RT Journal Article
SR Electronic
T1 Nocturnal asthma: snoring, small pharynx and nasal CPAP
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 902
OP 907
DO 10.1183/09031936.93.01100902
VO 1
IS 10
A1 C Guilleminault
A1 MA Quera-Salva
A1 N Powell
A1 R Riley
A1 A Romaker
A1 M Partinen
A1 R Baldwin
A1 G Nino-Murcia
YR 1988
UL http://erj.ersjournals.com/content/1/10/902.abstract
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.