Biomedical subjects

H Miljeteig

Publications and source records attributed to H Miljeteig.

At least 19 recordsLinked to original sources

PubMed2000

[Cost effective and quality assured (adeno)tonsillectomy in children].

BACKGROUND: The issues of whether minor surgery should be performed in private or public clinics and/or be funded by the national health service are under continuous debate in Norway. MATERIAL AND METHODS: A prospective study of the benefit of (adeno)tonsillectomies in 120 children is presented. Surgery included in the study was performed on an inpatient as well as an outpatient basis and in public as well as private clinics. RESULTS: There was no difference in patient satisfaction or in the quality of surgery depending on the type of organisation. Relief of symptoms associated with (adeno)tonsillar infections and obstruction following surgery was consistent. Less euresis was found in the study population following surgery. Increased haemoglobin concentration and less protoporfyrin IX in erythrocytes indicate an improved erythropoiesis following (adeno)tonsillectomy. Less manpower was needed to perform (adeno)tonsillectomies in private compared to public clinics. INTERPRETATION: We suggest that the Norwegian national health system opens up for funding surgery of established quality irrespective of whether it is performed in a public or a private clinic.

Adenoidectomy↗

PubMed1999

The sites of obstruction in OSA, identified by continuous measurements of airway pressure and flow during sleep: ambulatory versus in-hospital recordings.

Polysomnography provides information about the severity of obstructive sleep apnoea (OSA), but is less satisfactory in predicting the effect of uvulopalatopharyngoplasty (UVPP). Another possible investigation in patients with suspected OSA is to determine the sites of pharyngeal obstruction or collapse by an overnight recording of airflow and upper airway pressures at several levels during sleep. Before these measurements can be established as a routine investigation, reproducibility studies have to be carried out. In 11 men with suspected OSA, we recorded airway pressure and airflow during sleep for 2 nights, the first in hospital and the second at home (ambulatory). The recording conditions were deliberately different in order to set up a 'worst case' comparison. Transpalatal (upper) or subpalatal (lower) obstructive predominance remained constant in 9 patients despite considerable changes in the absolute number of obstructive events. Only one patient had exclusively upper or lower obstructive events during the initial recording and this suggests that the level diagnosis after an overnight study using pressure and airflow may be more accurately described as percentage upper obstructive events of total. We conclude that the relationship between upper and lower obstructive events is reproducible between ambulatory and hospital recording, but recommend that level diagnosis should be interpreted with caution in patients with low recorded apnoea hypopnoea index (AHI).

Adult↗

PubMed1999

Body mass index less than 28 kg/m2 is a predictor of subjective improvement after laser-assisted uvulopalatoplasty for snoring.

OBJECTIVE/HYPOTHESIS: To investigate whether body mass index (BMI) can be used to predict subjective improvement of snoring after laser-assisted uvulopalatoplasty (LAUP). STUDY DESIGN: One hundred nineteen consecutive adult patients who had LAUP performed for socially disruptive snoring were contacted by mail 3 months after surgery and asked to complete a questionnaire with the following alternatives as to the effect of surgery on their snoring: no improvement (1); some improvement (2); moderate improvement (3); substantial improvement (4) and abolished snoring (5). Patients reporting to categories 3, 4, or 5 were referred to as responders and to categories 1 or 2 as nonresponders. Seventy patients (59%) completed the questionnaire. METHODS: A one-stage LAUP was performed with local anesthesia in an outpatient ear, nose, and throat clinic with a CO2 laser. Patients were divided into two categories with BMI above and below 28 kg/m2 at the time of surgery. RESULTS: BMI correlated significantly with subjective postoperative improvement. (R = 0.29; P < .02; Pearson's correlation test). Odds ratio (OR) for success by BMI less than 28 kg/m2 compared to patients with BMI greater than 28 kg/m2 was 4.8 (95% confidence interval [CI]: 1.48-15.53). CONCLUSIONS: BMI is a simple, yet important predictor of subjective reduction of snoring after LAUP and should be considered before performing such surgery.

Adult↗

PubMed1997

[Snoring].

Explore the source record for details and available documents.

Humans↗

PubMed1997

The relationship between obstructive sleep apnoea and body mass index.

