[LEOSound, an innovative procedure for acoustic long-term monitoring of asthma symptoms (wheezing and coughing) in children and adults]. / LEOSound - Ein innovatives Verfahren zum akustischen Langzeit-Monitoring von asthmatischen Symptomen (Wheezing und Husten) bei Kindern und Erwachsenen.

Particularly in young children the diagnosis of asthma is difficult and mostly based on clinical symptoms like wheezing, cough and dyspnea. Children with nocturnal wheezing often suffer from a low quality of sleep and impaired sense of well-being during the day. Physicians recommend that parents record the frequency of asthma attacks or symptoms to help manage their children's disease. The lack of an appropriate method for standardized and objective monitoring makes asthma management difficult. The aim of this paper is to present a new method for automated wheeze and cough detection and analysis. The mobile LEOSound recording and analysing system described here should help improve diagnosis and monitoring of asthma symptoms in children.

Therapeutic options for postmenopausal female sexual dysfunction.

BACKGROUND: Female sexual dysfunction (FSD) is a multidimensional problem combining biological, psychological and interpersonal elements of multiple etiologies. Menopause-related sexual dysfunction may not be reversible without therapy. Hormonal deficiency does not usually decrease in severity over time. Many options are available for the successful treatment of postmenopausal FSD. OBJECTIVE: To review the pharmacological and non-pharmacological therapies available for postmenopausal FSD, focusing on practical recommendations for managing postmenopausal women with sexual complaints, through a literature review of the most relevant publications in this field. PSYCHOSOCIAL THERAPY: This type of therapy (basic counselling, physiotherapy and psychosexual intervention) is considered an adaptable step-by-step approach for diagnostic and therapeutic strategies, normally combined with biomedical interventions to provide optimal outcomes. PHARMACOLOGICAL THERAPY: For postmenopausal FSD, many interventional options are now available, including hormonal therapies such as estrogens, testosterone, combined estrogen/testosterone, tibolone and dehydroepiandrosterone. CONCLUSIONS: Menopause and its transition represent significant risk factors for the development of sexual dysfunction. FSD impacts greatly on a patient's quality of life. Consequently, it is receiving more attention thanks to the development of effective treatments. Non-pharmacological approaches should be used first, focusing on lifestyle and psychosexual therapy. If required, proven effective hormonal and non-hormonal therapeutic options are available.

Efficacy of pergolide in treatment of restless legs syndrome: the PEARLS Study.

OBJECTIVE: To evaluate the short- and long-term safety and efficacy of pergolide therapy for restless legs syndrome (RLS) in a double-blind, placebo-controlled, randomized trial (Pergolide European Australian RLS [PEARLS] study). METHODS: We randomized 100 patients with idiopathic RLS were randomized to pergolide, 0.25 to 0.75 mg, in the evening or placebo for 6 weeks (phase 1); thereafter, patients with response on the Patient Global Impression (PGI) scale continued on double-blind pergolide or placebo, and nonresponders received open-label pergolide up to 1.5 mg/d for 12 months of treatment (phase 2). Sleep efficiency (SE) and periodic limb movements during sleep (PLMS) arousal index were monitored by centrally evaluated polysomnography (PSG). The severity of RLS was assessed using the validated International RLS Scale (IRLS). RESULTS: In phase 1 (change from baseline to week 6), pergolide reduced PLMS arousal index vs placebo (mean +/- SD, -12.6 +/- 10.0 vs -3.6 +/- 15.9; p = 0.004), and SE did not improve (mean +/- SD, +11.3 +/- 11.9% vs +6.1 +/- 18.6%; p = 0.196). Pergolide improved RLS severity score (-12.2 +/- 9.9 vs -1.8 +/- 7.5 placebo; p < 0.001) and was associated with a higher PGI response (68.1% vs 15.1%; p < 0.001) and improvements in periodic limb movements (PLM) index, PGI improvement scale, Clinical Global Impression improvement, and IRLS (all p < 0.001), patient-reported SE (p = 0.019), and quality of sleep (p < 0.001). After 12 months (phase 2), double-blind pergolide maintained improvements in PLMS arousal index and PLM index. Placebo patients switched to open-label pergolide in phase 2 exhibited marked improvements in these measures that were maintained at 12 months. Pooled results from the blinded and open-label pergolide groups demonstrated improvements at 12 months in the PLMS arousal index (p = 0.028) and PLM index (p < 0.0001) compared with placebo. Nausea and headache were more frequent with pergolide than with placebo treatment. CONCLUSIONS: Pergolide substantially improves periodic limb movement measures and subjective sleep disturbance associated with restless legs syndrome. Low-dose pergolide was well tolerated and maintained its efficacy in the long term.

