continuous positive airway pressure via nasal mask (nasal CPAP) on occlusive, mixed, and central apneas (OA, MA, and CA, respectively), we performed nocturnal polysomnography without and with nasal CPAP on 21 patients with sleep apnea. Three patients were unable to tolerate nasal CPAP. The remaining 18 patients had significant reductions in the overall apnea frequency when using nasal CPAP (52.9 +/- 5 per hour slept vs 3.3 +/- 1 per hour slept, mean +/- SE, p less than 0.001). The use of nasal CPAP significantly reduced the frequency of OAs during both nonrapid eye movement (non-REM) and REM sleep (p less than 0.001). It also reduced the frequency of MAs during both non-REM and REM sleep (p less than 0.05). Nasal CPAP did not increase the frequency of CAs in patients who had MAs when sleeping without nasal CPAP indicating that both the "central" and obstructive portions of MA were eliminated. In those patients who had CAs while sleeping without nasal CPAP, the CA frequency was unchanged by nasal CPAP although there was a good deal of interindividual variability. We conclude that nasal CPAP is well tolerated and effective in reducing the frequency of OAs and MAs. The variability of the response of CA to nasal CPAP suggests that the pathogenesis of CA may not be homogeneous.

Topics: Adult; Aged; Humans; Male; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Nasal airway positive pressure (NAPP) effectively eliminates obstructive sleep apnea. This report describes construction and evaluation of a convenient NAPP apparatus used successfully in 15 patients with obstructive sleep apnea. An impeller blower with high flow, low pressure characteristics delivers room air to a flow divider and then to an injector attached to a custom-fitted nose mask. Of the total naris pressure supplied by the system, a large fraction derives from the kinetic energy of the air stream delivered to the naris by the injectors. This, together with the high flow rate of the system, promotes a constant naris pressure. Naris pressure is determined by the size of the flow divider and the aperture of the exhaust port(s) of the injector. A series of 10 flow divider-injector combinations are described that provide a variety of naris pressures between 2.5 and 13.6 cm H2O. Fourteen of 15 patients found the NAPP apparatus acceptable and effective. No maintenance or repair appears to be required.

Topics: Adult; Evaluation Studies as Topic; Feasibility Studies; Female; Humans; Male; Masks; Middle Aged; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Eighteen children were treated for snoring. Surgical removal of enlarged tonsils and/or adenoids resulted in prompt and total elimination of snoring in 17 of these patients. One child required nasal and sinus surgery to gain relief from snoring. Eighty-three adults were interviewed, examined, and treated for snoring. Correction of anatomical abnormalities in the nose, soft palate, uvula, and pharynx achieved elimination of snoring in 72% of surgically treated cases. By contrast, nonsurgical remedies achieved snoring elimination in only 5% of patients (controls). Tracheostomy was required in 10% of snoring adults--those who proved to have severe obstructive sleep apnea syndrome. Snoring is due to the combined effect of several anatomic and physiologic abnormalities in the nasal and pharyngeal segments of the airway. It may be amenable to surgical therapy when the severity of the problem warrants it.

Topics: Adenoidectomy; Adolescent; Adult; Aged; Airway Obstruction; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Muscle Tonus; Nasal Mucosa; Nasal Septum; Nose; Palate, Soft; Pharyngeal Muscles; Pharynx; Respiratory Sounds; Sleep Apnea Syndromes; Snoring; Tonsillectomy; Tracheotomy; Turbinates; Uvula

A 38-year-old man had incapacitating hypersomnolence and severe occlusive sleep apnea. Baseline polysomnography revealed 92.9 apneic episodes per hour of sleep. Application of nasal continuous positive airway pressure through a modified nasal nitrous mask using a ball-valve resistor resulted in reduction of occlusive apnea to 1.17 episodes per hour of sleep and marked improvement in the quality of sleep.

Topics: Adult; Humans; Male; Masks; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Topics: Humans; Male; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

The effect of alae nasi activation on nasal resistance in a group of healthy preterm infants was measured. Alae nasi activity was determined via the alae nasi electromyogram obtained from skin surface electrodes during both active and quiet sleep. Nasal resistance was calculated from airflow measured with a mask pneumotachograph and transnasal pressure drop obtained by simultaneous measurement of nasal pressure via a catheter inserted in one nostril and mask pressure. The percentage of breaths accompanied by phasic alae nasi activity was higher during active sleep than during quiet sleep (43% +/- 10% v 14% +/- 6%; P less than .005), and hypercapnic stimulation (4% CO2 inhalation) significantly increased the incidence of phasic alae nasi activity to comparable levels in both sleep states (82% +/- 8% in active sleep and 82% +/- 9% in quiet sleep). Elevation of tonic alae nasi activity also occurred more frequently during active sleep (P less than .05). The presence of either phasic or elevated tonic alae nasi activity decreased nasal resistance by 23% +/- 4% during active sleep and 21% +/- 3% during quiet sleep. This reduction in nasal resistance resulted in either a lower transnasal pressure during inspiration, a higher peak inspiratory airflow, or a combination of the two. Alae nasi activity may be an important mechanism that facilitates ventilation by reducing nasal resistance, and it may help stabilize the upper airway by preventing the development of large negative pharyngeal pressure during inspiration.

Topics: Airway Obstruction; Airway Resistance; Electromyography; Humans; Infant, Newborn; Infant, Premature; Nose; Sleep Apnea Syndromes

Topics: Airway Obstruction; Humans; Male; Nose; Sleep Apnea Syndromes; Sleep Wake Disorders; Time Factors

The tongue-retaining device (TRD) was designed to increase the unobstructed dimension of the nasal breathing passage during sleep. Twenty male patients with diagnoses of sleep apnea syndrome, primarily of the obstructive type, confirmed by clinical polysomnography, were fitted with the device. The TRD holds the tongue in a forward position by negative pressure. Fourteen patients have been tested before and after this treatment, and ten of these have also completed two follow-up recordings four to six months after being trained in the use of this device. There was significantly improved sleep and significantly fewer and shorter apneic events on all nights when the device was worn. On the first night of wearing the TRD for a half night only, there was a significant reduction in the number of obstructive and central apneic episodes. The mean apnea plus hypopnea index while wearing the TRD is comparable with the rate reported for patients who have been treated surgically by either tracheostomy or by uvulopalatopharyngoplasty, although the tracheostomy group contained more severe cases.

Topics: Adult; Airway Obstruction; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Respiration; Sleep Apnea Syndromes; Sleep Stages; Tongue

Five patients with severe obstructive sleep apnoea were treated with continuous positive airway pressure (CPAP) applied via a comfortable nose mask through the nares. Low levels of pressure (range 4.5-10 cm H2O) completely prevented upper airway occlusion during sleep in each patient and allowed an entire night of uninterrupted sleep. Continuous positive airway pressure applied in this manner provides a pneumatic splint for the nasopharyngeal airway and is a safe, simple treatment for the obstructive sleep apnoea syndrome.

Topics: Adolescent; Adult; Airway Obstruction; Carbon Dioxide; Hemoglobins; Humans; Male; Middle Aged; Monitoring, Physiologic; Nose; Oxygen; Positive-Pressure Respiration; Respiration; Sleep; Sleep Apnea Syndromes; Time Factors