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Changsiripun C, Chirakalwasan N, Dias S, McDaid C. Management of primary snoring in adults: A scoping review examining interventions, outcomes and instruments used to assess clinical effects. Sleep Med Rev 2024; 77:101963. [PMID: 38889620 DOI: 10.1016/j.smrv.2024.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/30/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
While various treatment options for primary snoring are available, evidence-based recommendations to determine the optimal intervention remain unestablished. To inform future directions of research to guide clinical decision-making, this scoping review was conducted to map the existing evidence on interventions for primary snoring, the outcomes and instruments used to assess their clinical effects in adults. The feasibility of conducting further systematic reviews and comparing outcomes across these therapies using network meta-analysis was also assessed. Of the 1673 records identified, 38 interventional studies met the inclusion criteria with three-fifths of them being before-after studies. The most common reason for study exclusion was results being reported for patients with primary snoring and obstructive sleep apnoea (OSA) combined. Interventions were surgical (73 %), behavioural and the use of devices/medications. Twenty-six common outcomes were identified and categorised into six domains. Fifty-nine instruments were used to assess the outcomes and based mainly on non-validated questionnaires. Our findings indicated (1) the need for randomised controlled trials with strict discrimination between patients with primary snoring and OSA, (2) further network meta-analyses using some outcomes is feasible, and (3) a core outcome set to inform standardised reporting for future research should be developed.
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Affiliation(s)
- Chidsanu Changsiripun
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; Department of Health Sciences, University of York, York, UK.
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Martinovic D, Tokic D, Puizina-Mladinic E, Kadic S, Lesin A, Lupi-Ferandin S, Kumric M, Bozic J. Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea-A Narrative Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010142. [PMID: 36676088 PMCID: PMC9866782 DOI: 10.3390/life13010142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina-Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-557-871
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Hema D, Prasanna JS. Radiosurgery in periodontics: Have we forgotten it? J Indian Soc Periodontol 2021; 25:6-10. [PMID: 33642734 PMCID: PMC7904008 DOI: 10.4103/jisp.jisp_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/15/2020] [Accepted: 07/16/2020] [Indexed: 11/12/2022] Open
Abstract
Radiosurgery (RS) has evolved from electrosurgery and uses ultra-high-frequency radio waves at a frequency ranging from 3 to 4 MHz. It is used to address numerous soft-tissue concerns in dentistry and as well as medicine with excellent and predictable results. A review of the indexed literature disclosed that RS has been employed for various periodontal procedures such as gingivectomy, gingivoplasty, crown lengthening, minimally invasive closed osteotomy, frenectomies, operculectomies, depigmentation, gingival curettage, periodontal flap procedures, mucogingival surgeries, harvesting soft-tissue grafts, and also in implantology. Reduced lateral heat production with minimal tissue damage, faster healing, availability of specialized electrodes, increased perception, and cost-effectiveness are some of the notable advantages of RS. The evidence available implies that RS when used appropriately might be a better and economical alternative to a scalpel, electrosurgery, and laser. Inadequate knowledge on the use of this treatment modality due to short of research conducted in this area could be the reason behind it becoming obsolete. This review is an attempt to reminiscence the uses of this versatile tool in periodontal therapy and reinstate its use in present-day clinical practice.
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Affiliation(s)
- Duddukuri Hema
- Department of Periodontics, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
| | - Jammula Surya Prasanna
- Department of Periodontics, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India
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Hofauer B, Braumann B, Heiser C, Herzog M, Maurer JT, Plößl S, Sommer JU, Steffen A, Verse T, Stuck BA. Diagnosis and treatment of isolated snoring-open questions and areas for future research. Sleep Breath 2020; 25:1011-1017. [PMID: 32623557 PMCID: PMC8195801 DOI: 10.1007/s11325-020-02138-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVES Snoring is a common phenomenon which is generated by vibration of soft tissue of the upper airway during sleep. Due to the high incidence of isolated snoring and the substantial burden for the patient and the bed partner, a thorough examination and appropriate therapy are required. Many recommendations for the treatment of isolated snoring are either not evidence-based or are derived from recommendations for the management of obstructive sleep apnea. Therefore, the aim of this study is the identification and description of open questions in the diagnosis and treatment of isolated snoring and the illustration of areas for further research. METHODS In the context of the development of the new version of the German guideline "Diagnosis and treatment of isolated snoring in adults," a multidisciplinary team of experts performed a systematic literature search on the relevant medical data and rated the current evidence regarding the key diagnostic and therapeutic measures for snoring. RESULTS The systematic literature review identified 2293 articles. As a major inclusion criterion, only studies on primary snoring based on objective sleep medical assessment were selected. After screening and evaluation, 33 full-text articles remained for further analysis. Based on these articles, open questions and areas for future research were identified for this review. CONCLUSION Several major gaps in the literature on the diagnosis and treatment of isolated snoring were identified. For the majority of diagnostic and therapeutic measures for snoring, high-level scientific evidence is still lacking.
