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Wang X, Chen YC, Li L, Pan HG, Teng YS. Effects of drug-induced sleep endoscopy in children with conventional obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis. Sleep Breath 2024; 28:935-944. [PMID: 37917282 PMCID: PMC11136838 DOI: 10.1007/s11325-023-02945-7] [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: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE This study aimed to conduct a meta-analysis and systematic review of drug-induced sleep endoscopy (DISE) in pediatric conventional obstructive sleep apnea-hypopnea syndrome (OSAHS) without previous upper airway surgery, or comorbidity, to evaluate the change in treatment strategies and to identify obstructive sites observed during DISE. This study aimed to explore the role of DISE in the management of pediatric conventional OSAHS. METHODS A comprehensive search was conducted using both computerized and manual methods to retrieve relevant case studies on DISE-guided treatment of pediatric conventional OSAHS from databases including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, WF, and VIP database. The search period extended from database inception to January 2023. Strict inclusion and exclusion criteria were applied to select relevant literature, and data extraction was performed accordingly. Meta-analysis was conducted using the Stata 16.0 software. RESULTS A total of 761 patients from four studies were included in the meta-analysis. All pediatric patients had no history of upper airway surgery, craniofacial abnormalities, or syndromes other than OSAHS. The quality assessment revealed that the included studies were of low methodological quality and consisted of non-randomized case studies. Meta-analysis results indicated that in pediatric patients with OSAHS, the obstruction rates observed during DISE were as follows: nasopharyngeal (adenoid) obstruction 93%, soft palate obstruction 35%, oropharyngeal (tonsil) obstruction 76%, tongue base obstruction 32%, supraglottic obstruction 31%, and multi-level obstruction 60%. DISE led to a change in the conventional surgical approach in 45% (95% CI: 29-60%) of patients with OSAHS, providing individualized treatment plans. Postoperative symptoms and sleep-related parameters improved significantly compared to preoperative values, with DISE findings possibly enhancing surgical success rates and potentially avoiding unnecessary procedures. CONCLUSION In some cases, DISE may potentially lead to alterations in conventional surgical approaches for children with OSAHS who had no history of upper airway surgery, craniofacial abnormalities, or other syndromes.. The results of our meta-analysis were in favor of DISE-directed approach for pediatric conventional OSAHS. However, further high-quality randomized controlled trials (RCTs) are warranted in future research to investigate the role of DISE in the management of pediatric OSAHS.
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Affiliation(s)
- Xin Wang
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Lan Li
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Hong-Guang Pan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Yi-Shu Teng
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China.
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Lam DJ, Friedman NR, Chan KC, Kirkham EM, Smith DF, Benedek P, Boudewyns A. Development and validation of the international pediatric sleep endoscopy scale (IPSES). Int J Pediatr Otorhinolaryngol 2023; 174:111748. [PMID: 37820572 DOI: 10.1016/j.ijporl.2023.111748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES To develop and validate a consensus international pediatric sleep endoscopy scale (IPSES) for pediatric drug-induced sleep endoscopy (DISE). METHODS Existing published DISE ratings scales were reviewed in order to develop a consensus rating scale synthesizing the most common features and adding new elements to address areas of controversy. Samples of 30 de-identified DISE video recordings were reviewed to develop and refine the scale. After the consensus scale was defined, a separate sample of 25 de-identified DISE videos were scored with the new consensus scale by the development group and a panel of independent raters. A weighted kappa statistic was used to quantify the inter-rater and intra-rater reliability of the consensus scale at each anatomic level. RESULTS Among all raters, intra-rater reliability was most variable for the nasal airway (kappa range 0.33-0.94) and best for the lateral oropharynx (kappa range 0.68-0.95). Inter-rater reliability ranged from 0.43 for the nasal airway to 0.57 at the soft palate. CONCLUSION The IPSES is a reliable consensus scale that reflects the most common features of existing scales and can be adopted as a universal scoring scale for pediatric DISE.
