Continuous positive airway pressure (CPAP) therapy is widely prescribed for patients with the sleep apnea/hypopnea syndrome (SAHS), but the use of CPAP for such patients is disappointingly low. We postulated that providing intensive educational programs and nursing support to SAHS patients might improve CPAP use and outcomes. We also examined the hypothesis that CPAP use would be greater among patients who had initiated their own referral than among those asked to seek help by a partner. We randomized 80 consecutive, new patients with SAHS to receive either usual support or additional nursing input including CPAP education at home and involving their partners, a 3-night trial of CPAP in our institution's sleep center, and additional home visits once they had begun CPAP. The primary outcome variable was objective CPAP use; symptoms, mood, and cognitive function were also assessed after 6 mo. CPAP use over 6 mo was greater (p = 0.003) among patients receiving intensive than among those receiving standard support (5.4 +/- 0.3 versus 3.9 +/- 0. 4 h/night [mean +/- SEM]), with greater improvements (p < 0.05) in SAHS symptoms, mood, and reaction time in the intensively supported group. CPAP use was greater (p = 0.002) among patients who initiated their own referrals. CPAP use and outcomes of therapy can be improved by provision of a nurse-led intensive CPAP education and support program. CPAP use is lower among patients whose partners ask them to seek treatment.

Waiting times for hospital-based monitoring of the obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are rising. This study tested whether Embletta, a new portable device, may accurately diagnose OSAHS at home.A synchronous comparison to polysomnography was performed in 40 patients and a comparison of home Embletta studies with in-laboratory polysomnography was performed in 61 patients.In the synchronous study, the mean difference (polysomnography–Embletta) in apnoeas+hypopnoeas (A+H)·h−1in bed was 2·h−1. In comparison to the apnoea/hypopnoea index (AHI)·h−1slept, the Embletta (A+H)·h−1in bed differed by 8·h−1. These data were used to construct diagnostic categories in symptomatic patients from their Embletta results: “OSAHS” (≥20 (A+H)·h−1in bed), “possible OSAHS” (10–20 (A+H)·h−1in bed) or “not OSAHS” (<10 (A+H)·h−1in bed). In the home study, the mean difference in (A+H)·h−1in bed was 3·h−1. In comparison to the polysomnographic AHI·h−1slept, the Embletta (A+H)·h−1in bed differed by 6±14·h−1. Using the above classification, all nine patients categorised as not OSAHS had AHI <15·h−1slept on polysomnography and all 23 with OSAHS on Embletta had an AHI ≥15 on polysomnography, but 18 patients fell into the possible OSAHS category potentially requiring further investigation and 11 home studies failed.Most patients were satisfactorily classified by home Embletta studies but 29 out of 61 required further investigation. The study suggested a 42% saving in diagnostic costs over polysomnography if this approach were adopted.

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Sleep-disordered breathing and snoring are common in pregnancy. The aim of this study was to determine whether pregnancy was associated with upper airway narrowing.One-hundred females in the third trimester of pregnancy were recruited and 50 agreed to be restudied 3 months after delivery. One-hundred nonpregnant females were also recruited. Upper airway dimensions were measured using acoustic reflection.Snoring was less common in nonpregnant (17%) than pregnant females (41%; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.65-6.74) and returned to nonpregnant levels after delivery (18%; OR 0.15; 95% CI 0.06-0.40). Pregnant females had significantly smaller upper airways than nonpregnant females at the oropharyngeal junction when seated (mean difference 0.12; 95% CI 0.008-0.25), and smaller mean pharyngeal areas in the seated (mean difference 0.14; 95% CI 0.001-0.28), supine (mean difference 0.11; 95% CI 0.01-0.22) and lateral postures (mean difference 0.13; 95% CI 0.02-0.24) compared with the nonpregnant females. Pregnant females had smaller mean pharyngeal areas compared with post-partum in the seated (mean difference 0.18; 95% CI 0.02-0.32), supine (mean difference 0.20; 95% CI 0.06-0.35) and lateral postures (mean difference 0.26; 95% CI 0.12-0.39).In conclusion, this study confirmed increased snoring and showed narrower upper airways during the third trimester of pregnancy.

Snoring is common in pregnancy, and snoring pregnant women have increased rates of pre-eclampsia. Patients with pre-eclampsia show upper airway narrowing during sleep. The present study aimed to compare upper airway dimensions in pregnant and nonpregnant women and in patients with pre-eclampsia. A total of 50 women in the third trimester of pregnancy and 37 women with pre-eclampsia were recruited consecutively from the antenatal service and matched with 50 nonpregnant women. Upper airway dimensions were measured using acoustic reflection. Comparisons were made by analysis of variance and Student-Newman-Keuls tests. Snoring was reported by 14% of nonpregnant women, 28% of pregnant women, and 75% of pre-eclamptic women (p < 0.001). When seated, pregnant women had wider upper airways than nonpregnant women (p < 0.02), but there was no difference when supine. Oropharyngeal junction area in the seated position was less (p < 0.01) in the women with pre-eclampsia (mean +/- SD: 0.9 +/- 0.1 cm2) than either nonpregnant (1.1 +/- 0.1 cm2) or pregnant women (1.3 +/- 0.1 cm2). Supine oropharyngeal junction area was less in the women with pre-eclampsia than in the nonpregnant women (0.8 +/- 0.1 versus 1.0 +/- 0.1 cm2; p = 0.01) but similar in women with pre-eclampsia and pregnant women (0.9 +/- 0.1 cm2; p > 0.3). The study showed that women with pre-eclampsia have upper airway narrowing in both upright and supine postures. These changes could contribute to the upper airway resistance episodes during sleep in patients with pre-eclampsia, which may further increase their blood pressure.