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Affiliation(s)
- B Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Freiburg, Killianstr. 5, 79106, Freiburg, Germany. .,Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
| | - B Braumann
- Department of Maxillofacial Surgery/Orthodontics, University of Cologne, Cologne, Germany
| | - C Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - M Herzog
- Department of Otorhinolaryngology/Head and Neck Surgery, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J T Maurer
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - S Plößl
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Halle, Halle, Germany
| | - J U Sommer
- Department of Otorhinolaryngology/Head and Neck Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - A Steffen
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - T Verse
- Department of Otorhinolaryngology/Head and Neck Surgery, Asklepios Hospital Hamburg Harburg, Hamburg, Germany
| | - B A Stuck
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Marburg, Philipps-Universit Marburg, Marburg, Germany
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Yaremchuk K. Why and When to Treat Snoring. Otolaryngol Clin North Am 2020; 53:351-365. [PMID: 32336469 DOI: 10.1016/j.otc.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is estimated that half of the adult population older than 60 years snores. This article discusses the many aspects of snoring, including impacts on bed partners, the individual who snores, and when and how to appropriately evaluate, diagnose, and treat the perpetrator. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of the phenomenon of snoring.It is estimated that half of the adult population over the age of 60 years of age snores. This chapter discusses snoring, including the impact on bed partners, the individual that snores and when and how to treat the snorer. The goal is for clinicians to expand their knowledge regarding diagnosis and treatment of patients who snores.
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Affiliation(s)
- Kathleen Yaremchuk
- Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Patel V, Ritchie CA, Padula C, McKinney JM. Radiofrequency Ablation, Where It Stands in Interventional Radiology Today. Semin Intervent Radiol 2019; 36:398-404. [PMID: 31798214 PMCID: PMC6887522 DOI: 10.1055/s-0039-1697945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Radiofrequency ablation (RFA) is one of the first developed minimally invasive definitive cancer therapies. The safety and efficacy of RFA is well documented and has led to its incorporation into multiple international societal guidelines. By expanding on the body of knowledge acquired during the clinical use of RFA, alternative ablative technologies have emerged and are successfully competing for locoregional therapy market share. The adaption of newer ablative technologies is leading to a rapid decline in the utilization of RFA by interventional radiologists despite the lack of proven superiority. In their 2010 article, Hong and Georgiades stated "… RFA is likely to remain the mainstay of ablations for small tumors until sufficient experience emerges for the widespread acceptance for alternative ablative modalities." Within a decade of this publication, has this time arrived?
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Affiliation(s)
| | | | - Carlos Padula
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
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S3-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-0211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Patel A, Kotecha B. MinimallyInvasive Radiofrequency Surgery in Sleep-Disordered Breathing. Healthcare (Basel) 2019; 7:healthcare7030097. [PMID: 31426606 PMCID: PMC6787708 DOI: 10.3390/healthcare7030097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed.
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Affiliation(s)
- Ankit Patel
- ENT Department, Queen's Hospital, Romford RM7 0AG, UK.
