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Pendolino AL, Unadkat S, Cheong RCT, Patel A, Ferreira J, Scarpa B, Andrews PJ. Objective and Subjective Outcomes Following Radiofrequency of Inferior Turbinates in Patients with Sleep-Disordered Breathing. Diagnostics (Basel) 2024; 14:1820. [PMID: 39202311 PMCID: PMC11353641 DOI: 10.3390/diagnostics14161820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Nasal obstruction is a frequent problem amongst patients with sleep-disordered breathing (SDB). Radiofrequency of the inferior turbinates (RFIT) is commonly utilized for inferior turbinate (IT) reduction but its effectiveness in SDB patients remains unproven. We aim to evaluate long-term objective and subjective nasal, olfactory and sleep outcomes following RFIT in SDB patients. METHODS Patients were assessed at baseline (T0) and at 3 months (T1), 6 months (T2) and 12 months (T3) following RFIT. At T0, T1, T2 and T3, the patients underwent objective assessments of their nasal airways and smell function and an evaluation of their quality-of-life, sinonasal, olfactory and sleep symptoms. Sleep studies were carried out at T0 and T2. RESULTS Seventeen patients (with a median age of 42 years) underwent RFIT. A statistically significant objective and subjective improvement of the patients' nasal airways was demonstrated at T1. No other statistically significant changes were observed in the patients' nasal airways, smell, sleep study parameters or patient-reported outcomes at the other follow-ups. A multivariate analysis confirmed a statistically significant influence of age (older), sex (male), a higher BMI, the presence of septal deviation and the presence of allergic rhinitis in some of the studies' parameters. A statistically significant objective and subjective improvement of the patients' nasal airways was confirmed in the fitted model when considering the influence of the available variables. CONCLUSIONS Our study confirms that the benefits of RFIT alone in SDB patients are limited and possibly only in the short-term period. Patient-related variables can potentially influence the final outcomes.
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Affiliation(s)
- Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK; (S.U.); (R.C.T.C.); (A.P.); (P.J.A.)
- Ear Institute, University College London (UCL), London WC1X 8EE, UK
| | - Samit Unadkat
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK; (S.U.); (R.C.T.C.); (A.P.); (P.J.A.)
| | - Ryan Chin Taw Cheong
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK; (S.U.); (R.C.T.C.); (A.P.); (P.J.A.)
| | - Ankit Patel
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK; (S.U.); (R.C.T.C.); (A.P.); (P.J.A.)
| | - Joshua Ferreira
- University College London (UCL) Medical School, London WC1E 6DE, UK;
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, 35122 Padova, Italy;
| | - Peter J. Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK; (S.U.); (R.C.T.C.); (A.P.); (P.J.A.)
- Ear Institute, University College London (UCL), London WC1X 8EE, UK
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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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3
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Khandanyan G, Shukrian A, Potosyan A, Zelveian P, Shukuryan A. Effectiveness of Uvulopalatoplasty and Nasal Surgery in OSAS Patients. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2023; 35:179-187. [PMID: 37497159 PMCID: PMC10368168 DOI: 10.22038/ijorl.2023.60817.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/07/2023] [Indexed: 07/28/2023]
Abstract
Introduction This study aims to evaluate the effectiveness of simultaneous uvulopalatoplasty and nasal surgery in patients with moderate obstructive sleep apnoea syndrome. Materials and Methods We studied 48 patients with obstructive sleep apnoea syndrome and nasal breathing disorders. The 1st group of 20 patients underwent septoplasty and volumetric tissue reduction of inferior turbinates and the 2nd group of 28 patients underwent septoplasty, volumetric tissue reduction of inferior turbinate, uvulopalatoplasty. Results In the 1st group, the pre-operative apnoea-hypopnea index median decreased from 22.1 ep/h to 14.9 ep/h after the surgery. Pre-operative median of nasal airflow volume grew from 167.0 cm3 to 609.5 cm3 post-operatively and the loudness of snoring decreased from 2.7±0.2 to 0.7±0.2. In the 2nd group, the apnoea-hypopnea index median decreased from 20.4 ep/h to 5.3 ep./h. The pre-operative median of nasal airflow volume grew from 189.5 cm3 to 519.5 cm3 post-operatively and the loudness of snoring improved from 2.6±0.2 pre-op to 1.1±0.2. Conclusion Patients with moderate obstructive sleep apnoea syndrome and nasal breathing disorders are advised to have nasal surgery combined with uvulopalatoplasty for a better outcome.