[Psychosomatic aspects of endometriosis]. / Psychosomatische Aspekte der Endometriose.

Endometriosis is a varied and unspecific disorder, which can be detected by way of subtle diagnostics in almost every woman. In one case it is a minor accidental finding, in another case it is a cancer-like, mostly incurable, chronic painful a disease, which often has sterility and aggressive therapies as subsequence. For the origin of endometriosis many causes are discussed. The theory of retrograde menstruation through an hyperperistaltic-dystocic uterus presents on one hand an organic explanation-concept. From the psychosomatic point of view this unphysiological menstruation could also be seen as the result of an unsolved conflict, which might be connected with the gender-role or personal, familiar and social attitudes about menstruation. The exo- and endogenic supply with hormones in a time with less pregnancies and therefore more menstruation is also a contributing factor to the origin and development of this disturbance. Beside the theory of endometriosis as an autoimmune disease also implicates psychosomatic thoughts. Though there is always a repeatedly talk the "cancer of the career-woman", there are however very few psychosomatic research projects regarding endometriosis. Therefore it is a characteristic of this disease, that finding and feeling are very often controversial. This emphasizes the importance of psychosomatic, psychosexual, social and biographical aspects in connection with endometriosis. This point of view makes a relative plausible and comfortable explanation for the CPPS and sterility uncertain. Without question diagnosis and therapy of endometriosis followed on one hand by stigmatization and on the other hand by often restriction of quality of life leads to a lot of subsequent psychosocial problems.

[Sexuality in the elderly]. / Sexualität im Alter.

Disturbance of sexual function and sexual perceptions in the aging often have a significant negative impact on overall quality of life. Epidemiological data on this phenomenon are sparse. Recently, however, more investigations have been undertaken to improve diagnostic and therapeutic approaches. First scientific concepts are now emerging that will allow better patients care in the future.

A new design of a polysomnography-based multi-center treatment study for the restless legs syndrome.

Periodic limb movements (PLM) cause sleep disorders and daytime symptoms and are frequently associated with restless legs syndrome (RLS). Treatment of RLS with increased PLM during sleep (PLMS) has been evaluated in studies limited in size, methodology and study length. This long-term, placebo-controlled, multi-center, study with polysomnography (PSG) recordings has been designed in order to assess efficacy and safety parameters of pergolide treatment in RLS. This novel approach for a study was created to assure consistently high quality of sleep recording and analysis. Using defined criteria, 21 sleep centers were approved for the study after a pilot phase. Seventeen centers with 16 different PSG systems randomized 100 patients. Digital sleep recordings from 4 visits (baseline, 6 weeks, 6 months, 1 year) were submitted to one central evaluation center following previously defined standardized operating procedures. Visual scoring of all recordings was performed by one independent scorer. Reliability of scoring was evaluated for 20 randomly selected baseline recordings. The mean epoch by epoch agreement for sleep stages was 88% (range 81-96%), mean arousal re-scoring differed by 0.5 (range: -16 to 20), and mean PLM index re-scoring differed by 0.1 (range: -1.5 to 2.1). Using one scorer with a demonstrated high reliability in PSG scoring for all sleep recordings was very effective in terms of study cost, study duration, and data quality.