Obese patients have a high prevalence of obstructive sleep apnoea (OSA), but a low response rate and high frequency of relapse after uvulopalatopharyngoplasty (UVPP). In this study we have determined the level of obstruction during sleep in 31 men with OSA, using a catheter with multiple micropressure transducers and a portable digital recorder. The proportion of apnoeic episodes with obstruction at lower levels correlated with increasing body mass index (BMI) (P < 0.05). Thus, with increasing obesity, there seems to be a shift to a lower level of obstruction. All patients with BMI > 30 and apnoea index (AI) > 5 had predominantly lower obstructions (P < 0.05). This may explain why many obese patients fail to respond, or have relapses after UVPP.

Body Mass Index↗

PubMed1995

Pharyngeal airflow during sleep.

This study was conducted to investigate the effects of sleep and nasal resistance on pharyngeal airflow in a group of healthy male adults without complaint of habitual snoring. Twelve subjects aged 21 to 60 years were studied in a sleep laboratory during exclusive nasal breathing. Nasal and pharyngeal airflow variables were measured concomitantly at different stages of sleep. Awake pharyngeal resistance averaged 0.02-0.03 Pa/cm3/s in recumbency. In stage 2 sleep and quiet breathing resistance increased by a factor of 3-4 and by a factor of 7-8 during snoring. Increased nasal loading did not increase pharyngeal resistance further or induce snoring. Mostly, increased pharyngeal resistances were of similar magnitude in both phases of respiration, but in a few instances inspiratory resistance exceeded that in expiration, and in a similar number the reverse was found. Overall, compliance of the pharyngeal airway was not a prominent feature in this group of subjects. The relationship between transpharyngeal pressure and resistance should be studied further in order to simplify future studies of airflow during sleep.

Adult↗

PubMed1995

The airflow resistance profile of healthy nasal cavities.

Distribution of resistance to respiratory airflow in the nasal cavities was determined by digitized pressure/flow measurements of consecutive 2-cm airway segments between nostril and nasopharynx. Healthy adult subjects seated in a head-out body plethysmograph breathed exclusively through a single nasal cavity while transnasal pressure and flow signals were transduced, digitized and processed by a programmed desk-top computer to provide resistance values. Mean total resistances of untreated and decongested single nasal cavities were 0.44 (n = 30; SD +/- 0.25) and 0.26 (n = 15; SD +/- 0.06) Pa/cm3/s, respectively. The proportion of total airway resistance of successive 2-cm segments from nostril to nasopharynx was 56%, 22%, 16%, and 6% in the untreated nose, and 88%, 5%, 2%, and 5% following decongestion. The findings from 45 nasal cavities are consistent with previous pressure/flow measurements from six nasal cavities and support recent acoustic reflection assessments of nasal cross-sectional areas of both untreated and decongested noses.

Adolescent↗

PubMed1995

Nasal resistance in recumbency and sleep.

Nasal resistances to respiratory airflow were measured by computer-assisted rhinomanometry in 21 adult males without major clinical nasal pathology. Measurements were obtained when seated and repeated on assumption of recumbency and during sleep. Resistance in Pa/cm3/s of subjects (n = 21) increased from a mean (+/- SD) of 0.14 +/- 0.07 in seated posture to 0.35 +/- 0.32 in recumbency. In the majority of subjects the increase was modest and was unaffected by sleep. It is suggested that unrecognized mucosal abnormality with resulting impairment of vascular tone or minor structural deviation of the nasal septum could account for the few cases of marked elevation of nasal resistance we observed in recumbency.

Adult↗

PubMed1995

Snoring: a review and a reassessment.

The pathophysiology of snoring is discussed and the etiologic importance of nasal obstruction and compliance of the pharynx with respiratory airflow pressures are questioned. The discrepancy between subjective and objective results of therapy is noted and wider use of objective measurement pre- and post-snoring treatment is advocated.

Airway Resistance↗

PubMed1994

Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea.

This study was designed to assess the subjective and objective effects of uvulopalatopharyngoplasty (UPPP) for treatment of snoring. We mailed a questionnaire dealing with snoring, quality of sleep, and interference with bed-partner's sleep to 100 unselected patients who were referred because of snoring. Replies were received from 69 patients. The answers were analyzed, and the subjective impressions were compared with preoperative and postoperative objective measurements of snoring and apnea. The average (+/- SD) length of follow-up was 45 +/- 20 mo. We found no significant differences in the apnea/hypopnea index, snoring index, and mean and maximal nocturnal sound intensity before and after surgery in this group. However, despite this lack of objective improvement. 78% of patients reported reduction in snoring, and 79% reported improvement in the quality of sleep; 18 of 69 bed partners no longer complained of interference with their sleep compared with only one preoperatively. We conclude that if the purpose of UPPP is to reduce the reported health hazards associated with snoring, then comparison between objective preoperative and postoperative measurements of snoring does not indicate success; if, on the other hand, the purpose of surgery is to alleviate the social hazard, then UPPP partially achieves this goal.