| | - Bhik Kotecha
- ENT Department, Queen's Hospital, Romford RM7 0AG, UK
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Soft Palate Modification Using a Collagen Crosslinking Reagent for Equine Dorsal Displacement of the Soft Palate and Other Upper Airway Breathing Disorders. Int J Biomater 2019; 2019:9310890. [PMID: 31057624 PMCID: PMC6463583 DOI: 10.1155/2019/9310890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Abstract
The mechanical properties of the soft palate can be associated with breathing abnormalities. Dorsal displacement of the soft palate (DDSP) is a naturally occurring equine soft palate disorder caused by displacement of the caudal edge of the soft palate. Snoring and a more serious, sometimes life-threatening, condition called obstructive sleep apnea (OSA) are forms of sleep-related breathing disorders in humans which may involve the soft palate. The goal of this study was to investigate the effect of injecting the protein crosslinker genipin into the soft palate to modify its mechanical properties for the treatment of equine DDSP with potential implications for the treatment of snoring and OSA in humans. Ex vivo experiments consisted of mechanical testing and a wind tunnel study to examine the effect of genipin on the mechanical properties, displacement, and vibration of equine soft palates. A pilot in vivo study was completed using DDSP and control horses to test the safety and effectiveness of injecting a genipin reagent into the soft palate. The wind tunnel testing demonstrated a greater than 50% decrease in transient deformation and a greater than 33% decrease in steady-state vibrations for all doses of genipin tested. Ultimate tensile stress, yield stress, and Young's modulus were higher in the genipin-treated distal soft palate specimens by 52%, 53%, and 63%, respectively. The pilot in vivo study showed a reduction of snoring loudness in all DDSP horses and elimination of DDSP in at least one of three horses. The difficulty of using a 1-meter-long endoscopic injection needle contributed to a consistent overinjection of the equine soft palates, causing excessive stretching (pillowing) and related degradation of the tissue. These ex vivo and in vivo results demonstrated reduced vibration amplitude and flaccidity and increased strength of genipin-treated soft palates, suggesting that genipin crosslinking could become an effective and safe treatment for soft palate related breathing abnormalities.
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12
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Wang Z, Zhang Y, Ye Y, Yao W, Xu Z, Xia Z, Wang S, Zhou C. Clinical efficacy of low-temperature radiofrequency ablation of pharyngolaryngeal cyst in 84 Chinese infants. Medicine (Baltimore) 2017; 96:e8237. [PMID: 29095253 PMCID: PMC5682772 DOI: 10.1097/md.0000000000008237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of the study is to investigate the advantages and disadvantages of low-temperature radiofrequency ablation of pharyngolaryngeal cyst.The study population was composed of 84 children diagnosed with pharyngolaryngeal cyst who underwent surgical treatment at the Department of Otolaryngology, Wuhan Children's Hospital, Wuhan, China, between January 1984 and December 2013. All patients were operated using a self-retaining laryngoscope and were divided into 3 groups: traditional cystectomy group (N = 9), dynamic cutting system group (N = 18), and low-temperature radiofrequency ablation group (N = 57). Clinical outcomes were analyzed to assess the efficacy of low-temperature radiofrequency ablation in treatment of pharyngolaryngeal cyst.Compared with traditional cystectomy group or dynamic cutting system group, operation time was shorter, bleeding was less and one-year recurrence rate was much lower in low-temperature radiofrequency ablation group. However, operation time and bleeding was not statistically different between traditional cystectomy and dynamic cutting system group.Low-temperature radiofrequency ablation may be an effective substitute for treating pharyngolaryngeal cyst.
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Affiliation(s)
- Zhinan Wang
- Department of Otolaryngology, Wuhan Pleiades ENT Hospital
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Yamin Zhang
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Yuhua Ye
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Wei Yao
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Zhongqiang Xu
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Zhongfang Xia
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Shufen Wang
- Department of Otolaryngology, Wuhan Children's Hospital, Wuhan
| | - Chengyong Zhou
- Department of Otolaryngology, First Affiliated Hospital of PLA General Hospital, China
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Vallejo-Balen A, Zabala-Parra SI, Amado S. Tratamiento quirúrgico por otorrinolaringología en el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) se caracteriza por la obstrucción parcial o el colapso total de la vía aérea superior, de manera intermitente y repetitiva, por lo que, en un principio, se vio el manejo quirúrgico como una alternativa curativa para esta patología. Sin embargo, en la actualidad se reconoce que la cirugía, aun sin lograr tasas de efectividad muy altas de manera consistente, sí mejora la tolerancia y adaptación a la terapia de presión positiva, la cual sigue siendo la primera línea de manejo.Así, el primer paso antes de pensar en cualquier procedimiento quirúrgico es un adecuado diagnóstico topográfico, de modo que siempre se debe realizar una nasofibrolaringoscopia para identificar el o los sitios de obstrucción. Además, se sabe que el 75% de los pacientes presentan obstrucciones en múltiples niveles y que, cuando el abordaje se hace multinivel, se logra corregir el SAHOS hasta en un 95%. Entre los procedimientos vigentes se encuentran cirugías de nariz, paladar blando, amígdalas, base de lengua, estimulación del nervio hipogloso y procedimientos del esqueleto facial, así como procedimientos coadyuvantes, entre los que están radiofrecuencia e implantes de paladar.
