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Qi Y, Zhao Y, Yan Y, Wu D. Surgical failure guided by DISE in patients with obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3333-3343. [PMID: 38324055 DOI: 10.1007/s00405-024-08484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES The failure rate and risk factors of upper airway surgery with drug induced sleep endoscopy (DISE) remain unknown in the treatment of obstructive sleep apnea (OSA). This review aims to analyze the failure rate of upper airway surgery with DISE and identify obstruction sites for surgical failure. METHODS A systematic review was conducted using PubMed, Embase, Web of Science, and Google Scholar until May 20th, 2023. We included studies that used DISE to assess obstructive sites before upper airway surgery and reported surgical failure rates and outcomes in patients with OSA. RESULTS 25 studies with a total of 1522 patients were included in the systematic review and meta-analysis. Upper airway surgery guided by DISE had a relatively low failure rate of 37% (95% CI 0.31-0.44) in the random effects model (I2 = 85.97%, P < 0.001). According to the velum, oropharynx, tongue base, and epiglottis (VOTE) scoring system, major risk factors for surgical failure included circumferential collapse at the velum, lateral wall collapse and small tonsils at the oropharynx, anterior-posterior lingual collapse and complete collapse at the tongue base. High body mass index and large preoperative apnea hypopnea index were also risk factors for OSA surgical failure. CONCLUSIONS Upper airway surgery guided by DISE in patients with OSA had a low failure rate of 37%. DISE can identify obstruction sites associated with surgical failure and guide single-level and multi-level surgeries.
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Affiliation(s)
- Yingting Qi
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
- Department of Medicine, Peking University, Beijing, People's Republic of China
| | - Yi Zhao
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China
- Department of Medicine, Peking University, Beijing, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Dawei Wu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, No. 49 Huayuan North Road, Haidian District, Beijing, 100191, People's Republic of China.
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Liu X, Wei Z, Ting L, Liu X, Shu Y, Ling H, Li L, Liu Y, Xia G, Peng D, Li H. Microstructural Changes in the Cerebral White Matter After 12 Months of CPAP Treatment for Moderate to Severe Obstructive Sleep Apnoea: A TBSS Study. Nat Sci Sleep 2024; 16:531-542. [PMID: 38827391 PMCID: PMC11141711 DOI: 10.2147/nss.s460919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Continuous positive airway pressure (CPAP) therapy improves clinical symptoms in patients with obstructive sleep apnea (OSA); however, the mechanism of this clinical improvement and how it may be associated with the restoration of white matter (WM) structures in the brain is unclear. Therefore, this study investigated the relationship between the structural recovery of brain WM and improvements in cognitive function and emotion after long-term (12 months) CPAP treatment in patients with OSA. Methods We collected data from 17 patients with OSA before and 12 months after CPAP treatment, including sleep monitoring, clinical assessment, and diffusion tensor imaging (DTI) magnetic resonance imaging. Results We observed a partial reversible recovery of brain WM (mean and radial diffusion coefficients) after treatment. This recovery involved the commissural fibers (cingulum, body of corpus callosum), projection fibers (retrolenticular part of the internal capsule, posterior thalamic radiation, posterior limb of the internal capsule, superior corona radiata, posterior corona radiata), association fibers (external capsule, superior longitudinal fasciculus, inferior longitudinal fasciculus), and other regions. In addition, the improvements in WM fibers in one part of the brain significantly were correlated with the Hamilton Anxiety Scale and Hamilton Depression Scale scores. Discussion Our results suggest that reversible recovery of reduced brain WM integrity due to OSA may require longer CPAP treatment. Moreover, changes in the integrity of the commissural fibers were associated with emotion regulation. These restored WM areas may explain the cognitive and mood improvements observed after OSA treatment.
