Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience

The role of upper airway and facial skeleton anatomy in the evolution of obstructive sleep apnea: an 8-year follow-up

PURPOSE

To evaluate the role of anatomic alterations of the upper airway and facial skeleton in the evolution of obstructive sleep apnea (OSA) in a prospective population-based study with an 8-year follow-up.

METHODS

This was a population-based, longitudinal, prospective study, which took place from 2007 to 2015 at the Instituto do Sono, Sao Paulo, Brazil. In 2007, type I polysomnography (PSG), otorhinolaryngological examination, and collection of anthropometric measurements of all volunteers were performed. Volunteers were classified according to their anatomical features of the upper airway and facial skeleton. After 8 years, volunteers were invited for reevaluation. The relationship between anatomical characteristics and polysomnographic evolution was evaluated.

RESULTS

The study included 554 patients. After 8 years of follow-up, there was an increase in neck circumference and body mass index of the participants. There was a worsening in all polysomnographic parameters analyzed, with an increase in the apnea-hypopnea index, a decrease in minimum saturation values, and an increase in the percentage of sleep time with peripheral oxyhemoglobin saturation <90%. There was no statistical relationship between the anatomical findings considered unfavorable and the worsening of polysomnographic parameters.

CONCLUSIONS

In a sample of the general population, after 8 years, we did not find any relationship between upper airway and facial skeleton characteristics and the progression of OSA.

Management of pharyngeal collapse in patients affected by moderate obstructive sleep apnoea syndrome

Objective

This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty.

Methods

In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/m², and mild-moderate obstructive sleep apnoea syndrome (OSAS). A clinical evaluation, including collection of anthropometric data and sleep endoscopy, was performed. Six months after surgery, symptoms recording, clinical evaluation and polysomnography (PSG) were repeated.

Results

We enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher’s criteria, of 90% for MESP and 80% for MBRP, respectively. Post-surgical pain and snoring reduction were significantly lower with MBRP.

Conclusions

We recorded similar success rates for both techniques. MBRP may be considered better than MESP due to less surgical time, no potential mucosal damage, absence of knots, and faster recovery with less pain.

OSAHS Growth Impairment and Resolution after Adenotonsillectomy in Children

INTRODUCTION

One of the most important complications of OSAHS in children is growth delay. The aim of this study was to investigate changes in clinical body growth, and laboratory growth in children with OSAHS after adeno-tonsillar surgery.

MATERIALS AND METHODS

In our study, among 102 children suffering from sleep-disordered breathing, 70 met the inclusion criteria because they were affected by OSAHS and adenotonsillar hypertrophy. In total, 96 children affected by adeno-tonsillar hypertrophy (55 males and 41 females) underwent nocturnal cardiorespiratory monitoring with Embletta MPR, monitoring for post-operative 24 hours. Patients underwent blood sampling to evaluate preoperative GH and IGF-1 serum levels, "placement" in Cacciari's growth charts and adenotonsillectomy and saturation monitoring for post-operative 24 hours. According to auxological parameters, 82.86% of the patients were below the fiftieth percentile of BMI Cacciari's growth charts and IGF-1 preoperative serum levels were below the normal range. All patients underwent adenotonsillectomy.

RESULTS

All 70 patients recovered from OSAHS according to the results of nocturnal cardiorespiratory monitoring after six months. IGF-1 serum levels significantly increased after three months and one year after. All the auxological parameters showed a significant increase after surgery. We calculated the average annual growth in height of the patients before and after adenotonsillectomy (AT): the growth rate was impaired by OSAHS (5.4±1.3 cm/year), while in the following year post-surgery we found a significant growth speed acceleration (9.9±1.7 cm/year, P=0.001).

CONCLUSIONS

In conclusion, growth delay in children can be caused by OSAHS, and when it is due to adenotonsillar hypertrophy, adenotonsillectomy is to be considered as the therapy of choice.

A Comparative Double Blind Study of Nasal Dressing Sponge® versus Merocel® as Nasal Pack after Nasal Surgery

INTRODUCTION

Nasal packing is a common procedure used to ensure haemostasis after nasal surgery.

