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Shaikh N, Tumlin P, Greathouse Z, Bulbul MG, Coutras SW. Effects of Soft Tissue Sleep Surgery on Morbidly Obese Patients. Ann Otol Rhinol Laryngol 2023; 132:138-147. [PMID: 35227070 DOI: 10.1177/00034894221081098] [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: 01/12/2023]
Abstract
INTRODUCTION Morbidly obese patients with obstructive sleep apnea (OSA) are often intolerant of continuous positive airway pressure (CPAP). The effects of sleep surgery in this population is not well documented, and sleep surgery is generally avoided due to the expectation of poor outcomes, leaving these patients untreated. METHODS This retrospective study included 42 patients with a body mass index (BMI) ≥40.0 and OSA with a preoperative apnea hypopnea index (AHI) ≥5. Preoperative BMI ranged from 40.0 to 69.0 kg/m2. Preoperative AHI ranged from 7.2 to 130.0. Of 42 patients, 12 (28.6%) underwent concurrent pharyngeal and retrolingual surgery. Subgroup analysis of change in AHI was measured with respect to preoperative OSA severity, change in preoperative BMI, and BMI severity. Univariate linear and logistic regression was performed assessing change in AHI and surgical success with respect to age, sex, preoperative AHI, preoperative BMI, change in BMI, total procedures, palatal procedure, retrolingual procedure, nasal procedure, and multilevel procedures. RESULTS The mean AHI improved from 45.9 ± 31.8 to 31.9 ± 31.6 (P = .007). Epworth sleepiness score (ESS) improved from 13.2 ± 5.5 to 9.6 ± 5.4 (P = .00006). Lowest oxygen saturation (LSAT) improved from 74.4 ± 10.7 to 79.9 ± 10.4 (P = .002). About 33.3% of patients had surgical success (AHI < 20 with at least 50% reduction in AHI). Preoperative AHI was the most significant factor for change in AHI in univariate and multivariate models (P = .015). CONCLUSION Sleep surgery is effective in reducing OSA burden in most morbidly obese patients and can result in surgical cure for a third of patients.
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Affiliation(s)
- Noah Shaikh
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Parker Tumlin
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | | | - Mustafa G Bulbul
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
| | - Steven W Coutras
- Otolaryngology Department, West Virginia University, Morgantown, WV, USA
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Rosenberg R, Abaluck B, Thein S. Combination of atomoxetine with the novel antimuscarinic aroxybutynin improves mild to moderate OSA. J Clin Sleep Med 2022; 18:2837-2844. [PMID: 35975547 PMCID: PMC9713910 DOI: 10.5664/jcsm.10250] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE Obstructive sleep apnea is a common and serious sleep disorder for which treatment remains challenging due to lack of adherence to approved therapies. Previous pharmacological studies addressing sleep-related upper airway muscle hypotonia suggested that the combination of atomoxetine and oxybutynin is effective in treating obstructive sleep apnea. The current study is with aroxybutynin (AD109), a new enantiomerically pure form of oxybutynin with better safety profile compared to racemic oxybutynin. METHODS This was a randomized, double-blind, placebo-controlled, crossover study in patients with mild to moderate obstructive sleep apnea. Each received low-dose AD109 (37.5/2.5 mg), high-dose AD109 (75/2.5 mg), and placebo at bedtime across 3 overnight periods in a randomized order. Adverse events were collected by telephone contact with participants during each washout period. The primary endpoint was change in hypoxic burden and secondary endpoint was apnea-hypopnea index. RESULTS Patients treated with both the high and low doses of AD109 had a statistically significant and clinically meaningful difference from placebo in hypoxic burden. Median [interquartile range] hypoxic burden for participants on placebo was 13.9[4.5-21.9] (%min)/h vs 2.3[0.1-10.5] (%min)/h for patients on the high dose (P < .001) and to 7.3[2-12.5] (%min)/h on the low dose (P < .01). Apnea-hypopnea index went from a median of 13.2[8.0-19.1] events/h on placebo reduced to 5.5[2.2 to 9.6] events/h on the high dose (P < .001) and to 7.8[4-13.7] events/h on the low dose (P < .05). AD109 demonstrated a favorable safety profile. CONCLUSIONS This study provides additional support that a pharmacological intervention for obstructive sleep apnea, namely the combination of atomoxetine and aroxybutynin, offers promising results. Additional development of this compound and others is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: AD109 Dose Finding in Mild to Moderate OSA; URL: https://clinicaltrials.gov/ct2/show/NCT04631107; Identifier: NCT04631107. CITATION Rosenberg R, Abaluck B, Thein S. Combination of atomoxetine with the novel antimuscarinic aroxybutynin improves mild to moderate OSA. J Clin Sleep Med. 2022;18(12):2837-2844.
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Affiliation(s)
| | - Brian Abaluck
- Brian Abaluck MD Sleep Medicine, Malvern, Pennsylvania
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Choi BY, Kim JK, Cho JH. A Review of a Recent Meta-Analysis Study on Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2022.00422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This paper summarizes a recent meta-analysis of various topics in obstructive sleep apnea (OSA). In addition to cardiovascular disease and neurocognitive dysfunction, a wide variety of diseases have been associated with OSA, and associations with cancer have also been reported. Although continuous positive airway pressure is a very effective treatment, the results have shown that it does not reduce the incidence of various complications. It has been reported that uvulopalatopharyngoplasty was effective, and robotic surgery for the tongue root and hypoglossal nerve stimulation were also effective. The effectiveness of various medications to reduce daytime sleepiness has also been demonstrated. Although exercise lowered the apnea-hypopnea index, it was not related to changes in body composition, and it was also reported that exercise combined with weight control were effective. Additionally, interesting and clinically meaningful meta-analysis results were summarized and presented.
