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Lavalle S, Masiello E, Iannella G, Magliulo G, Pace A, Lechien JR, Calvo-Henriquez C, Cocuzza S, Parisi FM, Favier V, Bahgat AY, Cammaroto G, La Via L, Gagliano C, Caranti A, Vicini C, Maniaci A. Unraveling the Complexities of Oxidative Stress and Inflammation Biomarkers in Obstructive Sleep Apnea Syndrome: A Comprehensive Review. Life (Basel) 2024; 14:425. [PMID: 38672697 PMCID: PMC11050908 DOI: 10.3390/life14040425] [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: 02/02/2024] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea syndrome (OSAS), affecting approximately 1 billion adults globally, is characterized by recurrent airway obstruction during sleep, leading to oxygen desaturation, elevated carbon dioxide levels, and disrupted sleep architecture. OSAS significantly impacts quality of life and is associated with increased morbidity and mortality, particularly in the cardiovascular and cognitive domains. The cyclic pattern of intermittent hypoxia in OSAS triggers oxidative stress, contributing to cellular damage. This review explores the intricate relationship between OSAS and oxidative stress, shedding light on molecular mechanisms and potential therapeutic interventions. METHODS A comprehensive review spanning from 2000 to 2023 was conducted using the PubMed, Cochrane, and EMBASE databases. Inclusion criteria encompassed English articles focusing on adults or animals and reporting values for oxidative stress and inflammation biomarkers. RESULTS The review delineates the imbalance between pro-inflammatory and anti-inflammatory factors in OSAS, leading to heightened oxidative stress. Reactive oxygen species biomarkers, nitric oxide, inflammatory cytokines, endothelial dysfunction, and antioxidant defense mechanisms are explored in the context of OSAS. OSAS-related complications include cardiovascular disorders, neurological impairments, metabolic dysfunction, and a potential link to cancer. This review emphasizes the potential of antioxidant therapy as a complementary treatment strategy. CONCLUSIONS Understanding the molecular intricacies of oxidative stress in OSAS is crucial for developing targeted therapeutic interventions. The comprehensive analysis of biomarkers provides insights into the complex interplay between OSAS and systemic complications, offering avenues for future research and therapeutic advancements in this multifaceted sleep disorder.
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Affiliation(s)
- Salvatore Lavalle
- Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (S.L.); (C.G.)
| | - Edoardo Masiello
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy;
| | - Giannicola Iannella
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.I.); (G.M.); (A.P.)
| | - Giuseppe Magliulo
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.I.); (G.M.); (A.P.)
| | - Annalisa Pace
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.I.); (G.M.); (A.P.)
| | - Jerome Rene Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, 7022 Mons, Belgium;
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15705 Santiago de Compostela, Spain;
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (S.C.); (F.M.P.)
| | - Federica Maria Parisi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (S.C.); (F.M.P.)
| | - Valentin Favier
- Service d’ORL et de Chirurgie Cervico-Faciale, Centre Hospitalo-Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34000 Montpellier, France
| | - Ahmed Yassin Bahgat
- Department of Otorhinolaryngology, Alexandria University, Alexandria 21577, Egypt;
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy;
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, University Hospital Policlinico-San Marco, 95125 Catania, Italy;
| | - Caterina Gagliano
- Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (S.L.); (C.G.)
| | - Alberto Caranti
- ENT and Audiology Department, University of Ferrara, 44121 Ferrara, Italy; (A.C.); (C.V.)
| | - Claudio Vicini
- ENT and Audiology Department, University of Ferrara, 44121 Ferrara, Italy; (A.C.); (C.V.)
| | - Antonino Maniaci
- Faculty of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (S.L.); (C.G.)