Adolescent↗

PubMed1993

Resistance to respiratory airflow of the extrapulmonary airways.

Resistances to respiratory airflow of nasal, pharyngeal, laryngeal, and tracheobronchial airway segments were determined by computer processing of digitized differential pressure and flow signals in four healthy, awake, male adults seated and breathing spontaneously at rest, exclusively through decongested noses. Resistances of the nasal and pharyngeal segments in Pa/cm3 per second averaged 0.139 (SD +/- 0.044) and 0.081 (SD +/- 0.051), respectively, with no resistive evidence of compliance with airflow pressures. The laryngeal segment exhibited the reciprocal of compliance, expiratory resistances exceeded those of inspiration, averaging 0.125 (SD +/- 0.037) and 0.035 (SD +/- 0.013), respectively (.005 < P < .01). Tracheobronchial resistances during spontaneous resting breathing were too small to record reliably at the calibration used, and values augmented by voluntary hyperventilation averaged only 0.012 (SD +/- 0.004). Laryngeal expiratory resistance approximated one fifth of the sum total of respiratory airflow resistances (including the pulmonary airways) and the authors suggest that, in addition to contributing to expiratory airflow braking, partial laryngeal closure induces orifice flow. This nonlaminar flow regime promotes the mucosal contact and mixing that enables greater than 30% of heat and water to be recovered from expiratory air by the human pharynx and nose.

Adult↗

PubMed1993

Determinants of continuous positive airway pressure level for treatment of obstructive sleep apnea.

The purpose of this study was (1) to examine the factors that account for the variability in continuous positive airway pressure (CPAP) levels required to abolish obstructive sleep apnea (OSA) in patients with this disorder, and (2) to examine the feasibility of predicting the lowest effective pressure (CPAPmin) from simple anthropometric and polysomnographic variables easily available in all patients considered for home CPAP therapy. To accomplish these tasks we studied a group of 208 patients with OSA all of whom were treated with nasal CPAP at home. We first analyzed a model set of 38 patients all of whom had at least two polysomnographic studies (the diagnostic one and a subsequent one to determine CPAPmin for home use), anthropometric measurements (including body mass index, neck circumference, and waist circumference), pulmonary function measurements (lung volumes, airways resistance, and flow-volume curves), pharyngeal and glottic cross-sectional areas at functional residual capacity and residual volume, and nasal airflow resistances. We compared patients requiring CPAP > 10 cm H2O with those who required CPAP < 5 cm H2O. The high CPAP group was characterized by a greater degree of obesity, more severe sleep apnea, and more collapsible pharynx. Multiple linear regression analysis using principal components and Mallows C(P) statistics revealed that the optimal set of predictors for CPAPmin consisted of only three variables: apnea/hypopnea index, body mass index, and neck circumference. This model accounted for 76% of the variability in CPAP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Laryngeal resistance to respiratory airflow in humans.

Although vocal cord adduction has been observed during expiration, measurements of absolute values of resistance changes in man have not been reported in the literature. The authors measured resistance to translaryngeal respiratory airflow in inspiratory and expiratory phases of the respiratory cycle of four healthy, awake men during nasal breathing. It was found that, during quiet breathing through a decongested nose, translaryngeal resistance was 1.245 cm H2O/L per second in expiration and 0.354 cm H2O/L per second in inspiration (.005 < P < or = .01), for a percentage of approximately 25% and 50% of extrathoracic expiratory and inspiratory resistances, respectively. Voluntary hyperventilation decreased expiratory resistance, and a partial nasal obstruction abolished the statistical difference between translaryngeal inspiratory and expiratory resistance. These results are in agreement with previous observations of vocal cord movement and are consistent with an expiratory braking effect on airflow.

Adult↗

PubMed1993

Snoring and nasal resistance during sleep.

Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variables is not clear, mainly because of the lack of studies in which nasal resistance (Rna) and snoring were measured concurrently. The authors studied eight nonapneic snoring men with healthy noses by nocturnal polysomnography that included quantitative assessment of snoring and concomitant nasal resistance. In six of these eight patients nasal resistance increased during sleep, but there was no significant change for the group as a whole between wakefulness (0.209 +/- 0.224 Pa/cm3 per second) and sleep (0.292 +/- 0.203 Pa/cm3 per second). Linear regression analysis showed no significant correlation between sleeping nasal resistance and snoring index (partial R2 = .44, P = .071). We used each subject as his own control and compared the snoring profile at a time during sleep when nasal resistance was at its highest (0.550 +/- 0.375 Pa/cm3 per second) and lowest (0.146 +/- 0.090 Pa/cm3 per second) levels. Despite the significant (P < .01) differences in nasal resistance, they were not reflected in the number of snores or their sound intensity. It is concluded that nasal obstruction during sleep is not correlated significantly to frequency or intensity of snoring during exclusively nasal breathing.

Adult↗

PubMed1992

Nasal airway dilation and obstructed breathing in sleep.

Nasal respiratory airflow resistances of awake snorers averaged 0.188 +/- 0.165 Pa/cm3/s (N = 306) and were not elevated beyond the normal range (less than 0.25 Pa/cm3/s). Resistances were decreased substantially from a mean of 0.164 +/- 0.128 to 0.065 +/- 0.037 Pa/cm3/s (N = 72) by a nasal vestibular dilator (Nozovent). Effects of the dilator on breathing disorders in sleep were determined by polysomnographic recordings that included frequency, duration and intensity of snoring, apneas, hypopneas, and oxygen saturation in 10 heavy snorers while asleep with and without the dilator in situ over periods of several hours. No significant changes were detected in these parameters in any stage of sleep.

Adolescent↗

PubMed1992

The effect of unilateral and bilateral nasal obstruction on snoring and sleep apnea.

The purpose of this study was to compare apnea and snoring in patients with different patterns of nasal resistance: normal, high unilateral, and high bilateral. The authors examined 683 unselected patients referred for evaluation of snoring and possible sleep apnea. All patients had determination of nasal resistance (performed during wakefulness in the seated posture) and nocturnal polysomnography including quantitative measurement of snoring. Analysis of variance showed no significant difference in apnea and snoring indices among the three nasal resistance groups (normal, high unilateral, and high bilateral). Furthermore, there was no significant difference in the frequency of patients with different severity of apnea and snoring among the three groups. It is concluded that 1. unilateral and bilateral elevation of nasal resistance may lead to equally severe snoring or apnea; 2. there is no direct relationship between awake seated nasal resistance measurement and sleep disordered breathing; and 3. measurements of supine nasal resistance during sleep may be required to elucidate the relationship between sleep-disordered breathing and nasal obstruction.

Airway Resistance↗

PubMed1992

Uvulopalatopharyngoglossoplasty (UPPGP) in the treatment of the obstructive sleep apnea syndrome.

Out-patient polysomnography was conducted prior to surgery in 26 male, obstructive sleep apnea patients. Resection of lateral aspects of the tongue base and conservation of the proximal part of the uvula muscle were carried out in addition to conventional palatopharyngoplasty. At a minimum of 6 months after surgery, the patients were given a questionnaire for assessment of treatment. At the same time, polysomnography was repeated for objective evaluation of the results of surgery. More than 90% of the patients were satisfied with the outcome of treatment. The objective results by means of apnea index and oxygen desaturation index matched the patients' personal experiences, which is not usual in this kind of treatment. Sixty-seven percent of the obstructive sleep apnea patients achieved more than a 50% reduction in apnea index and oxygen desaturation index. No more side effects than for similar surgical intervention (PPP) were encountered. Safety and efficiency lead us to recommend this procedure as standard whenever oropharyngeal surgery is indicated.

Follow-Up Studies↗

PubMed1992

Pressure recordings--a method for detecting site of upper airway obstruction in obstructive sleep apnea syndrome.

Polysomnography is the method of choice in diagnosis of obstructive sleep apnea syndrome (OSAS) establishing whether a patient has apneas or not. It does not, however, give any indications of where the obstructions occur. This is reflected in the limited success rate of current surgical procedures used in the treatment of this disorder. We have developed a simple method for simultaneous determination of OSAS and site of obstruction. The method implies continuously recording of pressure at different sites in pharynx. A catheter with five pressure transducers and corresponding markings is put into the pharynx through the nasal cavity and interfaced with a polygraph. Continuous pressure registrations were made in 12 patients. We have found characteristic patterns of pressure-changes which clearly indicate the level of obstruction. This may be of importance in selecting patients for further treatment.

Air Pressure↗