Long-term effects of pergolide in the treatment of restless legs syndrome.

An open follow-up of a controlled study in patients with restless legs syndrome (RLS) shows that the beneficial effect of pergolide on RLS symptoms persists throughout at least 1 year. Twenty-two patients of 28 (78.6%) continued to take pergolide. Polysomnographic measurements showed a persistent improvement of PLM index, PLMS arousal index, total sleep time, and sleep efficiency (p = 0.0001). Side effects, in particular nausea, were common but were well controlled by domperidone in most patients.

Obstructive sleep apnoea in acromegaly: the role of craniofacial changes.

Obstructive sleep apnoea (OSA) is due to craniofacial changes and acromegaly. The question addressed by this study was whether growth hormone (GH) induced craniofacial changes might explain persisting OSA despite endocrine inactivity in acromegaly. Nineteen patients treated for acromegaly were examined cephalometrically for craniofacial changes and polysomnographically for OSA. Twelve patients proved to have OSA with an apnoea/hypopnoea index >15; seven patients showed no evidence of OSA at all. With respect to the endocrinological parameters, there were no differences between the two groups that would explain the presence or absence of OSA. Neither group differed with respect to sex, age, or body mass index. Craniofacial changes were predominantly found in the mandible. The group with OSA proved to have increased vertical, dolichofacial growth compared to those without OSA. Consecutively, in the OSA group the posterior airway space was narrowed, and the hyoid was displaced more caudally. Thus, it seems that craniofacial structures of patients with acromegaly and persisting obstructive sleep apnoea are different from those without obstructive sleep apnoea. Surgical corrections of pertaining acromegaly-induced craniofacial changes should be performed with an awareness of the individual craniofacial condition so as not to enhance obstructive sleep apnoea.

Vigilance transitions in reaction time test: a method of describing the state of alertness more objectively.

Electrophysiological recordings are considered a reliable method of assessing a person's alertness. The aim of this study was to show, firstly, that changes in alertness during a Reaction Time Test (RTT) can be determined with certain adaptive scoring stages but not with R&K scoring and secondly, that the different adaptive stages can explain findings in reaction time. In 17 male patients (50.8+/-9.7 years, Body-Mass Index (BMI) 31.9+/-5.1 kg/m2) diagnosed with Obstructive Sleep Apnea Syndrome (OSAS) (Respiratory Disturbance Index (RDI) 53.3+/-24.1 /h sleep) a 90 min daytime vigilance test was performed twice, after the diagnostic polysomnographic investigation and after two nights spent with nCPAP. After a computerised adaptive segmentation analysis, a visual rule-defined classification system categorised alertness into one of 12 adaptive scoring stages. 6 of the 12 stages are described by the alertness conditions comparable to WAKE and NREM1.4 stages are nearly classified as NREM2-4, Rapid Eye Movement (REM) and Movement Time (MT), and one stage reflects the increase of alertness from drowsiness. The typical stage of an alert subject increased significantly from a median of 65.9% before therapy to 80.8% in the second investigation. The percentages of clearly drowsy stages decreased significantly. In contrast, there were no significant changes in the percentages of sleep stages according to R&K criteria for both investigations. According to R&K criteria 178 of 398 failed reactions (Reaction time >10 s) occurred in stage WAKE. According to adaptive scoring, only 12 failed reactions appeared in the alert stage. During the other failed reactions the electrophysiological recordings showed decreases in alertness. Neither the visual assessment nor the descriptive statistical results of R&K scoring were helpful to interpret the patient's alertness condition. In contrast, the patients' increases in alertness with nCPAP could be described by the adaptive scoring stages. This method could be a very useful procedure, when an expert opinion is necessary. It also has an actual context to the discussion of the effectiveness of CPAP in the treatment of OSAS.