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Affiliation(s)
- Gegham Khandanyan
- Department of ENT, Yerevan State Medical University, “Erebouni” Medical Center, Yerevan, Armenia.
| | - Anna Shukrian
- Department of ENT, Yerevan State Medical University, “Erebouni” Medical Center, Yerevan, Armenia.
| | | | - Parounak Zelveian
- Institute of Cardiology Named after Levon Hovhannisyan, Yerevan-Armenia.
| | - Artur Shukuryan
- Department of ENT, Yerevan State Medical University, “Erebouni” Medical Center, Yerevan, Armenia.
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Silva DVE, Alves DDSB, Nóbrega MDRR, Ribeiro FBCG, Franco LYY, Silva IRD, Joffily L, Rocha MD, Godoy PH. Obstructive sleep apnea screening in different age groups: performance of the Berlin, STOP-Bang questionnaires and Epworth Sleepiness Scale. Braz J Otorhinolaryngol 2023; 89:101283. [PMID: 37418853 PMCID: PMC10345254 DOI: 10.1016/j.bjorl.2023.101283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To evaluate the performance of the Berlin Questionnaire, the STOP-Bang Questionnaire, and the Epworth Sleepiness Scale in screening for the disease in adults of different age groups by comparing them with polysomnography. METHODS Cross-sectional study with prospective patient allocation, in which individuals underwent a medical interview, completion of the three screening instruments, and polysomnography. Individuals were categorized into three age groups: 18-39, 40-59, and ≥60 years. The results of the screening instruments were compared to the diagnostic criteria of the International Classification of Sleep Disorders-third edition. Performance was assessed using 2×2 contingency tables, estimating sensitivity, specificity, predictive value, likelihood ratio, and accuracy. Receiver Operating Characteristic curves were also constructed and the area under the curve was estimated for each instrument by age group. RESULTS We obtained a sample with 321 individuals suitable for analysis. The mean age was 50 years, with a predominance of females (56%). The prevalence of the disease in the overall sample was 79%, more prevalent in males in any age group and more frequent in the middle age group. The analyzes revealed that STOP-Bang performed better, both for the overall sample and for all age groups, followed by Berlin Questionnaire and Epworth Sleepiness Scale. CONCLUSION In an outpatient setting with individuals with characteristics similar to those in this study, it seems sensible to choose the STOP-Bang as a screening tool for the disease, regardless of age group. LEVEL OF EVIDENCE ACCORDING THE GUIDE FOR AUTHORS: level 2.
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Affiliation(s)
- Daniel Villela E Silva
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | - Lucia Joffily
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Maira da Rocha
- Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil; Hospital Universitário Gaffrée e Guinle (HUGG), Empresa Brasileira de Serviços Hospitalares (EBSERH), Rio de Janeiro, RJ, Brazil
| | - Paulo Henrique Godoy
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Laboratório do Sono da Universidade Federal do Estado de Rio de Janeiro (LABSONO-UNIRIO), Rio de Janeiro, RJ, Brazil
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Martinovic D, Tokic D, Puizina-Mladinic E, Kadic S, Lesin A, Lupi-Ferandin S, Kumric M, Bozic J. Oromaxillofacial Surgery: Both a Treatment and a Possible Cause of Obstructive Sleep Apnea-A Narrative Review. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010142. [PMID: 36676088 PMCID: PMC9866782 DOI: 10.3390/life13010142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
Obstructive sleep apnea (OSA) is a chronic, sleep-related breathing disorder. It is characterized by a nocturnal periodic decrease or complete stop in airflow due to partial or total collapse of the oropharyngeal tract. Surgical treatment of OSA is constantly evolving and improving, especially with the implementation of new technologies, and this is needed because of the very heterogeneous reasons for OSA due to the multiple sites of potential airway obstruction. Moreover, all of these surgical methods have advantages and disadvantages; hence, patients should be approached individually, and surgical therapies should be chosen carefully. Furthermore, while it is well-established that oromaxillofacial surgery (OMFS) provides various surgical modalities for treating OSA both in adults and children, a new aspect is emerging regarding the possibility that some of the surgeries from the OMFS domain are also causing OSA. The latest studies are suggesting that surgical treatment in the head and neck region for causes other than OSA could possibly have a major impact on the emergence of newly developed OSA, and this issue is still very scarcely mentioned in the literature. Both oncology, traumatology, and orthognathic surgeries could be potential risk factors for developing OSA. This is an important subject, and this review will focus on both the possibilities of OMFS treatments for OSA and on the OMFS treatments for other causes that could possibly be triggering OSA.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina-Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-557-871
