Sleep-related groaning: prevalence and characteristics in a cohort of patients with suspected obstructive sleep apnea.

Conclusion: Nocturnal groaning has the same prevalence in patients referred for diagnosis of sleep-disordered breathing as among other populations referred for sleep studies. The respiratory tracings in these patients have a distinct appearance that is possible to recognize with a polygraphic recording and thereby prevent the pattern from being misdiagnosed as central apneas.

Objectives: The aim of this study was first to estimate the prevalence of groaning in patients referred for diagnosis of sleep-related breathing disorders.

[Sleep-related breathing disorders].

Background: Sleep-related breathing disorders (SRBD) is a term that includes several different diagnoses. This paper describes aetiology, diagnostics, treatment options and consequences of untreated disease, in children and adults.

Material And Method: The paper is based on own clinical experience and literature identified through a non-systematic search of PubMed and various books.

[A ten-year-old girl with dizziness].

Childhood dizziness may take many forms; most often it presents as acute short-lived spinning attacks associated with headaches and nausea and less frequently as long-lasting symptoms with unsteadiness. Migrainous vertigo and middle ear infections are considered to be the most common causes of childhood dizziness, while head injury and pathology of the central nervous system are less common causes. We present a case history of a 10-year-old girl with acute positional vertigo attacks.

Evaluation of a portable recording device (Reggie) with actimeter and nasopharyngeal/esophagus catheter incorporated.

Background: Portable recording devices without electroencephalogram recordings are frequently used for diagnosis of sleep-disordered breathing. However, an exact measure of sleep is important, since the diagnosis is based on the average number of events per hour of sleep, the apnea/hypopnea index (AHI). Actimetry is a simplified method for distinguishing sleep and wakefulness by measurements of activity.

Patient discomfort in polysomnography with esophageal pressure measurements.

The reference method for measuring respiratory effort and for differentiating between obstructive and central apneas in the diagnosis of sleep-related breathing disorders is overnight monitoring of esophageal pressure. Despite this being the reference method, it is not widely used because it is considered invasive and uncomfortable for the patients. The aim of this study was to assess patient discomfort and insertion difficulty when using an esophageal catheter during polysomnography.

Pulseoximetry: sufficient to diagnose severe sleep apnea.

Objectives: To assess the clinical value of pulseoximetry in the diagnosis of sleep apnea when satisfactory agreement with polysomnography is obtained.

Methods: This was a prospective clinical study, set in the Department of Otorhinolaryngology, Ullevaal University Hospital, Oslo, Norway. One hundred consecutive patients were investigated for sleep related breathing disorders.

Oral breathing in patients with sleep-related breathing disorders.

Mouth breathing may contribute to increased collapsibility of the upper airways because of decreased contractile efficiency of the upper airway muscles as a result of mouth opening. Nasal airflow is also hypothesized to have a stimulating effect on the respiratory drive via receptors in the nose. Accordingly, patients with sleep-related breathing disorders (SRBD) are believed to breathe more through their mouth than healthy persons.

Dichotomous physiological effects of nocturnal external nasal dilation in heavy snorers: the answer to a rhinologic controversy?

The purpose of this article was to study the impact of external dilation on nasal airway dimensions, sleep architecture, and snoring. Eighteen heavy snorers without severe obstructive sleep apnea syndrome (mean apnea-hypopnea index (AHI) 9.3) reporting nocturnal nasal obstruction were enrolled in a randomized (controlled) cross-over study, evaluating subjective and objective effects of external nasal dilation (Breathe Right, 3M).

Advantages of measuring air flow in the pharynx with internal thermistors.

The measurement of air flow in patients suffering from breathing disturbances during sleep is usually accomplished by an oro-nasal thermistor located at the upper lip. The detection of hypopneas using this system may be difficult because the external thermistor may be unable to differentiate between high and low air flow rates. To improve the diagnosis of hypopneas we introduced a new method using internal thermistors contained in the same tube and using the same sensors as when recording pressures in the upper airways for localization of obstructions and measuring the respiratory work.

Does the oral device Noiselezz prevent sleep apnoea?

Both snoring and apnoea are caused by the collapse of soft tissue in the upper airways during sleep. Increasing the cross-sectional area of the airways in these segments by moving the mandible and/or the tongue forward stabilizes the upper airways in obstructive sleep apnoea syndrome (OSAS) patients. The aim of this study was to determine the effect of Noiselezz, which is an oral appliance of the mandibular advancing type, designed for easy use.

Diagnosing respiratory events and tracing air flow by internal thermistors.

We have developed a new method to measure flow in patients with sleep-related breathing disorders (SRBD). These flow sensors are modified thermistors located in the same sensors we use for pressure measurement in the upper airways to find the obstructive segments during apnoeas. The aim of this study was to test if using internal thermistors as indicator of air flow has advantages compared with the external thermistor method in detecting respiratory events.

Tracing air flow and diagnosing hypopnoeas in normal subjects.

Hypopnoea is a type of sleep-related breathing disorder (SRBD), and the apnoea plus hypopnoea index (AHI) is usually computed to diagnose this condition. We introduce a new method to diagnose flow with internal thermistors located on the same sensors as we use to diagnose obstructive segments in patients with sleep-related breathing disorders. The aim of this study is to investigate whether internal thermistors are reliable for diagnosis of hypopnoeas.