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Iannella G, Vicini C, Lechien JR, Ravaglia C, Poletti V, di Cesare S, Amicarelli E, Gardelli L, Grosso C, Patacca A, Magistrelli E, De Benedetto M, Toraldo DM, Arigliani M, Cammaroto G, Meccariello G, De Vito A, Magliulo G, Greco A, de Vincentiis M, Ralli M, Pace A, Montincone V, Maniaci A, Cocuzza S, Seligardi M, di Giacinto I, Corso RM. Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2024; 103:NP10-NP15. [PMID: 34318690 DOI: 10.1177/01455613211029783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA). METHODS Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19. RESULTS 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups (P = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, P = .01). CONCLUSIONS According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA. CURRENT KNOWLEDGE/STUDY RATIONALE Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease. STUDY IMPACT According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
- Department of ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Jerome R Lechien
- Faculty of Medicine, Laboratory of Anatomy and Cell Biology, University of Mons (UMONS), Mons, Belgium
| | - Claudia Ravaglia
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lucia Gardelli
- Medicine Department, G.B. Morgagni Hospital, Forlì, Italy
| | - Carmela Grosso
- Department of Infectious Diseases, G.B. Morgagni Hospital, Forlì, Italy
| | - Aria Patacca
- Department of Infectious Diseases, G.B. Morgagni Hospital, Forlì, Italy
| | | | | | | | | | | | | | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale "Santa Maria delle Croci", Viale Vincenzo Randi, Ravenna, Italy
| | | | - Antonio Greco
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | | | - Massimo Ralli
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | - Annalisa Pace
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | | | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Matteo Seligardi
- Infectious Disease Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio, Emilia, Italy
| | - Ida di Giacinto
- Anesthesia and Intensive Care, Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero-Universitaria, Sant'Orsola-Malpighi - Alma Mater Studiorum, Bologna, Italy
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3
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Hosseini H, Homayouni-Tabrizi M, Amiri H, Safari-Faramani R, Moradi MT, Fadaei R, Khazaie H. The effect of continuous positive airway pressure on total antioxidant capacity in obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2023; 27:1237-1245. [PMID: 36322225 DOI: 10.1007/s11325-022-02733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA), a sleep-related disorder with high prevalence, is associated with an imbalance in oxidative stress and is linked to cardiovascular disease. There are conflicting reports regarding the effectiveness of continuous positive airway pressure (CPAP) therapy on oxidative stress/antioxidant markers in patients with OSA. This review was performed to evaluate the influence of therapy with CPAP on serum/plasma total antioxidant capacity (TAC) in patients with OSA. METHODS The Cochrane Library, Web of Science, Scopus, Embase, and PubMed were searched through June 2022 to obtain studies evaluating CPAP treatment on TAC in patients with OSA. Overall results were tested using standardized mean difference (SMD) with a 95% confidence interval (CI). Comprehensive Meta-Analysis V2 software was employed to perform analyses. RESULTS Ten studies with 12 effect sizes were eligible for inclusion in this analysis. The overall SMD revealed that CPAP therapy significantly increased TAC [SMD 0.497; 95% CI: 0.21 to 0.77; p: 0.00] in OSA. Analyses based on subgroups showed that the effect of CPAP therapy was significant in all subgroups according to therapy duration, age, BMI, and AHI. Whereas the meta-regression results indicated that the impact of therapy with CPAP on TAC is associated with AHI, BMI, and age in patients with OSA. CONCLUSIONS The finding of this meta-analysis demonstrated a favorable impact of CPAP therapy on TAC levels in patients suffering from OSA.
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Affiliation(s)
- Hossein Hosseini
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamed Amiri
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad-Taher Moradi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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4
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Iannella G, Magliulo G, Lo Iacono CAM, Visconti IC, Lechien JR, Perrone T, Cammaroto G, Meccariello G, Maniaci A, Cocuzza S, Di Luca M, De Vito A, Martone C, Polimeni A, Greco A, de Vincentiis M, Ralli M, Pace A, Gulotta G, Pelucchi S, Eplite A, Vicini C. Quality of Life and Excessive Daytime Sleepiness in Adults with Obstructive Sleep Apnea Who Are Treated with Multilevel Surgery or Adherent to Continuous Positive Airway Pressure. J Clin Med 2022; 11:2375. [PMID: 35566499 PMCID: PMC9103957 DOI: 10.3390/jcm11092375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by a reduction (hypopnea) in or a complete cessation (apnea) of airflow in the upper airways at night, in the presence of breathing effort. The gold standard treatment for OSA is ventilation through continuous positive airway pressure (CPAP), although this often shows poor patient compliance. In recent years, transoral robotic surgery (TORS) has been proposed as a valid surgical treatment for patients suffering from OSA in a multilevel surgical setting. The aim of this study is to analyze the effects on QoL and daytime sleepiness of multilevel surgery for OSA (barbed pharyngoplasty + transoral robotic surgery). Furthermore, we compared the impact on QoL and daytime sleepiness of two different treatments for patients with moderate to severe OSA, such as CPAP and TORS. Sixty-seven OSA patients who underwent multilevel robotic surgery and sixty-seven OSA patients treated with CPAP were enrolled, defined as Group 1 and Group 2, respectively. The Glasgow Benefit Inventory (GBI) questionnaire was administrated to evaluate the changes in the QoL. Respiratory outcomes were evaluated and compared. Group 1 showed a GBI total average value of +30.4, whereas Group 2, a value of +33.2 (p = 0.4). General benefit score showed no difference between groups (p = 0.1). Better values of social status benefit (p = 0.0006) emerged in the CPAP Group, whereas greater physical status benefit (p = 0.04) was shown in the TORS Group. Delta-AHI (-23.7 ± 14.3 vs. -31.7 ± 15.6; p = 0.001) and Delta-ODI (-24.5 ± 9.5 vs. -29.4 ± 10.5; p = 0.001) showed better values in the CPAP group. Therapeutic success rate of the Multilevel TORS Group was 73.1% and 91% in the CPAP group (p = 0.01), respectively. Multilevel TORS and CPAP have a positive effect on the quality of life of OSA patients. Greater social support has been reported in the CPAP group and better physical health status in the TORS group. No statistical difference emerged in the reduction in daytime sleepiness between both groups.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Giuseppe Magliulo
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Cristina Anna Maria Lo Iacono
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Viale dell’Università, 33, 00185 Rome, Italy;
| | - Irene Claudia Visconti
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Jerome R. Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de Mars, 6, B7000 Mons, Belgium; (J.R.L.); (S.P.)
| | - Tiziano Perrone
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy;
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (A.M.); (S.C.); (M.D.L.)
