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Objective We sought to find a combination of noninvasive treatments for snoring by adding weight loss to previously studied treatments, including the combination of sleeping on one's side and using a decongestant nasal spray. Study population Twenty asymptomatic men who snore heavily were studied previously on a control night and on a night when they slept on their side and used a nasal spray. With these two treatments, minor improvements in apnea/hypopnea index (AHI) were seen, but no improvement occurred in snoring frequency. Nineteen of these subjects subsequently completed a 6-month weight loss program, and 12 lost weight. These 19 subjects comprise the study population of this report. Study design At the conclusion of the weight loss program, a repeated sleep study was done from which the effect of adding weight loss to the two previously studied treatments could be assessed. Results Those 12 subjects who lost any amount of weight showed a very mild reduction in snores per hour from 328 using two modalities of treatment to 232 per hour with the addition of weight loss (p=0.15). The nine subjects who lost ≥3 kg reduced the number of snores per hour from 320 to 176 (p=0.0496). Three subjects losing an average of only 7.6 kg showed virtual elimination of snoring after weight loss. Subjects who gained weight had no improvement in snoring. Weight loss added to the other two modalities of treatment had no effect on the AHI. Conclusion In most cases, the combination of weight loss, sleeping on one's side, and the administration of a nasal decongestant significantly reduces the frequency of snoring in asymptomatic men who snore heavily. The major effect appears to be related to weight loss.

Study Objective to determine if asymptomatic snorers have smaller pharyngeal volumes than age- and height-matched nonsnorers. Design we recruited asymptomatic heavy snorers and nonsnorers for a study. Each snorer was matched by age (±3 years) and height (±2 inches) with a nonsnorer. The nonsnorers were required to be near ideal body weight. All volunteers underwent overnight polysomnography, pulmonary function testing, and magnetic resonance imaging of the pharynx while awake. The volume of the pharynx was determined by a computer with data input from a digitizing instrument. Setting Veterans Administration Hospital and University of Florida Teaching Hospital Participants Nine volunteers were recruited for both the snorer and nonsnorer groups. Each participant was paid $50. There were no interventions. Measurements and results There were no differences in sleep variables between the two groups. There was also no significant difference between pharyngeal volumes for the two groups. Conclusions The volume of the pharynx in asymptomatic snorers is similar to the volume in age- and height-matched nonsnorers. (Chest 1991; 99:49–53)

We evaluated the accuracy of a new device for continuous noninvasive measurement of cutaneous Pco 2 . The Hewlett-Packard capnometer (model 47210/HA) works by means of an infrared transducer applied to the forearm over an area of skin that has been stripped of the stratum corneum. Capnometer transcutaneous carbon dioxide pressure (CPco 2 ) was compared with arterial carbon dioxide pressure (PaCO 2 ) during 60 simultaneously obtained measurements in 13 hemodynamically stable patients. Each patient was studied for 1½ to 5 hours, and a wide range of PaCO 2 values (21 to 82 mm Hg) was represented. The data show a clinically significant relationship whereby PaCO 2 = CPco 2 – 4.13, with a SE of ± 2.19 mm Hg. Clinical usefulness of noninvasive cutaneous CO 2 monitoring can be foreseen in patients whose ventilatory support is being tapered, in those with respiratory depression caused by various neuromuscular disorders, and in patients with chronic obstructive pulmonary disease and acute respiratory failure. Our results indicate that continuous transcutaneous CPco 2 measurements are safe and accurate and strongly suggest that they can be of clinical usefulness in a select group of hemodynamically stable patients.

Twelve patients with hypoxemia associated with severe chronic obstructive pulmonary disease were treated with continuous portable oxygen therapy and have been followed up for a mean period of 25.2 months at sea level. Pulmonary function testing has revealed no further significant deterioration at long-term follow-up (17 months). After oxygen therapy was initiated, arterial carbon dioxide tension increased slightly, but decreased to pretreatment levels when patients were allowed to breathe room air. The electrocardiogram, which was unchanged at one month, has shown some reversal of cor pulmonale in five patients. Six patients have died, yielding a 56 percent survival rate at two-and-one-half years by the life table analysis. Five patients were autopsied, with possible oxygen toxicity being present in only one. The quality of life in our patients was improved and was especially represented by a reduction in hospital admissions for respiratory illness. We believe that continuous oxygen therapy is beneficial and worthwhile economically in certain patients.

Men who snore heavily have an increased incidence of hypertension, angina, stroke, and neuropsychologic dysfunction, which may be due to nocturnal oxygen desaturation. Nocturnal oxygen therapy might be beneficial to such individuals by improving oxygenation and relieving tissue hypoxia. Twenty-eight asymptomatic heavy snoring men were recruited for polysomnographic monitoring during sleep. During the first half-night, air was breathed through a nasal cannula, and during the latter half-night, 2 L/min oxygen was administered. Breathing air, 20 subjects demonstrated sleep apneas, hypopneas and nocturnal oxygen desaturation. Eighteen subjects had more than ten apneas plus hypopneas per hour. Thirteen subjects reached low oxygen saturation below 80 percent and eight below 70 percent. Only 13 of the 20 subjects showed improvement with oxygen therapy. Apneas alone were not decreased in frequency and were lengthened with oxygen therapy. Episodes of oxygen desaturation were improved by oxygen therapy and consequently, rates of hypopnea were decreased. Severe sleep apnea, hypopnea and oxygen desaturation are common in asymptomatic male snorers, and oxygen therapy is not always beneficial.