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Affiliation(s)
- Xiang Liu
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Zhipeng Wei
- Department of Radiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Long Ting
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Xuming Liu
- Department of Radiology, Wenzhou People’s Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Yongqiang Shu
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Huang Ling
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Lifeng Li
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Yumeng Liu
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Guojin Xia
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Dechang Peng
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Haijun Li
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
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Di Bari M, Colombo G, Giombi F, Leone F, Bianchi A, Colombo S, Salamanca F, Cerasuolo M. The effect of drug-induced sleep endoscopy on surgical outcomes for obstructive sleep apnea: a systematic review. Sleep Breath 2024; 28:859-867. [PMID: 37851322 DOI: 10.1007/s11325-023-02931-z] [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: 02/20/2023] [Revised: 06/11/2023] [Accepted: 08/07/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Drug-induced sleep endoscopy (DISE) is the most widespread diagnostic tool for upper-airway endoscopic evaluation of snoring and obstructive sleep apnea (OSA). However, a consensus on the effectiveness of DISE on surgical outcomes is still lacking. This study aimed to quantify the effect of DISE on surgical outcomes and to compare DISE with awake examination using the Müller Maneuver (MM). METHODS This systematic review was performed according to the PRISMA guidelines. Published studies from the last 30 years were retrieved from the Cochrane Library, MEDLINE, SCOPUS, and PubMed databases. Studies comparing DISE with awake examination, or MM were included. Surgical success rate was defined according to Sher's criteria, achieving a postoperative apnoea-hypopnea index (AHI) value < 20 events per hour and a 50% improvement from preoperative AHI. Outcomes are presented in terms of surgical success, pre- and postoperative AHI, Epworth sleepiness score (ESS), oxygen desaturation index (ODI) and lowest oxygen saturation (LOS). RESULTS This review included 8 studies comprising 880 patients. DISE group showed a higher LOS increase, ODI decrease, ESS decrease than non-DISE group (6.83 ± 3.7 versus 3.68 ± 2.9, p<0.001; 19.6 ± 11.2 versus 12.6 ± 10.4, p<0.001; 6.72 ± 4.1 versus 3.69 ± 3.1, p<0.001). Differences in surgical success rate were significant only between DISE and MM (64.04% versus 52.48%, p = 0.016). AHI decrease resulted higher in non-DISE than in DISE group (39.92 ± 24.7 versus 30.53 ± 21.7, p<0.001). CONCLUSION Results of this systematic review suggest that the evidence is mixed regarding a positive effect of DISE on surgical outcomes.
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Affiliation(s)
- Matteo Di Bari
- ENT Department, Pitié-Salpétrière Hospital, Sorbonne Université, Paris, France
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
| | - Giovanni Colombo
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy.
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Milano, Italy.
| | - Francesco Giombi
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy
- Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milano, Italy
| | - Federico Leone
- Otorhinolaryngology Unit, San Pio X Hospital, Milano, Italy
| | | | - Stefano Colombo
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, ASST Ovest Milanese, Milano, Italy
| | | | - Michele Cerasuolo
- Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milano, Italy
- Otorhinolaryngology Unit, San Pio X Hospital, Milano, Italy
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Iannella G, Magliulo G, Greco A, De Virgilio A, Maniaci A, Lechien JR, Calvo-Henriquez C, Bahgat AY, Casale M, Lugo R, Baptista P, Salamanca F, D’Ecclesia A, Perrone T, Leone F, Cannavicci A, Cammaroto G, Vicini C, Pace A. Clinical Application of Pediatric Sleep Endoscopy: An International Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:94. [PMID: 38255407 PMCID: PMC10814917 DOI: 10.3390/children11010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE. METHODS A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations. RESULTS A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral. CONCLUSION Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.
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Affiliation(s)
- Giannicola Iannella
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
| | - Giuseppe Magliulo
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
| | - Antonio Greco
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Antonino Maniaci
- Department of Otolaryngology, Kore University, 94100 Enna, Italy;
| | - Jerome R. Lechien
- Department of Otolaryngology, Elsan Polyclinic of Poitiers, 86000 Poitiers, France;
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Rhinology Unit, Hospital Complex of Santiago de Compostela Travesía de Choupana, 15706 Santiago de Compostela, Spain;
| | - Ahmed Yassin Bahgat
- Department of Otorhinolaryngology-Head & Neck Surgery, Alexandria University, Alexandria 5424041, Egypt;
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy;
| | - Rodolfo Lugo
- Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey 64660, Mexico;
| | - Peter Baptista
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
| | - Fabrizio Salamanca
- Otorhinolaryngology Unit, San Pio X Hospital, 20159 Milan, Italy; (F.S.); (F.L.)