Internal thermistors in differentiating between oral and nasal breathing during sleep.

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.

Laser-assisted uvulopalatoplasty: description of the technique and pre- and postoperative evaluation of subjective symptoms.

A new surgical approach for treating patients suffering from heavy snoring or obstructive sleep apnoea is introduced. This procedure includes the use of a laser and is called laser-assisted uvulopalatoplasty (LUPP). However, the technique described here is unlike the laser-assisted uvulopalatoplasty (LAUP) as described by Kamami in 1990.

Nocturnal polysomnography with and without continuous pharyngeal and esophageal pressure measurements.

PSG with simultaneous pharyngeal and esophageal pressure measurements of the upper airway may interfere with sleep architecture and cause a bias. The aim of this study was to evaluate the degree of disturbance to sleep caused by inclusion of pressure measurements of the airway, and whether this would reduce the validity of the PSG. Thirty-two consecutive patients referred for PSG for possible obstructive sleep apnea syndrome (OSAS) were included.

Continuous pressure measurements in the evaluation of patients for laser assisted uvulopalatoplasty.

The aim of the present study was to evaluate the effect of laser-assisted uvulopalatoplasty (LUPP) performed under local anesthesia in an outpatient setting. No procedure included tonsillectomy. Obstruction related mainly to the velopharyngeal segment of the airway was defined in 16 consecutive patients by clinical examination, nocturnal polysomnography and pressure measurements.

Obstructive sleep apnoea: a cephalometric study. Part II. Uvulo-glossopharyngeal morphology.

A comprehensive cephalometric analysis of uvulo-glossopharyngeal morphology in 100 patients with obstructive sleep apnoea (OSA) and 36 controls was performed. The aberrations in OSA patients included: 1. Increased length, thickness, and sagittal area of soft palate (PM-U; SPT; SPA: P < 0.

Obstructive sleep apnoea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology.

A comprehensive cephalometric analysis of cervico-craniofacial skeletal morphology in 100 male patients with obstructive sleep apnoea (OSA) and 36 male controls was performed. The significant aberrations in the OSA group feature: (1) shorter dimension of cranial base with slight counter-clockwise rotation and depression of clivus; (2) shorter maxillary length with normal height; (3) maxillo-mandibular retrognathia related to nasion perpendicular plane (N perpendicular FH) despite normal angles of prognathism; (4) 47 per cent of the OSA group had mandibular retrognathia; (5) increased anterior lower facial height and mandibular plane angle; (6) reduced size of bony pharynx; (7) inferiorly positioned hyoid bone at C4-C6 level; (8) deviated head posture with larger cranio-cervical angle. Cephalometric analysis is highly recommended in OSA patients as one of the most important tools in diagnosis and treatment planning.

Continuous pressure measurements during sleep to localize obstructions in the upper airways in heavy snorers and patients with obstructive sleep apnea syndrome.

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.

Infant sleeping position and inspiratory pressures in the upper airways and oesophagus.

Inspiratory pressures were measured at three levels in the upper airways and in the oesophagus in different sleeping positions. Thirty one consecutive healthy infants were examined at the age of 1-3 days, 25 of these at 6 weeks, and 23 at 12 weeks. Oxygen saturation, an electrocardiogram, transthoracic impedance, nasal airflow, and inspiratory pressure in the epipharynx, oropharynx, hypopharynx, and in the intrathoracic part of the oesophagus were measured.

Localization of site of obstruction in snorers and patients with obstructive sleep apnea syndrome: a comparison of fiberoptic nasopharyngoscopy and pressure measurements.

The site of obstruction in the upper aerodigestive tract in 20 snorers and/or patients with obstructive sleep apnea syndrome was determined by two methods: fiberoptic nasopharyngoscopy with the Müller manoeuvre and continuous, nocturnal pressure measurements in the upper aerodigestive tract supplemented with recording of O2 saturation and oro-nasal air-flow. Identical results were obtained by both methods in only 5 (25%) of the patients, whilst in 11 (55%) obstruction was recorded in the pharynx by the pressure method which could not be demonstrated by the Müller manoeuvre. The latter method is not sufficiently accurate and should no longer be used in the pre-treatment assessment of this group of patients.

Continuous pressure measurements in the pharynx and esophagus during sleep in patients with obstructive sleep apnea syndrome.

Pressure measurements were made preoperatively at six sites in the pharynx and esophagus in 18 obstructive sleep apnea syndrome (OSAS) patients, 3 social snorers, and 6 healthy normal controls. Repeat measurements were made approximately 2 months after uvulopalatopharyngoglossoplasty (UPPGP) in 10 of the OSAS patients. The pressure transducers were contained in a thin silicone tube inserted through one nostril, and measurements were made both in the awake state and throughout a night's sleep.

[Parotid gland tumors. What not to do].

Patients with a tumour located anterior or inferior to the ear probably have a parotid gland tumour. These patients should be referred without further investigation to an ear, nose and throat specialist. Diagnostic measures that may be performed are fine needle aspiration cytology and ultrasonography.