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Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, 97239, USA.
| | - Norman R Friedman
- Pediatric Otolaryngology, Children's Hospital of Colorado (CHCO), Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Anschutz Medical Campus, USA
| | - Kate C Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Erin M Kirkham
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David F Smith
- Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA
| | - Palma Benedek
- Division of Sleep Laboratory and Sleep Surgery, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
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Aubertin G, Akkari M, Andrieux A, Colas des Francs C, Fauroux B, Franco P, Gagnadoux F, de Santerre OG, Grollemund B, Hartley S, Jaffuel D, Lafond L, Schröder CM, Schweitzer C, Charley-Monaca C. Management of obstructive sleep apnea syndrome type 1 in children and adolescents - A French consensus. Arch Pediatr 2023; 30:510-516. [PMID: 37537084 DOI: 10.1016/j.arcped.2023.06.009] [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: 03/28/2023] [Revised: 04/23/2023] [Accepted: 06/04/2023] [Indexed: 08/05/2023]
Abstract
This document is the outcome of a group of experts brought together at the request of the French Society of Sleep Research and Medicine to provide recommendations for the management of obstructive sleep apnea syndrome type 1 (OSA1) in children. The recommendations are based on shared experience and published literature. OSA1 is suspected when several nighttime respiratory symptoms related to upper airway obstruction are identified on clinical history taking. A specialist otolaryngologist examination, including nasofibroscopy, is essential during diagnosis. A sleep study for OSA1 is not mandatory when at least two nighttime symptoms (including snoring) are noted. Therapeutic management must be individualized according to the location of the obstruction. Ear, nose, and throat (ENT) surgery is often required, as hypertrophy of the lymphoid tissues is the main cause of OSA1 in children. According to clinical findings, orthodontic treatment generally associated with specialized orofacial-myofunctional therapy might also be indicated. Whatever treatment is chosen, follow-up must be continuous and multidisciplinary, in a network of trained specialists.
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Affiliation(s)
- G Aubertin
- Pediatric Pulmonology, Armand Trousseau Hospital, AP-HP Hospital, Sorbonne University, Paris, 75012, France; Centre de recherche Saint Antoine (CRSA), INSERM UMR-S 938, Paris, 75012, France; Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Boulogne-Billancourt, 92100, France.
| | - M Akkari
- Ear, Nose and Throat & Head and Neck Surgery, University Hospital Gui de Chauliac, University of Montpellier, Montpellier, 34000, France
| | - A Andrieux
- Cabinet de pneumo-pédiatrie et somnologie pédiatrique, Mérignac, 33700, France; Pôle d'Exploration des Apnées du Sommeil (PEAS), Nouvelle Clinique Bel Air, Bordeaux, 33200, France; Pediatric Pulmonology Unit, University Hospital Pellegrin - Enfants, University of Bordeaux, Bordeaux, 33000, France
| | - C Colas des Francs
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Réseau Morphée, Garches, 92380, France
| | - B Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, 75015, France; VIFASOM, University of Paris Cité, Paris, 75004, France
| | - P Franco
- Pediatric Sleep Unit, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, 69500, France; Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028, CNRS UMR5292 University of Lyon 1, Bron, 69675, France
| | - F Gagnadoux
- Department of Pulmonary and Sleep Medicine, University Hospital of Angers, Angers, 49000, France; INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, Angers, 49000, France
| | | | - B Grollemund
- Department of Dental-Facial Orthopedics, Pole of Bucco Dentaries' Medicine and Surgery, Cleft Competence Center, Strasbourg University Hospital, Strasbourg, 67000, France
| | - S Hartley
- Réseau Morphée, Garches, 92380, France; Sleep Unit, Department of Physiology, Raymond Poincaré Hospital, AP-HP, Garches, 92380, France
| | - D Jaffuel
- Department of Respiratory Diseases, University Hospital of Montpellier, Montpellier, 34000, France; PhyMedExp, CNRS, INSERM, Montpellier University, Montpellier, 34000, France
| | - L Lafond
- Oro-myofunctional Therapy Office, Bordeaux, 33000, France