MATERIALS AND METHODS

A prospective, randomized, controlled and double-blinded study was conducted on 80 consecutive subjects to investigate whether using Nasal Dressing Sponge® (NDS) instead of simple Merocel® might improve patients' postoperative experience of nasal packing.

RESULTS

During the stay of the tampons no differences were noticed between the two groups as regards the postoperative pain. When it comes to pain during the packing removal, patients complained of worse symptoms in the side packed with Merocel. There was no bleeding after the removal of Merocel, whereas 5,6% patients were subject to some bleeding when NDS was removed.

CONCLUSION

Merocel and NDS gave similar results regarding haemostatic activity. Nasal Dressing Sponge could decrease pain during the removal of the nasal pack, while it could be associated to a bigger incidence of mild bleeding after removing the pack.

Nasal function and CPAP use in patients with obstructive sleep apnoea: a systematic review

PURPOSE

This systematic review was conducted to answer the following 3 questions: 'Does nasal pathology affect CPAP use?', 'What is the effect of CPAP on the nose?' and 'Does treatment of nasal pathology affect CPAP use?'.

METHODS

Pubmed and Scopus databases were searched for articles relevant to the study questions up to October 2020.

RESULTS

Sixty-three articles were selected, of which a majority were observational studies. Most studies identified a correlation between larger nasal cross-sectional area or lower nasal resistance and higher CPAP compliance or lower CPAP pressures; however, nasal symptoms at baseline did not appear to affect CPAP use. The effect of CPAP on the nose remains uncertain: while most studies suggested increased mucosal inflammation with CPAP, those investigating symptoms presented contradictory results, with some reporting an increase and others an improvement in nasal symptoms. Evidence is clearer for nasal surgery leading to an increase in CPAP compliance and a decrease in CPAP pressures, whereas there is little evidence available for the use of topical nasal steroids.

CONCLUSION

There appears to be a link between nasal volumes or nasal resistance and CPAP compliance, an increase in nasal inflammation caused by CPAP and a beneficial effect of nasal surgery on CPAP usage, but no significant effect of CPAP on nasal patency or effect of topical steroids on CPAP compliance. Results are more mitigated with regard to the effect of nasal symptoms on CPAP use and vice versa, and further research in this area would help identify patients who may benefit from additional support or treatment alongside CPAP.

Our Assessment Using Palate Postoperative Problems Score (PPOPS): Tool for the Evaluation of Results in Palatal Surgery Techniques

Obstructive sleep apnoea syndrome is a chronic condition characterized by frequent episodes of collapse of upper airways during sleep. Prevalence of the disease is settled at about 3-7%. Today, palatal surgery is a reference point in OSAHS treatment and there are many different surgical techniques. The purpose of our work is to compare post-operative results of palate surgery techniques used in our practice in OSAHS patients, studying the degree of patients' satisfaction with a recent score recommended by Rashwan et al. called PPOPS (Palate Post-Operative Problems Score). A retrospective study was performed on a sample of 40 patients subject to different palate surgery techniques for OSAS. Analysed surgical techniques were: Expansion Sphincter Pharyngoplasty (ESP), Uvulopalatopharyngoplasty (UPPP), Anterior Pharyngoplasty (AP), Barbed Reposition Pharyngoplasty (BRP). Patients answered the PPOPS and the results for each of the four techniques were compared. Group differences in the questionnaire total score were evaluated through Tukey's honest significance test for multiple (pairwise) comparisons. Overall average scores in the four groups were: AP 2.21, ESP 5.92, UPPP 2.8 and BRP 2.4. Comparing ESP with the other techniques (BRP, AP and UPPP) the scores were significantly higher (P < 0.05). Pairwise comparisons between the other three techniques (FA, UPPP and BRP) had a P value higher than 0.05, allowing to state that questionnaire results, in these cases, were similar to each other. Our work shows that different surgical techniques, even with the same purpose, could have different characteristics during follow-up. PPOPS is useful in post-operative for a better surgical practice.