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Long-term results of a modified expansion sphincter pharyngoplasty for sleep-disordered breathing. Eur Arch Otorhinolaryngol 2016; 274:1665-1670. [DOI: 10.1007/s00405-016-4395-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Sinkkonen ST, Ruohoalho J, Pietarinen P, Aaltonen LM, Mäkitie AA, Bäck LJ. Limited long-term outcome of single-session soft palate interstitial radiofrequency surgery for habitual snoring in tertiary care academic referral centre: Our experience on 77 patients. Clin Otolaryngol 2016; 42:470-473. [PMID: 26865418 DOI: 10.1111/coa.12632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Ruohoalho
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Pietarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L-M Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology Karolinska Institutet, Stockholm, Sweden
| | - L J Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Abstract
Snoring and obstructive sleep apnoea (OSA) are disorders within a wide spectrum of sleep-related breathing disorders (SRBD). Given the obesity epidemic, these conditions will become increasingly prevalent and continue to serve as a large economic burden. A thorough clinical evaluation and appropriate investigations will allow stratification of patients into appropriate treatment groups. A multidisciplinary team is required to manage these patients. Patient selection is critical in ensuring successful surgical and non-surgical outcomes. A wide range of options are available and further long term prospective studies, with standardised data capture and outcome goals, are required to evaluate the most appropriate techniques and long term success rates.
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Affiliation(s)
- Jagdeep S Virk
- Department of Otolaryngology-Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | - Bhik Kotecha
- Department of Otolaryngology-Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
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Terryn S, De Medts J, Delsupehe K. Comparative Effectiveness of the Different Treatment Modalities for Snoring. Otolaryngol Head Neck Surg 2015. [DOI: 10.1177/0194599815596166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate what effects treatments of sleep-disordered breathing have on snoring and sleepiness: snoring surgery including osteotomies, mandibular advancement device (MAD), and continuous positive airway pressure (CPAP). Study Design Single-institution prospective comparative effectiveness trial. Setting University-affiliated secondary care teaching hospital. Subjects and Methods We prospectively studied 224 patients presenting with snoring at our department. All patients underwent detailed evaluation, including symptom questionnaires, clinical examination, polysomnography, and drug-induced sleep endoscopy. Based on these results, a treatment was proposed after multidisciplinary consultation. Treatment was evaluated through 4 questionnaires before treatment and 6 weeks and 6 months after. Treatment success was defined as a global snoring visual analog scale score ≤3 at 6 months. Results A total of 195 patients complied with full workup and were proposed treatment. The mean age was 46 ± 11 years; the mean body mass index, 27 ± 4; and the median apnea-hypopnea index, 10.0 (interquartile range, 4.7-20.1). After discussion, 116 (59.5%) patients agreed to start treatment (46%, surgery; 26% MAD; 28% CPAP). All symptom scores, including Epworth Sleepiness Scale, decreased significantly for all treatments at 6 weeks and 6 months. Treatment was successful in 67% of the surgery patients, 67% of the MAD group, and 76% of the CPAP group. Only 6.7% reported an unchanged snoring score in the surgery group, compared with 13.6% in the MAD group and 9.6 % in the CPAP group. Conclusion Multidisciplinary agreed-on treatment of snoring is effective across the proposed treatments.
