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Dellweg A, Kampmann M, Tschopp K. Evaluation of a nasopharyngeal stent in patients with obstructive sleep-related breathing disorders. J Int Med Res 2022; 50:3000605211073302. [PMID: 35062854 PMCID: PMC8796092 DOI: 10.1177/03000605211073302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study was performed to evaluate the therapeutic effect and diagnostic value of a novel nasopharyngeal stent (Naśtent; Corinium Medical Equipment Ltd., Cirencester, UK). The Naśtent is designed to stent palatal collapse in patients with sleep-related breathing disorders. Methods The study was conducted from 2018 to 2019. Patients who did not qualify for continuous positive airway pressure therapy underwent split-night examination with an inserted Naśtent for the first half of the night. The next morning, drug-induced sleep endoscopy (DISE) was performed. Results Of the 122 enrolled patients, 21 were excluded because of Naśtent intolerance (n = 14) or technically invalid examinations (n = 7). Among the remaining 101 patients, in correlation with DISE, the apnea–hypopnea index was significantly reduced in patients with palatal obstructions, mainly in those with anteroposterior collapse patterns. The Naśtent did not influence retrolingual or multilevel obstructions. Using a 40% reduction of the apnea–hypopnea index by the Naśtent as a cut-off value, 85.7% of soft palate obstructions were detected compared with DISE. Conclusions The Naśtent is a viable tool to reduce palatal obstructions, although it is not readily tolerated. It may also be helpful for diagnosis of sleep-related breathing disorders when DISE is unavailable.
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Affiliation(s)
- Alexander Dellweg
- Alexander Dellweg, Department of Otolaryngology – Head and Neck Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal, Baselland 4410, Switzerland.
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Die HNO-spezifische operative Therapie bei schlafbezogenen Atmungsstörungen. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-00218-8] [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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Bosco G, Pérez-Martín N, Racionero MA, Plaza G. Expansion Sphincter Pharyngoplasty: Usefulness of DISE. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2019.06.002] [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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Expansion sphincter pharyngoplasty: Usefulness of DISE. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:215-221. [PMID: 30115363 DOI: 10.1016/j.otorri.2018.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery. MATERIAL AND METHODS The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty. RESULTS Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP. CONCLUSION Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion.
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Pang KP, Plaza G, Baptista J PM, O'Connor Reina C, Chan YH, Pang KA, Pang EB, Wang CMZ, Rotenberg B. Palate surgery for obstructive sleep apnea: a 17-year meta-analysis. Eur Arch Otorhinolaryngol 2018; 275:1697-1707. [PMID: 29802464 DOI: 10.1007/s00405-018-5015-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Systematic review of palate surgery for the treatment of OSA. METHODS Independent searches to identify publications relevant to OSA treatment and upper airway palate surgery. All relevant studies published between January 2001 and February 2018 were included. Inclusion criteria were adult patients, documented airway evaluation methods and absent hypopharyngeal collapse. Outcomes included success rates of treatment, AHI, Epworth scale, QOL and snoring VAS. RESULTS Fifty-nine papers with a total of 2715 patients, UPPP accounted for 16.7% of all the procedures. Evident differentiation progressing from 2001 to 2018, from 2001 to 2010, the percentage of UPPP procedures were 25.67%, from 2011 to 2018, there were only 12.6% of UPPP procedures. The average follow up was 8.18 months. Meta-analysis on the AHI change for all procedures, showed the fixed effect AHI per follow-up (FU) month change was 1.45 (95% CI 1.33, 1.8), p < 0.001; while for ESS, the fixed effect AHI per FU month change was 0.61 (95% CI 0.56, 0.66), p < 0.001. The mean decrease in AHI was from 35.66 to 13.91 (p < 0.001). The mean decrease in ESS was from 11.65 to 5.08 (p < 0.001). The mean AHI change was 19.9 (p < 0.001). The mean ESS change was 5.8 (p < 0.001). The overall pooled success rate was 67.5%. Meta-analysis of the procedures, showed that the respective mean AHI reduction was 24.7 for the anterior palatoplasty (p = 0.015), 19.8 for the lateral/expansion pharyngoplasty (p = 0.046), and 17.2 for the uvulopalatopharyngoplasty (p = 0.360). CONCLUSIONS Better understanding of the upper airway and objective airway evaluation diagnostic techniques and innovative palate surgeries have improved success rates of OSA surgery.
