The purpose of this study was (1) to examine the factors that account for the variability in continuous positive airway pressure (CPAP) levels required to abolish obstructive sleep apnea (OSA) in patients with this disorder, and (2) to examine the feasibility of predicting the lowest effective pressure (CPAPmin) from simple anthropometric and polysomnographic variables easily available in all patients considered for home CPAP therapy. To accomplish these tasks we studied a group of 208 patients with OSA all of whom were treated with nasal CPAP at home. We first analyzed a model set of 38 patients all of whom had at least two polysomnographic studies (the diagnostic one and a subsequent one to determine CPAPmin for home use), anthropometric measurements (including body mass index, neck circumference, and waist circumference), pulmonary function measurements (lung volumes, airways resistance, and flow-volume curves), pharyngeal and glottic cross-sectional areas at functional residual capacity and residual volume, and nasal airflow resistances. We compared patients requiring CPAP > 10 cm H2O with those who required CPAP < 5 cm H2O. The high CPAP group was characterized by a greater degree of obesity, more severe sleep apnea, and more collapsible pharynx. Multiple linear regression analysis using principal components and Mallows C(P) statistics revealed that the optimal set of predictors for CPAPmin consisted of only three variables: apnea/hypopnea index, body mass index, and neck circumference. This model accounted for 76% of the variability in CPAP.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of this study was to compare apnea and snoring in patients with different patterns of nasal resistance: normal, high unilateral, and high bilateral. The authors examined 683 unselected patients referred for evaluation of snoring and possible sleep apnea. All patients had determination of nasal resistance (performed during wakefulness in the seated posture) and nocturnal polysomnography including quantitative measurement of snoring. Analysis of variance showed no significant difference in apnea and snoring indices among the three nasal resistance groups (normal, high unilateral, and high bilateral). Furthermore, there was no significant difference in the frequency of patients with different severity of apnea and snoring among the three groups. It is concluded that 1. unilateral and bilateral elevation of nasal resistance may lead to equally severe snoring or apnea; 2. there is no direct relationship between awake seated nasal resistance measurement and sleep disordered breathing; and 3. measurements of supine nasal resistance during sleep may be required to elucidate the relationship between sleep-disordered breathing and nasal obstruction.
This study was designed to assess the subjective and objective effects of uvulopalatopharyngoplasty (UPPP) for treatment of snoring. We mailed a questionnaire dealing with snoring, quality of sleep, and interference with bed-partner's sleep to 100 unselected patients who were referred because of snoring. Replies were received from 69 patients. The answers were analyzed, and the subjective impressions were compared with preoperative and postoperative objective measurements of snoring and apnea. The average (+/- SD) length of follow-up was 45 +/- 20 mo. We found no significant differences in the apnea/hypopnea index, snoring index, and mean and maximal nocturnal sound intensity before and after surgery in this group. However, despite this lack of objective improvement. 78% of patients reported reduction in snoring, and 79% reported improvement in the quality of sleep; 18 of 69 bed partners no longer complained of interference with their sleep compared with only one preoperatively. We conclude that if the purpose of UPPP is to reduce the reported health hazards associated with snoring, then comparison between objective preoperative and postoperative measurements of snoring does not indicate success; if, on the other hand, the purpose of surgery is to alleviate the social hazard, then UPPP partially achieves this goal.
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