Operating characteristics of the negative expiratory pressure technique in predicting obstructive sleep apnoea syndrome in snoring patients.
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BACKGROUND: This study examines the operating characteristics of the expiratory flow response to a negative pressure (NEP) applied to the mouth in the prediction of obstructive sleep apnoea syndrome (OSAS) in snoring patients. METHODS: Two hundred and thirty eight patients with normal spirometric values were studied. Full laboratory polysomnography was performed and an NEP of -5 cm H(2)O was applied in the sitting and supine positions. RESULTS: A significant correlation was found between the degree of flow limitation measured by NEP in both positions (expressed as the percentage of the expired tidal volume over which NEP induced flow did not exceed spontaneous flow) and the apnoea-hypopnoea index (AHI). This correlation was significantly higher in the supine position (p<0.0001) where an expiratory flow limitation cut off value of >/=27.5% of the tidal volume produced a sensitivity of 81.9% and a specificity of 69.1% in predicting OSAS. CONCLUSION: These findings show that the degree of instability of the upper airway measured by NEP is correlated with the severity of OSAS. NEP had moderate sensitivity and specificity and may be useful in predicting OSAS in a clinic based population. (+info)
Snoring in primary school children and domestic environment: a Perth school based study.
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BACKGROUND: The home is the predominant environment for exposure to many environmental irritants such as air pollutants and allergens. Exposure to common indoor irritants including volatile organic compounds, formaldehyde and nitrogen dioxide, may increase the risk of snoring for children. The aim of this study was to investigate domestic environmental factors associated with snoring in children. METHODS: A school-based respiratory survey was administered during March and April of 2002. Nine hundred and ninety six children from four primary schools within the Perth metropolitan area were recruited for the study. A sub-group of 88 children aged 4-6 years were further selected from this sample for domestic air pollutant assessment. RESULTS: The prevalences of infrequent snoring and habitual snoring in primary school children were 24.9% and 15.2% respectively. Passive smoking was found to be a significant risk factor for habitual snoring (odds ratio (OR) = 1.77; 95% confidence interval (CI): 1.20-2.61), while having pets at home appeared to be protective against habitual snoring (OR = 0.58; 95% CI: 0.37-0.92). Domestic pollutant assessments showed that the prevalence of snoring was significantly associated with exposure to nitrogen dioxide during winter. Relative to the low exposure category (<30 microg/m3), the adjusted ORs of snoring by children with medium (30 - 60 microg/m3) and high exposures (> 60 microg/m3) to NO2 were 2.5 (95% CI: 0.7-8.7) and 4.5 (95% CI: 1.4-14.3) respectively. The corresponding linear dose-response trend was also significant (P = 0.011). CONCLUSION: Snoring is common in primary school children. Domestic environments may play a significant role in the increased prevalence of snoring. Exposure to nitrogen dioxide in domestic environment is associated with snoring in children. (+info)
Dynamic upper airway soft-tissue and caliber changes in healthy subjects and snoring patients.
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BACKGROUND AND PURPOSE: The oropharyngeal airways are smaller in those who snore than in those who do not. We sought to determine which soft-tissue component surrounding the airways contributes to upper airway narrowing in those who snore. METHODS: Ten control subjects and 19 snoring patients underwent CT, with 2-mm-thick axial sections obtained every 0.6 seconds during the respiration cycle at the same oropharyngeal level. We selected two sections with the widest and narrowest parts of the oropharyngeal airway to measure the anteroposterior and lateral dimensions of the airway and the thickness of the bilateral parapharyngeal fat pads, pterygoid muscles, and parapharyngeal walls. Mean values were calculated for each phase. For each subject, differences were calculated by subtracting the values in narrowest phase from those in the widest phase. RESULTS: Changes in airway dimension (P < .05) and lateral parapharyngeal wall thickness (P < .01) were significantly different between snorers and control subjects. Changes in parapharyngeal wall thickness and transverse oropharyngeal airway diameter changes were significantly related (P < .01) in those who snored but not in control subjects. CONCLUSION: Airway narrowing predominantly occurs in the lateral dimension in people who snore. Changes in the lateral pharyngeal wall are more important than the parapharyngeal fat pads in airway calibration. Narrowing of the upper airway area at the end of the expirium and the beginning of the inspirium is thought to be the cause of snoring and due to augmented muscle mass and prolonged laxity rather than inadequate activation of the pharyngeal dilating muscles. (+info)
Chrome cobalt mandibular advancement appliances for managing snoring and obstructive sleep apnea.
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Snoring and sleep apnea are chronic conditions. This article describes the use of cobalt chrome mandibular advancement appliances as a long-term, robust addition to the appliances used to treat these conditions. The clinical indications, appliance design, construction stages and special features of using cast alloy bases are described. (+info)
Endoscopic-guided adenoidectomy using a classic adenoid curette: a simple way to improve adenoidectomy.
