PT  - JOURNAL ARTICLE
AU  - C Guilleminault
AU  - MA Quera-Salva
AU  - N Powell
AU  - R Riley
AU  - A Romaker
AU  - M Partinen
AU  - R Baldwin
AU  - G Nino-Murcia
TI  - Nocturnal asthma: snoring, small pharynx and nasal CPAP
AID  - 10.1183/09031936.93.01100902
DP  - 1988 Dec 01
TA  - European Respiratory Journal
PG  - 902--907
VI  - 1
IP  - 10
4099  - http://erj.ersjournals.com/content/1/10/902.short
4100  - http://erj.ersjournals.com/content/1/10/902.full
SO  - Eur Respir J1988 Dec 01; 1
AB  - We studied two populations of patients who snored and had frequent nocturnal asthma attacks: ten overweight men presenting with typical obstructive sleep apnoea syndrome, and a group of five adolescents with regular snoring and an increase in negative inspiratory oesophageal pressure during stage II non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. All subjects presented cranio-mandibular abnormalities at cephalometric evaluation, with a narrow space behind the base of the tongue. Both populations were treated with nasal continuous positive airway pressure (CPAP) during sleep. Snoring and partial or complete airway obstruction were eliminated, as were the nocturnal asthma attacks. Two adolescents treated with upper airway surgery after nasal CPAP showed no nocturnal asthma at short-term follow-up. Nasal CPAP had no effect on daytime asthma. One hypothesis is that a subgroup of asthmatic patients with small pharynxes may have enhanced vagal stimulation during sleep compared with other asthmatic patients. This enhancement would be related to the repetitive Muller manoeuvres noted with airway obstruction during sleep. Combined with the local effects of snoring, this extra vagal stimulation would be a precipitating factor in nocturnal asthma attacks.