Sleep Apnea Syndromes: Pirsig W

Verse T, de la Chaux R, Dreher A, Fischer Y, Grundmann T, Hecksteden K, Hörmann K, Hohenhorst W, Ilgen F, Kühnel T, Mahl N, Maurer JT, Pirsig W, Roth B, Siegert R, Stuck BA, Anonymous00280. · Klinik für HNO-Heilkunde, Asklepios Klinik Harburg, Hamburg. · Laryngorhinootologie. · Pubmed #17464894 No free full text.

This publication has no abstract.

Pirsig W. · No affiliation provided · Sleep Breath. · Pubmed #12861484 No free full text.

Abstract: The influence of nasal obstruction on the pathogenesis of sleep-disordered breathing (SDB) has not yet been clearly defined. Similarly, a lack of data about the long-term effect of nasal surgery on snoring and obstructive sleep apnea keeps discussion of this topic controversial. This special issue of Sleep and Breathing presents four review articles that try to elucidate the complex interrelationship between the nose and SDB. An outstanding review article opens our eyes to the fascinating palette of the activities of nitric oxide, focusing on its inseparable connection to obstructive sleep apnea. Another summarizes data on the role of the nose in the pathophysiology of SDB and the slow progress concerning rhinologic treatments for SDB. The part of nose in the diagnostics of SDB is treated in a third article that also focuses on acoustic reflectometry as the newest technical development in the diagnostics of SDB. The last article elucidates the effect of nasal continuous positive airway pressure on the nasal passages including the authors' own data on the relatively poor long-term compliance of nasal continuous positive airway pressure.

Pirsig W. · Universitäts-HNO-Klinik, Prittwitzstrasse 43, 89075 Ulm. · HNO. · Pubmed #11486582 No free full text.

This publication has no abstract.

Pirsig W. · Sektion Rhinologie und Rhonchopathien, Universitäts-HNO-Klinik Ulm. · HNO. · Pubmed #10407724 No free full text.

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Verse T, Pirsig W, Stuck BA, Hörmann K, Maurer JT. · Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany. · Am J Respir Med. · Pubmed #14720014 No free full text.

Abstract: Modern sleep medicine has been in existence for only 20 years and therefore has to be regarded as a comparatively recent field of specialization. For this reason it is not surprising that there are numerous new trends and developments concerning the treatment of sleep-related breathing disorders. This review focuses on developments in the treatment of obstructive sleep apnea (OSA) over the last 5 years.The review is based on a Medline bibliographic search using the key words 'treatment', 'obstructive sleep apnea' and 'sleep-related breathing disorders' and covers papers published since 1997, including references in these articles. In respect to conservative treatments the following important developments were found. Oral devices were shown to be effective in about 50-70% of patients with OSA, but at this stage it is not possible to predict in which patients successful treatment can be expected. As subjective compliance averages only about 50%, thermoplastic devices used as trial devices provide a reasonable alternative to reduce costs. Automatic continuous positive airway pressure (CPAP) units have been shown to cut costs when used for pressure titration in severe sleep apneics during the day or when used in so-called split-night procedures in appropriate cases. Nasal CPAP has proven to be effective in children, showing higher compliance rates than in adults. The development of mouth-pieces provides the possibility of using CPAP orally, e.g. after nasal surgery. Electrical stimulation of the tongue muscles shows promising preliminary results. Nevertheless, further research in this field is necessary.In the field of surgery, the most valuable development has been tissue reduction using radiofrequency energy, which has been shown to be effective and minimally invasive. Other fundamentally new surgical techniques have not been attempted within the last 5 years; instead, development in this area appears to be defined by a combination of previously known methods (so-called multilevel surgery) and optimized methods of patient selection. Such combined surgical procedures has achieved success rates of about 70%.Taking all these developments into account, CPAP therapy remains the gold standard for treatment of patients with OSA; yet the low long-term compliance rates of 60-70% have to be regarded as a major challenge warranting further effort.

Verse T, Pirsig W. · University ENT Clinic Mannheim, Mannheim, Germany. · Sleep Breath. · Pubmed #12861486 No free full text.