| | - C M Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University and Strasbourg University Hospitals, Strasbourg, 67000, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, 67000, France; Sleep Disorders Center & CIRCSom (International Research Center for ChronoSomnology), Strasbourg University Hospitals, Strasbourg, 67000, France
| | - C Schweitzer
- Children's Medicine, Department of Pediatric Lung Function Testing, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, 54501, France; EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Vandoeuvre les Nancy, 54505, France
| | - C Charley-Monaca
- Department of Clinical Neurophysiology-Sleep Disorders Unit, University of Lille, University Hospital of Lille, and U1172 - LilNCog - Lille Neurosciences & Cognition, Lille, 59000, France
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Qarbal J, Le Treut-Gay C, Allali L, Rossi ME, Nicollas R, Moreddu E. Drug-Induced sleep endoscopy in children: NAVOTEL scoring system development. Pediatr Pulmonol 2023. [PMID: 37036166 DOI: 10.1002/ppul.26408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/25/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES Pediatric drug-induced sleep endoscopy (DISE) lacks a universal and easy-to-use scoring system. The velum, oropharynx, tongue, epiglottis (VOTE) scoring system is widely used but needs to be completed in pediatrics. The main objective of this study was to investigate the distribution of obstructive sites in DISE and to propose an appropriate pediatric scoring system. The secondary objective was to evaluate the changes in surgical management induced by the proposed scoring system. METHODS A single-center prospective 5-year study was conducted from March 2016 to December 2021, including 99 children with a mean age of 7.2 years (±3.7), with pathological preoperative sleep recordings and undergoing DISE. The distribution of all upper airway obstructive sites was studied. RESULTS Adenoids (A) were the most frequent obstructive site (63% of patients), and the nasal cavities (N) and the larynx (L) were other frequent obstructive sites. These sites are not explored by the VOTE scoring system, leading to the creation of the nose, adenoids, velum, oropharynx, tongue, epiglottis, larynx (NAVOTEL) scoring system. NAVOTEL was significantly correlated with the severity of obstructive sleep apnea-hypopnea syndrome (OSAS) (ρ = 0.2; p = 0.04) and highlighted obstructive sites in 6/9 patients with VOTE = 0. Of these patients, 4 had a complete obstructive site, and 3 had a multisite obstruction. VOTE indicated 8 additional surgical actions; NAVOTEL indicated 50 other actions compared to clinical examination. The NAVOTEL scoring system was exhaustive regarding surgical indications for OSAS. CONCLUSIONS The NAVOTEL scoring system is exhaustive in pediatric DISE and correlated to OSAS severity. It should be preferred in pediatric DISE.
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Affiliation(s)
- Jawad Qarbal
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Claire Le Treut-Gay
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Laure Allali
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Marie-Eva Rossi
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Richard Nicollas
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Eric Moreddu
- Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France
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Herzig MX, Hildebrand AD, Nguyen T, Lam DJ. Drug-Induced Sleep Endoscopy Differences by Age in Surgically Naive Children With Sleep-Disordered Breathing. JAMA Otolaryngol Head Neck Surg 2023; 149:327-333. [PMID: 36821100 PMCID: PMC9951097 DOI: 10.1001/jamaoto.2022.5187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/29/2022] [Indexed: 02/24/2023]
Abstract
Importance Drug-induced sleep endoscopy (DISE) is increasingly used to guide treatment decisions in children with sleep-disordered breathing (SDB). Previous reports of DISE findings in children have typically included a broad age range, but it is unclear how these patterns of obstruction vary with age. Objective To compare patterns of airway obstruction observed during DISE in 3 age groups of surgically naive children with SDB. Design, Setting, and Participants This cross-sectional analysis of a prospective cohort of surgically naive nonsyndromic children with SDB or obstructive sleep apnea [OSA] at risk for residual disease after adenotonsillectomy (defined as having at least 1 of these criteria: severe OSA, older than 7 years, obesity, or Black race) who were recruited between May 1, 2015, and February 28, 2020, was conducted at a tertiary children's hospital. Data analysis was conducted from September 2021 to February 2022. Exposures