R Re el la at ti io on ns sh hi ip p b be et tw we ee en n b bo od dy y m ma as ss s i in nd de ex x, , a ag ge e a an nd d u up pp pe er r a ai ir rw wa ay y m me ea as su ur re em me en nt ts s i in n s sn no or re er rs s a an nd d s sl le ee ep p a ap pn no oe ea a p pa at ti ie en nt ts s ABSTRACT: Anatomical pharyngeal and craniofacial abnormalities have been reported using upper airway imaging in snorers with or without obstructive sleep apnoea (OSA). However, the influences of the age and weight of the patient on these abnormalities remain to be established. The aim of this study was, therefore, to evaluate in a large population of snorers with or without OSA, the relationship between body mass index (BMI), age and upper airway morphology. One hundred and forty patients were referred for assessment of a possible sleeprelated breathing disorder and had complete polysomnography, cephalometry and upper airway computed tomography.For the whole population, OSA patients had more upper airway abnormalities than snorers. When subdivided for BMI and age, however, only lean or younger OSA patients were significantly different from snorers as regards their upper airway anatomy. The shape of the oropharynx and hypopharynx changed significantly with BMI both in OSA patients and snorers, being more spherical in the highest BMI group due mainly to a decrease in the transverse axis. On the other hand, older patients (>63 yrs), whether snorers or apnoeics, had larger upper airways at all pharyngeal levels than the youngest group of patients (<52 yrs). For the total group of patients, upper airway variables explained 26% of the variance in apnoea/hypopnoea index (AHI), whereas in lean (BMI <27 kg·m -2 ) or youngest (age <52 yrs) subjects upper airway variables explained, respectively 69 and 55% of the variance in AHI.In conclusion, in lean or young subjects, upper airway abnormalities explain a major part of the variance in apnoea/hypopnoea index and are likely to play an important physiopathogenic role. This study also suggests that the shape of the pharyngeal lumen in awake subjects is more dependent on body mass index than on the presence of obstructive sleep apnoea. Further investigation looking at upper airway imaging for surgical selection in obstructive sleep apnoea should focus on lean and young patients. Eur Respir J., 1996Respir J., , 9, 1801Respir J., -1809

Similar to earlier findings in animals, nondependent opiate addicts, and postoperative patients, morphine was found to reduce duration of slow-wave sleep. Unlike previous reports, however, its acute administration produced a moderate reduction in rapid eye movement sleep and did not increase correlates of arousal (ie, awakenings, electroencephalogram arousals, wake after sleep onset). Future studies should correlate these findings in patients with pain and evaluate whether optimal pain relief with opioid therapy can improve sleep disturbances in pain patients.

No abstract

The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.

No abstract

The literature on sensory perception during sleep suggests that light sleep (Stage 2) is more responsive to external sensory stimulation (e.g. sound, electrical shock) than deep sleep (Stages 3 and 4) and REM sleep. The main objective of this study was to characterize the specificity of nociceptive stimulation to trigger sleep arousal-awakening over all sleep stages. Thirteen healthy adults (e.g. without pain or sleep problems; six female and seven male of a mean age of 24.2+/-1.3 years) were included in the study. The responses to noxious intramuscular 5% hypertonic infusion were compared to innocuous vibrotactile and to respective control stimulations: isotonic infusion and auditory stimulations. These stimulations were applied during wakefulness and were repeated during sleep. Polygraphic signals (e.g. brain activity, heart rate) signals were recorded to score sleep arousal over all sleep stages. A subjective assessment of sleep quality was made on next morning. No overnight sensitization or habituation occurred with any of the experimental stimulations. The vibratory-auditory stimulations and the noxious hypertonic infusions triggered significantly (P < 0.05) more awakenings in sleep Stage 2 and in REM than their respective control stimulations. In sleep Stage 2, both vibratory + auditory stimulations and the noxious hypertonic infusions has the same awakening response frequency (approximately 30%), however, with the noxious infusions the response frequency were similar in sleep Stages 3 and 4 (P < 0.05) and in REM (trend). Compared to the baseline night, sleep quality was lower following the night with noxious stimulation (90.1+/-2.7 and 73.3+/-7.4 mm, respectively; P < 0.03. These data suggest that pain during sleep could trigger a sleep awaking response over all sleep stages and not only in light sleep.

Cephalometric radiography and CT can demonstrate hooking of the soft palate in awake patients. This finding indicates a high risk for OSAS.

In a sleep clinic population, the French version of the ESS performed similarly to the English version. However, the systematic underscoring during physician administration may be important to consider in the research setting if questionnaire administration methods are not consistent.