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June 19, 1981, Vol 245, No. 23 >
ARTICLE | June 19, 1981

The Detection of Sleep Apnea in the Awake Patient: Title and subTitle BreakThe 'Saw-Tooth' Sign FREE

Mark H. Sanders, MD; Richard J. Martin, MD; Bernard E. Pennock, PhD; Robert M. Rogers, MD
[+] Author Affiliations

Reprint requests to University of Cincinnati Medical Center, Room 7511, Medical Sciences Bldg, Cincinnati, OH 45267 (Dr Sanders).


JAMA. 1981;245(23):2414-2418. doi:10.1001/jama.1981.03310480030021
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References

We studied 21 subjects, 13 of whom had the sleep apnea hypersomnolence syndrome associated with upper airway obstruction during sleep (SAHS-UAO) to determine if "saw-toothing" on the flow-volume loop was significantly associated with the phenomenon of airway occlusion during sleep. A "saw-tooth" pattern was present on the flow-volume loop in 11 of 13 subjects with SAHS-UAO. The presence of saw-toothing correlated with fluttering of tissue that was visualized in the upper airway via the fiberoptic bronchoscope. The specificity of the saw-tooth pattern for SAHS-UAO was 100%. Generalized obesity may indirectly influence the presence of saw-toothing due to deposition of what appeared to be adipose tissue in the pharyngeal walls. Although the number of subjects in this study is small, saw-toothing on the flow-volume loop appears to be an important aid in the diagnosis of SAHS-UAO.

(JAMA 1981;245:2414-2418)

REFERENCES

1 +
Coccagna G, DiDonato G, Veruechi P, et al:  Hypersomnia with periodic apneas in acquired micrognathia . Arch Neurol 1976;;33:769-776.
2 +
Guilleminault C, Eldridge FL, Tilkian A, et al:  Sleep apnea syndrome due to upper airway obstruction . Arch Intern Med 1977;;137:296-300.
3 +
Remmers JE, deGroot WJ, Sauerland EK:  Upper airway obstruction during sleep: Role of the geniglossus, abstracted . Clin Res 1976;;24:33.
4 +
Remmers JE, deGroot WJ, Sauerland EK, et al:  Pathogenesis of upper airway occlusion during sleep . J Appl Physiol 1978;;44:931-938.
5 +
Walsh RE, Michaelson ED, Harkleroad LE, et al:  Upper airway obstruction in obese patients with sleep disturbance and somnolence . Ann Intern Med 1972;;76:185-192.
6 +
Borowiecki B, Pollack CP, Weitzman ED, et al:  Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep apnea syndrome . Laryngoscope 1978;;88:1310-1313.
7 +
Rotman HH, Liss HP, Weg JG:  Diagnosis of upper airway obstruction by pulmonary function testing . Chest 1975;;68:796-799.
8 +
Sackner M:  Assessment of upper airway obstruction . Chest 1972;;62:414-417.
9 +
Empey DW:  Assessment of upper airways obstruction . Br Med J 1972;;3:503-505.
10 +
Miller RD, Hyatt RE:  Obstructing lesions of the larynx and trachea: Clinical and physiologic characteristics . Mayo Clin Proc 1969;; 44:145-161.
11 +
Miller RD, Hyatt RE:  Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops . Am Rev Respir Dis 1973;; 108:475-481.
12 +
Orr WC, Imes NK, Martin RJ:  Progester-one therapy in obesity with sleep apnea . Arch Intern Med 1979;;139:109-111.
13 +
Morris JF, Koski A, Johnson LC:  Spirometric standards for healthy non-smoking adults . Am Rev Respir Dis 1971;;103:57-67.
14 +
Morris JF, Temple WP, Koski A:  Normal values for the ratio of one-second forced expiratory volume to forced vital capacity . Am Rev Respir Dis 1973;;108:1000-1003.
15 +
DuBois AB, Botelho SY, Comroe JH Jr:  A new method for measuring airway resistance in man using a body plethysmograph: Values in normal subjects and in patients with respiratory disease . J Clin Invest 1956;;35:327-335.
16 +
Briscoe WA, DuBois AB:  The relationship between airway conductance and lung volume in subjects of different age and body size . J Clin Invest 1958;;37:1279-1285.
17 +
Statistical Bulletin . Metropolitan Life Insurance Co, 1959;, vol 40, pp 1-4.
18 +
Martin RJ, Pennock BE, Orr WC, et al:  The respiratory system in sleep apnea . J Appl Physiol 1980;;48:432-437.

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1 +
Coccagna G, DiDonato G, Veruechi P, et al:  Hypersomnia with periodic apneas in acquired micrognathia . Arch Neurol 1976;;33:769-776.
2 +
Guilleminault C, Eldridge FL, Tilkian A, et al:  Sleep apnea syndrome due to upper airway obstruction . Arch Intern Med 1977;;137:296-300.
3 +
Remmers JE, deGroot WJ, Sauerland EK:  Upper airway obstruction during sleep: Role of the geniglossus, abstracted . Clin Res 1976;;24:33.
4 +
Remmers JE, deGroot WJ, Sauerland EK, et al:  Pathogenesis of upper airway occlusion during sleep . J Appl Physiol 1978;;44:931-938.
5 +
Walsh RE, Michaelson ED, Harkleroad LE, et al:  Upper airway obstruction in obese patients with sleep disturbance and somnolence . Ann Intern Med 1972;;76:185-192.
6 +
Borowiecki B, Pollack CP, Weitzman ED, et al:  Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep apnea syndrome . Laryngoscope 1978;;88:1310-1313.
7 +
Rotman HH, Liss HP, Weg JG:  Diagnosis of upper airway obstruction by pulmonary function testing . Chest 1975;;68:796-799.
8 +
Sackner M:  Assessment of upper airway obstruction . Chest 1972;;62:414-417.
9 +
Empey DW:  Assessment of upper airways obstruction . Br Med J 1972;;3:503-505.
10 +
Miller RD, Hyatt RE:  Obstructing lesions of the larynx and trachea: Clinical and physiologic characteristics . Mayo Clin Proc 1969;; 44:145-161.
11 +
Miller RD, Hyatt RE:  Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops . Am Rev Respir Dis 1973;; 108:475-481.
12 +
Orr WC, Imes NK, Martin RJ:  Progester-one therapy in obesity with sleep apnea . Arch Intern Med 1979;;139:109-111.
13 +
Morris JF, Koski A, Johnson LC:  Spirometric standards for healthy non-smoking adults . Am Rev Respir Dis 1971;;103:57-67.
14 +
Morris JF, Temple WP, Koski A:  Normal values for the ratio of one-second forced expiratory volume to forced vital capacity . Am Rev Respir Dis 1973;;108:1000-1003.
15 +
DuBois AB, Botelho SY, Comroe JH Jr:  A new method for measuring airway resistance in man using a body plethysmograph: Values in normal subjects and in patients with respiratory disease . J Clin Invest 1956;;35:327-335.
16 +
Briscoe WA, DuBois AB:  The relationship between airway conductance and lung volume in subjects of different age and body size . J Clin Invest 1958;;37:1279-1285.
17 +
Statistical Bulletin . Metropolitan Life Insurance Co, 1959;, vol 40, pp 1-4.
18 +
Martin RJ, Pennock BE, Orr WC, et al:  The respiratory system in sleep apnea . J Appl Physiol 1980;;48:432-437.

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