DISE. Main Outcomes and Measures DISE findings were rated at 6 anatomic sites using the Sleep Endoscopy Rating Scale (SERS). The association between age and severity of obstruction at each anatomic site and overall were compared using correlation (Kendall τ) and ordinal logistic regression analysis. Results Data from 288 children (144 girls [50%]; 20 American Indian/Alaska Native [7%], 4 Asian [1%], 19 Black [7%], 93 Hispanic [33%], 2 Middle Eastern [1%], 6 Native Hawaiian/Pacific Islander [2%], and 203 White [70%] individuals; median [IQR] age, 9.2 [7.0-11.7] years) were stratified by participant age into preschool (age 2-5 years; 27 [9%]), younger school-aged (age 5-10 years; 146 [51%]), and older school-aged (age 10-18 years; 115 [40%]). Among these subgroups, the prevalence of multilevel obstruction was 59%, 51%, and 30%, respectively. Increasing age was inversely correlated with obstruction of the nasal airway (τb, -0.19; 95% CI, -0.29 to -0.09), nasopharynx (τb, -0.20; 95% CI, -0.31 to -0.10), velopharynx (τb, -0.16; 95% CI, -0.26 to -0.06), and overall obstruction (SERS total score: τb, -0.24; 95% CI, -0.33 to -0.14). An adjusted analysis demonstrated an inverse association between age and nasopharyngeal obstruction (odds ratio [OR], 0.84; 95% CI, 0.76 to 0.92), SERS total score (OR, 0.83; 95% CI, 0.76 to 0.90), and the number of sites of complete obstruction (OR, 0.87; 95% CI, 0.87 to 0.95). Conclusions and Relevance This cross-sectional analysis of data from a prospective cohort study of surgically naive children with SDB found that preschool-aged children had more frequent multilevel obstruction, more severe overall obstruction, and nasopharyngeal obstruction compared with older children. Understanding the most common sites of obstruction and expected changes with age could inform personalized treatment for children with SDB.
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Affiliation(s)
- Maya X. Herzig
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Andrea D. Hildebrand
- Biostatistics and Design Program, Oregon Health and Science University, Portland
| | - Thuan Nguyen
- Biostatistics and Design Program, Oregon Health and Science University, Portland
| | - Derek J. Lam
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
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Hazkani I, Stein E, Ghadersohi S, Ida J, Thompson DM, Valika T. Epiglottopexy for refractory obstructive sleep apnea in children - A single-institution experience. Am J Otolaryngol 2023; 44:103798. [PMID: 36764227 DOI: 10.1016/j.amjoto.2023.103798] [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: 08/18/2022] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Refractory obstructive sleep apnea (OSA) is a common condition in children with medical comorbidities, leading to a significant impact on quality of life. Drug-induced sleep endoscopy (DISE) has become the standard of care in identifying the levels of obstruction in children with refractory OSA. Epiglottopexy has been shown to improve OSA symptoms in adults and healthy children with epiglottic prolapse in a few studies, with minimal long-term complications. The objective of our study was to evaluate the role of epiglottopexy in children with refractory OSA. METHODS A retrospective chart review of children with refractory OSA who were found to have epiglottic prolapse on DISE, and underwent epiglottopexy between January 2018 and November 2021 at a pediatric tertiary care hospital. RESULTS 42 patients (age 8.1 ± 5.1 years) met inclusion criteria. Thirty patients (71.4 %) suffered from neurodevelopmental disease or congenital syndrome, and 14 patients (33.3 %) were gastrostomy-tube dependent. All patients had at least one prior surgical procedure to address their OSA. Thirty-six patients (85.7 %) were diagnosed with refractory OSA by polysomnography prior to surgery, with an average apnea-hypopnea index (AHI) of 12.4 ± 9.7/h. Forty patients (95.2 %) required an additional procedure in conjunction with epiglottopexy including lingual tonsillectomy (n = 27, 64.3 %), supraglottoplasty (n = 14, 33.3 %), tonsillectomy with or without revision adenoidectomy (n = 9, 21.4 %) and tongue base suspension (n = 1, 2.4 %). Twenty-one patients had repeated polysomnography; 4 patients were found to have residual severe OSA post-operatively (average AHI 17.4 ± 11.4/h), while the remaining patients demonstrated clinical improvement and a significant reduction in OSA severity, with an average AHI of 1.5 ± 2.2/h. Regression analysis identified pre-operative oxygen nadir <75 % to be associated with residual OSA postoperatively. Following surgery, 7 patients were found to have new-onset or worsening dysphagia, 6 of whom were diagnosed with complex medical comorbidities. CONCLUSIONS Epiglottopexy, as part of multi-level airway surgery, is associated with a significant improvement in the severity of refractory OSA. Dysphagia may complicate the post-operative course, particularly in children with medical comorbidities.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Eli Stein