A randomized controlled study of pergolide in patients with restless legs syndrome.

BACKGROUND: Open clinical trials indicate that low doses of pergolide, a long-acting D1 and D2 dopamine agonist, lead to a reduction in the symptoms of restless legs syndrome (RLS) with subjective improvement in sleep quality. OBJECTIVE: To assess the therapeutic efficacy of pergolide in improving sleep and subjective measures of well-being in patients with idiopathic RLS using polysomnography and clinical ratings. METHODS: In a randomized, double-blind, placebo-controlled crossover design we enrolled 30 patients with idiopathic RLS according to the criteria of the International RLS Study Group. All patients were free of psychoactive drugs for at least 2 weeks before the study. Patients were monitored using polysomnography, clinical ratings, and sleep diaries at baseline and at the end of a 4-week pergolide or placebo treatment period. The initial dosage of 0.05 mg pergolide was increased to the best subjective improvement paralleled by 20 mg domperidone tid. RESULTS: At a mean dosage of 0.51 mg pergolide as a single daily dose 2 hours before bedtime, there were fewer periodic leg movements per hour of time in bed (5.7 versus 54.9, p < 0.0001), and total sleep time was significantly longer (373 versus 261 minutes, p < 0.0001). Ratings of subjective sleep quality, quality of life, and severity of RLS were improved significantly without relevant adverse events. CONCLUSION: Pergolide given as a single low-to-medium bedtime dose in combination with domperidone provides a well-tolerated and effective treatment of sensorimotor symptoms and sleep disturbances in patients with primary RLS.

Arousal in patients with gastro-oesophageal reflux and sleep apnoea.

Nocturnal gastro-oesophageal reflux has been observed in patients with obstructive sleep apnoea (OSA). Negative intrathoracic pressure during apnoeas and arousal have been suggested as the underlying mechanisms. In order to evaluate this hypothesis, the coincidence and sequence in time of arousal, apnoea and reflux events were analysed. Fifteen patients with OSA or heavy snoring were studied by means of standard polysomnograpy with parallel recording of 24-h oesophageal pH. Reflux events during the day were present in all patients, five of whom had symptoms of reflux. In three of these and in five other patients, a total of 69 nocturnal reflux events were found. In 68 events, arousal was found with the reflux event. Only one reflux without arousal was found (sleep stage 2). Seventeen events occurred during wakefulness after sleep onset. The percentage of time with a pH of <4 during wakefulness after sleep onset was significantly higher than the percentage of time with a pH of <4 during total sleep time (p<0.05). In 37 of the 52 reflux events which occurred during sleep, either an apnoea or a hypopnoea was found prior to the event. The investigation of sequence in time did not prove a causal relation between respiratory events and reflux events. The results indicate that gastro-oesophageal reflux and obstructive sleep apnoea are two separate disorders, which both have a high prevalence in obese patients.

Complement system in healthy term newborns: reference values in umbilical cord blood.

Activation of the complement system occurs in several diseases. For reliable identification of complement activation in neonates, we establish reference ranges of several components in cord blood of healthy term newborns. For this study, cord blood samples were taken from 125 healthy term newborns. Concentrations of C1r, C2, C5, C7, Properdin, and factors D, H, and I were determined by single radial immunodiffusion. C3a and C5a were measured by specific EIA and complement function was measured by hemolytic assays. The results were expressed as 5th percentile, median, and 95th percentile. The following respective concentrations were found: C1r: 27, 47, 65 mg/l; C2: 12.0, 18.0, 24.0 mg/l; C5: 64, 92, 127 mg/l; C7: 32, 60, 89 mg/l; Properdin: 5.6, 9.7, 14.2 mg/l; factor D: 3.6, 5.2, 7.3 mg/l; factor H: 178, 234, 296 mg/l; and factor I: 15, 24, 32 mg/l. The functional activity of the whole complement system was 24%, 43%, 97% and for the alternative pathway 39%, 58%, 76%. The concentration of the activated split products C3a was 4, 65, 255 microg/l and of C5a, 0.11, 0.26, 1.19 microg/l. These reference values may be important for the detection of deficiencies of native complement proteins or perinatal processes leading to an activation of the complement system.

