The first study included all patients who presented to the ENT and thoracic medicine departments with severe and persistent dysphonia while receiving inhaled steroids for asthma. A careful history of dysphonia was recorded, with particular reference to the onset and its relation to the start of treatment with inhaled steroids. The type and total daily dose of inhaled and oral treatment were noted and the patient's inhaler technique was scrutinised and graded " efficient" or " inefficient." "Efficiency" was recorded if the following criteria were fulfilled: (1) mixture of the aerosol contents by shaking; (2) depression of the actuator shortly after the start of a deep inspiration, followed by (3) breath holding for at least four seconds.In each patient an independent assessment of dysphonia was made by two speech therapists after an interview and analysis of the patient's voice recordings. Specific inquiry was made about smoking, shouting, coughing, loud voice, noise during work, family deafness, and excessive throat clearing.The patient was considered to have vocal abuse if three or more of these factors were present. The same criteria for vocal abuse were applied to a 813 on 7 April 2019 by guest. Protected by copyright.

Health utilities in evaluating intervention in the sleep apnoea/hypopnoea syndrome. I. Chakravorty, R.M. Cayton, A. Szczepura. #ERS Journals Ltd 2002. ABSTRACT: Formulating a rational health policy necessitates the ability to compare between different healthcare interventions and disease scenarios. Continuous positive airway pressure (CPAP) therapy with a conservative lifestyle strategy in sleep apnoea/ hypopnoea syndrome (SAHS) was evaluated using health utility and quality-adjusted life years (QALYs) as outcome measures.A total 71 SAHS (apnoea/hypopnoea index o15 h -1 ) patients completed a randomised, parallel group study over 3 months using utilities derived by the standard gamble approach (Usg) and European quality of life questionnaire (Euroqol) (Ueq).The severely impaired health status at baseline improved by 23% (Usg 0.32 to 0.55) adding 8 QALYs in the CPAP group, compared to a 4% improvement with 4.7 QALYs added in the lifestyle group (Usg 0.31 to 0.35). The Ueq showed a marginal change with CPAP (0.73 to 0.77) but did not demonstrate any improvement with lifestyle intervention.The health status impairment in sleep apnoea/hypopnoea syndrome patients is markedly improved by continuous positive airway pressure compared to a modest improvement with conservative lifestyle strategies using the standard gamble utility, which may be incorporated in effectiveness and economic analyses. The European quality of life questionnaire did not reflect a similar degree of impact and is probably not useful in this population.

Background-The British Thoracic Society report on the diagnosis and treatment of the sleep apnoea/hypopnoea syndrome (SAHS) suggests that, ifthe pulse oximetry baseline oxygen saturation is above 90%,

The sleep apnoea/hypopnoea syndrome (SAHS) elicits a unique heart rate rhythm that may provide the basis for an effective screening tool. The study uses the receiver operator characteristic (ROC) to assess the diagnostic potential of spectral analysis of heart rate variability (HRV) using two methods, the discrete Fourier transform (DFT) and the discrete harmonic wavelet transform (DHWT). These two methods are compared over different sleep stages and spectral frequency bands. The HRV results are subsequently compared with those of the current screening method of oximetry. For both the DFT and the DHWT, the most diagnostically accurate frequency range for HRV spectral power calculations is found to be 0.019-0.036 Hz (denoted by AB2). Using AB2, 15 min sections of non-REM sleep data in 40 subjects produce ROC areas, for the DFT, DHWT and oximetry, of 0.94, 0.97 and 0.67, respectively. In REM sleep, ROC areas are 0.78, 0.79 and 0.71, respectively. In non-REM sleep, spectral analysis of HRV appears to be a significantly better indicator of the SAHS than the current screening method of oximetry, and, in REM sleep, it is comparable with oximetry. The advantage of the DHWT over the DFT is that it produces a greater time resolution and is computationally more efficient. The DHWT does not require the precondition of stationarity or interpolation of raw HRV data.

The modest daytime hypertension and sympathetic upregulation associated with the sleep apnoea/hypopnoea syndrome (SAHS), does not explain the relatively large increased risk of cardiac morbidity and mortality in the SAHS patients population. Therefore, efferent vagal and sympathetic activity was evaluated during wakefulness in SAHS subjects and matched healthy controls, in order to determine if vagal downregulation may play a role in the aetiology of cardiac disease in the SAHS.The awake autonomic nervous system function of 15 male subjects, with mild-tomoderate SAHS was compared to that of 14 healthy controls matched for age, body mass index, gender and blood pressure. All subjects were free from comorbidity. Vagal activity was estimated from measurements of heart rate variability high frequency power (HF) and sympathetic activity was measured from urine catecholamine excretion.The %HF power was significantly (pv0.03) reduced in SAHS patients (10¡1.6 (mean¡SEM)) as compared to controls (17¡3). In addition, HF power correlated with the apnoea/hypopnoea index in the SAHS subjects (R~-0.592, p~0.02). There was no statistically significant difference in the daytime excretion of nonadrenaline between control (242¡30 nmol?collection -1 ) and SAHS (316¡46 nmol?collection -1 ) subjects (p~0.38).In these sleep apnoea/hypopnoea syndrome patients there was limited evidence of increased waking levels of urine catecholamines. The principal component altering waking autonomic nervous system function, in the sleep apnoea/hypopnoea syndrome subjects, was a reduced daytime efferent vagal tone.