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Effect of sleep surgery on lipid profiles in adults with obstructive sleep apnea: a meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:3811-3820. [DOI: 10.1007/s00405-022-07382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
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Hillman DR. Treatment options for obstructive sleep apnea: general and perioperative. Int Anesthesiol Clin 2022; 60:74-82. [PMID: 35125482 DOI: 10.1097/aia.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David R Hillman
- West Australian Sleep Disorders Research Institute, Centre for Sleep Science, University of Western Australia, Perth, Australia
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The Rise of IGFBP4 in People with Obstructive Sleep Apnea and Multilevel Sleep Surgery Recovers Its Basal Levels. DISEASE MARKERS 2021; 2021:1219593. [PMID: 34646401 PMCID: PMC8505101 DOI: 10.1155/2021/1219593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 02/08/2023]
Abstract
IGFBP4 is the smallest member of the insulin-like growth factor binding protein family (IGFBP). It is a hepatic protein that plays a role in modulating the activity and bioavailability of IGF-I. The expression of IGFBP4 was found to increase under conditions of hypoxia. Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic episodes of intermittent hypoxia and fragmented sleep. Our aim was to quantify levels of circulating IGFBP1, IGFBP2, IGFBP3, IGFBP4, and IGFBP7 in fasting plasma samples of 69 Kuwaiti participants and explore its correlation with indices of OSA. The quantification was performed using multiplexing assay. The study involved 28 controls and 41 patients with OSA. Levels of circulating IGFBP4 were significantly higher in people with OSA (289.74 ± 23.30 ng/ml) compared to the control group (217.60 ± 21.74 ng/ml, p = 0.028). The increase in IGFBP4 correlated significantly and positively with AHI (r = .574, p = .01) and AI (r = .794, p = .001) in people with moderate and severe OSA. There was a significant decline in circulating IGFBP4 after 3 months of surgery (225.89 ± 18.16 ng/ml, p = 0.012). This was accompanied by a prominent improvement in OSA (AHI 8.97 ± 2.37 events/h, p = 0.001). In this study, our data showed a significant increase in circulating IGFBP4 in people with OSA. We also report a significant positive correlation between IGFBP4 and indices of OSA at baseline, which suggests IGFBP4 as a potential diagnostic biomarker for OSA. There was a significant improvement in OSA after 3 months of surgical intervention, which concurred with a significant decline in IGFBP4 levels. Altogether, the detected change suggests a potential link between IGFBP4 and OSA or an OSA-related factor, whereby OSA might play a role in triggering the induction of IGFBP4 expression.
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Adenotonsillectomy for the Treatment of Obstructive Sleep Apnoea in Extreme Paediatric Obesity. The Journal of Laryngology & Otology 2021; 136:1071-1076. [PMID: 34593058 DOI: 10.1017/s0022215121002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Marco-Pitarch R, García-Selva M, Plaza-Espín A, Puertas-Cuesta J, Agustín-Panadero R, Fernández-Julián E, Marco-Algarra J, Fons-Font A. Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi- and three-dimensional evaluation. J Oral Rehabil 2021; 48:927-936. [PMID: 33977548 DOI: 10.1111/joor.13176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/21/2020] [Accepted: 04/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The efficiency of the mandibular advancement device (MAD) in patients with obstructive sleep apnoea syndrome (OSAS) has been demonstrated. Nevertheless, the behaviour of the upper airway once MAD is placed and titrated, and its correlation with the apnoea-hypopnoea index (AHI) is still under discussion. OBJECTIVES To analyse the morphological changes of the upper airway through a bi- and three-dimensional study and correlate it with the polysomnographic variable, AHI. METHODS Patients were recruited from two different hospitals for the treatment of OSAS with a custom-made MAD. A cone-beam computer tomography and a polysomnography were performed at baseline and once the MAD was titrated. RESULTS A total of 41 patients completed the study. Treatment with MAD reduced the AHI from 22.5 ± 16.8 to 9.2 ± 11.6 (p ≤ .05). There was a significant increase of the total airway volume with MAD from 21.83 ± 7.05 cm3 to 24.19 ± 8.19 cm3 , at the expense of the oropharynx. Moreover, the correlation between the improvement of the AHI and the augmentation of the volume of the upper airway was not statistically significant. CONCLUSIONS The oral device used in this prospective study increased the mean upper pharyngeal airway volume and significantly reduced the AHI. Future studies that measure the muscular tone are needed to completely understand the association between the AHI and the physiological and anatomical response of the upper airway.
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Affiliation(s)
- Rocío Marco-Pitarch
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Marina García-Selva
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Andrés Plaza-Espín
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - Rubén Agustín-Panadero
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | | | - Jaime Marco-Algarra
- Department of Otorhinolaryngology, Medical School of Medicine and Dentistry, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - Antonio Fons-Font
- Department of Stomatology, Medical School of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Cheong CS, Loke W, Thong MKT, Toh ST, Lee CH. The Emerging Role of Drug-Induced Sleep Endoscopy in the Management of Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2020; 14:149-158. [PMID: 33092317 PMCID: PMC8111386 DOI: 10.21053/ceo.2020.01704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea is a prevalent sleep disorder characterized by partial or complete obstruction of the upper airway. Continuous positive airway pressure is the first-line therapy for most patients, but adherence is often poor. Alternative treatment options such as mandibular advancement devices, positional therapy, and surgical interventions including upper airway stimulation target different levels and patterns of obstruction with varying degrees of success. Drug-induced sleep endoscopy enables the visualization of upper airway obstruction under conditions mimicking sleep. In the era of precision medicine, this additional information may facilitate better decision-making when prescribing alternative treatment modalities, with the hope of achieving better adherence and/or success rates. This review discusses the current knowledge and evidence on the role of drug-induced sleep endoscopy in the non-positive airway pressure management of obstructive sleep apnea.
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Affiliation(s)
- Crystal Sj Cheong
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
| | - Weiqiang Loke
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Mark Kim Thye Thong
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
| | - Song Tar Toh
- Department of Otolaryngology, Singapore General Hospital, SingHealth Duke-NUS Sleep Centre, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
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Impact of a shift in treatment funding on a multidisciplinary sleep clinic: a cohort study. Acta Neurol Belg 2020; 120:1151-1156. [PMID: 32647972 DOI: 10.1007/s13760-020-01419-x] [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: 03/21/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
Multidisciplinary Sleep Clinics for sleep apnea have long existed, bringing together neurologists, sleep specialists, dentists, orthodontists and surgeons. In Belgium, a shift in funding for obstructive sleep apnea treatment was implemented from January 1st, 2017. Funding was allowed for moderate to severe obstructive sleep apnea and the rules shifted for treatments delivery and monitoring by authorised medical opinion. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann-Whitney U tests and descriptive statistics were produced. There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline obstructive sleep apnea severity was significantly lower (mean apnea-hypopnea index and mean oxygen desaturation index lowered with p = 0.0189 and p = 0.0466, respectively) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. The key changes of the new funding rules for obstructive sleep apnea were reflected in the patient selection and management by sleep multidisciplinary team meeting. Funding terms could influence the care we give, not only in treatment options, but also in patients selection.