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Affiliation(s)
- Stefanie Terryn
- ENT Department, AZ Delta, Roeselare, Belgium
- ENT Department, University Hospitals Leuven, Leuven, Belgium
| | - Joris De Medts
- ENT Department, AZ Delta, Roeselare, Belgium
- ENT Department, University Hospitals Leuven, Leuven, Belgium
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An absorbable thread suture technique to treat snoring. Eur Arch Otorhinolaryngol 2015; 273:1173-8. [DOI: 10.1007/s00405-015-3722-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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The treatment of snoring by radiofrequency-assisted uvulopalatoplasty and results after one-session protocol: a prospective, longitudinal, non-randomized study. Eur Arch Otorhinolaryngol 2015; 272:3059-63. [PMID: 25837987 DOI: 10.1007/s00405-015-3617-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Snoring is usually caused by the vibration of walls of the soft palate at the pharyngeal level. Its worldwide prevalence is estimated to range between 2 and 85% depending on age, gender or population group. The aim of this study is to determine the degree of improvement that can be subjectively evident in patients treated by snoring with radiofrequency-assisted uvulopalatoplasty based on a one-session protocol. This is a prospective, longitudinal, non-randomized study. Patients of both sexes, aged 18 years, who attended to the ENT consultation in a tertiary hospital with snoring during the period of July 2012-July 2013 were included. Age, body mass index, Epworth sleepiness scale were calculated. The volume of snoring of each subject was assessed using a visual analog scale. A total of 27 patients were included in the study; the average age of the sample was 49 years (±8.7; min 36/max 74); of these 22 (81.5%) were male and 5 (18.5%) females. The average BMI was 27.07 ± 2.5 (min 23.15/max 29.39) before the test and after 1 year was 26.75 ± 2.32 (min 23.11/max 29.56) with no statistically significant differences in BMI before and after surgery (p = 0.407). Preoperative snoring intensity was 8.10 ± 0.93 according to VAS. We found a statistically significant difference in the post-operative intensity at 3 months of 3.93 ± 0.88 (p ≤ 0.05) at 6 months of 4.41 ± 1.08 (p ≤ 0.05), and after 1 year 4.90 ± 0.77 (p ≤ 0.05). The average rate of ESS was significantly higher preoperatively than post-operative, being 8.76 ± 3.1 preoperative and 6.93 ± 1.68 post-operative (p ≤ 0.05). We conclude that the use of radiofrequency in simple snorers with an apnea/hypopnea index <15 events per hour and a BMI < 30 kg/m(2) in whom clinically proven that the source of snoring is the soft palate, can be treated by one-session protocol, being possible to obtain an improvement of snoring up to 70% of cases by a short follow-up period.
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The National Institute for Health and Clinical Excellence, and otolaryngology: review of the evidence. The Journal of Laryngology & Otology 2014; 128:2-12. [PMID: 24507798 DOI: 10.1017/s0022215113003204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The adoption of evidence-based practice is fundamental to good medical care; it ensures that intervention is clinically effective and safe. In a world of limited healthcare resources, consideration of cost-effectiveness must, unfortunately, restrict clinicians' choice. The National Institute for Health and Clinical Excellence has, for over 10 years, developed guidance to achieve a national consensus on best practice. OBJECTIVES This review describes the Institute's methodology, examines guidance relevant to otolaryngology and presents more recent research to update the evidence.
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Holmlund T, Levring-Jäghagen E, Franklin KA, Lindkvist M, Berggren D. Effects of Radiofrequency versus sham surgery of the soft palate on daytime sleepiness. Laryngoscope 2014; 124:2422-6. [PMID: 24390800 DOI: 10.1002/lary.24580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the effect of radiofrequency surgery of the soft palate on daytime sleepiness in snoring men with mild or no sleep apnea. STUDY DESIGN Randomized controlled trial. METHODS Thirty-five men were recruited from consecutive patients referred to the Ear, Nose, and Throat Clinic due to snoring and complaints of daytime sleepiness. The inclusion criteria were an apnea-hypopnea index (AHI) of ≤ 15, male gender, and age 18 to 65 years. Patients were randomized to either radiofrequency or sham surgery of the soft palate. All but one chose and received the option of three treatments. All patients participated in a follow-up, including an overnight sleep apnea recording and questionnaires 12 months after the last treatment. The primary outcome was daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) and other questionnaires. Secondary outcomes were effects on the AHI and subjective snoring. RESULTS Thirty-two of 35 patients-19 of 20 patients in the radiofrequency surgery group and 13 of 15 patients in the sham surgery group-completed the study. No differences between the two groups in relation to the ESS or AHI were found at follow-up. CONCLUSION Radiofrequency surgery of the soft palate has no effect on daytime sleepiness, snoring, or apnea frequency in snoring men with mild or no sleep apnea 1 year after surgery. LEVEL OF EVIDENCE 1b. Laryngoscope 124:2422-2426, 2014.
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Affiliation(s)
- Thorbjorn Holmlund
- Department of Otorhinolaryngology, Umeå School of Business and Economics, Sweden
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Virk JS, Kumar G, Al-Okati D, Kotecha B. Radiofrequency ablation in snoring surgery: local tissue effects and safety measures. Eur Arch Otorhinolaryngol 2014; 271:3313-8. [PMID: 24970292 DOI: 10.1007/s00405-014-3152-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 06/12/2014] [Indexed: 11/29/2022]
Abstract
Radiofrequency ablation is now widely used in the treatment of patients with snoring and obstructive sleep apnoea. It is well suited to the multilevel approach typically required in snoring surgery and can be used interstitially or in cutting mode. However, no research has been performed to analyse the collateral local tissue damage or size of lesions induced by radiofrequency application. This is the first study of the histological effects of interstitial radiofrequency. We studied the size of tissue lesions generated at differing power settings with and without local anaesthetic application in human tonsils and chicken breast tissue. The size of the lesion was independent of power setting and local anaesthetic infiltration. The typical effect was an oval-shaped lesion centred on the active electrode, 6-7 mm in width and 7-8 mm in length. This was confirmed histopathologically, with smaller lesions generated in the submucosa (2 × 3 mm) but with no collateral tissue damage beyond this distinct zone of injury. To avoid complications, we recommend placing contiguous radiofrequency applications at least 8 mm apart. Post-nasal space packing raises and tautens the soft palate. The use of local anaesthetic increases interstitial volume, thereby reducing the risk of incorrect probe placement and resultant ulceration or fistulation.