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (A.M.); (S.C.); (M.D.L.)
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (A.M.); (S.C.); (M.D.L.)
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale “Santa Maria delle Croci”, Viale Vincenzo Randi, 5, 48121 Ravenna, Italy; (A.D.V.); (C.M.)
| | - Chiara Martone
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale “Santa Maria delle Croci”, Viale Vincenzo Randi, 5, 48121 Ravenna, Italy; (A.D.V.); (C.M.)
| | - Antonella Polimeni
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Antonio Greco
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Marco de Vincentiis
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Massimo Ralli
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Annalisa Pace
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Giampiero Gulotta
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università, 33, 00185 Rome, Italy; (G.M.); (I.C.V.); (A.P.); (A.G.); (M.d.V.); (M.R.); (A.P.); (G.G.)
| | - Stefano Pelucchi
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de Mars, 6, B7000 Mons, Belgium; (J.R.L.); (S.P.)
| | - Angelo Eplite
- ENT Department, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, Italy; (G.I.); (G.M.); (C.V.)
- Department ENT & Audiology, University of Ferrara, Via Savonarola, 9, 44121 Ferrara, Italy;
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5
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Maniaci A, Ferlito S, Lechien JR, Di Luca M, Iannella G, Cammaroto G, Cannavicci A, Pollicina I, Stilo G, Di Mauro P, Magliulo G, Pace A, Vicini C. Anxiety, depression and sleepiness in OSA patients treated with barbed reposition pharyngoplasty: a prospective study. Eur Arch Otorhinolaryngol 2022; 279:4189-4198. [PMID: 35396954 DOI: 10.1007/s00405-022-07369-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the efficacy of barbed reposition pharyngoplasty (BRP) on sleepiness, anxiety, and depression o adult patients with obstructive sleep apnea (OSA). METHODS We performed a prospective multicentric study to assess functional outcomes in 20 OSA patients treated with BRP and compare the results with an observational group of 20 subjects. All recruited subjects performed at baseline and 6-months postoperative follow-up Polysomnography (PSG), daytime sleepiness scoring using the Epworth Sleepiness Scale (ESS), and anxiety and depression evaluation via the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory-II (BDI-II) questionnaires. RESULTS At follow-up the BRP demonstrated greater improvements in AHI (8.92 ± 2.29 vs. 30.66 ± 2.56; p < 0.001) and ODI (7.65 ± 2.39 vs. 24.55 ± 3.20; p < 0.001) than control at intergroup analysis. Surgical group reported significant data in daytime sleepiness (5.15 ± 1.19 vs. 13.15 ± 1.35; p < 0.001), anxiety (12.65 ± 3.11 vs. 24.2 ± 2.37; p < 0.001), and depression domains (5.85 ± 1.19 vs. 17.55 ± 3.24; p < 0.001). AHI, ODI, and advanced age have been shown to multiple regression as independent predictors of treatment response for mood domains (p < 0.001; p = 0.02; p = 0.041, respectively). CONCLUSIONS Patients with OSA may benefit from palate surgery, reducing not only the apnea and hypopnea index, daytime sleepiness but also associated mood comorbidities. However, further studies are needed to confirm our preliminary results to validate the evidence to date reported.
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Affiliation(s)
- Antonino Maniaci
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy.
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.
| | - Salvatore Ferlito
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Jerome Rene Lechien
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Milena Di Luca
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Giannicola Iannella
- Department of Sensory Organs, "Sapienza" University of Rome, 00100, Rome, Italy
| | - Giovanni Cammaroto
- Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy
| | - Angelo Cannavicci
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy
| | - Isabella Pollicina
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Giovanna Stilo
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Paola Di Mauro
- Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, ENT Section, University of Catania, Via Santa Sofia, 95100, Catania, Italy
| | - Giuseppe Magliulo
- Department of Sensory Organs, "Sapienza" University of Rome, 00100, Rome, Italy
| | - Annalisa Pace
- Department of Sensory Organs, "Sapienza" University of Rome, 00100, Rome, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, 47121, Forli, Italy
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6
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Lin YC, Chen CT, Chao PZ, Chen PY, Liu WT, Tsao ST, Lin SF, Bai CH. Prevention of Incident Hypertension in Patients With Obstructive Sleep Apnea Treated With Uvulopalatopharyngoplasty or Continuous Positive Airway Pressure: A Cohort Study. Front Surg 2022; 9:818591. [PMID: 35402497 PMCID: PMC8987371 DOI: 10.3389/fsurg.2022.818591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/03/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine whether treatment with uvulopalatopharyngoplasty (UPPP) or continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) prevents hypertension, compared to those not receiving any treatment. Methods A retrospective cohort study was conducted among 413 patients with OSA (age ≥ 35 years) at the Shuang Ho Hospital between 2009 and 2016. The patients were divided into three groups: UPPP, CPAP, and non-treatment groups. Data about the personal characteristics, history of comorbidities, and polysomnography (PSG) reports were collected at baseline. A Cox model with inverse probability of treatment weighting was used to adjust for confounders and baseline diversity. Results After multivariate adjustment and weighting for incident hypertension, patients in both the CPAP and UPPP groups showed a significant preventive effect on hypertension than in the non-treatment group. Moreover, patients in the CPAP group had lower event rates than those in the UPPP group. Conclusion UPPP can prevent the development of new-onset hypertension in patients with OSA. CPAP had a better preventive effect than UPPP. UPPP might be a good alternative for reducing the risk of the onset of hypertension when compliance to CPAP is poor.