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Alterki A, Joseph S, Thanaraj TA, Al-Khairi I, Cherian P, Channanath A, Sriraman D, Ebrahim MAK, Ibrahim A, Tiss A, Al-Mulla F, Rahman AMA, Abubaker J, Abu-Farha M. Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery. Metabolites 2020; 10:metabo10090358. [PMID: 32882816 PMCID: PMC7569907 DOI: 10.3390/metabo10090358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with an increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. METHODS This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and five months after surgery. RESULTS The mean Apnea-Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value < 0.001). Epworth's sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value < 0.001), indicating the success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value < 0.05), whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value < 0.05) after surgery. CONCLUSION This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in an improvement of the metabolic status that was characterized by decreased TG, PCs, and Cer metabolites after surgery, indicating that the success of the surgery positively impacted the metabolic status of these patients.
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Affiliation(s)
- Abdulmohsen Alterki
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait; (A.A.); (M.A.K.E.); (A.I.)
| | - Shibu Joseph
- Special Service Facility Department, Dasman Diabetes Institute, Dasman 15462, Kuwait; (S.J.); (D.S.); (F.A.-M.)
| | - Thangavel Alphonse Thanaraj
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman 15462, Kuwait; (T.A.T.); (A.C.)
| | - Irina Al-Khairi
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait; (I.A.-K.); (P.C.); (A.T.)
| | - Preethi Cherian
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait; (I.A.-K.); (P.C.); (A.T.)
| | - Arshad Channanath
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute, Dasman 15462, Kuwait; (T.A.T.); (A.C.)
| | - Devarajan Sriraman
- Special Service Facility Department, Dasman Diabetes Institute, Dasman 15462, Kuwait; (S.J.); (D.S.); (F.A.-M.)
| | - Mahmoud A. K. Ebrahim
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait; (A.A.); (M.A.K.E.); (A.I.)
| | - Alaaeldin Ibrahim
- Department of Otolaryngology Head & Neck Surgery, Zain and Al Sabah Hospitals and Dasman Diabetes Institute, Dasman 15462, Kuwait; (A.A.); (M.A.K.E.); (A.I.)
| | - Ali Tiss
- Department of Biochemistry and Molecular Biology, Dasman Diabetes Institute, Dasman 15462, Kuwait; (I.A.-K.); (P.C.); (A.T.)
| | - Fahd Al-Mulla
- Special Service Facility Department, Dasman Diabetes Institute, Dasman 15462, Kuwait; (S.J.); (D.S.); (F.A.-M.)
| | - Anas M. Abdel Rahman
- Department of Genetics, King Faisal Specialist Hospital and Research Centre (KFSHRC), Zahrawi Street, Al Maather, Riyadh 11211, Saudi Arabia;
- Department of Biochemistry and Molecular Medicine, College of Medicine, Al Faisal University, Riyadh 11533, Saudi Arabia
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1B 3X7, Canada
| | - Jehad Abubaker
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1B 3X7, Canada
- Correspondence: (J.A.); (M.A.-F.); Tel.: +965-2224-2999 (ext. 3563) (J.A.); +965-2224-2999 (ext. 3010) (M.A.-F.)
| | - Mohamed Abu-Farha
- Department of Chemistry, Memorial University of Newfoundland, St. John’s, NL A1B 3X7, Canada
- Correspondence: (J.A.); (M.A.-F.); Tel.: +965-2224-2999 (ext. 3563) (J.A.); +965-2224-2999 (ext. 3010) (M.A.-F.)
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Lan WC, Chang WD, Tsai MH, Tsou YA. Trans-oral robotic surgery versus coblation tongue base reduction for obstructive sleep apnea syndrome. PeerJ 2019; 7:e7812. [PMID: 31592178 PMCID: PMC6778434 DOI: 10.7717/peerj.7812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/01/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives To compare the efficacy of trans-oral robotic surgery (TORS) with that of coblation assisted tongue base reduction surgery in patients with obstructive sleep apnea syndrome (OSAS). Subjects and Methods The medical charts were retrospectively reviewed for all OSAS patients admitted to one institution for surgical intervention between 2012 and 2017. We analyzed 33 cases; 16 patients received TORS and 17 received coblation surgery for tongue base reduction. Both groups received concomitant uvulopalatoplasty. Surgical outcomes were evaluated by comparing the initial polysomnography (PSG) parameters with the follow-up PSG data (at least 3 months after the surgery). Epworth sleepiness scale (ESS) and complications were also compared between the 2 groups. Results The success rate (≥50% reduction of pre-operative AHI and post-operative AHI <20) in the TORS group and coblation group were 50% and 58%, respectively, and there was no significant difference (p = .611). The AHI (mean ± SD) reduction in the TORS and coblation groups were 24.9 ± 26.5 events/h and 19.4 ± 24.8 events/h, respectively; the between-group difference was not significant (p = .631). ESS improvement did not differ significantly between the TORS and coblation groups (3.8 ± 6.6 and 3.1 ± 9.2, respectively, p = .873). The rates of minor complication were higher in the TORS group (50%) than that of the coblation group (35.3%) without statistical significance (p = .393). Conclusion TORS achieved comparable surgical outcomes compared to coblation assisted tongue base reduction surgery in OSAS patients. Multilevel surgery using either TORS or coblation tongue base reduction combined with uvulopalatoplasty is an effective approach for the management of OSAS.
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Affiliation(s)
- Wei-Che Lan
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Dien Chang
- Department of Sport Performance, National Taiwan University of Sport, Taichung, Taiwan
| | - Ming-Hsui Tsai
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
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Sethukumar P, Kotecha B. Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all. Breathe (Sheff) 2018; 14:e84-e93. [PMID: 30364490 PMCID: PMC6196320 DOI: 10.1183/20734735.020118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
While continuous positive airway pressure (CPAP) remains the gold standard treatment of choice in patients with moderate or severe obstructive sleep apnoea (OSA), surgery has been established as a means to improve compliance and facilitate the use of CPAP, both of which are potential pitfalls in the efficacy of this treatment modality. In a minority of cases, with obvious oropharyngeal anatomical obstruction, corrective surgery may completely alleviate the need for CPAP treatment. In this review, we summarise clinical assessment, surgical options, discuss potential new treatments, and outline the importance of investigating and addressing the multiple anatomical levels that can contribute to OSA. Research into effectiveness of these procedures is rapidly accumulating, and surgery can be an effective treatment. However, given the myriad of options available and multiple levels of anatomical pathology that can present, it is imperative that correctly selected patients are matched with the most appropriate treatment for the best outcomes. KEY POINTS OSA is an increasingly prevalent disorder which has significant systemic effects if left untreated.Anatomical abnormalities can be corrected surgically to good effect with a growing and robust evidence base.Drug-induced sleep endoscopy is a key tool in the otolaryngologist's armamentarium to tailor specific surgery to address specific anatomical concerns, and to facilitate appropriate patient selection.Multilevel surgical approaches are often indicated instead of a "one size fits all" model. EDUCATIONAL AIMS To discuss how to assess patients presenting with OSA in clinic, from an otorhinolaryngology perspective.To discuss the indications for intervention.To provide an overview of nonsurgical interventions for treating OSA, with evidence.To discuss the different surgical modalities available for treatment of OSA, with evidence.