Abstract: OBJECTIVE: The role of the nose and its importance in the development and severity of sleep-disordered breathing (SDB) is still a matter of discussion. In the first part of this study, often-controversial data and theories about the nose are reviewed concerning its influence on the pathophysiology of SDB and to interpret certain clinical findings connected with impaired nasal breathing. In the second part, the effectiveness of some nonsurgical and surgical therapies is evaluated. METHOD: A worldwide literature research (Medline) was the basis for this review. RESULTS: The study of the literature on nasal resistance and clinical findings about the effects of incomplete or complete nasal blockage, particularly in comparison of healthy persons and persons with SDB, allows the assumption of the existence of two different groups of responders: a larger group where the importance of the nose for SDB is negligible and a smaller group where the influence of the nose on SDB is crucial. The same seems to hold true for the responses to nonsurgical and surgical treatments with only a few surgical results available in the literature. While the success rate of nasal surgery for patients with obstructive sleep apnea, for instance, seems to be less than 20%, the normalization of nasal resistance often leads to a positive impact on the well-being and the sleep quality of these patients. However, because criteria to identify responders are lacking, the prediction of success of any treatment for the individual with SDB is not possible.

Verse T, Pirsig W. · Universitäts-HNO-Klinik Ulm, Germany. · Eur Arch Otorhinolaryngol. · Pubmed #11271432 No free full text.

Abstract: This review of the literature summarizes new trends in the diagnosis and treatment of obstructive sleep apnea (OSA) over the last 3 years. A literature search in Medline on 5 March 2000 using the keywords "OSA" and "OSAS" identified 123 papers. Another 86 articles were added from the references of the first 123 papers. New trends were observed concerning measurements of quality of life. There are new developments regarding conservative treatment, for example, nasal continuous positive airway pressure (nCPAP) therapy and oral devices. With regard to surgical treatment of OSA new surgical procedures, the radiofrequency technique, and the concept of multilevel surgery are discussed. After more than 25 years of interdisciplinary sleep medicine there still are some new developments of interest for ears, nose, and throat surgeons, which indicate the need for the involvement of otorhinolaryngologists in modern sleep medicine.

Verse T, Pirsig W. · Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Ulm. · HNO. · Pubmed #11219413 No free full text.

Abstract: Various diagnostic procedures are available to diagnose sleep-related breathing disorders.The present review examines the amount of diagnostics necessary for daily routine. Concerning taking patients' history, the medical examination and nasal parameters, no new recommendations derive from this review. On the other hand,the detection of the site of pharyngeal obstruction seems to have become less important than it was a couple of years ago.Today, the upper airway is considered to be a complex, functional unit.The classification of the obstruction site into retropalatal and retrolingual seems to be oversimplified. A fully attended, complete polysomnography in the sleep laboratory no longer seems to be necessary in every case of suspected sleep-related breathing disorders. Under certain conditions, ambulatory recording units provide cost-effective alternatives.

Pirsig W, Verse T. · Universitäts-HNO-Klinik Ulm, Sektion Rhinologie und Rhonchopathien, Germany. · Eur Arch Otorhinolaryngol. · Pubmed #11195039 No free full text.

Abstract: No recent update is available on long-term results of the various types of treatment of obstructive sleep apnea (OSA) which can help the physician in evaluating the individually tailored treatment for patients with OSA in the long term. We arbitrarily defined "long-term" results as those after at least 3 years and reviewed the literature from the past 25 years for reports on conservative, apparative, and surgical therapy of OSA in children and adults. Another inclusion criterion was that the diagnosis was also confirmed by polysomnography before treatment and at follow-up. Only relatively few long-term studies meeting the criteria of 'evidence based medicine' were found, comparing the findings of these was difficult or impossible due to varying criteria for success. Long-term data were available about the effect of weight reduction, nasal ventilation therapy, oral devices, tonsillectomy, uvulopalatopharyngoplasty, maxillomandibular advancement osteotomies, and tracheotomy. After approx. 25 years many treatment modalities in sleep medicine are still experimental concerning the long-term use for the individual. In particular, randomized controlled trials in surgery are lacking. Late results show that at least 50% of patients with OSA can be treated effectively by one or a combination of treatments. Nasal continuous positive airway pressure, tracheotomy, maxillomandibular advancement osteotomy, and tonsillectomy are the most effective treatments of OSA.