Sleep fragmentation and daytime vigilance in patients with OSA treated by surgical maxillomandibular advancement compared to CPAP therapy.

Impaired vigilance is a frequent daytime complaint of patients with obstructive sleep apnoea (OSA). To date, continuous positive airway pressure (CPAP) is a well established therapy for OSA. Nevertheless, in patients with certain craniofacial characteristics, maxillomandibular advancement osteotomy (MMO) is a promising surgical treatment. Twenty-four male patients with OSA (pretreatment respiratory disturbance index (RDI) 59.3 SD +/- 24.1 events/h) participated in this investigation. The mean age was 42.7 +/- 10.7 years and the mean body mass index was 26.7 +/- 2.9 kg/m2. According to cephalometric evaluation, all patients had a narrow posterior airway space, more or less due to severe maxillary and mandibular retrognathia. All patients except two were treated first with CPAP for at least 3 months and afterwards by MMO. Two patients only tolerated a CPAP trial for 2 nights. Polysomnographic investigation and daytime vigilance were assessed before therapy, with CPAP therapy and 3 months after surgical treatment. Patients' reports of impaired daytime performance were confirmed by a pretreatment vigilance test using a 90-min, four-choice reaction-time test. The test was repeated with effective CPAP therapy and postoperatively. Daytime vigilance was increased with CPAP and after surgical treatment in a similar manner. Respiratory and polysomnographic patterns clearly improved, both with CPAP and after surgery, and showed significant changes compared to the pretreatment investigation. The RDI decreased significantly, both with CPAP (5.3 +/- 6.0) and postoperatively (5.6 +/- 9.6 events/h). The percentages of non-rapid eye movement Stage 1 (NREM 1) sleep showed a marked decrease (with CPAP 8.2 +/- 3.6% and after MMO 8.2 +/- 4.4% vs. 13.3 +/- 7.4% before treatment), whereas percentages of slow wave sleep increased significantly from 8.0 +/- 6.1% before therapy to 18.2 +/- 12.8 with CPAP and 14.4 +/- 7.3% after MMO. The number of awakenings per hour time in bed (TIB) was significantly reduced after surgery (2.8 +/- 1.3), compared to both preoperative investigation (baseline 4.2 +/- 2.0 and CPAP 3.4 +/- 1.5). Brief arousals per hour TIB were reduced to half with CPAP (19.3 +/- 20.0) and after MMO (19.7 +/- 13.6), compared to baseline (54.3 +/- 20.0). We conclude that the treatment of OSA by MMO in carefully selected cases has positive effects on sleep, respiration and daytime vigilance, which are comparable to CPAP therapy.

Antileukemic effects of rapid cyclosporin withdrawal in patients with relapsed chronic myeloid leukemia after allogeneic bone marrow transplantation.

The results of rapid tapering of Cyclosporin therapy in 7 patients with Philadelphia chromosome-positive chronic myeloid leukemia (CML) in relapse after allogeneic bone marrow transplantation are reported. All patients had cytogenetically-documented relapse within 6 months of transplant, and were on oral Cyclosporin therapy. Rapid tapering of Cyclosporin resulted in moderately severe acute GVHD in 2 cases, and in extensive chronic GVHD in a further 2 patients (fatal in 1 case). An antileukemic effect was observed in 6 patients, with complete haematological and cytogenetic remission observed in all cases. The seventh patient did not respond, and died after infusion of donor leucocytes. Four of the responders remain in complete remission of CML 30 to 120 months after BMT. One patient died in remission of chronic GVHD, and one patient had a complete response lasting 5 months, but relapsed and died 13 months post transplant. Rapid withdrawal of Cyclosporin therapy appears to be an effective means of treatment of early relapse of CML after transplant, and is an alternative to the use of donor leucocyte infusions for those patients still receiving Cyclosporin at the time of relapse.