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Fujito N, Ohshima Y, Hokari S, Takahashi A, Nagai A, Suzuki R, Aoki N, Watanabe S, Koya T, Kikuchi T. The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome. PLoS One 2023; 18:e0283070. [PMID: 36920951 PMCID: PMC10016634 DOI: 10.1371/journal.pone.0283070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
Nasal breathing disorders are associated with obstructive sleep apnea (OSA) syndrome and influence the availability of continuous positive airway pressure (CPAP) therapy. However, information is scarce about the impact of nasal resistance assessed by rhinomanometry on CPAP therapy. This study aimed to examine the relationship between CPAP adherence and nasal resistance evaluated by rhinomanometry, and to identify clinical findings that can affect adherence to CPAP therapy for patients with OSA. This study included 260 patients (199 men, 61 women; age 58 [interquartile ranges (IQR) 50-66] years) with a new diagnosis of OSA who underwent rhinomanometry (before, and 1 and 3 months after CPAP introduction) between January 2011 and December 2018. CPAP use was recorded, and the good and poor CPAP adherence groups at the time of patient registration were compared. Furthermore, those with improved and unimproved pre-CPAP high rhinomanometry values were also compared. Their apnea-hypopnea index (AHI) by polysomnography at diagnosis was 45.6 (IQR 33.7-61.6)/hour, but the residual respiratory event (estimated AHI) at enrollment was 2.5 (IQR 1.4-3.9)/hour and the usage time was 318 (IQR 226-397) minutes, indicating that CPAP was effective and adherence was good. CPAP adherence was negatively correlated with nasal resistance (r = -0.188, p = 0.002). The participants were divided into good (n = 153) and poor (n = 107) CPAP adherence groups. In the poor adherence group, rhinomanometry values before CPAP introduction were worse (inspiration, p = 0.003; expiration, p = 0.006). There was no significant difference in patient background when comparing those with improved (n = 16) and unimproved (n = 12) pre-CPAP high rhinomanometry values. However, CPAP usage time was significantly longer in the improved group 1 month (p = 0.002) and 3 months (p = 0.026) after CPAP introduction. The results suggest that nasal resistance evaluated by rhinomanometry is a useful predictor of CPAP adherence, and that improved rhinomanometry values may contribute to extending the duration of CPAP use.
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Affiliation(s)
- Nobuhiro Fujito
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Yasuyoshi Ohshima
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
- * E-mail:
| | - Satoshi Hokari
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Atsunori Takahashi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Asuka Nagai
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Ryoko Suzuki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Nobumasa Aoki
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Toshiyuki Koya
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata-shi, Niigata, Japan
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Neagos A, Dumitru M, Neagos CM, Mitroi M, Vrinceanu D. Correlations between Morphology, the Functional Properties of Upper Airways, and the Severity of Sleep Apnea. J Clin Med 2022; 11:jcm11185347. [PMID: 36142994 PMCID: PMC9502432 DOI: 10.3390/jcm11185347] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) is considered the silent killer pathology of the new millennium. This is due to increased risk factors such as obesity. Healthcare systems face an increasing burden from severe cases of OSA. We performed a study on a group of 152 Romanian patients with OSA recording data obtained through polysomnography and cephalometric variables, recorded in lateral plain X-rays. The results confirmed some of the data available from previous studies worldwide, but some of the variables presented a positive statistical correlation specific to our study group. For example, the apnea-hypopnea index (AHI) correlated with the uvula length but surprisingly did not correlate with body mass index (BMI) because obesity tends to become endemic in Romania. To our knowledge, this is one of the first studies focusing on cephalometric data in Romanian OSA patients. The results obtained through this study will be further analyzed in research on larger groups of Romanian OSA patients.
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Affiliation(s)
- Adriana Neagos
- ENT Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Tirgu Mures, Romania
- Correspondence: (A.N.); (M.D.)