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Saied Ghadersohi
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan Ida
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dana M Thompson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Taher Valika
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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7
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Frederick RM, Brandt J, Sheyn A. Drug-induced sleep endoscopy effect on intraoperative decision making in pediatric sleep surgery: A 2-year follow up. Laryngoscope Investig Otolaryngol 2022; 7:2112-2118. [PMID: 36544916 PMCID: PMC9764739 DOI: 10.1002/lio2.918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To further demonstrate sleep endoscopy's utility in improving surgical outcomes for pediatric OSA. Methods This is a retrospective review of surgically naïve patients <18 years old with diagnosed moderate-severe OSA who underwent DISE at the time of initial sleep surgery. Patients included in final analysis had both preoperative and postoperative polysomnograms. Surgical success was defined as an oAHI decrease by at least one diagnostic category. Residual OSA was defined as any patient with postoperative oAHI >1. Results A total of 106 patients had preoperative and postoperative polysomnograms. Patients with comorbidities comprised 53.8% of the group. Average BMI% was 88.2, with 75.5% classified as obese. The most common area of collapse was the base of tongue, occurring in 32.1% of patients. There was a statistically significant decrease from the mean preoperative oAHI of 29.7 to the mean postoperative oAHI of 6.6 (p < 0.001). Surgical success occurred in 76.4% of patients. A postoperative oAHI of <5 was achieved in 57.7% of patients with moderate or severe OSA. The average BMI% of patients who met surgical success was 86.4, while the average BMI% of patients who did not was 90.8. A postoperative oAHI of <5 was achieved in 68.4% of patients with a BMI% < 85, compared with 55.2% of patients with a BMI% ≥ 85. Conclusion This study supports the utilization of DISE during initial surgery for severe sleep apnea in the pediatric population. It was found to effectively aid in significantly reducing surgically naïve patients' mean oAHI. Level of Evidence Level III.
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Affiliation(s)
- Robert M. Frederick
- Department of Otolaryngology, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Josiah Brandt
- Department of Otolaryngology, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Anthony Sheyn
- Department of Otolaryngology, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
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8
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Simultaneous enucleation of the tonsils in "Pickwickian patients". Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:489-491. [PMID: 34446387 DOI: 10.1016/j.anorl.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Tonsillar surgery was, from the 19th century, the reference treatment for apneic patients. Adapting to the technical limitations of the time, surgeons devised ingenious procedures. The purpose of this historical note is to travel back to that time and rediscover one of the techniques favored by Chassaignac: "simultaneous enucleation" of the tonsils.
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9
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Arganbright JM, Lee JC, Weatherly RA. Pediatric drug-induced sleep endoscopy: An updated review of the literature. World J Otorhinolaryngol Head Neck Surg 2021; 7:221-227. [PMID: 34430829 PMCID: PMC8356111 DOI: 10.1016/j.wjorl.2021.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The field of drug-induced sleep endoscopy (DISE) has grown considerably over the last 10∼15 years, to now include its use in pediatric patients. In this review article, we outline our approach to the use of this technology in Children with Airway Obstruction, most specifically in the management of children with airway obstruction and known or suspected adenotonsillar enlargement.