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Affiliation(s)
- Kenny Peter Pang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore.
| | - Guillermo Plaza
- Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | | | | | - Yiong Huak Chan
- Biostatistics Unit, School of Medicine, National University Singapore, Singapore, Singapore
| | - Kathleen A Pang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore
| | - Edward B Pang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore
| | - Cybil Mei Zhi Wang
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore.,Western University, London, ON, Canada
| | - Brian Rotenberg
- Asia Sleep Centre, Paragon, 290 Orchard Road, Unit 18-04, Singapore, 238859, Singapore.,Western University, London, ON, Canada
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Complete concentric collapse at the soft palate in sleep endoscopy: what change is possible after UPPP in patients with CPAP failure? Sleep Breath 2018; 22:933-938. [PMID: 29766410 DOI: 10.1007/s11325-018-1657-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/21/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this work was to assess whether uvulopalatopharyngoplasty in patients with failure for positive airway pressure not only reduces the degree of obstructive sleep apnea but also to determine as well if it changes the collapse pattern of the soft palate and thereby fulfills the qualifications for implementing upper airway stimulation (UAS) as an adjunctive solution. METHOD Fifteen patients with intolerance for positive airway pressure were included in this retrospective cohort study. Polygraphy and drug-induced sleep endoscopy were used in order to evaluate the reduction of the apnea-hypopnea index (AHI), as well as the change of collapse pattern at the soft palate level before and about 3 months after uvulopalatopharyngoplasty and tonsillectomy (TE-UPPP). RESULTS In 93% of the patients, a postoperative change of the initially complete concentric palatal collapse pattern could be found during drug-induced sleep endoscopy. In one patient, no obstruction at all was seen at the soft palatal level. Only one patient still presented with a complete concentric collapse at velum level. AHI decreased from mean 34.7 events per hour to 20.2/h and oxygen desaturation index from 25.3 events per hour to 16.1/h. CONCLUSION Patients seeking for positive airway pressure alternatives could not only benefit from reduction of AHI by TE-UPPP postoperatively; additionally, by changing the collapse pattern at the soft palate, they might also fulfill criteria for upper airway stimulation (UAS) in case of persistent OSA of at least moderate degree.
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Steinbichler TB, Bender B, Giotakis AI, Dejaco D, Url C, Riechelmann H. Comparison of two surgical suture techniques in uvulopalatopharyngoplasty and expansion sphincter pharyngoplasty. Eur Arch Otorhinolaryngol 2017; 275:623-628. [PMID: 29270682 DOI: 10.1007/s00405-017-4852-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Uvulopalatopharyngoplasty (UPPP) and expansion sphincter pharyngoplasty (ESP) are two standard surgical procedures for treatment of snoring and sleep apnea. In a prospective clinical trial, we compared a standard simple interrupted suture technique for closure of the tonsillar pillars with a running locked suture. METHODS Each suture technique was randomly assigned either to the left or the right tonsillar pillars in 28 patients. During the first week, patients were daily checked for suture dehiscence and again on days 10 and 21, the end of followup. Time to perform the sutures was measured intraoperative and surgical complications were recorded. RESULTS During followup, suture dehiscence was observed in 15/28 interrupted and 16/28 running sutures (p > 0.5). If a dehiscence occurred during the observation period, the median day of dehiscence was 10 (1 and 3 quartile: 5.75 and 17) days for the interrupted suture and 10 (5-11) days for the running locked suture technique (p > 0.05). The mean (± SD) surgical time for the interrupted suture was 5.2 ± 1.9 and 3.5 ± 1.8 min for the running locked suture (p < 0.001). Postoperative bleedings occurred in 4/28 running sutures and 2/28 interrupted sutures. CONCLUSION The running locked suture technique is an equally safe and time saving way of wound closure in UPPP and ESP.
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Affiliation(s)
- Teresa B Steinbichler
- Department for Otorhinolaryngology, Medical University of Innsbruck, Anichstr.35, 6020, Innsbruck, Austria.
| | - Birte Bender
- Department for Otorhinolaryngology, Medical University of Innsbruck, Anichstr.35, 6020, Innsbruck, Austria
| | - Aristeidis I Giotakis
- Department for Otorhinolaryngology, Medical University of Innsbruck, Anichstr.35, 6020, Innsbruck, Austria
| | - Daniel Dejaco
- Department for Otorhinolaryngology, Medical University of Innsbruck, Anichstr.35, 6020, Innsbruck, Austria
| | - Christoph Url
- Department for Otorhinolaryngology, Medical University of Innsbruck, Anichstr.35, 6020, Innsbruck, Austria
| | - Herbert Riechelmann
- Department for Otorhinolaryngology, Medical University of Innsbruck, Anichstr.35, 6020, Innsbruck, Austria
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