| | - Aurelio D’Ecclesia
- IRCCS ‘Casa Sollievo della Sofferenza’, 71013 San Giovanni Rotondo, Italy;
| | - Tiziano Perrone
- Otorhinolaryngology Unit, Civil Hospital of Alghero, 07041 Alghero, Italy;
| | - Federico Leone
- Otorhinolaryngology Unit, San Pio X Hospital, 20159 Milan, Italy; (F.S.); (F.L.)
| | - Angelo Cannavicci
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy; (A.C.); (G.C.)
| | - Giovanni Cammaroto
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Pierantoni Hospital, 47121 Forlì, Italy; (A.C.); (G.C.)
| | - Claudio Vicini
- Department ENT & Audiology, University of Ferrara, 44121 Ferrara, Italy;
| | - Annalisa Pace
- Department of Organi di Senso, Sapienza University, 00185 Rome, Italy; (G.M.); (A.G.); (A.P.)
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De Vito A, Olszewska E, Kotecha B, Thuler E, Casale M, Cammaroto G, Vicini C, Vanderveken OM. A Critical Analysis of Pharyngeal Patterns of Collapse in Obstructive Sleep Apnea: Beyond the Endoscopic Classification Systems. J Clin Med 2023; 13:165. [PMID: 38202171 PMCID: PMC10779773 DOI: 10.3390/jcm13010165] [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: 11/03/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Drug-Induced Sleep Endoscopy (DISE) enables the three-dimensional and dynamic visualization of the upper airway (UA) during sleep, which is useful in selecting the best treatment option for obstructive sleep apnea (OSA) patients, particularly for surgical procedures. Despite international consensus statements or position papers, a universally accepted DISE methodology and classification system remain a controversial open question. (2) Methods: A review of the English scientific literature on DISE related to endoscopic classification systems and surgical outcome predictors (3) Results: Of the 105 articles, 47 were included in the analysis based on their content's relevance to the searched keywords. (4) Conclusions: A final report and scoring classification system is not universally accepted; the most internationally applied endoscopic classification system during DISE does not cover all patterns of events that occur simultaneously during the endoscopic examination, highlighting that several configurations of collapse and obstruction at different UA levels could be observed during DISE, which should be described in detail if DISE has to be considered in the decision-making process for the UA surgical treatment in OSA patients and if DISE has to have a role as a predictive factor for surgical outcomes analysis.
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Affiliation(s)
- Andrea De Vito
- ENT Unit, Department of Surgery, Ravenna-Lugo Hospitals, Health Local Agency of Romagna, 48121 Ravenna, Italy;
- ENT Unit, Department of Surgery, Forlì—Faenza Hospitals, Health Local Agency of Romagna, 47122 Forlì, Italy
| | - Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, 15-328 Bialystok, Poland;
| | - Bhik Kotecha
- Queens Hospital, Barking Harvering and Redbridge University Hospitals NHS Trust, Rom Vally Way, Romford RM1 2BA, UK;
| | - Eric Thuler
- Sleep Surgery Division, OHNS Department, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy;
| | - Giovanni Cammaroto
- ENT Unit, Department of Surgery, Forlì—Faenza Hospitals, Health Local Agency of Romagna, 47122 Forlì, Italy
| | - Claudio Vicini
- ENT Unit, Faenza Hospital, Villa Maria Group, 48018 Faenza, Italy;
| | - Olivier M. Vanderveken
- Department of Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital (UZA), 2650 Antwerp, Belgium;
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
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Nunes HDSS, Vaz de Castro J, Favier V, Carsuzaa F, Kim MHR, Mira FA, Meccariello G, Vicini C, De Vito A, Lechien JR, Chiesa Estomba C, Maniaci A, Iannella G, Cammaroto G. Predictors of Success of Pharyngeal Surgery in the Treatment of Obstructive Sleep Apnea: A Narrative Review. J Clin Med 2023; 12:6773. [PMID: 37959237 PMCID: PMC10649816 DOI: 10.3390/jcm12216773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: This narrative review aims to explore the predictors of success for pharyngeal surgery in the treatment of obstructive sleep apnea (OSA). An extensive literature search was conducted, identifying relevant studies published up to June 2023, utilizing various databases and key search terms related to OSA, surgical interventions, and predictors of success. The review encompasses both retrospective and prospective studies, case series, and cohort studies to provide a broad understanding of the topic; (2) Methods: Review of English scientific literature on phenotypes of OSA related to predictors of success of pharyngeal surgery; (3) Results: Of 75 articles, 21 were included, in these the following were determined to be factors for surgical success: body mass index (BMI) (8 articles), apnea/hypopnea index (AHI) (8 articles), cephalometry (8 articles), palatine tonsil size (7 articles), Modified Mallampati score (2 articles), genioglossus electromyography (2 articles), Friedman score or upper airway anatomy (3 articles), nasopharyngolaryngoscopy (2 articles), drug-induced sleep endoscopy (DISE) (1 article), oral cavity anatomy (1 article) and oxygen desaturation index (ODI) (1 article); (4) Conclusions: The lack of standardized protocols for the indication of pharyngeal surgery is a reality, however identifying known predictors of surgical success may facilitate homogenizing indications.