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Affiliation(s)
- Priya Sethukumar
- Otolaryngology, Head and Neck Surgery, Queen's Hospital, Romford, UK
| | - Bhik Kotecha
- Otolaryngology, Head and Neck Surgery, Queen's Hospital, Romford, UK
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
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Combined Surgical Approach for Obstructive Sleep Apnea Patient. Case Rep Otolaryngol 2018; 2018:4798024. [PMID: 29796330 PMCID: PMC5896225 DOI: 10.1155/2018/4798024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a disease that is associated with high morbidity and mortality and can significantly impact the quality of life in a patient. OSA is strongly associated with obesity, and literature showed that weight loss will lead to improvement in OSA. The gold standard treatment for OSA is continuous positive airway pressure (CPAP). However, other methods of treatment are available. One of these methods is multilevel sleep surgery (MLS). Literature showed that bariatric surgery can also improve OSA. A common question is which surgical procedure of these two should be performed first. We present a 5-year follow-up of a patient who underwent simultaneously bariatric surgery and MLS. His apnea-hypopnea index (AHI) decreased from 53 episodes per hour to 5.2 per hour within the first 18 months, which was measured via a level 3 polysomnography. Five years after the surgery, a repeat level 3 polysomnography showed an AHI of 6.8 episodes per hour, and the patient is asymptomatic. The patient maintained his weight and did not use CPAP after the combined surgery during the five-year period.
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Marco Pitarch R, Selva García M, Puertas Cuesta J, Marco Algarra J, Fernández Julian E, Fons Font A. Effectiveness of a mandibular advancement device in obstructive sleep apnea patients: a prospective clinical trial. Eur Arch Otorhinolaryngol 2018; 275:1903-1911. [DOI: 10.1007/s00405-018-4978-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/13/2018] [Indexed: 11/24/2022]
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16
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Alex R, Panza G, Mateika JH. The role of loop gain in predicting upper airway surgical outcomes-what do we know? J Thorac Dis 2018; 10:126-129. [PMID: 29600038 DOI: 10.21037/jtd.2017.12.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Raichel Alex
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gino Panza
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jason H Mateika
- John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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17
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Stevens D, Martins RT, Mukherjee S, Vakulin A. Post-Stroke Sleep-Disordered Breathing-Pathophysiology and Therapy Options. Front Surg 2018. [PMID: 29536012 PMCID: PMC5834929 DOI: 10.3389/fsurg.2018.00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sleep-disordered breathing (SDB), encompassing both obstructive and central sleep apnea, is prevalent in at least 50% of stroke patients. Small studies have shown vast improvements in post-stroke functional recovery outcomes after the treatment of SDB by continuous positive airway pressure. However, compliance to this therapy is very poor in this complex patient group. There are alternative therapy options for SDB that may be more amenable for use in at least some post-stroke patients, including mandibular advancement, supine avoidance, and oxygen therapy. There are few studies, however, that demonstrate efficacy and compliance with these alternative therapies currently. Furthermore, novel SDB-phenotyping approaches may help to provide important clinical information to direct therapy selection in individual patients. Prior to realizing individualized therapy, we need a better understanding of the pathophysiology of SDB in post-stroke patients, including the role of inherent phenotypic traits, as well as the contribution of stroke size and location. This review summarizes the available literature on SDB pathophysiology and treatment in post-stroke patients, identifies gaps in the literature, and sets out areas for further research.
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Affiliation(s)
- David Stevens
- A Flinders Centre of Research Excellence, College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Daw Park, SA, Australia
| | | | - Sutapa Mukherjee
- A Flinders Centre of Research Excellence, College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Daw Park, SA, Australia.,Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Vakulin
- A Flinders Centre of Research Excellence, College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Daw Park, SA, Australia.,The NHMRC Centre of Research Excellence, NEUROSLEEP, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
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18
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Lechner M, Wilkins D, Kotecha B. A review on drug-induced sedation endoscopy - Technique, grading systems and controversies. Sleep Med Rev 2018; 41:141-148. [PMID: 29627276 DOI: 10.1016/j.smrv.2018.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/19/2017] [Accepted: 02/07/2018] [Indexed: 12/19/2022]
Abstract
Sleep disordered breathing (SDB) comprises a spectrum of disorders, ranging from simple snoring to severe obstructive sleep apnoea (OSA), with a significant burden to health care systems in high income countries. If left untreated, OSA has significant cumulative, long-term health consequences. In the 1990s drug induced sedation endoscopy (DISE) has been developed to become a primary tool in the diagnosis and management of OSA. It allows meticulous endoscopic evaluation of the airway and identifies areas of collapse, thereby informing both on the selection of surgical techniques, where efficacy depends entirely on success at relieving obstruction at a certain level and on the usefulness of conservative measures, such as mandibular advancement splints. This article provides a review of the literature on DISE, covering different grading systems and techniques, explaining different rationales and discussing controversies.
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Affiliation(s)
- Matt Lechner
- Royal National Throat, Nose & Ear Hospital, Gray's Inn Road, London, UK
| | - Dominic Wilkins
- Royal National Throat, Nose & Ear Hospital, Gray's Inn Road, London, UK
| | - Bhik Kotecha
- Royal National Throat, Nose & Ear Hospital, Gray's Inn Road, London, UK.
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19
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Dijemeni E, D'Amone G, Gbati I. Drug-induced sedation endoscopy (DISE) classification systems: a systematic review and meta-analysis. Sleep Breath 2017; 21:983-994. [PMID: 28584940 PMCID: PMC5700212 DOI: 10.1007/s11325-017-1521-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/09/2017] [Accepted: 05/23/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Drug-induced sedation endoscopy (DISE) classification systems have been used to assess anatomical findings on upper airway obstruction, and decide and plan surgical treatments and act as a predictor for surgical treatment outcome for obstructive sleep apnoea management. The first objective is to identify if there is a universally accepted DISE grading and classification system for analysing DISE findings. The second objective is to identify if there is one DISE grading and classification treatment planning framework for deciding appropriate surgical treatment for obstructive sleep apnoea (OSA). The third objective is to identify if there is one DISE grading and classification treatment outcome framework for determining the likelihood of success for a given OSA surgical intervention. METHODS A systematic review was performed to identify new and significantly modified DISE classification systems: concept, advantages and disadvantages. RESULTS Fourteen studies proposing a new DISE classification system and three studies proposing a significantly modified DISE classification were identified. None of the studies were based on randomised control trials. CONCLUSION DISE is an objective method for visualising upper airway obstruction. The classification and assessment of clinical findings based on DISE is highly subjective due to the increasing number of DISE classification systems. Hence, this creates a growing divergence in surgical treatment planning and treatment outcome. Further research on a universally accepted objective DISE assessment is critically needed.