Fischer Y, Neagos A, Pirsig W. · Universitätsklinik und Hochschulambulanz für Hals-Nasen-Ohren-Heilkunde, Ulm. · HNO. · Pubmed #16211411 No free full text.

Abstract: Sleep-related breathing disorders (SBAS) affect approximately 8% of the population of middle aged adults. At the age of 20 years, approximately 10% of the population snore, while at the age of 60 about 50% of men snore. Some 9% of middle aged women and 24% of middle aged men have an apnea hypopnea index (AHI) of >5 (number of nocturnal apnea and hypopnea per hour of sleep). Sleep apnea hypopnea syndrome is found in 2% of the women and 4% of the men, i.e. they have an AHI>5 associated with daytime sleepiness. Forms, check lists, summaries and patient-readable questionnaires have proved helpful in the evaluation of SBAS.

Brausewetter F, Hecht M, Pirsig W. · Department of Diagnostic Radiology, University Hospitals of Ulm, Steinhovelstrasse 9, D-89070 Ulm, Germany. · J Laryngol Otol. · Pubmed #15285865 No free full text.

Abstract: Antrochoanal polyps were first documented in the 18th century. They represent one of the most common types of nasal polyps in children without cystic fibrosis. Only a few reports on children who had a history of snoring due to an antrochoanal polyp and only two cases where the antrochoanal polyp caused documented obstructive sleep apnoea (OSA) have been published so far. This report adds a third case of paediatric OSA induced by an antrochoanal polyp in a 12-year-old boy. After endonasal endoscopically-controlled polypectomy and a recurrence, transoral osteoplastic antrotomy in combination with endoscopic endonasal polypectomy eliminated the antrochoanal polyp and OSA was resolved. The authors have reviewed essential historical aspects about children suffering from snoring and/or OSA caused by an antrochoanal polyp.

Paulsen FP, Steven P, Tsokos M, Jungmann K, Müller A, Verse T, Pirsig W. · Institute of Anatomy, Christian Albrecht University of Kiel, Olshausenstrasse 40, D-24098 Kiel, Germany. · Am J Respir Crit Care Med. · Pubmed #12186828 links to  free full text

Abstract: The etiology of upper airway collapsibility in patients with snoring and obstructive sleep apnea (OSA) remains unclear. Structural mucosal changes could be contributory factors. The objective of this study was to determine whether pathologic changes in the epithelium or the epithelial-connective tissue interface are present in patients with snoring and/or OSA by means of scanning electron microscopy and immunohistochemistry. Uvulae were obtained by uvulopalatopharyngoplasty from three patients with habitual snoring and nine patients with mild to severe OSA, as well as by dissection from 43 nonsnoring body donors. Scanning electron microscopy revealed structural changes in the epithelial-connective tissue boundary that significantly differed from age-related changes in the control subjects. The immunohistochemical staining with antibodies against epithelial cytokeratins showed differences in the expression pattern of cytokeratin 13 between patients and control subjects. No differences were found in the distribution pattern of laminin. Analysis of defense cells revealed a significant diffuse infiltration of leukocytes, mainly T cells, inside the lamina propria of the patient group, which was not observed in the control group. In conclusion, these results support the hypothesis that progressive structural changes in the mucosa caused by the trauma of snoring are a possible contributory factor to upper airway collapsibility.

Verse T, Maurer JT, Pirsig W. · Department of Otorhinolaryngology, Head and Neck Surgery, Section for Rhinology and Rhonchopathies, University of Ulm, Ulm, Germany. · Laryngoscope. · Pubmed #11802040 No free full text.