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
- Correspondence: (A.N.); (M.D.)
| | - Cristian Mircea Neagos
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
| | - Mihaela Mitroi
- ENT Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 010271 Bucharest, Romania
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Calvo-Henríquez C, Abelleira R, González-Barcala FJ. Positional nasal congestion. Sleep apnea's forgotten cousin. Arch Bronconeumol 2021; 57:453-454. [PMID: 35698949 DOI: 10.1016/j.arbr.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/09/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Christian Calvo-Henríquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), París, France; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
| | - Romina Abelleira
- Service of Pneumology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
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Calvo-Henríquez C, Chiesa-Estomba C, Lechien JR, Carrasco-Llatas M, Cammaroto G, Mayo-Yáñez M, Abelleira-Paris R, Gonzalez-Barcala FJ, Martinez-Capoccioni G, Martin-Martin C. The Recumbent Position Affects Nasal Resistance: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:6-16. [PMID: 33720430 DOI: 10.1002/lary.29509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Nasal diseases are among the main motives for the early discontinuation of continuous positive airway pressure therapy and for long-term therapeutic compliance with mandibular advancement device. Although our clinical experience leads us to the belief that recumbency impacts nasal airflow in some patient populations, there is no consensus regarding the magnitude of this effect and the specific group of patients who are the most affected by this condition. In this study, we conducted a meta-analysis to assess the effect of the recumbent position on nasal resistance and nasal airflow. REVIEW METHODS PubMed (Medline), Cochrane Library, EMBASE, Scopus, and SciELO databases were checked for relevant studies by two members of the YO-IFOS study group. The two authors extracted the data. The main outcome was expressed as the difference between nasal resistance and nasal airflow before and after recumbency. RESULTS Nine studies with a total population of 291 individuals were included in the meta-analysis for nasal resistance after recumbency. We found a statistically significant difference in nasal airway resistance of -0.18 Pa sec/cm3 as compared to before and after recumbency through rhinomanometry (RMM) analysis. A subgroup analysis revealed a variation of -0.20 Pa sec/cm3 for patients with snoring or sleep apnea and - 0.10 Pa sec/cm3 for healthy individuals. Regarding nasal airflow measured with RMM, three studies (n = 32) in asymptomatic controls revealed a statistically significant difference of 47.33 ml/sec. CONCLUSIONS Recumbency increases nasal resistance and diminishes nasal airflow. This finding is of utmost importance in snorers and sleep apnea patients. Laryngoscope, 2021.
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Affiliation(s)
- Christian Calvo-Henríquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - Carlos Chiesa-Estomba
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain
| | - Jerome R Lechien
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Foch Hospital, University of Paris-Saclay, Paris, France
| | | | - Giovani Cammaroto
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Department of Head-Neck Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Miguel Mayo-Yáñez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Hospital Complex of La Coruña, La Coruña, Spain
| | | | | | - Gabriel Martinez-Capoccioni
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France.,Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago, Spain
| | - Carlos Martin-Martin
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago, Spain
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10
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Calvo-Henríquez C, Abelleira R, González-Barcala FJ. Positional Nasal Congestion. Sleep Apnea's Forgotten Cousin. Arch Bronconeumol 2021:S0300-2896(20)30552-4. [PMID: 33509624 DOI: 10.1016/j.arbres.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Christian Calvo-Henríquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), París, Francia; Service of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, La Coruña, España.
| | - Romina Abelleira
- Service of Pneumology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, La Coruña, España
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11
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Lan MC, Lan MY, Kuan EC, Huang YC, Huang TT, Hsu YB. Nasal Obstruction as a Potential Factor Contributing to Hypoxemia in Obstructive Sleep Apnea. Nat Sci Sleep 2021; 13:55-62. [PMID: 33469400 PMCID: PMC7811484 DOI: 10.2147/nss.s288618] [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] [Received: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study aimed to evaluate the correlation between nasal resistance and oxygen desaturation to better elucidate the role of nasal obstruction in the pathophysiology of obstructive sleep apnea (OSA). PATIENTS AND METHODS Eighty-eight OSA patients aged between 22 and 77 years were enrolled in this study. Nasal resistance was measured at pressures of 75, 150, and 300 Pa, with the patients first in the seated position than in the supine position. Relationships between the oximetric variables and nasal resistance in the seated and supine positions were analyzed. RESULTS From seated to supine position, a statistically significant increase in nasal resistance was observed at pressures of 75 and 150 Pa (p=0.001 and p=0.006, respectively). Significant positive correlations were noted between nasal resistance in the supine position at 75 Pa (SupineNR75) and oximetry variables, including oxygen desaturation index (ODI, p=0.015) and the percentage of total time with oxygen saturation level lower than 90% (T < 90%, p=0.012). However, significant positive correlations existed only in moderate to severe OSA when the study group was further divided into two subgroups (mild vs moderate to severe OSA). Body mass index (β = 0.476, p<0.001) and SupineNR75 (β = 0.303, p=0.004) were identified as independent predictors for increased ODI. CONCLUSION Nasal resistance in the supine position measured at 75 Pa significantly correlated with the severity of oxygen desaturation. Therefore, nasal obstruction may play an important role in the pathophysiology of hypoxemia in OSA patients, especially in patients with moderate to severe OSA.