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Affiliation(s)
- Esuabom Dijemeni
- Research and Development Department, DISE INNOVATION, 24 Park Central Building, Bow Quarters, 60 Fairfield Road, London, UK.
- Department of Bioengineering, Imperial College London, London, UK.
| | - Gabriele D'Amone
- Research and Development Department, DISE INNOVATION, 24 Park Central Building, Bow Quarters, 60 Fairfield Road, London, UK
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Israel Gbati
- Research and Development Department, DISE INNOVATION, 24 Park Central Building, Bow Quarters, 60 Fairfield Road, London, UK
- School of Design, Royal College of Art, London, UK
- Department of Mechanical Engineering, Imperial College London, London, UK
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20
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Vallejo-Balen A, Zabala-Parra SI, Amado S. Tratamiento quirúrgico por otorrinolaringología en el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) se caracteriza por la obstrucción parcial o el colapso total de la vía aérea superior, de manera intermitente y repetitiva, por lo que, en un principio, se vio el manejo quirúrgico como una alternativa curativa para esta patología. Sin embargo, en la actualidad se reconoce que la cirugía, aun sin lograr tasas de efectividad muy altas de manera consistente, sí mejora la tolerancia y adaptación a la terapia de presión positiva, la cual sigue siendo la primera línea de manejo.Así, el primer paso antes de pensar en cualquier procedimiento quirúrgico es un adecuado diagnóstico topográfico, de modo que siempre se debe realizar una nasofibrolaringoscopia para identificar el o los sitios de obstrucción. Además, se sabe que el 75% de los pacientes presentan obstrucciones en múltiples niveles y que, cuando el abordaje se hace multinivel, se logra corregir el SAHOS hasta en un 95%. Entre los procedimientos vigentes se encuentran cirugías de nariz, paladar blando, amígdalas, base de lengua, estimulación del nervio hipogloso y procedimientos del esqueleto facial, así como procedimientos coadyuvantes, entre los que están radiofrecuencia e implantes de paladar.
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21
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Garas G, Kythreotou A, Georgalas C, Arora A, Kotecha B, Holsinger FC, Grant DG, Tolley N. Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s)? Ann Med Surg (Lond) 2017. [PMID: 28649379 PMCID: PMC5470525 DOI: 10.1016/j.amsu.2017.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS) is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA) in obese patients following failure of conventional treatment(s). A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances). TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm-2) exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s). There is a paucity of evidence on the subject with complete absence of RCTs. The literature supports TORS as a safe multilevel treatment for OSA. The effectiveness of TORS for OSA drops with increasing BMI. TORS represents an important treatment for OSA in non-morbidly obese patients after failure of conventional treatment(s). There is no role for TORS as an OSA treatment in morbidly obese patients.
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Affiliation(s)
- George Garas
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Anthousa Kythreotou
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christos Georgalas
- Department of Otorhinolaryngology and Head & Neck Surgery, Hygeia Hospital, Athens, Greece
| | - Asit Arora
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Bhik Kotecha
- Department of Otorhinolaryngology and Head & Neck Surgery, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK
| | - Floyd C Holsinger
- Department of Otorhinolaryngology and Head & Neck Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - David G Grant
- Department of Otorhinolaryngology and Head & Neck Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Neil Tolley
- Department of Otorhinolaryngology and Head & Neck Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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22
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Souza FJFDB, Evangelista AR, Silva JV, Périco GV, Madeira K. Cervical computed tomography in patients with obstructive sleep apnea: influence of head elevation on the assessment of upper airway volume. J Bras Pneumol 2016; 42:55-60. [PMID: 26982042 PMCID: PMC4805388 DOI: 10.1590/s1806-37562016000000092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) has a high prevalence and carries significant cardiovascular risks. It is important to study new therapeutic approaches to this disease. Positional therapy might be beneficial in reducing the apnea-hypopnea index (AHI). Imaging methods have been employed in order to facilitate the evaluation of the airways of OSAS patients and can be used in order to determine the effectiveness of certain treatments. This study was aimed at determining the influence that upper airway volume, as measured by cervical CT, has in patients diagnosed with OSAS. METHODS This was a quantitative, observational, cross-sectional study. We evaluated 10 patients who had been diagnosed with OSAS by polysomnography and on the basis of the clinical evaluation. All of the patients underwent conventional cervical CT in the supine position. Scans were obtained with the head of the patient in two positions (neutral and at a 44° upward inclination), and the upper airway volume was compared between the two. RESULTS The mean age, BMI, and neck circumference were 48.9 ± 14.4 years, 30.5 ± 3.5 kg/m2, and 40.3 ± 3.4 cm, respectively. The mean AHI was 13.7 ± 10.6 events/h (range, 6.0-41.6 events/h). The OSAS was classified as mild, moderate, and severe in 70%, 20%, and 10% of the patients, respectively. The mean upper airway volume was 7.9 cm3 greater when the head was at a 44° upward inclination than when it was in the neutral position, and that difference (17.5 ± 11.0%) was statistically significant (p = 0.002). CONCLUSIONS Elevating the head appears to result in a significant increase in the caliber of the upper airways in OSAS patients.
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23
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Bruwier A, Poirrier R, Albert A, Maes N, Limme M, Charavet C, Milicevic M, Raskin S, Poirrier AL. Three-dimensional analysis of craniofacial bones and soft tissues in obstructive sleep apnea using cone beam computed tomography. Int Orthod 2016; 14:449-461. [PMID: 27836768 DOI: 10.1016/j.ortho.2016.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A total of 154 adult patients with sleep complaints underwent a polysomnography and a craniofacial cone beam computed tomography (CBCT). OSA was defined as an apnea and hypopnea index (AHI) or an oxygen desaturation index (ODI) ≥ 10. Soft tissues and craniofacial bones volumes were prospectively measured by CBCT and collected blindly from sleep polysomnography. Among the study patients, 127 (83%) suffered from OSA and 27 (17%) did not. OSA patients demonstrated a narrower maxillo-palatine core volume (11.7±3.2 vs 14.6±4.9cm3) even when adjusting for age, gender, height, neck circumference and body mass index. These upper airway measures provide a comprehensive analysis of bony structures and soft tissues, which can be involved in OSA.