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Affiliation(s)
- Yi-Chih Lin
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Tien Chen
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Pin-Zhir Chao
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Yueh Chen
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Te Liu
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Chest, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Sheng-Teng Tsao
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Feng Lin
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- *Correspondence: Chyi-Huey Bai
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Saenwandee P, Neruntarat C, Saengthong P, Wiriyaamornchai P, Khuancharee K, Sirisomboonwech S, Chuoykwamdee N. Barbed pharyngoplasty for obstructive sleep apnea: A meta-analysis. Am J Otolaryngol 2022; 43:103306. [PMID: 34906825 DOI: 10.1016/j.amjoto.2021.103306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/02/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to perform a meta-analysis of barbed pharyngoplasty (BP) in the treatment of obstructive sleep apnea (OSA). METHODS Databases included PubMed, Ovid MEDLINE, Cochrane Library, Web of Science and Scopus, and reference lists. Relevant articles were searched through August 2021, following the PRISMA guidelines. RESULTS Twenty articles with 762 participants were included. The mean success in BP as a single-level surgery was 85.2% (MD, 95% CI 77.6%, 92.7%). There was a significant reduction of oxygen desaturation index (ODI) of -11.7 (MD 95% CI -16, -7.4). The lowest oxygen saturation (LSAT) improved 8.9% (MD, 95% CI 1.3%, 16.7%). Epworth Sleepiness Scale (ESS) and snoring score significantly decreased -6.8 (MD 95% CI -8.3, -5.2) and -5.3 (MD 95% -7.9, -2.7), respectively. The apnea-hypopnea index (AHI) significantly decreased -23.9 events/h (MD, 95% CI -25.5, -22.9) with a 69% reduction. The mean surgical time was 23 min. A significant improvement of AHI, ODI, ESS, and LSAT was also revealed in BP as a multilevel surgery. Complications included suture extrusion (18%), dysphagia (20%), velopharyngeal insufficiency (15%), and dysgeusia (3%) without serious consequences. The median follow-up period was 6 months, ranged 1 to 26 months. CONCLUSION Barbed pharyngoplasty as a single-level or multilevel surgery is a safe and effective procedure with significant objective and subjective outcomes for OSA patients with palatal obstruction. However, randomized clinical controlled trials with multicenter cooperation and long-term study are necessary.
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Affiliation(s)
- Piroonya Saenwandee
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand
| | - Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
| | - Petcharat Saengthong
- Department of Otorhinolaryngology Head and Neck Surgery, Police General Hospital, 492/1 Rama 1 Road, Patumwan, Bangkok, Thailand
| | - Pannipa Wiriyaamornchai
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
| | | | - Nuttaphum Chuoykwamdee
- Faculty of Medicine, Srinakharinwirot University, Sukhumvit 23, Watana, Bangkok, Thailand.
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Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042459. [PMID: 35206645 PMCID: PMC8872290 DOI: 10.3390/ijerph19042459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 01/16/2023]
Abstract
Obstructive sleep apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete recurrent episodes of upper airway collapse that occur during the night. The OSA manifests with a reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways, associated with breathing effort. OSA is a frequent and often underestimated pathology affecting between 2 and 5% of the middle-aged population. Typical nocturnal symptoms are the persistent snoring and awakenings with dyspnea sensation. On the other hand, diurnal symptoms could be sleepiness, headaches, asthenia, neurological disorders, and impaired personal relationships. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls.
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9
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The utility of acoustic pharyngometry in treatment of obstructive sleep apnea patients with expansion sphincter pharyngoplasty surgery. Sleep Breath 2022; 26:1955-1962. [DOI: 10.1007/s11325-021-02554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
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10
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Lateral pharyngoplasty vs. traditional uvulopalatopharyngoplasty for patients with OSA: systematic review and meta-analysis. Sleep Breath 2022; 26:1539-1550. [PMID: 34978022 DOI: 10.1007/s11325-021-02520-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/19/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To compare the efficacy and success rates of lateral pharyngoplasty techniques (LP) vs. uvulopalatopharyngoplasty (UPPP) among adult patients surgically treated for obstructive sleep apnea. METHODS A systematic literature review of the last 20 years' papers was conducted using PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library until April 2021. Only full-text English articles comparing LP and UPPP outcomes in adult patients with objective outcomes were included in the study. RESULTS We included 9 articles for a total of 312 surgically treated patients with OSA. LP techniques for obstructive sleep apnea were used on 186 (60%) subjects, while 126 patients (40%) were treated with UPPP. Both surgical procedures resulted in significant improvements in apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS) score, and lowest oxygen saturation (LOS) (p < 0.001 in all cases). Although better outcomes were reported with lateral pharyngoplasty, the differences were not significant compared to UPPP post-operative results (p > 0.05 in all cases). CONCLUSIONS UPPP and LP are both effective surgical procedures in treating OSA in adults. Although not significant, LPs demonstrated improved post-operative outcomes. However, further evidence comparing the surgical effect on patients with OSA is needed to discriminate post-operative outcomes.