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Affiliation(s)
- Heloisa dos Santos Sobreira Nunes
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo 04090-010, Brazil
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
| | - Joana Vaz de Castro
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, Armed Forces Hospital, 1649-026 Lisbon, Portugal
| | - Valentin Favier
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, University Hospital of Montpellier, 34080 Montpellier, France
| | - Florent Carsuzaa
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Marina He Ryi Kim
- ENT and Sleep Medicine Department, Nucleus of Otolaryngology, Head and Neck Surgery and Sleep Medicine of São Paulo, São Paulo 04090-010, Brazil
| | - Felipe Ahumada Mira
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- ENT Department, Hospital of Linares, Linares 3582259, Chile
| | - Giuseppe Meccariello
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Claudio Vicini
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Andrea De Vito
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
| | - Jerome R. Lechien
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Division of Laryngology and Broncho-Esophagology, Department of Otolaryngology and Head and Neck Surgery, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons, 7000 Mons, Belgium
| | - Carlos Chiesa Estomba
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of Otorhinolaryngology, Donostia University Hospital, Biodonostia Research Institute, Osakidetza, 20014 San Sebastian, Spain
| | - Antonino Maniaci
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Piazza Università 2, 95100 Catania, Italy
| | - Giannicola Iannella
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Department of ‘Organi di Senso’, University “Sapienza”, Viale dell’Università 33, 00185 Rome, Italy
| | - Giovanni Cammaroto
- Young Otolaryngologists-International Federations of Oto-Rhinolaryngological Societies (YO-IFOS), 75000 Paris, France (V.F.); (F.A.M.); (A.M.)
- Head and Neck Department, ENT & Oral Surgery Unity, G.B. Morgagni, L. Pierantoni Hospital, 47100 Forlì, Italy
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Qi F, Fan L, Wang C, Liu Y, Yang S, Fan Z, Miao F, Kan M, Feng K, Wang T. Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial. BMC Anesthesiol 2023; 23:331. [PMID: 37794331 PMCID: PMC10548750 DOI: 10.1186/s12871-023-02300-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Based on electroencephalogram (EEG) analysis, index of consciousness (IoC) monitoring is a new technique for monitoring anesthesia depth. IoC is divided into IoC1 (depth of sedation) and IoC2 (depth of analgesia). The potential for concurrent monitoring of IoC1 and IoC2 to expedite postoperative convalescence remains to be elucidated. We investigated whether combined monitoring of IoC1 and IoC2 can effectively enhances postoperative recovery compared with bispectral index (BIS) in elderly patients undergoing laparoscopic urological surgery under general anesthesia. METHODS In this prospective, controlled, double-blinded trail, 120 patients aged 65 years or older were arbitrarily assigned to either the IoC group or the control group (BIS monitoring). All patients underwent blood gas analysis at T1 (before anesthesia induction) and T2 (the end of operation). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to all patients at T0 (1 day before surgery) and T4 (7 days after surgery). Serum concentrations of C-reactive protein (CRP) and glial fibrillary acid protein (GFAP) were assessed at T1, T2, and T3 (24 h after surgery). Postoperative complications and the duration of hospitalization were subjected to comparative evaluation. RESULTS The incidence of postoperative cognitive dysfunction (POCD) was notably lower in the IoC group (10%) than in the control group (31.7%) (P = 0.003). Postoperative serum CRP and GFAP concentrations exhibited significant differences at time points T2 (CRP: P = 0.000; GFAP: P = 0.000) and T3 (CRP: P = 0.003; GFAP: P = 0.008). Postoperative blood glucose levels (P = 0.000) and the overall rate of complications (P = 0.037) were significantly lower in Group IoC than in Group control. CONCLUSION The employment of IoC monitoring for the management of elderly surgical patients can accelerate postoperative convalescence by mitigating intraoperative stress and reducing peripheral and central inflammatory injury. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR1900025241 (17/08/2019).