[Actigraphy: methodological limits for evaluation of sleep stages and sleep structure of healthy probands]. / Aktigraphie: Methodische Begrenzungen für die Beurteilung von Schlafstadien und Schlafstruktur gesunder Probanden.

UNLABELLED: Purpose of the investigation was to evaluate the differences of movement density during the sleep stages and waking. 22 diurnally active, healthy, male volunteers of mean age 30.7 (+/-Standard deviation +/- 3.3) years and a Body-Mass-Index 23.6 +/- 3.3 kg/m2 participated in the study. All subjects were recorded in the sleep lab via cardiorespiratory polysomnography and wrist actigraphy (Ambulatory Monitoring, Ardsley, USA) worn on the non-dominant hand, for two consecutive nights. The activity data, consisting of the number of zero crossings (NZC) were recorded in 1-minute periods. Sleep stages were scored visually according to standard criteria. EEG- and actigraphy data were converted to the same data format (European Feature Files). Attaching the actimetry data to the sleep stages was calculated mean NZC for every sleep stage and Wake. In spite of high differences in total individual NZC we observed that most NZC occurred during Wake. NREM 1 movement density was significantly higher in 19 recordings (86%) than in any other sleep stage. In 18 cases (82%) lowest movement density was found in NREM 3/4 with significant difference to all other sleep stages. Within 50% of the recordings were found decreasing activity in the following sequence of stages: Wake > NREM 1 > REM > NREM 2 > NREM 3/4 However, in all other cases there was a varying pattern of activity. CONCLUSION: Although there is some correlation between motor activity and sleep stages, the predictive value of actimetry data analysis in the assessment of sleep structure appeared to be limited mainly by individual movement density, especially during REM and NREM 2.

[Respiratory function diagnosis during sleep: possibilities and limitations]. / Atmungsfunktionsdiagnostik im Schlaf: Möglichkeiten und Grenzen.

Diagnosis of the respiratory function during sleep is based on a continuous recording of all necessary signals. These are basically respiratory flow, respiratory effort and blood gases. In addition, sleep stages, body position and cardiovascular function have to be monitored to distinguish the different forms of sleep related breathing disorders as there are obstructive, mixed and central apnea and hypoventilation. The main evaluation is a simple counting of events and the calculation of an index related to total sleep time. These indices are of limited value because all information about the duration of the events is lost and about the severity which depends on the actual blood gas values. A computer assisted evaluation of respiration can overcome these limitations and allows to evaluate sleep stage dependencies in addition. Based on the duration of respiratory events only it was possible to distinguish patient groups which also provided different blood gas values at daytime. Determination of the critical closing pressure of the upper airways during sleep can help to quantify effects of body weight loss and other therapeutic interventions beside ventilation therapy in patients with sleep related breathing disorders. Quantitative characterisation of respiration during sleep is limited by the fact that most methods available induce changes in sleep or respiration itself. A study on healthy subjects proved an increased number of arousals during cardiorespiratory polysomnography. Therefore the added value obtained by quantitative methodology (pneumotachograph and esophageal pressure) must be weighted against non-invasive technology (inductive plethysmography). Non-invasive methods can provide comprehensive information about the respiratory function, especially if extensive computer-assisted evaluation is used. These evaluations still need further improvements. Nevertheless they can help to clarify the different types of respiratory regulation present in NREM-, REM-sleep and awake state.

Surgical maxillofacial treatment of obstructive sleep apnea.