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11
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Iannella G, Lechien JR, Perrone T, Meccariello G, Cammaroto G, Cannavicci A, Burgio L, Maniaci A, Cocuzza S, Di Luca M, Stilo G, De Vito A, Magliulo G, Greco A, de Vincentiis M, Ralli M, Pelucchi S, Ciorba A, Vicini C. Barbed reposition pharyngoplasty (BRP) in obstructive sleep apnea treatment: State of the art. Am J Otolaryngol 2022; 43:103197. [PMID: 34492427 DOI: 10.1016/j.amjoto.2021.103197] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/15/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE In this paper, we perform a systematic review that discusses the state of the art and evolution on the barbed reposition pharyngoplasty (BRP) in the velo-pharyngeal surgery. Clinical evidence and published outcomes of this surgical technique are reported and discussed. MATERIALS AND METHODS We performed a systematic review of the current literature through the analysis of the last 10 years of literature on barbed palate surgery. Study design, number of patients enrolled, inclusion criteria, pre- and posttreatment outcomes (AHI, ODI), surgical success rate, follow-up time and complication has been collected and reported. RESULTS 15 studies for a total of 1531 patients, out of which 1061 underwent barbed reposition pharyngoplasty. Five trials were uncontrolled prospective studies (215 patients, 14% of total), nine were retrospective studies (1266 patients, 82,6% of total), and one randomized prospective clinical trial (RCT) (50 patients, 3,32% of total). All analyzed studies reported good outcomes after BRP surgery. Average preoperative values of AHI and ODI reduced in all studies considered with a significative statistical difference between preoperative and postoperative values (p < 0.05 in all cases). The postoperative surgical success rate ranged between 65.4 and 93% of cases. There were no significant intra-operative or post-operative complications in all studies considered in this systematic review. CONCLUSIONS Barbed reposition pharyngoplasty has proven to be an easy to learn, quick, safe and effective new palatopharyngeal procedure, that can be used in a single level surgery or as a part of multilevel procedures.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy.
| | - Jerome R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons (UMONS), Avenue du Champ de mars, 6, B7000 Mons, Belgium
| | - Tiziano Perrone
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Angelo Cannavicci
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Luca Burgio
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, Catania, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale "Santa Maria delle Croci", Viale Vincenzo Randi, 5, 48121 Ravenna, Italy
| | - Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Antonio Greco
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Marco de Vincentiis
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Massimo Ralli
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy
| | - Stefano Pelucchi
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Andrea Ciorba
- Department ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department ENT & Audiology, University of Ferrara, Ferrara, Italy
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12
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Pollicina I, Maniaci A, Lechien JR, Iannella G, Vicini C, Cammaroto G, Cannavicci A, Magliulo G, Pace A, Cocuzza S, Di Luca M, Stilo G, Di Mauro P, Bianco MR, Murabito P, Bannò V, La Mantia I. Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art. Behav Sci (Basel) 2021; 11:bs11120180. [PMID: 34940115 PMCID: PMC8698492 DOI: 10.3390/bs11120180] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic–pituitary–adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature. Methods: We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered. Results: Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function. Conclusions: CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.
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Affiliation(s)
- Isabella Pollicina
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Antonino Maniaci
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium; (A.M.); (J.R.L.)
| | - Jerome R. Lechien
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium; (A.M.); (J.R.L.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFRSimone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Giannicola Iannella
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
- Department of “Organi di Senso”, University “Sapienza”, 00185 Rome, Italy;
- Correspondence:
| | - Claudio Vicini
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Giovanni Cammaroto
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Angelo Cannavicci
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Giuseppe Magliulo
- Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy; (C.V.); (G.C.); (A.C.); (G.M.)
| | - Annalisa Pace
- Department of “Organi di Senso”, University “Sapienza”, 00185 Rome, Italy;
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Giovanna Stilo
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Paola Di Mauro
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Maria Rita Bianco
- Otolaryngology, Department of Health Science, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy;
| | - Paolo Murabito
- Department of Surgery and Medical and Surgical Specialties—Section of Anaesthesiology and Intensive Care, University of Catania (Italy), 95123 Catania, Italy;
| | - Vittoria Bannò
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, 95123 Catania, Italy; (I.P.); antonino.maniaciphd.unict.it (A.M); (S.C.); (M.D.L.); (G.S.); (P.D.M.); (V.B.); (I.L.M.)
