Videoradiography of patients with habitual snoring and/or sleep apnea. Technical description and presentation of videoradiographic results during sleep concerning occurrence of apnea, type of apnea, and site of obstruction.

PURPOSE: The videoradiographic examination described was designed for habitual snorers and sleep apnea syndrome (SAS) patients and was performed during wakefulness and sleep. During wakefulness the purpose was to reveal any dysfunction in deglutition and speech as well as morphologic abnormalities. The purpose during sleep, which usually was induced by low-dose midazolam intravenously, was to reveal the site and form of obstruction in obstructive sleep apnea patients and the site of snoring in habitual snorers. MATERIAL: The preoperative results of 104 patients are presented. In 57 patients who had apneas, the occurrence and type of apnea could be determined. RESULTS AND CONCLUSION: A continuous recording over some minutes gave a rough estimate of the degree of SAS and mean duration of apnea. Although much information on SAS can be obtained by this method, it cannot replace polygraphic sleep recording in the investigation of habitual snorers and SAS patients. However, these 2 methods are complementary and can be performed simultaneously as polygraphic videoradiography.

Myotonic dystrophy revealed at videoradiography of deglutition and speech in adult patients with velopharyngeal insufficiency: presentation of four cases.

Patients with velopharyngeal insufficiency (VPI) without cleft palate, who appear for the first time in adulthood for treatment, will probably reveal a high percentage of undiagnosed myotonic dystrophy (MD). Videoradiography of deglutition and speech reveals the diagnosis. Eleven adult noncleft palate patients with VPI were studied with videoradiography of the pharynx and esophagus. Three exhibited functional radiographic manifestations of MD during deglutition and speech. The diagnosis confirmed by neurologic examination was not known or suspected prior to videoradiography. An additional patient with VPI and suspected MD displayed the same constellation of radiographic findings. Follow-up examinations confirmed the diagnosis of MD. Three of the four patients had had symptoms of VPI since childhood, but none had complaints of deglutition problems except for accidental nasal regurgitations.

Videoradiography at submental electrical stimulation during apnea in obstructive sleep apnea syndrome. A case report.

Percutaneous submental electrical stimulation during sleep may be a new therapeutic method for patients with obstructive sleep apnea syndrome (OSAS). Electrical stimulation to the submental region during obstructive apnea is reported to break the apnea without arousal and to diminish apneic index, time spent in apnea, and oxygen desaturation. The mode of breaking the apnea by electrical stimulation has not yet been shown. However, genioglossus is supposed to be the muscle responsible for breaking the apnea by forward movement of the tongue. To visualize the effect of submental electrical stimulation, one patient with severe OSAS has been examined with videoradiography. Submental electrical stimulation evoked an immediate complex muscle activity in the tongue, palate, and hyoid bone. This was followed by a forward movement of the tongue which consistently broke obstructive apnea without apparent arousal. Time spent in apnea was diminished but intervals between apnea were not affected.

Esophageal motor function evaluated by scintigraphy, video-radiography and manometry in diabetic patients.

Prolonged esophageal scintigraphic transit time is frequent in diabetic patients and is related to autonomic neuropathy. In this study, esophageal scintigraphic transit time was correlated to esophageal motor function as evaluated by video-radiography and manometry in 13 diabetic patients. An abnormal scintigraphic transit time (greater than 15 s) occurred in 6 patients. All patients with abnormal transit time showed abnormal results at video-radiography (n = 4) and/or manometry (n = 5), which were observed in only 2 of 7 patients with normal transit time (both with abnormal video-radiography and manometry). A prolonged scintigraphic transit appears reliable as an indicator of disturbed esophageal smooth muscle function since it is well correlated with abnormalities shown by a combination of video-radiography and manometry.

Radiologic evaluation of the oral stage of swallowing.

The oral stage of swallowing was radiologically evaluated in 19 patients with swallowing complaints. Eight patients had had surgical resection and reconstruction due to tumours of the tongue, floor of the mouth or mandible. Eleven patients had suffered from cerebrovascular disease. All patients had incoordination of tongue movements including defective initiation of pharyngeal swallow. In patients who had undergone surgical resection, oral dysfunction correlated with the extension of resection as well as type of reconstruction, and was more profound compared with the disorder present in patients with cerebrovascular disease. Moreover, muscular derangement due to surgery of the floor of the mouth interfered with the elevation of the hyoid bone, larynx and pharynx and thereby the pharyngeal stage of swallowing also became abnormal. Cineradiography seems to be an appropriate method for evaluation of the oral stage of swallowing in patients with deglutition complaints.