New directions for pulse oximetry in sleep disorders

Obstructive Sleep Apnea-Hypopnea Syndrome

OSAHS should be an expected condition in many patients encountered by primary care providers. The diagnosis may arise because of patient daytime dysfunction, partner prompting, or in the course of managing comorbidities adversely influenced by the hemodynamic, neural, humoral,and inflammatory consequences of repetitive desaturations and arousals.OSAHS should be suspected in patients who exhibit habitually loud snoring, witnessed apneas/choking/gasping during sleep, hypertension, neck circumferences of 17 inches or greater, obesity, and laterally narrowed oropharynxes. Diagnosis is established by polysomnography. CPAP is the treatment of choice for most patients. Education, follow-up, and heated humidification may help bolster compliance. Lifestyle modifications, oral appliances, and upper surgeries are additional treatment options.

Obstructive sleep apnea-hypopnea syndrome

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repetitive episodes of airflow reduction (hypopnea) or cessation (apnea) due to upper airway collapse during sleep. Increasing recognition and a greater understanding of the scope of this condition have substantially affected the practices of many clinicians. This review provides practical information for physicians assessing patients with OSAHS. It discusses complications, clinical recognition, the polysomnographic report, and treatment of OSAHS, including strategies for troubleshooting problems associated with continuous positive airway pressure therapy.

A new technique for laser-assisted uvulopalatoplasty: decision-tree analysis and results

OBJECTIVE

Report a new technique of laser-assisted uvulopalatoplasty (LAUP) for snoring performed as a one-stage procedure.

STUDY DESIGN

A decision-tree was used in a prospective study of 89 patients from April 1994 to May 1997. It included a fiberscopy and Muller's maneuver, rhinomanometry, pH monitoring, computed tomography scan to measure the pharyngeal lumen, pulse oximetry, and polysomnography in case of sleep apnea syndrome was suspected.

METHODS

The authors performed their LAUP technique on 43 patients (48.5%) whose snoring was mainly caused by the velum. This technique consists of scarifying the velum by vaporizing the mucosa and the submucosa along a rectangle extending from the palatal dimple to the uvula and having a width of 1.5 to 2 cm. Vaporization of the palatal arches follows without exceeding the junction of the anterior and posterior pillars in height. The uvula is cut if necessary, preserving a length of at least 0.5 cm. The other patients underwent different procedures according to the cause of snoring.

RESULTS

There was no significant difference between LAUP and uvulopalatoplasty (UPPP) regarding pain. No permanent phonatory disorders and no regurgitation occurred. Satisfaction evaluated on a scale ranging from 0 to 10 was equivalent for the two techniques: mean value = 7.68 (+/-2.18) for LAUP and 8.60 (+/-2.27) for UPPP. The mean follow-up was 17 months (range, 1-37 mo). Satisfaction was also identical for all techniques.

CONCLUSION

Our LAUP technique combined with other procedures according to a decision-tree is efficient and safe.