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13
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Lee WJ, Jung KH, Nam HW, Lee YS. Effect of obstructive sleep apnea on cerebrovascular compliance and cerebral small vessel disease. PLoS One 2021; 16:e0259469. [PMID: 34767578 PMCID: PMC8589195 DOI: 10.1371/journal.pone.0259469] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Reduced cerebrovascular compliance is the major mechanism of cerebral small vessel disease (SVD). Obstructive sleep apnea (OSA) also promotes SVD development, but the underlying mechanism was not elucidated. We investigated the association among OSA, cerebrovascular compliance, and SVD parameters. This study retrospectively included individuals ≥ 50 years of age, underwent overnight polysomnographic (PSG) for the evaluation of OSA, and performed MRI and transcranial Doppler (TCD) within 12 months of interval without a neurological event between the evaluations. TCD parameters for the cerebrovascular compliance included middle cerebral artery pulsatility index (MCA PI) and mean MCA resistance index ratio (MRIR). SVD parameters included white matter hyperintensity (WMH) volume, number of lacunes, enlarged perivascular space (ePVS) score, and the presence of microbleeds or lacunes. Ninety-seven individuals (60.8% male, mean age 70.0±10.5 years) were included. MRIR was associated with higher respiratory distress index (B = 0.003; 95% confidence interval [CI] 0.001-0.005; P = 0.021), while MCA PI was not associated with any of the PSG markers for OSA severity. Apnea-hypopnea index was associated with the log-transformed total WMH volume (B = 0.008; 95% confidence interval [CI] 0.001-0.016; P = 0.020), subcortical WMH volume (B = 0.015; 95% CI 0.007-0.022; P<0.001), total ePVS score (B = 0.024; 95% CI 0.003-0.045; P = 0.026), and centrum semiovale ePVS score (B = 0.026; 95% CI 0.004-0.048; P = 0.019), and oxygen-desaturation index with periventricular WMH volume, independently from age, MCA PI, and MRIR. This study concluded that OSA is associated with reduced cerebrovascular compliance and also with SVD independently from cerebrovascular compliance. Underlying pathomechanistic link might be region specific.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Woo Nam
- Department of Neurology, College of Medicine Seoul National University, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Yong-Seok Lee
- Department of Neurology, College of Medicine Seoul National University, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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Camañes-Gonzalvo S, Marco-Pitarch R, Plaza-Espín A, Puertas-Cuesta J, Agustín-Panadero R, Fons-Font A, Fons-Badal C, García-Selva M. Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices. J Clin Med 2021; 10:5255. [PMID: 34830533 PMCID: PMC8621062 DOI: 10.3390/jcm10225255] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. METHODS All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. RESULTS The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. CONCLUSIONS The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).
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Affiliation(s)
- Sara Camañes-Gonzalvo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Rocío Marco-Pitarch
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Andrés Plaza-Espín
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Javier Puertas-Cuesta
- Medical School of Medicine, Universidad Católica de Valencia, 46002 Valencia, Spain;
| | - Rubén Agustín-Panadero
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Antonio Fons-Font
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Carla Fons-Badal
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
| | - Marina García-Selva
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (S.C.-G.); (A.P.-E.); (R.A.-P.); (A.F.-F.); (C.F.-B.); (M.G.-S.)
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15
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Elevated Monocytic Interleukin-8 Expression under Intermittent Hypoxia Condition and in Obstructive Sleep Apnea Patients. Int J Mol Sci 2021; 22:ijms222111396. [PMID: 34768826 PMCID: PMC8583894 DOI: 10.3390/ijms222111396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a disease with great cardiovascular risk. Interleukin-8 (IL-8), an important chemokine for monocyte chemotactic migration, was studied under intermittent hypoxia condition and in OSA patients. Monocytic THP-1 cells were used to investigate the effect of intermittent hypoxia on the regulation of IL-8 by an intermittent hypoxic culture system. The secreted protein and mRNA levels were studied by means of enzyme-linked immunosorbent assay and RT/real-time PCR. The chemotactic migration of monocytes toward a conditioned medium containing IL-8 was performed by means of the transwell filter migration assay. Peripheral venous blood was collected from 31 adult OSA patients and RNA was extracted from the monocytes for the analysis of IL-8 expression. The result revealed that intermittent hypoxia enhanced the monocytic THP-1 cells to actively express IL-8 at both the secreted protein and mRNA levels, which subsequently increased the migration ability of monocytes toward IL-8. The ERK, PI3K and PKC pathways were demonstrated to contribute to the activation of IL-8 expression by intermittent hypoxia. In addition, increased monocytic IL-8 expression was found in OSA patients, with disease severity dependence and diurnal changes. This study concluded the monocytic IL-8 gene expression can be activated by intermittent hypoxia and increased in OSA patients.