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Affiliation(s)
- Fengling Qi
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
- Department of Anesthesiology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Long Fan
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Chunxiu Wang
- Department of Evidence-based Medicine, Xuanwu Hospital, National Clinical Research Center of Geriatric Diseases, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Shuyi Yang
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Zhen Fan
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Fangfang Miao
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Minhui Kan
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China.
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Luca C, Pasquale C, Caterina T, Antonio M, Federico L, Annalisa P, Riccardo A, Giuditta M, Gennaro R, Giovanni C. Barbed palatal surgery: single stage or multilevel setting-a systematic review by the Young Otolaryngologists of the Italian Society of Otolaryngology. Eur Arch Otorhinolaryngol 2023; 280:3905-3913. [PMID: 37227471 DOI: 10.1007/s00405-023-08018-5] [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: 02/28/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE This systematic review aims to compare the efficacy and safety of multilevel and single level surgery, including barbed pharyngoplasties, in the treatment of obstructive sleep apnea (OSA). METHODS The study followed PRISMA guidelines and searched PubMed/MEDLINE, Google Scholar, and Ovid databases for studies evaluating the effect of barbed pharyngoplasties on adults with OSA. Prospective and retrospective cohort studies were included with pre- and post-treatment comparisons of sleep tests and self-reported clinical outcomes. Exclusion criteria were non-English studies, case reports, reviews, conference abstracts, letters, and pediatric studies. Successful surgery was classified using Sher's criteria. RESULTS The study selected a total of 1014 patients from 26 studies, 24 of which were longitudinal studies with 10 retrospective trials and 14 prospective studies. The average age of the patients was 46.9 years, with an average Body Mass Index (BMI) of 25.6 kg/m2. Most of the patients were male (84.6%). The study included only palatal surgical techniques with barbed sutures, and patients who underwent cardio-respiratory monitoring and Drug Induced Sleep Endoscopy (DISE) before surgery. Mean Apnea Hypopnea Index (AHI) preoperative was 32.9/h, AHI postoperative was 11.9/h, and mean reduction of AHI was 62.3%. The most commonly adopted palatoplasty was Barbed Repositioning Pharyngoplasty (BRP) in 16 out of 26 studies, followed by its subsequent modifications in 3 studies. CONCLUSIONS Barbed pharyngoplasties appear to be effective both on objective measurement and subjective scores. DISE represents a fundamental tool to assess uni-level or multilevel obstruction. When retro-palatal collapse is present, barbed pharyngoplasty appears to be effective. Barbed pharyngoplasties maintain their good results both in single level or multilevel surgery. Randomized clinical controlled trials with multi-center cooperation and long-term study are necessary.
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Affiliation(s)
- Cerritelli Luca
- Ent Department, University of Ferrara, via A. Moro 8, loc. Cona, 4412, Ferrara, Italy.
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy.