Abstract: OBJECTIVE/HYPOTHESIS: Single cases of patients who have experienced obstructive sleep apnea (OSA) and who recovered completely after nasal surgery have been described in various studies. The purpose of this study was to evaluate the efficacy of only nasal surgery 1) in a group of patients with obstructive sleep apnea and 2) in simple snorers. STUDY DESIGN: A prospective, controlled study with 26 adult patients who underwent nasal surgery as single treatment of their sleep-related breathing disorders. The cases were evaluated based on the severity level of their preoperative Apnea Hypopnea Index (AHI). MATERIAL AND METHODS: Between August 1996 and July 2000, 26 patients who snored and had impaired nasal breathing underwent attended polysomnography in the sleep laboratory as single treatment nasal surgery was performed. Postoperative polysomnographic findings and complications were reviewed. RESULTS: Nineteen of 26 patients (73.1%) were diagnosed as having OSA. Seven patients were simple snorers with an AHI below 10. The surgical response rates, defined as greater than or equal to 50% reduction in the postoperative AHI and a postoperative AHI of less than 20, was 15.8% in the apneics. For the whole group, the AHI decreased postoperatively from 31.6 to 28.9. However, daytime sleepiness improved significantly and arousals decreased significantly in both apneics and simple snorers after nasal surgery. CONCLUSIONS: We conclude that nasal surgery has a limited efficacy in the treatment of adult patients with sleep apnea. Nevertheless, nasal surgery significantly improves sleep quality and daytime sleepiness independent of the severity of obstructive sleep-related breathing disorders.

Dorn M, Pirsig W, Verse T. · Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Ulm. · HNO. · Pubmed #11544886 No free full text.

Abstract: BACKGROUND: Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy. PATIENTS AND METHOD: Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively. RESULTS: None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed. CONCLUSION: The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.

Verse T, Pirsig W. · Universitäts-HNO-Klinik Ulm Prittwitzstrasse 43 89075 Ulm. · Laryngorhinootologie. · Pubmed #11138519 No free full text.

This publication has no abstract.

Pirsig W, Verse T. · Universitäts-HNO-Klinik Ulm Sektion Rhinologie und Rhonchopathien Prittwitzstrasse 43 89075 Ulm. · Laryngorhinootologie. · Pubmed #11138518 No free full text.

This publication has no abstract.

Verse T, Kroker BA, Pirsig W, Brosch S. · Department of Ear, Nose and Throat Surgery, University of Ulm, Germany. · Laryngoscope. · Pubmed #10983961 No free full text.

Abstract: OBJECTIVES: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. STUDY DESIGN: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). MATERIAL AND METHODS: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. RESULTS: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI > or = 50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. CONCLUSIONS: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.

Verse T, Pirsig W. · Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Ulm. · Laryngorhinootologie. · Pubmed #10911603 No free full text.

Abstract: BACKGROUND: Laser-assisted uvulopalatoplasty (LAUP) was not recommended by the American Sleep Disorders Association for the treatment of snoring and obstructive sleep apnea (OSA) because of data lacking in 1994. In the meantime numerous new papers concerning this subject have been published in peer reviewed journals. A new evaluation of the value of LAUP is presented. METHODS: In a world-wide literature search (Medline) from 1980 until March 1999, seventy articles were identified. The papers were analyzed concerning the subtopics "operative techniques", "LAUP and OSA", "LAUP and snoring", "pain", "side-effects", "indications" and "predictive criteria". RESULTS: On the basis of the collected data, it is possible to put definitive values on the subtopics "operative techniques", "LAUP and snoring" and "side-effects". In contrast, objective long-term results concerning "LAUP and OSA" are still missing. Short-term results are promising. CONCLUSION: Nevertheless, LAUP and its related procedures presently should not be recommended for the treatment of any severity of OSA.