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Yamagata K, Shinozuka K, Ogisawa S, Himejima A, Azaki H, Nishikubo S, Sato T, Suzuki M, Tanuma T, Tonogi M. A preoperative predictive study of advantages of airway changes after maxillomandibular advancement surgery using computational fluid dynamics analysis. PLoS One 2021; 16:e0255973. [PMID: 34379704 PMCID: PMC8357109 DOI: 10.1371/journal.pone.0255973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to develop a simulation approach for predicting maxillomandibular advancement-induced airway changes using computational fluid dynamics. Eight patients with jaw deformities who underwent maxillomandibular advancement and genioglossus advancement surgery were included in this study. Computed tomography scans and rhinomanometric readings were performed both preoperatively and postoperatively. Computational fluid dynamics models were created, and airflow simulations were performed using computational fluid dynamics software; the preferable number of computational mesh points was at least 10 million cells. The results for the right and left nares, including simulation and postoperative measurements, were qualitatively consistent, and surgery reduced airflow pressure loss. Geometry prediction simulation results were qualitatively consistent with the postoperative stereolithography data and postoperative simulation results. Simulations were performed with either the right or left naris blocked, and the predicted values were similar to those found clinically. In addition, geometry prediction simulation results were qualitatively consistent with the postoperative stereolithography data and postoperative simulation results. These findings suggest that geometry prediction simulation facilitates the preoperative prediction of the postoperative structural outcome.
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Affiliation(s)
- Kanako Yamagata
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan.,Laboratory of Fluid-Structural Simulation and Design, Strategic Innovation and Research Center, Teikyo University, Tokyo, Japan
| | - Keiji Shinozuka
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | - Shouhei Ogisawa
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | - Akio Himejima
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Hiroaki Azaki
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | - Shuichi Nishikubo
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | - Takako Sato
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
| | - Masaaki Suzuki
- Department of Otolaryngology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Tadashi Tanuma
- Laboratory of Fluid-Structural Simulation and Design, Strategic Innovation and Research Center, Teikyo University, Tokyo, Japan
| | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, Tokyo, Japan
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17
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Elsobki A, Moussa HH, Eldeeb ME, Fayed A, Elzayat S. Efficacy, predictors of success and failure of an updated lateral pharyngoplasty approach as an independent procedure in treating obstructive sleep apnea with CPAP failures. Eur Arch Otorhinolaryngol 2021; 279:945-953. [PMID: 33885973 DOI: 10.1007/s00405-021-06825-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess predictors of success and failure of an updated lateral pharyngoplasty as an independent procedure in treating obstructive sleep apnea with CPAP failures. METHODS Forty-six patients with known OSAS who were resistant to CPAP or failures were included. BMI, Stop-Bang score, and sleep study data were recorded before and after the updated Cahali pharyngoplasty procedure. Pre-operative DISE was done for all cases; however, postoperative DISE was done only for non-responders. RESULTS Successful operation outcomes achieved in 69.6% (32 cases) and 30.4% (14 cases) were failure rates. Postoperative snoring index, Stop Bang score, and AHI were significantly decreased compared to pre-operative data (p value < 0.001). There is statistically a significant increase in minimal and baseline SpO2 postoperatively (p value < 0.001). Patients with no laryngeal collapse (L0) predict operation success. However, patients with high pre-operative snoring index, collapse at lateral wall hypopharynx, high tongue collapse, laryngeal collapse, tongue palate interaction, and low grades tonsils (1, 2) predict the failure of the surgery (p value = 0.006*,0.024*,0.047*, respectively). CONCLUSION Updated Cahali lateral pharyngoplasty could not be used as an independent procedure in all OSA patients. The lack of laryngeal collapse (L0) is a considerable success predictor for the procedure. However, the pre-operative low-grade tonsils (1, 2) and high snoring index predict operation failure.
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Affiliation(s)
- Ahmed Elsobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hany H Moussa
- Chest Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed E Eldeeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
| | - Ashraf Fayed
- Otorhinolaryngology Department, El Galaa Military Hospital, Cairo, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Gasparini G, Saponaro G, Todaro M, Ciasca G, Cigni L, Doneddu P, Azzuni C, Foresta E, De Angelis P, Barbera G, Parcianello RG, Hreniuc HV, Moro A. Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2393. [PMID: 33804517 PMCID: PMC7967765 DOI: 10.3390/ijerph18052393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. METHODS This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. RESULTS We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. CONCLUSION Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.
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Affiliation(s)
- Giulio Gasparini
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Gianmarco Saponaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Mattia Todaro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Lorenzo Cigni
- Department of Odonto-Stomatology, Azienda Ospedaliera Valtellina e Valchiavenna, 23100 Sondrio, Italy;
| | - Piero Doneddu
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Camillo Azzuni
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Enrico Foresta
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Paolo De Angelis
- Departement of Head, Division of Oral Surgery and Implantology, Neck and Sensory Organs, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy;
| | - Giorgio Barbera
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Roberta Gaia Parcianello
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
| | - Horia Vasile Hreniuc
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy;
| | - Alessandro Moro
- Maxillofacial Surgery Unit, Faculty of Medicine, University Hospital ‘A. Gemelli’, Catholic University of the Sacred Heart, IRCCS, 00168 Rome, Italy; (G.G.); (G.S.); (P.D.); (C.A.); (E.F.); (G.B.); (R.G.P.); (A.M.)
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Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients. J Clin Med 2021; 10:jcm10020277. [PMID: 33451164 PMCID: PMC7828672 DOI: 10.3390/jcm10020277] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO2) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO2). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade’s activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease’s severity and treatment.
