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Van Daele M, Smolders Y, Van Loo D, Bultynck C, Verbraecken J, Vroegop A, Lapperre T, Op de Beeck S, Dieltjens M, Vanderveken OM. Personalized Treatment for Obstructive Sleep Apnea: Beyond CPAP. Life (Basel) 2024; 14:1007. [PMID: 39202749 PMCID: PMC11355307 DOI: 10.3390/life14081007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/22/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance and resistance to CPAP can limit its long-term effectiveness. Alternative treatments are available, such as Mandibular Advancement Devices (MADs), positional therapy, upper airway surgery, and maxillomandibular osteotomy. However, often less efficient in reducing the apnea-hypopnea index, the higher tolerance of and compliance to alternative treatment has resulted in the adequate treatment of OSA in CPAP-intolerant patients. This paper describes the protocol of a prospective single-center cohort study including adult patients with moderate to severe OSA (15 events/h ≤ apnea-hypopnea index (AHI) < 65 events/h) that failed to comply with CPAP therapy. Selected patients will be invited to the clinic to explore alternative treatment options where DISE will be a first step in further identifying upper airway collapse during sleep. By exploring alternative treatment options in CPAP-intolerant patients and systematically documenting their treatment paths, an algorithm can be defined to better guide patients towards personalized treatment for OSA. The follow-up is aimed at 5 years with an inclusion of 170 patients per year, including a drop-out rate of 15%. By leveraging a real-world database, this study aims to bridge the gap between research and clinical practice, facilitating the development of evidence-based guidelines and personalized treatment algorithms for CPAP-intolerant patients.
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Affiliation(s)
- Margot Van Daele
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Yannick Smolders
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Dorine Van Loo
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Charlotte Bultynck
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Respiratory Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Anneclaire Vroegop
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Thérèse Lapperre
- Department of Respiratory Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2000 Antwerp, Belgium
| | - Sara Op de Beeck
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Marijke Dieltjens
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
| | - Olivier M. Vanderveken
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium
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Pang KA, Pang KP, Lim JW, Pang EB, Cheong RCT, Baptista PM, Plaza G, Siow JK, Rotenberg B. Clinical outcomes of expansion sphincter pharyngoplasty-a 17-year systematic review. Eur Arch Otorhinolaryngol 2024; 281:2691-2698. [PMID: 38315175 DOI: 10.1007/s00405-024-08469-4] [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: 10/03/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To systematically review long-term (> 5 years) outcomes of ESP surgery for OSA treatment over 17 years. METHODS Systemic review of MEDLINE, Google Scholar, Cochrane Library and Evidence Based Medicine Reviews to identify publications relevant to OSA and Expansion Pharyngoplasty and its variants. All relevant studies published between January 2007 and June 2023 were included. RESULTS Twelve studies were included in this systematic review with a combined total of 1373 patients who had the ESP procedure were included. The clinical outcomes included encouraging long-term success rate, reductions in Epworth sleepiness scale, good mean disease alleviation, anatomical structural area and volume improvements, blood pressure reductions, biochemical improvements in acute phase reactants after ESP surgery, reductions in intra-ocular pressures, and post-operative reduction of sympathetic overdrive. CONCLUSIONS Seventeen years on, the expansion sphincter pharyngoplasty has demonstrated not only increase in anatomical area and volume but significant desired improvements in polysomnographic, clinical and biochemical parameters post-surgery.
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Affiliation(s)
| | | | - Joon Wei Lim
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Peter M Baptista
- Otolaryngology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Guillermo Plaza
- Otolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Jin Keat Siow
- Otolaryngology Head and Neck Surgery, Tan Tock Seng Hospital, Nanyang Technological University, National University Singapore, Singapore, Singapore
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Pang KP, Wei Lim J, Pang KA, Vicini C, Montevecchi F, Cheong RCT, Pang EB, Siow JK, Huak Chan Y, Rotenberg B. Reasonable Risk Ratio of Palate Surgery: A New Critical Analysis. J Otolaryngol Head Neck Surg 2024; 53:19160216241279074. [PMID: 39287430 PMCID: PMC11409292 DOI: 10.1177/19160216241279074] [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] [Indexed: 09/19/2024] Open
Abstract
OBJECTIVE. A new critical complication risk analysis, the reasonable risk ratio (RRR or R3) for palate surgeries in obstructive sleep apnea patients. METHODS. Analysis from published meta-analyses, systematic reviews on success rates, and complications encountered for 3 palate surgeries, expansion sphincter pharyngoplasty (ESP), barbed repositioning pharyngoplasty (BRP) and modified uvulopalatopharyngoplasty (mUPPP), over 20 years. The RRR is derived from a ratio of the percentage of each respective complication over the success rate of that particular surgical procedure. The benchmark RRR of tonsillectomy is set at 0.035 to 0.078. An RRR below this benchmark value is more favorable as tonsillectomy is a widely accepted ENT procedure with risks to benefit well accepted. RESULTS. The RRR for foreign body (FB) sensation (BRP) ranged from 0.03 to 0.23 (mean RRR of 0.14), FB sensation (ESP) 0.01, FB sensation (mUPPP) ranged from 0.33 to 0.55 (mean RRR of 0.44). The RRR for swallowing difficulties (BRP) ranged from 0.04 to 0.23 (mean RRR of 0.11), mUPPP, was 0.37; no reported swallowing difficulties with the ESP. The RRR for velopharyngeal insufficiency (VPI) (BRP) ranged from 0.009 to 0.18 (mean RRR of 0.07), and RRR VPI (mUPPP) was 0.14. The RRR (BRP) for dry throat was 0.06 and the mUPPP was 0.35, with no reported VPI or dry throat for ESP. The overall RRR for the BRP was 0.09, ESP was 0.01 and mUPPP was 0.29. CONCLUSION. RRR provides a summarized data-driven, statistical guide to aid decision-making, and helps in patient counseling. BRP and ESP have been shown to have less complications compared to mUPPP.Level of evidence: IV.
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Affiliation(s)
- Kenny P Pang
- Otolaryngology, Asia Sleep Centre, Paragon, Singapore, Singapore
| | - Joon Wei Lim
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kathleen A Pang
- Medicine Faculty, National University Singapore, Singapore, Singapore
| | - Claudio Vicini
- GB Morgagni-L Pierantoni Hospital, University of Ferrara and Bologna in Forli, Forli, Italy
| | | | | | - Edward B Pang
- Medicine Faculty, University of Glasgow, Glasgow, UK
| | - Jin Keat Siow
- Otolaryngology Head and Neck Surgery, National University Singapore, Nanyang Technological University, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, School of Medicine, National University Singapore, Singapore, Singapore
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