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Affiliation(s)
- Ming-Chin Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ming-Ying Lan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Yun-Chen Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tung-Tsun Huang
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yen-Bin Hsu
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Doğan A, Bayar Muluk N, Şahin H. Olfactory Bulb Volume and Olfactory Sulcus Depth in Patients With OSA: An MRI Evaluation. EAR, NOSE & THROAT JOURNAL 2019; 99:442-447. [PMID: 31608681 DOI: 10.1177/0145561319881571] [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: 11/17/2022] Open
Abstract
OBJECTIVES We evaluated olfactory functions in patients with obstructive sleep apnea (OSA). METHODS The cranial magnetic resonance images of 58 adult patients (36 males and 22 females) aged 27 to 79 years were retrieved from the hospital picture archiving and communication system (PACS) system. There were 29 patients with OSA (17 males and 12 females), diagnosed according to the polysomnography results. A control group consisted of 29 healthy patients without OSA. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth measurements were performed. Nasal septal deviation (SD) was also evaluated and recorded as no SD, deviation to the right, and deviation to the left in all groups. RESULTS Olfactory bulb volumes of the OSA group were significantly lower than those of the control group (P < .05), whereas OS depth values were not different (P > .05). There was a positive correlation between the right and left OB volumes and right and left OS depth values (P < .05). In older patients with OSA and in female patients with OSA, OB volumes decreased bilaterally (P < .05). Olfactory sulcus depth of the right side was lower in the female patients with OSA compared to the male patients with OSA (P < .05). There were no significant correlations between apnea-hypopnea index and OB volumes and OS depth values in the OSA group (P > .05). CONCLUSION In patients with OSA, OB volumes decreased bilaterally. It may be related to intermittent nocturnal hypoxia/reoxygenation episodes, which may be a trigger for upper airway inflammation; and proinflammatory mediators maybe harmful on olfactory neuroepithelium and olfactory impairment may occur.
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Affiliation(s)
- Adil Doğan
- Radiology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hamza Şahin
- Neurology Department, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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MAGLIULO G, IANNELLA G, CIOFALO A, POLIMENI A, DE VINCENTIIS M, PASQUARIELLO B, MONTEVECCHI F, VICINI C. Nasal pathologies in patients with obstructive sleep apnoea. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2019; 39:250-256. [PMID: 30933181 PMCID: PMC6734203 DOI: 10.14639/0392-100x-2173] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/24/2018] [Indexed: 11/23/2022]
Abstract
Nasal obstruction is a frequent condition in patients with obstructive sleep apnoea (OSA). Nasal obstruction leads to mouth breathing, which is thought to destabilise the upper airway and aggravate the condition. Three conditions could be considered as the cause of the nasal breathing obstruction: anatomical conditions of the nose (septum deviation, hypertrophy of the inferior turbinates), chronic rhinosinusitis (CRS) and chronic nasal inflammation caused by allergic rhinitis or non-allergic cellular rhinitis. In this prospective study, we present an evaluation of all these possible rhino-sinusal aspects in OSA patients to correlate different nasal pathologies with nasal obstruction. Fifty patients with a diagnosis of OSA were enrolled in the study. In 70% of OSA patients, nasal obstruction was confirmed by clinical evaluation and rhinomanometry testing. Normal rhino-sinus aspects were present in only 20% of OSA patients, whereas one or more pathological rhino-sinus conditions were present in the remaining 80%. The percentage of OSA patients with a diagnosis of allergic rhinitis and non-allergic rhinitis was 18% and 26% respectively. Non-allergic rhinitis with neutrophils (NARNE) was the most frequent type of cellular rhinitis diagnosed in OSA patients (20% of cases). The results of the present study support and extend the observation that rhinitis is present in OSA patients. Mucosal inflammation caused by these conditions could be the cause of upper airway patency impairment inducing nasal mucosa swelling.
