This study describes a simple method, based on a movable catheter technique, for use during routine polysomnography to identify the site of obstruction, and this has been applied to 51 patients with suspected sleep apnea. The obstruction was found to be retropalatal in 30, retrolingual in 7, and could not be determined in 14 patients (12 had no sleep apnea, 1 did not sleep, and 1 had central sleep apnea). Twelve of these patients had uvulopalatopharyngoplasty with preoperative and postoperative polysomnograms to determine the site of obstruction. The preoperative obstruction was retropalatal in nine and retrolingual in three. Postoperatively, four patients (one with retrolingual obstruction and three with retropalatal obstruction) no longer had sleep apnea. In the remaining eight patients, the site of obstruction was unchanged from the preoperative one. Several conclusions result: 1. the movable catheter technique offers a simple way to determine the site of obstruction in patients with significant obstructive sleep apnea, 2. most such patients obstruct in the retropalatal region, and 3. preoperative localization of the site of obstruction to the retropalatal region does not seem to improve the surgical outcome of uvulopalatopharyngoplasty.
Nasal respiratory airflow resistances of awake snorers averaged 0.188 +/- 0.165 Pa/cm3/s (N = 306) and were not elevated beyond the normal range (less than 0.25 Pa/cm3/s). Resistances were decreased substantially from a mean of 0.164 +/- 0.128 to 0.065 +/- 0.037 Pa/cm3/s (N = 72) by a nasal vestibular dilator (Nozovent). Effects of the dilator on breathing disorders in sleep were determined by polysomnographic recordings that included frequency, duration and intensity of snoring, apneas, hypopneas, and oxygen saturation in 10 heavy snorers while asleep with and without the dilator in situ over periods of several hours. No significant changes were detected in these parameters in any stage of sleep.
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