| | - Capasso Pasquale
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Otolaryngology Head and Neck Surgery Unit of "Azienda Ospedaliera di Rilievo Nazionale dei Colli, Ospedale Monaldi", Napoli, Italy
| | - Tripodi Caterina
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Otolaryngology Head and Neck Surgery, F. Spaziani Hospital, ASL Frosinone, Frosinone, Italy
| | - Moffa Antonio
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128, Rome, Italy
| | - Leone Federico
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Otorhinolaryngology-Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Pace Annalisa
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Sense Organs, 9311Sapienza University of Rome, Roma, Italy
| | - Albertini Riccardo
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Otolaryngology, Ospedale Maggiore "C.A. Pizzardi", 2, Largo Nigrisoli, 40100, Bologna, Italy
| | - Mannelli Giuditta
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Head and Neck Oncology and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Russo Gennaro
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Otolaryngology Head and Neck Surgery Unit of "Azienda Ospedaliera di Rilievo Nazionale dei Colli, Ospedale Monaldi", Napoli, Italy
| | - Cammaroto Giovanni
- Young Otolaryngologists of the Italian Society of Otolaryngology (GOS-SIO), Ferrara, Italy
- Department of Otolaryngology-Head and Neck Surgery, Morgagni Pierantoni Hospital, 47121, Forli, Italy
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Liu J, Fang S, Wang Y, Wang L, Gao L, Xin T, Liu Y. The safety and efficacy of ultrasound-guided erector spinae plane block in postoperative analgesic of PCNL: A systematic review and meta-analysis. PLoS One 2023; 18:e0288781. [PMID: 37450461 PMCID: PMC10348577 DOI: 10.1371/journal.pone.0288781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia method of plane block, has a positive effect on postoperative analgesia. But evidence of ESPB in PCNL is still lacking. The objective of this study was to systematically analyze the postoperative analgesic effect of ESPB in patients receiving PCNL. METHODS The literature searching was conducted in PubMed, EMBASE, Cochrane Library and Clinical Trial Database (clinicaltrials.gov). Two independent researchers screened the included studies and extracted data. Meta-analysis was conducted by using the random-effect model with 95% confidence intervals. Chi-squared test with a significance level of 0.1 was utilized to evaluate the heterogeneity of included studies. The subgroup analysis and meta-regression analysis were conducted in studies with high heterogeneity. The publication bias was assessed based on whether there were discrepancies between prospective trial registration and reported protocols. RESULTS There were 8 studies involving 456 patients assessing the efficacy of ESPB in reducing postoperative pain score of PCNL compared with no block or other blocks, such as subcutaneous infiltration, general anesthesia or TPVB intrathecal morphine. ESPB was a significantly effective and safe anesthesia method, which not only improved postoperative pain response (MD -1.76; 95% CI -2.57 to -0.94; I 2 = 85%; p<0.01), but also reduced analgesic consumption (MD -16.92; 95% CI -26.25 to -7.59; I 2 = 92.2%; p<0.01) and prolonged the time of first request for postoperative analgesia (MD 93.27; 95% CI 35.79 to 150.75; I 2 = 85.3%; p = 0.001) in patients receiving PCNL without significant postoperative complications (MD 0.80; 95% CI 0.31 to 2.03; I 2 = 0%; p = 0.404). CONCLUSIONS Compared with no block or other blocks, the ESPB was a safe and effective anesthesia for patients receiving PCNL.
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Affiliation(s)
- Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Shirong Fang
- Weifang People’s Hospital, Weifang Medical University, Weifang, China
| | - Yuxi Wang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Lin Wang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Lunan Gao
- School of Nursing, Weifang Medical University, Weifang, China
| | - Tingting Xin
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nursing, Weifang Medical University, Weifang, China
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Vicini C, Cammaroto G. Treatment of sleep disordered breathing relapse after surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S103-S110. [PMID: 37698107 PMCID: PMC10159645 DOI: 10.14639/0392-100x-suppl.1-43-2023-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 09/13/2023]
Abstract
This narrative review provides a general overview of the management of relapses after surgery for the treatment of sleep disordered breathing. This clinical scenario represents a challenging field, but fortunately several therapeutic options are included in sleep surgeons’ armamentarium. Each therapeutic modality is described in detail in a dedicated section.
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Affiliation(s)
- Claudio Vicini
- University of Ferrara, University of Bologna
- ENT Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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11
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Lisan Q, Baudouin R, Lechien JR, Hans S, Blumen M. Is drug-induced sleep endoscopy associated with better outcomes after soft tissue surgery for sleep apnea? A systematic review and meta-analysis. Clin Otolaryngol 2023; 48:122-129. [PMID: 36383205 DOI: 10.1111/coa.14008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/24/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim was to estimate the effect of drug-induced sleep endoscopy (DISE) on surgical outcomes after soft tissue surgery for obstructive sleep apnea (OSA). DESIGN AND SETTING Systematic review and meta-analysis. PARTICIPANTS Adult patients with OSA and candidates for soft tissue surgery, with and without preoperative DISE, were included. MAIN OUTCOMES MEASURES A systematic literature search of Medline, Web of Science, and Cochrane databases was performed from inception to December 31, 2021. Studies directly comparing patients with and without preoperative DISE were included. Success rate, change in apnea-hypopnea index (AHI), change in minimum SpO2 and change in Epworth Sleepiness Scale (ESS) score were extracted. Random-effect models were used to pool estimates. RESULTS Seven out of 619 articles were included, representing 791 patients (389 in the DISE group and 402 in the no DISE group). DISE was neither associated with a higher success rate (pooled OR 1.34, 95% CI 0.69-2.59, p = 0.39) after soft tissue surgery for OSA, nor a significant change in AHI (-4.69 events/hour, 95% CI -11.10 to 1.72, p = 0.15), minimal SpO2 (mean increase of 2.02%, 95% CI -0.26 to 4.29, p = 0.08) and ESS (mean difference of 1.29, 95% CI -0.48 to 3.05, p = 0.15) when compared to patients without preoperative DISE. CONCLUSIONS Soft tissue surgery does not give better results after DISE compared to when DISE is not performed. However, given the overall low level of evidence of included studies, future well-conducted studies should confirm or overturn these results and clarify the added value of DISE.