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Affiliation(s)
- Jill M Arganbright
- Children's Mercy Kansas City, Division of Otolaryngology, Kansas City, MO, USA.,University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
| | - Jason C Lee
- University of Kansas Medical Center, Department of Otolaryngology, Kansas City, KS, USA
| | - Robert A Weatherly
- Children's Mercy Kansas City, Division of Otolaryngology, Kansas City, MO, USA.,University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA
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10
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Shivaji VS, Wilson JC, Schmidt NL, Kolokythas O, Lalwani N. Carcinoma of unknown primary with hepatic metastases: a need of judicious and contemplative diagnostic algorithm. Abdom Radiol (NY) 2021; 46:257-267. [PMID: 32632467 DOI: 10.1007/s00261-020-02630-3] [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: 05/01/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
Carcinoma of Unknown Primary presenting primarily as hepatic metastases encompasses a dismal subgroup of tumors with a median survival of 5.9 months. Adenocarcinoma is the most common histological subtype identified upon biopsy and the primary tumor remains undetectable in the majority of cases despite extensive workup. It is important to have a validated and standardized algorithm to follow these tumors to avoid unnecessary tests, as the wishes and health status of the patient represent the principal concerns. The purpose of this paper is to briefly review the current literature on carcinoma of unknown primary with hepatic metastases and propose a standardized diagnostic approach.
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11
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Shehan JN, Du E, Cohen MB. Robot-assisted epiglottopexy as a method for managing adult obstructive sleep apnea. Am J Otolaryngol 2020; 41:102742. [PMID: 32979662 DOI: 10.1016/j.amjoto.2020.102742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients who do not tolerate continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA) often seek surgical management. A variety of procedures exist to address the nasal passages, oropharynx, hypopharynx, and larynx. Diagnostic studies including drug-induced sleep endoscopy (DISE) are helpful in identifying areas of obstruction. One potential site of obstruction is at the level of the epiglottis. We describe the use of robotic technology to assist with epiglottopexy to manage epiglottic retroflexion as a cause of two patients' OSA. This is the first reported robot-assisted epiglottopexy in the adult otolaryngology literature. METHODS This is a case series of two patients with OSA who demonstrated epiglottis collapse into the airway during DISE. They were evaluated by polysomnographic testing (PSG), Epworth Sleepiness Scale (ESS), and physical exam. Given their epiglottic collapse seen on DISE, they underwent robot-assisted epiglottopexy. RESULTS Both patients had moderate to severe OSA preoperatively. They successfully underwent robot-assisted epiglottopexy as a surgical intervention. They tolerated the procedure, and there have been no complications. Each reported improved symptoms, with patient one showing a decrease in total AHI and a substantial decrease in oxygen desaturations at night. The second patient reported a significant decrease in AHI and ESS. CONCLUSION There are many options for surgical intervention in patients with OSA. Epiglottopexy is one method for addressing collapse of the epiglottis and can be achieved successfully through robot-assisted epiglottopexy in adult patients with OSA. LEVEL OF EVIDENCE IV.
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Gozal D, Tan HL, Kheirandish-Gozal L. Treatment of Obstructive Sleep Apnea in Children: Handling the Unknown with Precision. J Clin Med 2020; 9:jcm9030888. [PMID: 32213932 PMCID: PMC7141493 DOI: 10.3390/jcm9030888] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022] Open
Abstract
Treatment approaches to pediatric obstructive sleep apnea (OSA) have remarkably evolved over the last two decades. From an a priori assumption that surgical removal of enlarged upper airway lymphadenoid tissues (T&A) was curative in the vast majority of patients as the recommended first-line treatment for pediatric OSA, residual respiratory abnormalities are frequent. Children likely to manifest persistent OSA after T&A include those with severe OSA, obese or older children, those with concurrent asthma or allergic rhinitis, children with predisposing oropharyngeal or maxillomandibular factors, and patients with underlying medical conditions. Furthermore, selection anti-inflammatory therapy or orthodontic interventions may be preferable in milder cases. The treatment options for residual OSA after T&A encompass a large spectrum of approaches, which may be complementary, and clearly require multidisciplinary cooperation. Among these, continuous positive airway pressure (CPAP), combined anti-inflammatory agents, rapid maxillary expansion, and myofunctional therapy are all part of the armamentarium, albeit with currently low-grade evidence supporting their efficacy. In this context, there is urgent need for prospective evidence that will readily identify the correct candidate for a specific intervention, and thus enable some degree of scientifically based precision in the current one approach fits all model of pediatric OSA medical care.
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Affiliation(s)
- David Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
- Correspondence:
| | - Hui-Leng Tan
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK;
| | - Leila Kheirandish-Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA;
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