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Tiotropium

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TREATMENT OF SNORING
DR. SCANES SPICER (Welbeck Street) writes: In reply to “Stertor’s” query, I would suggest that the condition of the nose and naso-pharynx be thoroughly explored by anterior and posterior rhinoscopy, to ascertain whether there is an obstruction, structural or erectile. In my experience, most snorers have some obstruction of the nose, which increases from erectile conditions of the mucous membrane on assuming the horizontal position; and most cases of snoring will yield when the physiological path of the breath is permanently restored, together with many of the symptoms so often accompanying snoring, such as nightmare, restless nights, dryness of mouth, and unpleasant taste of mouth in the morning, necessity for placing the water-bottle by the bedside to allay the parched throat, post-nasal catarrh, and throat irritation and cough. Over-indulgence in food, alcohol, and tobacco undoubtedly increases the erectile condition of the obstruction.
Thereafter, some discussion could always be found on the causes of snoring and methods to minimize it, but it was not until the 1960s that the diverse branches of medical science began to focus their attention on the subject, paving the way for significant developments into our understanding of snoring and its consequences. Research into the nature of sleep was accelerated after the late 1930s when it was discovered that sleep, rather than being a steady state, was characterized by a series of discrete and measurable stages. However, it was not until the late 1950s and the following decade that these stages were accurately described to an extent where they could be applied with some confidence in a clinical setting. An unfortunate fact of medical practice and research has been the need for some sort of invasive monitoring, a good example being the collection of blood samples. After years of observation and speculation about the effects of snoring, medical scientists had accumulated enough evidence to suspect that the airway obstruction of severe snoring impaired the normal oxygenation of blood. The most direct way to measure blood oxygen levels was, and still is, to take a sample of blood with a needle and syringe and have it analyzed, but this presents very real problems if one proposes to take samples from sleeping, snoring patients. Many patients are so intimidated by the thought of multiple blood collections that they would find it impossible to sleep, and it would also be necessary to take a large number of samples during the period of sleep to give a true indication of oxygenation throughout the night.
In the 1940s a non-invasive technique for estimating blood oxygen levels was developed which, to put very simply, relied on the absorbance of light by oxygenated blood. The device was called an ear oximeter, and by placing a light source and detector on the earlobe it was possible to measure blood oxygen levels continuously with minimal trauma to the patient. The first commercially viable oximeters became available in the 1970s, a decade which established their usefulness in a variety of clinical situations, particularly in the management of respiratory and sleep disorders. Oximeters have since been substantially modified. They are readily portable and suitable for bedside use, are attached with reasonable comfort to either ear or finger and are probably the most important diagnostic tools in those laboratories which have been set up to investigate snoring and other sleep disorders.
An understanding of snoring has resulted from the contributions of several medical specialties. Mention has been made of advances in sleep staging and oxygen monitoring technology but we owe just as much to the physiologists who told us about the mechanisms which control breathing, to the radiologists who filmed the collapse of the upper airway during snoring, to the cardiologists who verified the dramatic response of the heart to the suffocating effects of severe snoring and finally to the band of dedicated researchers who would spend months observing the snoring patient from one night to another while the rest of the community slept.
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