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Affiliation(s)
- Annick Bruwier
- Department of Orthodontics, Liege University Hospital, Liege, Belgium.
| | - Robert Poirrier
- Sleep Disorder Center, Department of Neurology, Liege University Hospital, Liege, Belgium
| | - Adelin Albert
- Biostatistics, Liege University Hospital, Liege, Belgium
| | - Nathalie Maes
- Department of Biostatistics and Medico-Economic Information, Liege University Hospital, Liege, Belgium
| | - Michel Limme
- Department of Orthodontics, Liege University Hospital, Liege, Belgium
| | - Carole Charavet
- Department of Orthodontics, Liege University Hospital, Liege, Belgium
| | - Mladen Milicevic
- Department of Medical Imaging, Liege University Hospital, Liege, Belgium
| | - Sylvianne Raskin
- Department of Orthodontics, Liege University Hospital, Liege, Belgium
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24
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Bruwier A, Poirrier R, Albert A, Maes N, Limme M, Charavet C, Milicevic M, Raskin S, Poirrier AL. Analyse tridimensionnelle des os craniofaciaux et des tissus mous dans l’apnée obstructive du sommeil utilisant la tomographie volumétrique à faisceau conique. Int Orthod 2016; 14:449-461. [PMID: 27836770 DOI: 10.1016/j.ortho.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Annick Bruwier
- Department of Orthodontics, Liege University Hospital, Liège, Belgique.
| | - Robert Poirrier
- Sleep Disorder Center, Department of Neurology, Liege University Hospital, Liège, Belgique
| | - Adelin Albert
- Biostatistics, Liege University Hospital, Liège, Belgique
| | - Nathalie Maes
- Department of Biostatistics and Medico-Economic Information, Liege University Hospital, Liège, Belgique
| | - Michel Limme
- Department of Orthodontics, Liege University Hospital, Liège, Belgique
| | - Carole Charavet
- Department of Orthodontics, Liege University Hospital, Liège, Belgique
| | - Mladen Milicevic
- Department of Medical Imaging, Liege University Hospital, Liège, Belgique
| | - Sylvianne Raskin
- Department of Orthodontics, Liege University Hospital, Liège, Belgique
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25
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Abstract
Obstructive sleep apnoea (OSA) is increasingly prevalent, particularly in the context of the obesity epidemic, and is associated with a significant social, health and economic impact. The gold standard of treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However compliance rates can be low. Methodology to improve patient tolerance to CPAP alongside with alternative, non-surgical and surgical, management strategies are discussed. All patients that fail CPAP therapy would benefit from formal upper airway evaluation by the otolaryngologist to identify any obvious causes and consider site-specific surgical therapies. Patient selection is integral to ensuring successful outcomes. A multidisciplinary team is needed to manage these patients.
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Affiliation(s)
| | - Bhik Kotecha
- Royal National Throat Nose & Ear Hospital, London, UK
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26
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Abstract
Surgical management of snoring and obstructive sleep apnea is indicated when a surgically correctable abnormality is believed to be the source of the problem. Many patients opt for surgical treatment after noninvasive forms of treatment have been proven ineffective or difficult to tolerate. With increasing frequency, functional rhinoplasty, septoplasty, turbinoplasty, palatal surgery, and orthognathic surgery are being used in the management of snoring and obstructive sleep apnea. Plastic surgeons' experience with aesthetic nasal surgery, nasal reconstruction, palatal surgery, and craniofacial surgery puts them at the forefront of performing surgery for snoring and sleep apnea. The role of functional septorhinoplasty, turbinoplasty, palatal surgery, genioglossal advancement, and orthognathic surgery is indispensable in the surgical management of obstructive sleep apnea. Multidisciplinary management of these patients is critical, and plastic surgeons are encouraged to work collaboratively with sleep medicine clinicians and centers.
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27
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Justin GA, Chang ET, Camacho M, Brietzke SE. Transoral Robotic Surgery for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2016; 154:835-46. [PMID: 26932967 DOI: 10.1177/0194599816630962] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/15/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To perform a systematic review of the international biomedical literature evaluating the effectiveness, complications, and safety of transoral robotic surgery (TORS) for the treatment of obstructive sleep apnea (OSA). DATA SOURCES PubMed/MEDLINE, Embase, and EMB Reviews databases were searched up to November 27, 2015. REVIEW METHODS Two authors systematically and independently searched for articles on TORS for the treatment of OSA in adults that reported either outcomes for the apnea-hypopnea index (AHI), lowest oxygen saturation percentage (LSAT) or changes in the Epworth Sleepiness Scale (ESS), and/or rates and types of complications associated with the operation. RESULTS In total, 181 records were identified and 16 articles met inclusion criteria. Transoral robotic surgery was almost always combined with other sleep surgery procedures. The summary estimate of the decrease in AHI using TORS as part of a multilevel surgical approach was 24.0 (95% confidence interval [CI], 22.1-25.8; P < .001, I(2) = 99%). The summary estimate of a decrease in ESS score was 7.2 (95% CI, 6.6-7.7; P < .001, I(2) = 99%) and of the overall surgical "success" (defined as AHI <20 and 50% reduction) was 48.2% (95% CI, 38.8%-57.7%; P < .001, I(2) = 99%). Three large studies reported on their total complication rates with an average of 22.3% (range, 20.5%-24.7%). CONCLUSIONS The initial results for the use of TORS as part of a multilevel surgical approach for OSA are promising for select patients. However, the cost and morbidity may be greater than with other techniques offsetting its advantages in visualization and precision. More prospective studies are needed to determine the optimal role of this tool.
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Affiliation(s)
- Grant A Justin
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edward T Chang
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Macario Camacho
- Department of Otolaryngology-Head and Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Scott E Brietzke
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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28
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Kim KB. How has our interest in the airway changed over 100 years? Am J Orthod Dentofacial Orthop 2016; 148:740-7. [PMID: 26522033 DOI: 10.1016/j.ajodo.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 12/01/2022]
Abstract
Since the beginning of our specialty, our understanding of the link between function and facial growth and development has progressively improved. Today, we know that children with sleep-related breathing problems will often develop distinctive facial characteristics. In adults, sleep apnea can result in serious morbidity and mortality. Orthodontists can ask sleep-related questions in the health history to help identify sleep breathing disorders. Treating these patients presents unique opportunities for orthodontists to collaborate with other medical specialties to improve a patient's health and treatment outcome. Research presented in our Journal in the next century may shed new light that will help us better identify the problem and aid the specialty in developing more effective evidence-based treatment. Additional efforts are needed to understand the physiology, neurology, and genetics of sleep breathing disorders.