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Affiliation(s)
- Quentin Lisan
- Department of Head and Neck surgery, Foch Hospital, Suresnes, France
| | - Robin Baudouin
- Department of Head and Neck surgery, Foch Hospital, Suresnes, France
| | - Jérôme R Lechien
- Department of Head and Neck surgery, Foch Hospital, Suresnes, France.,Department of Otolaryngology, Elsan Hospital, Paris, France
| | - Stéphane Hans
- Department of Head and Neck surgery, Foch Hospital, Suresnes, France
| | - Marc Blumen
- Department of Head and Neck surgery, Foch Hospital, Suresnes, France
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Viana A, Estevão D, Zhao C. The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea. Ann Med 2022; 54:2909-2920. [PMID: 36269026 PMCID: PMC9590429 DOI: 10.1080/07853890.2022.2134586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: Obstructive sleep apnoea (OSA) is characterized by nocturnal repetitive upper airway (UA) collapse. For sleep physicians, the recognition of UA collapse characteristics is critical for understanding OSA mechanisms and developing individualized treatment plans. Drug-induced sleep endoscopy (DISE) is an exam during simulated sleep that allows the dynamic assessment of the UA of individuals with OSA. The initial recognition of DISE was to locate the sites of UA obstruction and direct the surgical selection of OSA since it was introduced in the 1990s. After approximately 30 years of studies, based on advances in endoscopic operative techniques and innovative treatments of OSA, DISE had been performed to explore mechanisms and comprehensive treatments related to UA collapse. Methods: This article reviewed contemporary DISE advances, including indications and contraindications, technique of induced sleep, endoscopic operation, UA characteristics classification.Results and Conclusions: Precise selection based on the association between collapse patterns and treatment modalities, such as continuous positive airway pressure, oral appliance, positional therapy, robotic surgery and neurostimulator implanting, is the future research prospect based on DISE.Key messagesDISE provides sleep physicians with valuable information about the upper airway collapse characteristics and dynamic changes during sleep.The studies based on DISE findings improve the selectivity and efficiency of treatment modalities, including classical therapies such as continuous positive airway pressure, oral appliance, positional therapy, and innovative therapies such as neurostimulator implanting and robotic surgery, promote the advancement of OSA precision medicine.
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Affiliation(s)
- Alonço Viana
- Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil
| | - Débora Estevão
- Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Rio de Janeiro, Brazil.,Department of Otorhinolaryngology, Glória D'Or Hospital - Rede D'Or São Luiz, Rio de Janeiro, Brazil
| | - Chen Zhao
- Department of Otorhinolaryngology, the First Hospital of China Medical University, Shenyang, China
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Lembacher S, Gantner S, Uhl B, Holzer M, Patscheider M, Hempel JM. The RonchAP® palatinal device: A conservative approach in treating obstructive sleep apnea syndrome—a randomized, controlled study. Eur Arch Otorhinolaryngol 2022; 280:2373-2385. [PMID: 36441246 PMCID: PMC10066138 DOI: 10.1007/s00405-022-07738-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose
The aim of the present study was to assess the efficacy of the Ronch®AP palatal device in treating patients with moderate and severe forms of obstructive sleep apnea syndrome.
Methods
In a randomized controlled trial 22 patients were examined with the Ronch®AP palatal device after 4 weeks of usage. Their results were compared to a control group of 30 patients who did not receive any treatment during this time. All patients included did not tolerate CPAP therapy. Among other parameters the apnea–hypopnea index (AHI) was measured using nocturnal cardiorespiratory polysomnography. Daytime sleepiness was assessed using Epworth Sleepiness Scale. Pittsburgh Sleep Quality Index was used to analyze sleep quality.
