Search

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.

In conclusion, CSR that occurs during sleep in patients with severe CHF is eliminated by HT.

This is a retrospective analysis of 73 patients with non-oat cell carcinoma of the lung presenting as a Pancoast tumor. All patients were treated with curative intent between October 1964 and September 1987 (minimum follow-up 2 years). The treatment plan consisted of preoperative radiation therapy (usually 3000 cGy in 2 weeks or 4500 cGy in 5 weeks) in 41 patients and radiation therapy alone (usually 6500–7000 cGy in 6.5–8.0 weeks) in 32 patients. In general, radiation therapy alone was reserved for poor-prognosis patients (extensive disease or medical inoperability). Although 41 patients were initially scheduled to receive preoperative radiation therapy and surgery, the surgery was not performed in 12 cases (29%) because of patient refusal (4 patients), poor response to radiation therapy (4 patients), distant metastasis (2 patients), or debilitation (2 patients). Separate calculations were carried out for the patients who completed the surgery as planned (preoperative radiation therapy and surgery) and the entire group originally scheduled for combined-modality therapy. There was no significant difference in the absolute or cause-specific survival rates between treatment groups, but severe complications were significantly more common in patients receiving combined therapy.

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)

A controversy exists over whether or not preoperative exercise testing can predict postthoracotomy complications. This study was designed to evaluate the usefulness of a presurgical exercise protocol in patients with lung disease, but no evidence of cardiac disease. Seventy patients underwent baseline pulmonary function testing and split function perfusion studies, when indicated, to calculate predicted postoperative pulmonary function. Noninvasive data were incrementally collected from 17 patients by using a treadmill exercise tolerance test that was designed to elicit maximal performance. Inhaled and exhaled gas flow and, volume, the partial pressure of O 2 and CO 2 , maximal O 2 consumption (VO 2 max), and maximal minute ventilation (V E Max) were measured. The breathing and heart rate reserves were calculated by standard formulae in an attempt to separate cardiac from pulmonary exercise limitation. Two patients had postoperative cardiopulmonary complications after thoracotomy and lung resection, and six patients had noncardiopulmonary complications. There was no significant prognostic relationship among VO 2 max, V E max. maximum O 2 pulse, and the incidence of postoperative cardiopulmonary complications. The percentages of predicted V E max and predicted maximum heart rate were related to the occurrence of total complications, but not specifically to cardiopulmonary complications. The results emphasize the difficulty in attempting to exercise thoracotomy candidates with chronic lung disease to maximal performance. Excluding patients from further surgical consideration because of exercise limitation is not feasible based on these data.

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.

Chronic low flow oxygen is useful therapy for patients with chronic obstructive lung disease who are crippled by hypoxemia despite optimal programs of usual respiratory care. Patients should be considered for chronic oxygen therapy who have (a) a resting Pao2 less than 55 mm Hg while breathing room air; or (b) profound tissue hypoxemia measured by mixed venous Pao2 and suggested by symptoms such as cor pulmonale and congestive heart failure; or (c) pulmonary hypertension or polycythemia even though daytime Pao2 is greater than 55 mm Hg. Arterial blood must be obtained to demonstrate hypoxemia and assess the benefits of oxygen therapy. Patients on chronic oxygen must remain under close medical supervision. There are no absolute contraindications to chronic oxygen therapy, other than refusal of the patient to quit smoking. Complications of therapy appear to be negligible. The exciting suggestion of improved prognosis in patients with chronic obstructive lung disease on oxygen therapy and the possibility of delaying the long-term sequelae of chronic respiratory failure bear careful watching in the future.

Using standard sleep techniques, we performed a placebo-controlled and randomized study to assess the effect of alcohol ingestion (2 ml/kg of body weight) on breathing and oxygen saturation during sleep. Twenty asymptomatic men volunteered for the two-night study: 11 were given a placebo on night 1, and alcohol on night 2 (group A); nine were given alcohol on night 1 and a placebo on night 2 (group B). We compared the incidence of sleep events (apnea, hypopnea and arterial oxygen disaturation) during the nights the subjects received alcohol and during the nights they received the placebo. Alcohol was associated with significant increases in the occurrence of the following: the number of sleep events (207 to 383,p less than 0.01), the events of arterial oxygen disaturation (118 to 226, p less than 0.01) and the number of apneic events (20 to 110, p less than 0.01). Alcohol had no significant effects on the number of times hypopnea occurred. Values obtained during sleep on the control night after alcohol ingestion also showed that the episodes of arterial oxygen desaturation remained statistically increased over control values before the ingestion of any alcohol (p = 0.01). These results show that in asymptomatic men alcohol ingestion increases the incidence of arterial oxygen desaturation and disordered breathing during sleep and that the increase in arterial oxygen desaturation persists for an additional night, even when no alcohol is consumed.