Verse T, Pirsig W, Junge-Hülsing B, Kroker B. · University of Ulm, Otorhinolaryngological Clinic Section for Rhinology und Rhonchopathies, Germany. · Chest. · Pubmed #10858392 links to  free full text

Abstract: STUDY OBJECTIVES: To determine the recording capabilities of the POLY-MESAM (PM) unit (MAP; Martinsried, Germany), an American Sleep Disorders Association level III system, and to compare it with simultaneous 12-channel polysomnography in the sleep laboratory. MEASUREMENTS AND RESULTS: Fifty-three patients (49 men and 4 women) with obstructive sleep-related breathing disorders of varying severity were included. The apnea-hypopnea indexes (AHIs) obtained using the two methods differed significantly from each other, although the correlation was close. The PM unit produced false-negative results in patients with mild to moderate obstructive sleep apnea (OSA). The sensitivity of the PM unit in detecting patients with an AHI > 10 was 92%, while the specificity was 96.3%. CONCLUSIONS: The correlation of AHIs obtained with polysomnography and with the PM unit is close. However, in some cases, the PM may underestimate OSA parameters. The PM unit produces false-negative results in patients with mild to moderate OSA. While inpatient polysomnography remains the "gold standard," the PM unit may provide an inexpensive alternative in some special cases.

Brosch S, Matthes C, Pirsig W, Verse T. · Section of Phoniatrics and Paediatric Audiology, University of Ulm, Germany. · J Laryngol Otol. · Pubmed #10748826 No free full text.

Abstract: The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.

Verse T, Pirsig W, Zimmermann E. · Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Ulm. · Dtsch Med Wochenschr. · Pubmed #10700876 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The closure of tracheostomies may postoperatively induce an obstructive sleep apnea (OSA) even in patients who never complained about sleep related breathing disorders before they underwent tracheotomy. The present study was designed to evaluate, whether OSA appears after the tracheostomy has been airtightly blocked and if so, whether there are typically illnesses predictive for OSA after operative closure of tracheostomies. PATIENTS AND METHODS: Twelve consecutive patients (3 male; 9 female; mean age 66 years), who addressed our clinic for operative closure of their tracheostomies were enrolled in this study over a period of 18 months. On basis of patient's history and clinical findings the patients were divided into two groups. Group A included 7 patients with laryngeal pathologies and group B included 5 patients with normal larynges. All patients underwent a 12-channel polysomnography (PSG) with airtightly blocked tracheostomies preoperatively. RESULTS: In 5 patients a mild OSA and in one patient a severe OSA was diagnosed by PSG. The patients of group A with laryngeal pathologies were older, had a lower Body Mass Index (BMI) and a higher Apnea-Hypopnea Index than patients of group B (p < 0.05). CONCLUSION: Laryngeal pathologies in the elderly might facilitate the development of OSA after operative closure of tracheostomies. Based on the results postoperative reevaluation is recommended for all elderly patients with laryngeal abnormalities after operative closure of the tracheostomy.

Verse T, Pirsig W. · Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany. · J Laryngol Otol. · Pubmed #10696386 No free full text.

Abstract: At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position. At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8. Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep. This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.

Verse T, Lehnhardt E, Pirsig W, Junge-Hülsing B, Kroker B. · Universitätsklinikum Ulm, Klinik und Poliklink für HNO-Heilkunde. · Laryngorhinootologie. · Pubmed #10535065 No free full text.

Abstract: BACKGROUND: Nasal continuous positive airway pressure ventilation therapy is the present gold standard in the treatment of obstructive sleep apnea. Depending on the definitions used, about 60% of the patients tolerate nCPAP therapy. The reason for this limited tolerance is a varying number of side effects. The aim of the present retrospective study was to analyze the incidence and intensity of otorhinolaryngological side effects of nCPAP therapy. METHOD: Questionnaires inquiring about the frequency of using nCPAP and objective and subjective complaints were sent to 92 patients who were treated with nCPAP in our department within the last years. Six of 92 patients also used a heated humidifier. A telephone interview was added to complete the questionnaires as correctly as possible. RESULTS: Eighty questionnaires were sent back completely answered. The mean frequency of using nCPAP (+/- standard deviation) was 6.8 +/- 1.6 hours per night and 6.5 +/- 1.4 nights per week. The mean duration of nCPAP therapy was 28.0 +/- 21.0 months; the mean pressure used was 6.8 +/- 1.2 cm H2O. The following side effects were specified most frequently: disturbance of sleep during the night (71.3%), dry mouth (47.5%), dry nose (46.3%), pressure marks by the mask (41.3%), crusts within the nasal cavity (38.8%), and hearing loss (26.3%). Dryness within the nose and mouth was considered the most irritating side effects. CONCLUSIONS: NCPAP therapy has a number of different side effects in the head and neck. These side effects are seen frequently. Prospective analysis must show whether there are correlations between the intensity and frequency of side effects and the duration of therapy, and whether technical improvements (quality of masks, noise reduction, humidifiers) are able to reduce the frequency of side effects.