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Affiliation(s)
- Jagdeep Singh Virk
- ENT Department, Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK,
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Balsevičius T, Uloza V, Sakalauskas R, Miliauskas S, Jarutienė I. Efficacy of radiofrequency treatment of the soft palate for patients with mild to moderate obstructive sleep apnea hypopnea syndrome: treatment protocol with nine lesions to the soft palate. Sleep Breath 2014; 19:1003-9. [PMID: 24839238 DOI: 10.1007/s11325-014-1004-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed at assessing the efficacy and safety of a radiofrequency treatment (RFT) protocol with nine lesions to the soft palate in the treatment of mild to moderate obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS Twenty-eight mild to moderate OSAHS patients underwent two sessions of RFT (CelonLab ENT system) at the palatal level within the interval from 6 to 8 weeks. Nine lesions (power setting of 10 W) were made per session. The baseline and posttreatment polysomnography and clinical tests battery consisting of visual analogue scales (VAS), Sleep Apnea Quality of Life Index (SAQLI), Beck Depression Inventory--second edition (BDI-II), and Epworth sleepiness scale (ESS) were applied to assess the RFT outcomes. RESULTS Mild to moderate OSAHS patients demonstrated statistically significantly reduced posttreatment mean VAS values for most of the OSAHS-related complaints. A significant improvement in sleepiness (ESS score 6.7 ± 3.7 vs 8.5 ± 4.1, p < 0.01), depressivity (BDI-II score 7.5 ± 6.5 vs 13.1 ± 11.7, p < 0.01), and health-related quality of life (SAQLI score 5.3 ± 0.8 vs 4.7 ± 0.9, p < 0.01) was observed after the RFT. The mean AHI decreased from 13.7 ± 5.9 to 8.3 ± 4.9 points (p < 0.01) in the entire group of patients. According to Sher's criteria of success, 17 out of 28 (60.7 %) patients improved after RFT. No major complications were noted with RFT. CONCLUSIONS RFT protocol with nine lesions to the soft palate seems to be an effective and safe treatment modality associated with low morbidity in selected mild to moderate OSAHS patients.
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Affiliation(s)
- Tomas Balsevičius
- Department of Otolaryngology, Lithuanian University of Health Sciences, Eivenių 2, Kaunas, 50009, Lithuania,
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Lee LA, Yu JF, Lo YL, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY. Comparative effects of snoring sound between two minimally invasive surgeries in the treatment of snoring: a randomized controlled trial. PLoS One 2014; 9:e97186. [PMID: 24816691 PMCID: PMC4016275 DOI: 10.1371/journal.pone.0097186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 04/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Minimally invasive surgeries of the soft palate have emerged as a less-invasive treatment for habitual snoring. To date, there is only limited information available comparing the effects of snoring sound between different minimally invasive surgeries in the treatment of habitual snoring. Objective To compare the efficacy of palatal implant and radiofrequency surgery, in the reduction of snoring through subjective evaluation of snoring and objective snoring sound analysis. Patients and Method Thirty patients with habitual snoring due to palatal obstruction (apnea-hypopnea index ≤15, body max index ≤30) were prospectively enrolled and randomized to undergo a single session of palatal implant or temperature-controlled radiofrequency surgery of the soft palate under local anesthesia. Snoring was primarily evaluated by the patient with a 10 cm visual analogue scale (VAS) at baseline and at a 3-month follow-up visit and the change in VAS was the primary outcome. Moreover, life qualities, measured by snore outcomes survey, and full-night snoring sounds, analyzed by a sound analytic program (Snore Map), were also investigated at the same time. Results Twenty-eight patients completed the study; 14 received palatal implant surgery and 14 underwent radiofrequency surgery. The VAS and snore outcomes survey scores were significantly improved in both groups. However, the good response (postoperative VAS ≤3 or postoperative VAS ≤5 plus snore outcomes survey score ≥60) rate of the palatal implant group was significantly higher than that of the radiofrequency group (79% vs. 29%, P = 0.021). The maximal loudness of low-frequency (40–300 Hz) snores was reduced significantly in the palatal implant group. In addition, the snoring index was significantly reduced in the radiofrequency group. Conclusions Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures of subjective and objective snoring. Multi-stage radiofrequency surgery was not tested. Trial Registration ClinicalTrials.gov NCT01955083
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.; Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, Fujian Province, China
| | - Jen-Fang Yu
