Single-night studies indicate that hypnotics can worsen obstructive sleep apnea (OSA) in some people and reduce OSA severity in others. However, clinical trial data beyond night 1 is lacking. Accordingly, this study aimed to determine the effects of 1 month of nightly zopiclone on OSA severity and next day sleepiness and alertness in people predicted to yield a reduction in OSA severity with zopiclone (ACTRN12613001106729). Screening polysomnography (PSG) quantified the respiratory arousal threshold (nadir epiglottic pressure prior to arousal) and nadir SaO2 in 69 individuals. 30 eligible OSA patients (AHI =22.4 ± 11.3 events/h sleep) with a low to moderate respiratory arousal threshold (0 to -25cmH2O) and nadir SaO2≥75% then underwent PSG on three occasions at baseline, night 1 and night 30. Participants received either nightly zopiclone (7.5 mg) or placebo during the 30 day trial according to a double-blind, randomized, parallel design. Subjective sleepiness (ESS and KSS) and next day alertness during a 30 minute driving simulator task (AusEd) were performed at each visit. The mean reduction in AHI from baseline on night 30 was 5.9 ± 10.2 during zopiclone vs. 2.4 ± 5.5 events/h sleep during placebo (p=0.2). The change in nadir SaO2 was also not different between zopiclone and placebo (-0.9 ± 3.2 vs. -0.1 ± 5.6 %, p=0.6). Similarly, neither the change in ESS (-1.3 ± 2.7 vs. -0.2 ± 2.4), KSS (0 ± 1.8 vs. 0 ± 1.7) or steering deviation (0.3 ± 4.4 vs. 3.9 ± 10.3 cm) during the AusEd driving task from baseline to night 30 significantly differed between zopiclone vs. placebo (p>0.05). One month of nightly zopiclone does not worsen OSA severity, daytime sleepiness or simulated driving performance in OSA patients with low to moderate respiratory arousal thresholds who do not have major hypoxemia at baseline. These findings challenge previous assumptions about the role of hypnotics in these patients. National Health and Medical Research Council of Australia (1042493).

Upper airway muscles are important in maintaining airway patency. Visualization of their dynamic motion should allow measurement, comparison, and further understanding of their roles in healthy subjects and those with upper airway disorders. Currently, there are few clinically feasible real-time imaging methods. Methods such as tagged magnetic resonance imaging have documented movement of genioglossus (GG), the largest upper airway dilator. Inspiratory movement was largest in the posterior region of GG. This study aimed to develop a novel ultrasound (US) method to measure GG movement in real time. We tested 20 healthy, awake subjects (21-38 yr) breathing quietly in the supine posture with the head in a neutral position. US images were collected using a transducer positioned submentally. Image correlation analysis measured regional displacement of GG within a grid of points in the midsagittal plane throughout the respiratory cycle. Typically, motion began before inspiratory flow in an anteroinferior direction and peaked in midinspiration. Average peak displacements of the anterior, posterior, superior, and inferior grid points were 0.44 ± 0.23 (mean ± SD), 0.57 ± 0.35, 0.38 ± 0.20, and 0.62 ± 0.41 mm, respectively. Largest displacements occurred in the most inferoposterior part (0.70 ± 0.48 mm). This method had good intrarater repeatability within the same testing session, as well as across sessions. We have devised a simple noninvasive US method, which should be a useful tool to assess GG movement in normal subjects and those with sleep-disordered breathing.

Medical Journal of AustraliaVolume 196, Issue 1 p. 38-38 Letter Prevalence and characteristics of complaint-prone doctors in private practice in Victoria Matt Vance, Corresponding Author Matt Vance Manager, Quality Monitoring, Quality Services info@hqcc.qld.gov.au Health Quality and Complaints Commission, Brisbane, QLD.Correspondence: info@hqcc.qld.gov.auSearch for more papers by this authorMichael Ward, Michael Ward Commissioner Health Quality and Complaints Commission, Brisbane, QLD.Search for more papers by this authorDavid McKenzie, David McKenzie Manager, Investigations Health Quality and Complaints Commission, Brisbane, QLD.Search for more papers by this author Matt Vance, Corresponding Author Matt Vance Manager, Quality Monitoring, Quality Services info@hqcc.qld.gov.au Health Quality and Complaints Commission, Brisbane, QLD.Correspondence: info@hqcc.qld.gov.auSearch for more papers by this authorMichael Ward, Michael Ward Commissioner Health Quality and Complaints Commission, Brisbane, QLD.Search for more papers by this authorDavid McKenzie, David McKenzie Manager, Investigations Health Quality and Complaints Commission, Brisbane, QLD.Search for more papers by this author First published: 16 January 2012 https://doi.org/10.5694/mja11.10963Read the full textAboutRelatedInformationPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessClose modalShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume196, Issue1January 2012Pages 38-38 RelatedInformation RecommendedFitness‐to‐practise policies in Australian medical schools — are they fit for purpose?Paul M McGurgan MB BCh, MRCOG, FRANZCOG, Debbie Olson-White, Marie Holgate, Di Carmody RM, MPH, Medical Journal of AustraliaDefining remote medical practiceJanie D Smith MPHC, EdD, Stephen A Margolis DRANZCOG, FRACGP, FACRRM, Jeff Ayton AFFTM, DRANZCOG, DA, Victoria Ross MB BS, FRACGP, MPHTM, Elizabeth Chalmers FACRRM, ACRRM, AFPHM, Patrick Giddings FACRRM, FRACGP, DRANZCOG, Louise Baker FRACGP, DRANZOC, DCH, Martin Kelly MB BS, PhD, Catherine Love MB, FACRRM, FRACGP, Medical Journal of AustraliaPrevalence and characteristics of complaint‐prone doctors in private practice in VictoriaJohn A Buntine, Medical Journal of AustraliaPrevalence and characteristics of complaint‐prone doctors in private practice in VictoriaMarie M Bismark MB ChB, LLB, MBHL, Matthew J Spittal BSc(Hon), PhD, David M Studdert LLB, ScD, MPH, Medical Journal of AustraliaHumanising doctors: what can the medical humanities offer?J Jill Gordon MPsychMed, PhD, FRACGP, Medical Journal of Australia

Background -Toincrease thesensitivity ofmeasurements ofmaximalinspiratory pressure (MIP)asa testofinspiratory musclestrength andendurance, software wasdeveloped tocorrect forvariation in lungvolume. Methods-Usingabodyplethysmograph todetermine absolute lungvolumeduring eachmanoeuvre, values forMIPwereexpressed asa percentage ofthepressure expected fromtheunfatigued MIP/lung volumerelation ineachsubject. Results -Themethodreduced thevariance inpeakandaveragepressure duringa series of18MIPmanoeuvres of10seconds duration separated byrestintervals of10 seconds. Conclusions -Thecorrelation between averagepressure andcontraction number wasimproved significantly bytheMIPI lungvolumecorrection. Thissimple correction hasmanyapplications inmeasurementsoftheMIP. (Thorax 1995;50:230-234)