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Affiliation(s)
- G. MAGLIULO
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - G. IANNELLA
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - A. CIOFALO
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - A. POLIMENI
- Department of Oral and Maxillo Facial Sciences, University “Sapienza”, Rome, Italy
| | - M. DE VINCENTIIS
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - B. PASQUARIELLO
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - F. MONTEVECCHI
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - C. VICINI
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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Rocha JÍTD, Lima AMJD, Silva HJD, Gomes ADOC, Vitorino PA, Clímaco DCS, Cunha DAD. Comparison of nasal geometry among adults with obstructive sleep apnea: a preliminary study. REVISTA CEFAC 2019. [DOI: 10.1590/1982-0216/201921610719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to compare nasal geometry between two groups of patients with different degrees of obstructive sleep apnea and to correlate apnea-hypopnea index, apnea severity and degree of daytime sleepiness with nasal areas and volume. Methods: a total of 20 adults (15 women and 5 men, mean age of 52.0±11.4 years old) without nasal obstruction were submitted to polysomnography. The subjects were divided into two groups: a) 10 individuals without apnea or with mild-grade apnea; b) 10 with moderate or severe apnea. Nasal geometry was evaluated by acoustic rhinometry. The volume, comprising the distance from the nasal valve to the posterior part of the middle nasal turbinate, and the three sectional areas corresponding to nasal valve, anterior part of the inferior nasal turbinate and posterior part of the inferior nasal turbinate, were considered. The Shapiro-Wilk, Mann-Whitney, Student’s t tests for independent samples and Spearman’s correlation coefficient were used for the analysis, with a significance level lower than 5%. Results: group 2 presented lower values in the area corresponding to the nasal valve (on the right), and higher values in the nasal turbinate areas. There was no correlation between the drowsiness scale and nasal areas and volumes. Conclusion: the area of the nasal valve was unilaterally smaller in the group with moderate and severe apnea. There was no correlation between volumes and nasal areas and excessive daytime sleepiness.
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Magliulo G, De Vincentiis M, Iannella G, Ciofalo A, Pasquariello B, Manno A, Angeletti D, Polimeni A. Olfactory evaluation in obstructive sleep apnoea patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:338-345. [PMID: 30197425 PMCID: PMC6146584 DOI: 10.14639/0392-100x-1981] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/24/2018] [Indexed: 12/31/2022]
Abstract
The sense of smell has a high impact on the quality of life. The aim of the present study was to investigate olfactory dysfunction in patients with obstructive sleep apnoea syndrome (OSAS) and correlate the severity of disease with olfactory dysfunction. The relationships between nasal obstruction, nasal mucociliary cleareance and olfactory tests were also evaluated. Sixty patients with a diagnosis of OSAS were enrolled and underwent olfactory function evaluation. In all patients olfactory performance was tested with the Sniffin' Sticks method. Mucociliary transport times and anterior rhinomanometry were performed to identify eventual nasal obstruction and deficits in nasal mucociliary clearance. Olfactory dysfunction was present in 22 (36.6%) patients of the study group: of these, hyposmia was present in 19 (86.4%) and anosmia in 3 (13.6%). The mean TDI score in the study group was 30. A strong correlation between the olfactory dysfunction and severity of sleep apnoea measured using the AHI was found. Patients with OSA would seem to have a high incidence of olfactory dysfunction. The degree of olfactory dysfunction appears to be related to the severity of disease. However, other co-factors such as nasal obstruction and reduced mucociliary clearance might also play a role in of the aetiology of this condition.
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Affiliation(s)
- G. Magliulo
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | | | - G. Iannella
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - A. Ciofalo
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - B. Pasquariello
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - A. Manno
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - D. Angeletti
- Department of Organi di Senso, University Sapienza, Rome, Italy
| | - A. Polimeni
- Department of Oral and Maxillo Facial Sciences, University Sapienza, Rome, Italy
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