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Affiliation(s)
- Ki Beom Kim
- Associate professor, Department of Orthodontics, Center for Advanced Dental Education, Saint Louis University, St Louis, Mo.
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29
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Song SA, Wei JM, Buttram J, Tolisano AM, Chang ET, Liu SYC, Certal V, Camacho M. Hyoid surgery alone for obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016; 126:1702-8. [DOI: 10.1002/lary.25847] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/10/2015] [Accepted: 12/02/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Sungjin A. Song
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii U.S.A
| | - Justin M. Wei
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii U.S.A
| | - Jonathan Buttram
- College of Medicine; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Anthony M. Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii U.S.A
| | - Edward T. Chang
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii U.S.A
| | - Stanley Yung-Chuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Stanford Hospitals and Clinics; Stanford California U.S.A
| | - Victor Certal
- Department of Otorhinolaryngology/Sleep Medicine Centre; Hospital CUF; Porto Portugal
- Centre for Research in Health Technologies and Information Systems; University of Porto; Porto Portugal
| | - Macario Camacho
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii U.S.A
- Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division; Stanford Hospital and Clinics; Stanford California U.S.A
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30
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Baron KG, Bardsley L. Sleep Management. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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31
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Azbay S, Bostanci A, Aysun Y, Turhan M. The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery. Eur Arch Otorhinolaryngol 2015; 273:2813-8. [PMID: 26714802 DOI: 10.1007/s00405-015-3865-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 12/16/2015] [Indexed: 12/21/2022]
Abstract
The aim of this study was to evaluate the influence of multilevel upper airway surgery on subsequent continuous positive airway pressure (CPAP) use and tolerance in patients with moderate to severe obstructive sleep apnea (OSA). The study cohort enrolled 67 consecutive patients, who underwent septoplasty plus modified uvulopharyngopalatoplasty (mUPPP) with or without modified tongue base suspension (mTBS) due to CPAP intolerance, and who had residual OSA requiring CPAP therapy [non-responders to surgery, apnea-hypopnea index (AHI) >15 events/h] that had been confirmed by control polysomnography at the sixth month postoperatively. A questionnaire including questions on postoperative CPAP use, problems faced during CPAP use after the surgery, change in OSA symptoms, and satisfaction with the surgery was designed, and filled through interviews. Seventeen (25.4 %) patients had septoplasty plus mUPPP and 50 (74.6 %) had septoplasty plus mUPPP combined with mTBS. Postoperatively, mean AHI (45.00 ± 19.76 vs. 36.60 ± 18.34), Epworth sleepiness scale (ESS) score (18.00 ± 4.45 vs. 13.00 ± 4.72), oxygen desaturation index (ODI) (48.98 ± 16.73 vs. 37.81 ± 17.03), and optimal CPAP level (11.80 ± 1.40 vs. 8.96 ± 1.20) were decreased (p < 0.001 for all parameters). Fifty-nine percent of patients reported that they fairly satisfied with the surgery and 49.2 % reported that their symptoms were completely resolved. While none of the cases could tolerate CPAP before surgery, almost half (47.8 %) of the cases used CPAP without problems postoperatively. Postoperative CPAP users had significantly higher postoperative AHI (p = 0.001), supine AHI (p = 0.009), ESS (p = 0.019), and ODI (p = 0.014), and significantly lower postoperative minimum O2 saturation (p = 0.001) compared with non-users. Multilevel upper airway surgery with less invasive techniques may improve CPAP tolerance in well-selected patients.
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Affiliation(s)
- Sule Azbay
- Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, 07070, Antalya, Turkey
| | - Asli Bostanci
- Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, 07070, Antalya, Turkey.
| | - Yasin Aysun
- Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, 07070, Antalya, Turkey
| | - Murat Turhan
- Department of Otolaryngology, Head and Neck Surgery, Akdeniz University School of Medicine, 07070, Antalya, Turkey
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Arora A, Chaidas K, Garas G, Amlani A, Darzi A, Kotecha B, Tolley NS. Outcome of TORS to tongue base and epiglottis in patients with OSA intolerant of conventional treatment. Sleep Breath 2015; 20:739-47. [PMID: 26669877 DOI: 10.1007/s11325-015-1293-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/10/2015] [Accepted: 10/14/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE Transoral robotic surgery (TORS) of the tongue base with or without epiglottoplasty represents a novel treatment for obstructive sleep apnea (OSA). The objective was to evaluate the clinical efficacy of TORS of the tongue base with or without epiglottoplasty in patients who had not tolerated or complied with conventional treatment (continuous positive airway pressure or oral appliance). METHODS Four-year prospective case series. The primary outcome measure was the apnea-hypopnea index (AHI) in combination with the Epworth Sleepiness Score (ESS). Mean oxygen saturation levels (SaO2) before and after TORS on respective sleep studies were also recorded. Secondary outcome measures included operative time and complications. Patient reported outcome measures (PROMs) assessed included voice, swallow and quality of life. RESULTS Fourteen patients underwent TORS for tongue base reduction with ten having additional wedge epiglottoplasty. A 64 % success rate was achieved with a normal post-operative sleep study in 36 % of cases at 6 months. There was a 51 % reduction in the mean AHI (36.3 ± 21.4 to 21.2 ± 24.6, p = 0.02) and a sustained reduction in the mean Epworth Sleepiness Score (p = 0.002). Mean SaO2 significantly increased after surgery compared to pre-operative values (92.9 ± 1.8 to 94.3 ± 2.5, p = 0.005). Quality of life showed a sustained improvement 3 months following surgery (p = 0.01). No major complications occurred. CONCLUSIONS TORS of the tongue base with or without epiglottoplasty represents a promising treatment option with minimal morbidity for selected patients with OSA. Long-term prospective comparative evaluation is necessary to validate the findings of this study.