- Graduate Institute of Medical Mechatronics, Taiouan Interdisciplinary Otolaryngology Laboratory, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Yu-Lun Lo
- Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.; Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Ning-Hung Chen
- Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.; Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Wen-Nuan Cheng
- Graduate School of Recreation and Sports Management, Taipei Physical Education College, Taipei, Taiwan, R.O.C
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R.O.C.; Sleep Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C
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Multilevel radiofrequency ablation to the soft palate and tongue base: tips and pitfalls. Eur Arch Otorhinolaryngol 2013; 271:1809-13. [PMID: 24337879 DOI: 10.1007/s00405-013-2858-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
The objective of the study is to increase awareness and understanding of the techniques and safety measures to minimise complications and improve patient outcomes. Literature review using MedLine and keywords snoring; obstructive sleep apnoea; radiofrequency ablation; electrosurgery; palate; tongue base was conducted. There is no accepted gold standard technique for radiofrequency ablation; to date, there is no published literature regarding common tips and pitfalls in radiofrequency application specifically for superficial applications and second-stage surgery. Surgery for snoring and obstructive sleep apnoea is typically multilevel. Pre-operative patient assessment and selection are critical to ensure good outcomes. Radiofrequency is generally safe and efficacious in this subset of patients. However, as with all surgery, it is operator-dependent. In particular, we emphasise the methodology for second-stage surgery, optimising visualisation and avoiding ulceration/fistulation of the soft palate, which are previously undescribed in the literature.
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Abstract
Obstructive sleep apnea (OSA) is a disease characterized by intermittent and repetitive narrowing of the airway during sleep. Surgical therapies for the treatment of OSA aim to improve airway patency by addressing selected site(s) of obstruction. Because several areas may each be responsible for the narrowing, different surgical modalities have also been developed. In this review, we give an overview of surgery for each of potential obstruction site(s). As a consequence of the multi-factorial and heterogeneous etiology of OSA, surgical therapies need to be selected and performed specifically for each patient, as there is no perfect surgery that will fit all patients. As with any other treatment modalities for OSA, surgical therapies have variable efficacy, but are a very important tool on OSA management in selected patients and have been shown effectiveness in decreasing the morbidity and mortality associated with the disease.
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Affiliation(s)
- Bettina Carvalho
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5739 USA
| | - Jennifer Hsia
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5739 USA
| | - Robson Capasso
- Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA 94305-5739 USA
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Landes CA, Weichert F, Steinbauer T, Schröder A, Walczak L, Fritsch H, Wagner M. Letter to the editor. Cleft Palate Craniofac J 2012; 50:124-5. [PMID: 22909220 DOI: 10.1597/12-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Constantin A Landes
- Adjunct Professor, Department of Oral, Maxillofacial and Plastic Facial Surgery, Cleft Centre, Goethe University, Frankfurt am Main, Germany
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Krespi YP, Kizhner V. Palatal stiffening via transoral, retrograde interstitial laser coagulation. SURGICAL TECHNIQUES DEVELOPMENT 2011. [DOI: 10.4081/std.2011.e23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Current treatment modalities for snoring may include mucosal removal, coblation or radiofrequency palatoplasty, injection snoreplasty and placement of palatal implants with described disadvantages. We introduce a new laser assisted method avoiding intraoral injury. A pilot study treating 13 loud snorers having an RDI<8 was conducted. A diode laser coupled to a flexible fiberand a handle with curved needle was used. The fiber was introduced into the nasal surface of soft palate between palatoglossal and glossopharyngeal arches and advanced progressively anteriorly after pulling the uvula forward three times to create palatal scarring and stiffening. All responded to a phone survey. Six patients reported significant improvement, 4 had some improvement, 2 had mild improvement and one patient had no change. Pain score was moderate for 3 patients while the rest had mild pain. The laser harbors many advantages over other methods. Results with this technique are encouraging further studies.
