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Self-reported snoring is common in pregnancy, particularly in females with pre-eclampsia. The prevalence of inspiratory flow limitation during sleep in pre-eclamptic females was objectively assessed and compared with normal pregnant and nonpregnant females.Fifteen females with pre-eclampsia were compared to 15 females from each of the three trimesters of pregnancy, as well as to 15 matched nonpregnant control females (total study population, 75 subjects). All subjects had overnight monitoring of respiration, oxygen saturation, and blood pressure (BP).No group had evidence of a clinically significant sleep apnoea syndrome, but patients with pre-eclampsia spent substantially more time (31±8.4% of sleep period time, mean±sd) with evidence of inspiratory flow limitation compared to 15.5±2.3% in third trimester subjects and <5% in the other three groups (p=0.001). In the majority of pre-eclamptics, the pattern of flow limitation was of prolonged episodes lasting several minutes without associated oxygen desaturation. As expected, systolic and diastolic BPs were significantly higher in the pre-eclamptic group (p<0.001), but all groups showed a significant fall (p≤0.05) in BP during sleep.Inspiratory flow limitation is common during sleep in patients with pre-eclampsia, which may have implications for the pathophysiology and treatment of this disorder.

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passed behind Poupart's ligament, and made to project from the saphenous opening ; as this is done the director is withdrawn ; in its descent it guides the forceps and prevents it from catching. The fundus of the sac is now seized by the forceps (Fig. 2), which is completely withdrawn, dragging the sac out through the opening in the external oblique aponeurosis (Fig. 3). The sac is now pulled out as much as possible and ligatured at the top of its neck. By this manoeuvre no pouch is left in which recurrence may take place. A suture (silk, silkworm gut, and chromicised catgut have been used) is now passed through the fundus of the sac, the suture is drawn through to its middle and then tied, thus leaving two free ends of equal length, or this may be done before the sac is pulled up through the opening in Poupart's ligament, the thread being seized by the forceps and used to pull up the sac. But if the sac is large the thread may tear out and time be lost.One end is now threaded in a strong curved needle, one which will not rotate in the forceps which grasps it. The needle is now passed backwards and forwards through the sac several times, starting at the fundus and finishing at the neck, as described by Macewen for puckering the sac. The needle is now grasped in forceps, or a needle on a handle may be used, and its point is passed through the hole above Poupart's ligament, through the neck of the sac, down to the transverse ramus of the pubes, then by a turn of the wrist the point is made to slide forwards across the pubic bone, as close to it as possible, then to pierce the pectineus muscle and to appear through the inner part of the saphenous opening ( Fig. 4). The needle is pulled through, bringing its thread with it. By drawing on the thread and by tucking the sac back again through the hole above Poupart's ligament by means of a stout probe or similar blunt instrument the sac disappears from view and comes to rest in a puckered-up condition behind the transversalis fascia and at the top of the crural canal, which it effectually roofs in. By this time the other end of the thread is hanging out of the hole above Poupart's ligament (Fig. 5). It is tied fairly firmly, but not too tightly, to the thread which projects from the saphenous opening ; this fixes the sac in its place and fixes Poupart's ligament to the pectineus muscle, so obliterating the crural canal (Fig. 6). If necessary a second suture may be put in for this purpose but nearer the pubic spine. A suture is now put in to close the hole above Poupart's ligament and the skin incision is closed. Thus there are three distinct checks against the recurrence of the hernia : (1) the sac is ligatured higher up than is possible by the ordinary method and leaves no peritoneal pouch ; (2) the sac is used as a buffer or roof above the crural canal; and (3) Poupart's ligament is approximated to the pectineus muscle and obliterates the crural canal.It may be urged that the sac will slough and cause trouble. This does not take place. It no doubt becomes vascularised...

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