Obstructive sleep apnea is the most common sleep-related breathing disorder, with a surprisingly high prevalence. The treatment of choice is nasal continuous positive airway pressure (CPAP) ventilation during sleep, which has to be applied throughout the patient's whole life. Because of various underlying pathomechanisms in patients with certain craniofacial disorders--narrow posterior airway space and maxillary-mandibular deficiency--surgical therapy by craniofacial osteotomies seems possible. A series of 38 consecutive patients were treated by 10-mm maxillomandibular advancement by retromolar sagittal split osteotomy and Le Fort I osteotomy, respectively. Obstructive sleep apnea syndrome was improved considerably in all patients; there was no significant difference compared to the results under nasal CPAP. In 37 of 38 patients, the postoperative apnea-hypopnea index was reduced clearly to under 10 per hour, oxygen saturation rose, and sleep quality improved. This was achieved by maxillomandibular advancement of 10 mm without secondary refinements in all but 2 patients. In one patient, the apnea-hypopnea index could only be reduced to 20 per hour, probably because of insufficient maxillary advancement. These results indicate that successful surgical treatment is possible in a high percentage of selected patients with certain craniofacial characteristics. In addition to cardiorespiratory polysomnography, there should be routine cephalometric evaluation of all patients. Maxillomandibular advancement should be offered as an alternative therapy to all patients with maxillary and/or mandibular deficiency or dolichofacial type in combination with narrow posterior airway space.

Long-term follow-up after surgical treatment of obstructive sleep apnoea by maxillomandibular advancement.

Obstructive sleep apnoea (OSA) is a common disorder with potentially serious consequences. If maxillary and mandibular deficiency, often in combination with a narrow posterior airway space is present, therapy of OSA by maxillomandibular osteotomy is possible. However, long-term follow-up of patients undergoing these procedures is lacking. We present the results of 15 OSA patients (1 female and 14 males), who underwent maxillomandibular advancement surgery with a follow-up of at least 2 yrs. Polysomnography was performed before surgery, after 6-12 weeks, and 1 and 2 yrs postoperatively. Mean apnoea/hypopnoea index (AHI) decreased from 51.4 events.h-1 before therapy to 5.0 events.h-1 6 weeks postoperatively, and was 8.5 events.h-1 after 2 yrs. Oxygen saturation significantly increased following surgery. After 2 yrs, the AHI was < 10 events.h-1 in 12 out of 15 subjects. No significant changes were found comparing the 6-12 weeks versus the 2 year follow-up data. The significant increase in stage 3/4 non-rapid eye movement (NREM) sleep and decrease in stage 1 NREM sleep, indicative of the restoration of normal physiological sleep structure, persisted in 14 of the 15 subjects 2 yrs postoperatively. Three patients, however, did not show satisfactory improvement 2 yrs postoperatively; two showed obstructive and one central respiratory events. This study demonstrates that maxillomandibular advancement is successful in a high percentage of patients carefully selected by cephalometric and polysomnographic investigation. Postoperative success has proved to be stable over a period of 2 yrs. Further preoperative evaluation seems necessary in patients with predominantly mixed or central apnoeas.

Mandibular setback for surgical correction of mandibular hyperplasia--does it provoke sleep-related breathing disorders?

The question has arisen as to whether mandibular setback may possibly cause sleep-related breathing disorders (SRBD). To evaluate the possible effects of mandibular setback on posterior airway space (PAS), 16 consecutive patients were examined prospectively. All patients underwent surgical mandibular setback using bilateral sagittal split osteotomy. Polysomnographic evaluation for SRBD was performed according to the Marburg graded diagnostic protocol before and after surgery. Cephalometric analysis was performed preoperatively, and 1 week, 3 months, and 1 year postoperatively, with particular attention to pharyngeal changes. PAS decreased considerably in all patients. Nevertheless, the preoperative PAS was enlarged in all patients with mandibular hyperplasia compared to normal subjects. Despite the pharyngeal narrowing, there was no evidence of postoperative SRBD in any of these patients. SRBD as a consequence of mandibular setback may be rare; nevertheless, the pharyngeal airway does decrease.