Results
Using the Ronch®AP palatal device AHI was reduced from an average of 35.34 ± 14.9/h to 19.18 ± 14.93/h, whereas the control group only showed a minimal mean reduction from 31.32 ± 12.76/h to 29.37 ± 17.11/h. The difference in reduction between the two randomized groups was highly significant (d = − 14.2, 95% CI 5.9–22.6, t = 3.4, df = 49.9, p = 0.001). Epworth Sleepiness Scale score was lowered from 9.18 ± 4.73 to 7.82 ± 4.14 on average and sleep quality improved by − 1.91 ± 2.31. Both changes were also statistically relevant (p < 0.005).
Conclusions
The Ronch®AP device is an effective alternative treatment option for patients suffering from moderate and severe forms of obstructive sleep apnea syndrome and not tolerating CPAP therapy.
Trial registration number
407-16 with approval from the local ethical committee (Ethikkommission der Medizinischen Fakultät der LMU München).
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Affiliation(s)
- Sophie Lembacher
- University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria
| | - Sophia Gantner
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Bernd Uhl
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Martin Holzer
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Martin Patscheider
- Department of Otorhinolaryngology, Head and Neck Surgery, Südtiroler Sanitätsbetrieb, Brixen, Italy
| | - John-Martin Hempel
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilian University Munich, Munich, Germany
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The Effects of Barbed Repositioning Pharyngoplasty in Positional and Non-Positional OSA Patients: A Retrospective Analysis. J Clin Med 2022; 11:jcm11226749. [PMID: 36431226 PMCID: PMC9697864 DOI: 10.3390/jcm11226749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. METHODS A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher's criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. RESULTS The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. CONCLUSIONS BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure.
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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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Zhang C, Chen M, Shen Y, Gong Y, Ma J, Wang G. Impact of Upper Airway Characteristics on Disease Severity and CPAP Therapy in Chinese Patients With OSA: An Observational Retrospective Study. Front Neurol 2022; 13:767336. [PMID: 35309580 PMCID: PMC8930821 DOI: 10.3389/fneur.2022.767336] [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: 08/30/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The characteristics of the upper airway (UA) are important for the evaluation and treatment of obstructive sleep apnea (OSA). This study aimed to investigate the association of UA characteristics with OSA severity, titration pressure, and initiation of and 3-month compliance with continuous positive airway pressure (CPAP). Methods This retrospective study included consecutive patients examined using a semi-quantitative UA evaluation system (combination with physical examination and awake endoscopy) during 2008–2018 at the Department of Respiratory and Critical Care Medicine, Peking University First Hospital. First, the differences in UA characteristics were compared between patients with simple snorers and mild OSA and those with moderate-to-severe OSA. Then, the effect of UA characteristics on the initiation to CPAP therapy and 3-month adherence to CPAP was conducted. Results Overall, 1,002 patients were included, including 276 simple snorers and patients in the mild OSA group [apnea-hypopnea index (AHI) <15] and 726 patients in the moderate-to-severe OSA group (AHI ≥15). Tongue base hypertrophy, tonsillar hypertrophy, mandibular recession, neck circumstance, and body mass index (BMI) were independent risk factors for moderate-to-severe OSA. Among those patients, 119 patients underwent CPAP titration in the sleep lab. The CPAP pressures in patients with thick and long uvulas, tonsillar hypertrophy, lateral pharyngeal wall stenosis, and tongue hypertrophy were higher than those of the control group (P < 0.05, respectively). The logistic regression analysis showed that nasal turbinate hypertrophy, mandibular retrusion, and positive Müller maneuver in the retropalate and retroglottal regions were independent predictors for the initiation of home CPAP treatment. Conclusion Multisite narrowing and function collapse of the UA are important factors affecting OSA severity, CPAP titration pressure, and the initiation of home CPAP therapy. Clinical evaluation with awake endoscopy is a safe and effective way for the assessment of patients with OSA in internal medicine.
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Affiliation(s)
- Cheng Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Mingxin Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yane Shen
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yuhong Gong
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jing Ma
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
- *Correspondence: Jing Ma
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
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