Verse T, Pirsig W, Junge-Hülsing B, Kroker B. · Sektion für Rhinologie und Rhonchopathien, Universitäts-HNO-Klinik Ulm. · HNO. · Pubmed #10407730 No free full text.

Abstract: PURPOSE: For some time, the ambulatory diagnosis of respiratory disturbances during sleep has included the use of seven-channel recording units. One of these systems is the POLY-MESAM unit (MAP, Germany). METHODS: The aim of the present study was to validate the POLY-MESAM system by simultaneously performing 12-channel polysomnography. Forty-nine patients (45 males and 4 females) with different severities of obstructive sleep-related breathing disorders were included. Obstructive sleep apnea was diagnosed, when an apnea-hypopnea index (AHI) > 15 was found by polysomnography. The sensitivity and specificity for POLY-MESAM were calculated on the basis of the polysomnographic AHI. RESULTS: The sensitivity of POLY-MESAM for detecting patients with an AHI > 15 was 86.4% and the specificity was 100%. CONCLUSIONS: The POLY-MESAM system was easy to use. The sensitivity and specificity for the MESAM4 unit were 92% and 97% respectively, which was similar to POLY-MESAM. Additionally, POLY-MESAM provided the possibility for distinguishing the different kinds of apneas. Thus, POLY-MESAM was considered to be a useful development of the previous MESAM4 unit. In some cases, use of the POLY-MESAM unit resulted in underestimation of the AHI. POLY-MESAM produced false-negative results in patients with mild to moderate OSA. This finding was reflected in the relatively poorer sensitivity of the method (86.4%). Cardiorespiratory sleep studies (as possible with POLY-MESAM) are best limited to patients for whom the diagnosis of OSA is highly probable or as a follow-up tool in selected circumstances.

Verse T, Pirsig W, Kroker B, Junge-Hülsing B, Zimmermann E. · Sektion für Rhinologie und Rhonchopathien, Universitäts-HNO-Klinik Ulm. · HNO. · Pubmed #10407729 No free full text.

Abstract: PURPOSE: For some time, the ambulatory diagnosis of sleep-related breathing disorders has included the use of seven-channel recording units. One such unit is the POLY-MESAM (MAP, Martinsried, FRG). The first part of the present study prospectively investigated the handling of the system for physicians and patients, its technical reliability, reliability of the software used and the results in comparison to handscoring. METHODS: In all, 104 patients (95 males, 9 females) were studied for different severities of obstructive sleep-related breathing disorders. The first 51 patients were connected to the POLY-MESAM in the evening within the clinic. The patients then slept at home and returned the next day. Another 53 patients received only a short briefing in the clinic and connected themselves at home to the POLY-MESAM System. Each patient's status was monitored by means of a visual analogue scale. Automatic evaluation of the data was compared with the results of manual scoring. RESULTS: From the data recorded only 6% of the results were not usable. Patients acceptances of the system were very high (94.3%). On average each patient required 21 minutes for attaching and detaching the device. Scoring and instructing the patients required an average of 23 min. Regarding the apnea-hypopnea index (AHI), the correlation between automatic (AHI = 11.1) and manual (AHI = 11.3) evaluations was high. Analysis of snoring turned out to be insufficient. CONCLUSIONS: The POLY-MESAM proved to be reliable and user-friendly. Our findings show that the system can be recommended for outpatient screening of sleep-related breathing disorders, with patients able to manage the system without help. Validation by using simultaneous polysomnography is the subject of part two of the study.