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a Department
of Respiratory Medicine, Sleep Laboratory and PRETA Laboratory, CHRU,
Grenoble, France, b Respiratory Department, Bristol Royal Infirmary,
Bristol, UK
Correspondence to: Professor PA Levy, EFCR, Pneumologie, Rez-de-chaussée-haut, CHRU, 38043 Grenoble, Cedex 9, France.
Received 29 July 1998; Returned to authors 23 October 1998; Revised version received 1 December 1998; Accepted for publication 2 December 1998
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Introduction |
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Current techniques for investigating patients with suspected
sleep disordered breathing are inadequate. Not only are many of the
tests expensive, but they are also cumbersome and many centres require
these investigations to be performed in the sleep laboratory. At the
heart of the problem is the difficulty in identifying and quantifying
the spectrum of respiratory events responsible for the sleep
fragmentation and disabling excessive daytime sleepiness that is
characteristic of obstructive sleep apnoea and its related conditions.
Obstructive apnoeic episodes are not usually difficult to detect, even
when only a basic measure of respiratory effort such as thoracic and
abdominal movement is used. On the other hand, correctly identifying
obstructive hypopnoeas and episodes of upper airway resistance needs a
sensitive measure of airflow and inspiratory effort. The measurement of
swings in pleural pressure by oesophageal manometry is the current gold
standard technique for detecting changes in inspiratory effort.
However, the
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