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Amorós-Sebastiá LI. Radiofrequency Treatment in Simple Snoring: Tolerance, Safety and Results. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011. [DOI: 10.1016/j.otoeng.2011.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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[Radiofrequency treatment in simple snoring: tolerance, safety and results]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2011; 62:300-5. [PMID: 21531359 DOI: 10.1016/j.otorri.2011.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Snoring is a non-pathologic social problem. In the search for non-aggressive efficacious treatment, we introduce our experience in using temperature-controlled radiofrequency treatment for snoring. METHODS A 6-month follow-up revision of thirty-seven patients that received a mean of 1.1 radiofrequency treatment sessions at turbinates, soft palate, tonsils and/or tongue-base. RESULTS Mean sample age was 39.6+-9 years; mean BMI was 29.5±4. Good tolerance was presented by 78% of our patients, 78% had no postoperative pain complaints and 68.3% no postoperative symptoms a week after procedure. Minor complications (mainly mucosal breakdown) were presented by 14.6% of the patients. The snoring score went from a mean of 8.6 to 5.6 on the visual analogue scale; 86.5% of the patients improved their clinical snoring and 37.8% were cured of it. Epworth daytime somnolence test results went from mean 9.3 to 6.1. CONCLUSIONS Radiofrequency is a procedure that is safe, well-tolerated and fairly painless postoperatively, effective in improving clinical snoring in simple snorers. Radiofrequency is an effective primary treatment for snoring whose cause is accessible to radiofrequency.
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The impact of pretreatment assessment of oropharynx on interstitial soft palate radiofrequency surgery outcome—a multi-center study in patients with habitual snoring. Sleep Breath 2011; 16:199-204. [DOI: 10.1007/s11325-011-0490-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/04/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
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Oliven A, Kaufman E, Kaynan R, Oliven R, Steinfeld U, Tov N, Odeh M, Gaitini L, Schwartz AR, Kimmel E. Mechanical parameters determining pharyngeal collapsibility in patients with sleep apnea. J Appl Physiol (1985) 2010; 109:1037-44. [DOI: 10.1152/japplphysiol.00019.2010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The relative impact of mechanical factors on pharyngeal patency in patients with obstructive sleep apnea is poorly understood. The present study was designed to evaluate parameters of the “tube law” on pharyngeal pressure-flow relationships and collapsibility in patients with obstructive sleep apnea. We developed a mathematical model that considered the collapsible segment of the pharynx to represent an orifice of varying diameter. The model enabled us to assess the effects of pharyngeal compliance ( C), neutral cross-sectional area ( A o), external peripharyngeal pressure (Pex), and the resistance proximal to the site of collapse on flow mechanics and pharyngeal collapsibility [critical pressure (Pcrit)]. All parameters were measured in 15 patients with obstructive sleep apnea under propofol anesthesia, both at rest and during mandibular advancement and electrical stimulation of the genioglossus. The data was used both to confirm the validity of the model and to compare expected and actual relationships between the tube-law parameters and the pharyngeal pressure-flow relationship and collapsibility. We found a close correlation between predicted and measured Pcrit ( R = 0.98), including changes observed during pharyngeal manipulations. C and A o were closely and directly interrelated ( R = 0.93) and did not correlate with Pcrit. A significant correlation was found between Pex and Pcrit ( R = 0.77; P < 0.01). We conclude that the pharynx of patients with obstructive sleep apnea can be modeled as an orifice with varying diameter. Pharyngeal compliance and A o are closely interrelated. Pharyngeal collapsibility depends primarily on the surrounding pressure.
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Affiliation(s)
| | - Eran Kaufman
- Faculty of Biomedical Engineering, Technion, Haifa, Israel; and
| | - Rotem Kaynan
- Faculty of Biomedical Engineering, Technion, Haifa, Israel; and
| | | | | | | | | | - Luis Gaitini
- Anesthesiology, Bnai-Zion Medical Center, Technion, Haifa
| | | | - Eitan Kimmel
- Faculty of Biomedical Engineering, Technion, Haifa, Israel; and
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Uloza V, Balsevičius T, Sakalauskas R, Miliauskas S, Žemaitienė N. Changes in emotional state of bed partners of snoring and obstructive sleep apnea patients following radiofrequency tissue ablation: a pilot study. Sleep Breath 2009; 14:125-30. [DOI: 10.1007/s11325-009-0293-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 08/12/2009] [Indexed: 10/20/2022]
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