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20
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Neruntarat C, Khuancharee K, Saengthong P. Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta-Analysis. Laryngoscope 2020; 131:1420-1428. [PMID: 33368308 DOI: 10.1002/lary.29357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study was to compare barbed reposition pharyngoplasty (BRP) and expansion sphincter pharyngoplasty (ESP) in the treatment of obstructive sleep apnea (OSA). METHODS Relevant 907 articles were searched from various databases until August 2020, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science and Scopus, and reference lists. RESULTS Four studies with a total of 208 participants were included. The mean reduction of apnea-hypopnea index (AHI) in the BRP group was 74.03% and the mean reduction of AHI in the ESP group was 60.17%. The mean success rate in the BRP group and the ESP group was 84.96% and 79.87%, respectively. The mean difference (MD) of the change in AHI between groups was not significantly different (MD = -1.24 event/hr, 95% CI [-11.86, 9.36], P = .82). There was no significant difference in postoperative AHI, postoperative Epworth Sleepiness Scale, pain, hospital stay, time to oral diet, and the change in oxygen desaturation index in both groups whereas the analgesic requirement was lower in the BRP group. Operative time was lower in the BRP group (MD = 21.72 minutes, 95% CI [18.85, 24.60], P < .0001). CONCLUSION The outcomes in both procedures are comparable in the improvement of OSA with palatal collapse. BRP is superior to ESP in term of surgical time. However, randomized clinical controlled trials with multicenter cooperation and long-term follow-up are essential to further demonstrate the efficacy of these procedures. Laryngoscope, 131:1420-1428, 2021.
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Affiliation(s)
- Chairat Neruntarat
- Department of Otolaryngology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Kitsarawut Khuancharee
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Petcharat Saengthong
- Department of Otorhinolaryngology Head and Neck Surgery, Police General Hospital, Bangkok, Thailand
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21
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Iannella G, Magliulo G, Maniaci A, Meccariello G, Cocuzza S, Cammaroto G, Gobbi R, Sgarzani R, Firinu E, Corso RM, Pace A, Gulotta G, Visconti IC, Di Luca M, Pelucchi S, Bianchi G, Melegatti M, Abita P, Solito C, La Mantia I, Grillo C, Vicini C. Olfactory function in patients with obstructive sleep apnea: a meta-analysis study. Eur Arch Otorhinolaryngol 2020; 278:883-891. [PMID: 32914257 DOI: 10.1007/s00405-020-06316-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This meta-analysis study was designed to analyze the olfactory function in obstructive sleep apnea patients (OSA). METHODS A comprehensive review of the English language literature regarding OSA patients and olfactory function/dysfunction was performed. The papers assessing olfactory dysfunction with Sniffin' Sticks test were taken into consideration. RESULTS A total of 420 OSA patients were judged eligible for the study. The average TDI score was found to be 24.3 ± 5.6. The olfactory identification (OD), the olfactory discrimination (OD), and the olfactory threshold (OT) average values were calculated resulting 9.9 ± 2.1, 9.8 ± 1.5, and 5.3 ± 2, respectively. There were 161 healthy control subjects in this meta-analysis. The average TDI of the control group was 30.7 ± 6.0 showing a statistical difference with the group of OSA patients (p = 0.03). A linear correlation between Apnea-Hypopnea Index (AHI) increase and TDI decrease (R2 = 0.1, p = 0.05) was detected. Finally, the average values of TDI of 151 patients classified as mild-moderate OSA and 159 patients considered as severe OSA were calculated. The difference between these two groups resulted not statistically significant (p = 0.3). CONCLUSION The comparison between OSA patients and healthy subjects using Sniffin' Sticks test showed lower values of the various olfactory parameters. Although a linear correlation between AHI increase and olfactory dysfunction was observed, no statistical difference between mild-moderate and severe OSA patients in terms of the severity of olfactory dysfunction could be proved.
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Affiliation(s)
- Giannicola Iannella
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy. .,Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.
| | - Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Antonino Maniaci
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Giuseppe Meccariello
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Salvatore Cocuzza
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Giovanni Cammaroto
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Riccardo Gobbi
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Rossella Sgarzani
- Department of Emergency, Burn Center, Bufalini Hospital, Azienda USL Della Romagna, viale Giovanni Ghirotti, 286, 47521, Cesena, Italy
| | - Elisabetta Firinu
- Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Ruggero Massimo Corso
- Intensive Care Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy
| | - Annalisa Pace
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Giampiero Gulotta
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Irene Claudia Visconti
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Milena Di Luca
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Stefano Pelucchi
- Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
| | - Giulia Bianchi
- Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
| | - Michela Melegatti
- Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
| | - Pietro Abita
- Unit of Otorhinolaryngology, Department of Adult and Development Age Human Pathology "Gaetano Barresi", University of Messina, Messina, Italy
| | - Carmen Solito
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Ignazio La Mantia
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Calogero Grillo
- ENT Section, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Via S. Sofia, 78, 95125, Catania, Italy
| | - Claudio Vicini
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.,Department ENT and Audiology, University of Ferrara, Via Savonarola, 9, 44121, Ferrara, Italy
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