Although nasal continuous positive airway pressure (nCPAP) treatment is the most efficient therapy for obstructive sleep apnea (OSA), compliance with therapy is poor because of several side effects. Among these adverse effects some are related to the reactions of the nose to nCPAP which are briefly described. In a long-term survey of 109 OSA patients, 80.6% continued nCPAP for at least 3 years until the last follow-up. Follow-up ranged between 0.8 and 109 months with a mean time of 43 (SD +/- 24.7) months. Among all patients treated with nCPAP, only 46.6% met our criteria for long-term compliance, defined as a mean use of the CPAP machine for at least 5 hours per night. Within the objective measures such as age, body mass index, neck circumference, nasal airflow, apnea-hypopnea index, minimal oxygen saturation, and level of nCPAP pressure, no predictive factor for daily use of nCPAP could be found. However, pretherapeutic daytime somnolence (measured by visual analogue scale and Epworth Sleepiness Scale) and its improvement obtained from the therapy showed a significant effect on the daily use of the CPAP machine.
Despite there being no difference between responders and non-responders with respect to the number and severity of complications, it should not be presumed that these side effects do not influence long-term patient compliance with nCPAP therapy. Patients who suffer from symptoms of OSAS tend to accept these adverse effects, while those who do not feel limited by their disease are less persistent in their use of this treatment modality. Identification and elimination of the problems associated with the use of nCPAP equipment may increase longterm patient compliance. Close monitoring in the outpatient department combined with intermittent inpatient assessment in the sleep laboratory will also help to improve acceptance of nCPAP therapy.
Although nCPAP is the safest treatment for OSAS, there is still a large group of patients with moderate to severe OSAS who are not efficiently treated with nCPAP because of the low long-term acceptability of this therapy. With respect to this group of patients, surgical approaches have to be considered as an alternative therapy.
Vincent's angina (Plaut-Vincent) is the most prominent disease caused by coinciding infections from fusibacteria and spirochaeta both belonging to obligate anaerobic bacteria. A possible symbiotic infection of both anaerobics may become manifest on the mucous membranes of the oral cavity and the oropharynx beside the tonsillas. The clinical outcome may be different and pose difficulties in the differential diagnosis. We report the case of a 29 year old female patient with necrotizing ulcera of the soft palate suspicious for stomatitis ulceromembranacea. In case necrotizing inflammations of the oral cavity area were to be found infections due to anaerobic bacteria should be considered mostly occurring as mixed infections. The correct identification by cultivation turns out to be difficult in that it requires special conditions. Furthermore, reliable detection of these bacteria necessitates careful collection and transport of patients specimens. In case of Fusospirochaetosis (Fusotreponematose) a specimen should be prepared for microscopic examination beside setting up a special culture. This is because the staining is the most suitable procedure for bacteril identification to support the clinical diagnosis of stomatitis ulceromembranacea.
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