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A total of 13 adenoidectomies using a nasal endoscopic-guided transoral adenoid curette (not yet a published standardised method) were performed to treat snoring. Nasal endoscopy allows easy assessment of the size of the adenoids and improves the accuracy of the adenoidectomy. This technique is particularly useful for paediatric patients who have small oral cavities. The assessment and excision of the adenoids in these cases are often difficult. Using the nasal endoscope, the curette can be accurately inserted at the superior border of the adenoid, allowing the complete transoral removal of the main bulk of the adenoid tissue. All 13 patients showed considerably decreased snoring and improvements in the quality of sleep as reported by the parents and the patients. We believe that nasal endoscopic-guided transoral adenoidectomy is a viable alternative to classic adenoidectomy. This technique also has the advantage of using commonly available simple ear, nose, and throat instruments. (+info)
Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint.
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Snoring and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are often treated with mandibular repositioning splints (MRS), but the efficacy and satisfaction of them has not been comprehensively addressed. A survey on the use of and satisfaction with MRS was posted to 177 patients referred by a hospital orthodontic department for custom-fitting of a MRS. Data were analysed using non-parametric techniques. The response rate was 81% (n=144). Responders (30F, 114M) had mean (SD) age of 51 (11) years, apnoea+hypopnoea index (AHI) of 24 (21) per hr and Epworth Score of 10 (5) at diagnosis, and had been supplied with their MRS a median 7 (IQR 5-11) months previously. Fifty of the 144 patients (35%) had been offered continuous positive airway pressure (CPAP) treatment but had declined or abandoned this. Self-reported MRS use was 5 (2) h/night, with 74 of the 144 patients (51%) continuing to use MRS at least occasionally at a median 7 months after fitting. Survival analysis showed 12% still using MRS at 12 months. Epworth score fell slightly with MRS therapy [-2.4 (3.5); P=0.005] and 7 daytime and 2 nocturnal symptoms improved in MRS users (all P<0.05). Marital satisfaction did not change with MRS. Problems preventing MRS use in 70 non-users included: non-retention (n=12), sore mouth (n=13) or jaw (n=7), difficulties falling asleep (n=10) or breathing (n=7), excessive salivation (n=4), dental damage (n=4) and other problems (n=3). Continued use of MRS therapy was associated with a higher number of teeth, low marital satisfaction perceived by partners and greater improvement in symptoms reported by patients and partners. Continuance with MRS may be low and linked to tolerance problems. (+info)
A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study.
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This prospective, randomized, crossover study of 16 patients with obstructive sleep apnoea (OSA) [12 males, four females; median body mass index (BMI) 29.2 kg/m(2) (range 23.8-51.1); median age 44.8 years (range 24.0-68.4)] analysed the efficacy of the Twin Block (TB) in relation to the Herbst appliance as a mandibular advancement splint (MAS). Each subject was fitted with a TB and Herbst MAS in a random order with a washout period of 2 weeks between appliances. Once each patient was subjectively happy with the performance of each appliance, questionnaires and a visual analogue scale (VAS) were used to determine differences in snoring, daytime sleepiness, quality of life, side-effects of the appliances and patient preference. All patients underwent overnight domiciliary sleep recordings prior to and after fitting each appliance in order to objectively assess sleep quality in terms of the apnoea-hypopnoea index (AHI), snoring frequency and arterial oxygen saturation. The results suggested that there was no difference in the treatment performance of the TB and Herbst MAS for AHI (P = 0.71), snoring frequency (P = 0.49), arterial blood oxygen saturation (P = 0.97), quality of life and side-effects. The Herbst MAS proved to be the more effective appliance for reducing daytime sleepiness (P = 0.04) and was the more popular appliance among the patients. Side-effects with both appliances were minor and improved in the longer term. The TB MAS represents a viable alternative to the Herbst MAS in the treatment of patients with OSA. (+info)
Approach to obstructive sleep apnea syndrome at Tokyo Dental College, Ichikawa General Hospital.
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In this communication, we report the current status of OSAS (Obstructive Sleep Apnea Syndrome) in the southern region of Higashikatsushika around Ichikawa City, our effort to improve patient QOL as well as to establish diagnostic and therapeutic methods, and the results of a comparison of therapeutic options with the focus on improvement of compliance by using nCPAP (nasal continuous positive airway pressure). We examined 112 patients who visited the Otolaryngology Department at Tokyo Dental College, Ichikawa General Hospital, with the chief complaint of nocturnal snoring or sleep apnea from January 2001 to April 2003 and underwent all-night PSG (polysomnography). Based upon the results of these all-night PSGs, 89 and 23 patients were diagnosed as having OSAS and simple snoring, respectively. Using the AHI classification of severity, 58 and 31 patients were assessed as having severe OSAS and mild OSAS, respectively. (1) nCPAP was tried in 61 patients, and 39 patients (63%) were able to continue it. After the introduction of nCPAP, surgery was performed in 18 patients (30%). As a result, weaning from nCPAP was successfully achieved in 10 cases, compliance with nCPAP was improved in six cases, alleviation of symptoms (decreased pressure) was seen in one case, and aggravation was noted in one case. In addition, four patients (7%) unilaterally discontinued nCPAP. (2) Surgery was performed in 34 patients, and 18 of them had surgery after nCPAP was tried. (3) We asked the dental department to make OAs (oral appliances) for 31 patients but seven of them did not attend the department, so a total of 24 patients used OAs. Fourteen patients (58%) were able to tolerate an OA for 3 months or more. Based on these results, we are hoping to achieve a better control of OSAS by combining nCPAP and other modalities. (+info)