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Affiliation(s)
- Asit Arora
- Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Konstantinos Chaidas
- Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - George Garas
- Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Ashik Amlani
- Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, London, UK
| | - Bhik Kotecha
- Department of Otorhinolaryngology and Head & Neck Surgery, Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, UK
| | - Neil S Tolley
- Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Bostanci A, Turhan M. A systematic review of tongue base suspension techniques as an isolated procedure or combined with uvulopalatopharyngoplasty in obstructive sleep apnea. Eur Arch Otorhinolaryngol 2015; 273:2895-901. [DOI: 10.1007/s00405-015-3814-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
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Tornari C, Wong G, Arora A, Kotecha B. A unique complication of radiofrequency therapy to the tongue base. Int J Surg Case Rep 2015; 8C:9-12. [PMID: 25603484 PMCID: PMC4353955 DOI: 10.1016/j.ijscr.2014.12.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/07/2014] [Accepted: 12/27/2014] [Indexed: 12/26/2022] Open
Abstract
Tongue base radiofrequency ablation may introduce infection to a thyroglossal cyst. This can be managed with antibiotics and ultrasound-guided needle aspiration. Caution is required in radiofrequency therapy for patients with thyroglossal cysts.
Introduction Radiofrequency ablation treatment of the tongue base can be used either alone or as part of a multilevel approach in the treatment of snoring. This involves the generation of thermal energy around the circumvallate papillae of the tongue. Potential complications include ulceration, dysphagia, haematoma and abscess formation. Presentation of case We present the case of a 50-year-old patient who developed an anterior neck swelling following a second application of radiofrequency ablation therapy to the tongue base for snoring. This was secondary to an infection of a previously undiagnosed thyroglossal cyst. The patient made a full recovery following intravenous antibiotic therapy and ultrasound-guided needle aspiration. Discussion Thyroglossal tract remnants are thought to be present in seven percent of the adult population. An infection in a thyroglossal tract cyst has not previously been reported following radiofrequency ablation of the tongue base. Given the relatively high complication rate of tongue base radiofrequency ablation in some series, this complication may be under-recognised. Conclusion An infected thyroglossal tract cyst should be suspected in patients with anterior neck swellings following radiofrequency ablation therapy to the tongue base. We advise caution when performing this procedure on patients with known thyroglossal tract remnants though there is insufficient evidence to suggest that this procedure is contraindicated.
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Affiliation(s)
| | - Gentle Wong
- Royal National Throat, Nose and Ear Hospital, UK
| | - Asit Arora
- Royal National Throat, Nose and Ear Hospital, UK
| | - Bhik Kotecha
- Royal National Throat, Nose and Ear Hospital, UK
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Vroegop AVMT, Smithuis JW, Benoist LBL, Vanderveken OM, de Vries N. CPAP washout prior to reevaluation polysomnography: a sleep surgeon's perspective. Sleep Breath 2014; 19:433-9. [PMID: 25487311 DOI: 10.1007/s11325-014-1086-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/26/2014] [Accepted: 11/11/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, leading to decreased oxygen blood levels and arousal from sleep. The gold standard treatment option for moderate to severe OSA is considered continuous positive airway pressure (CPAP). In case primary treatment with CPAP fails, a reevaluation of disease severity [by means of the apnea/hypopnea-index (AHI)] can be required. A subset of patients that prefer a CPAP alternative is still using CPAP until the reevaluation polysomnography (PSG), and a so-called washout effect is not ruled out. The purpose of this study is to evaluate the evidence on the existence and duration of this washout effect and its clinical relevance for current practice. METHODS To identify papers for this review, an extensive literature search was run electronically through MEDLINE and EMBASE databases. RESULTS An overview of currently available literature on this washout effect and the findings of 13 studies on this topic are discussed. CONCLUSION There is some evidence that CPAP washout exists in patients with a stable BMI throughout the follow-up period. However, the intensity and duration of this effect remains unclear. Within the limitations of the present study, it seems reasonable to maintain a washout period of 1 week, in case alternative treatments options are considered and especially when a baseline PSG (and subsequent repeat PSG after treatment) is needed in case of clinical trials.
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Affiliation(s)
- Anneclaire V M T Vroegop
- Department of ENT, Head and Neck Surgery, Saint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands,
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Güzeldir OT, Aydil U, Kizil Y, Akyildiz I, Köybaşioğlu A. The effect of infrahyoid muscle sectioning on hyoid bone position and oropharyngeal air column volume. Laryngoscope 2014; 125:1480-4. [PMID: 25418540 DOI: 10.1002/lary.25049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/26/2014] [Accepted: 10/29/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE/HYPOTHESIS To evaluate the spatial hyoid bone position and the oropharyngeal air column volume after infrahyoid muscle sectioning as a single procedure. STUDY DESIGN Animal experiment. METHODS Six adult New Zealand rabbits underwent sternohyoid, omohyoid, and thyrohyoid muscle sectioning for infrahyoid release. Preoperative and postoperative computed tomography scans were obtained and transferred to the Mimics software program. By using the program, preoperative and postoperative three-dimensional models of the spatial hyoid bone position and the oropharyngeal air column volume were determined and compared. RESULTS After the surgical intervention, it was found that the hyoid bone significantly moved to a more anterior (P = .028, P = .046), and superior (P = .028, P = .028) position. The preoperative mean oropharyngeal air column volume (618.88 ± 176.54 mm(3) ) also increased after infrahyoid muscle sectioning (797.01 ± 155.33 mm(3) ). and this change was also statistically significant (P = .028). CONCLUSIONS Infrahyoid release improves oropharyngeal air column volume, as the hyoid bone moves to a more anterior and superior position after this operation in an animal model. However, additional animal and human studies are necessary to evaluate a possible therapeutic role of this procedure. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Osman T Güzeldir
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey
| | - Utku Aydil
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey
| | - Yusuf Kizil
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey
| | - Ilker Akyildiz
- Department of Otorhinolaryngology, Ankara Research and Training Hospital, Ankara, Turkey
| | - Ahmet Köybaşioğlu
- Department of Otorhinolaryngology, Gazi University School of Medicine, Ankara, Turkey
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Sutherland K, Cistulli PA. Recent advances in obstructive sleep apnea pathophysiology and treatment. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kate Sutherland
- Department of Respiratory and Sleep Medicine; Center for Sleep Health and Research; Royal North Shore Hospital; University of Sydney; Sydney New South Wales Australia
- Discipline of Sleep Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Woolcock Institute of Medical Research; University of Sydney; Sydney New South Wales Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine; Center for Sleep Health and Research; Royal North Shore Hospital; University of Sydney; Sydney New South Wales Australia
- Discipline of Sleep Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
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Fu D, Pinto JM, Wang L, Chen G, Zhan X, Wei Y. The effect of nasal structure on olfactory function in patients with OSA. Eur Arch Otorhinolaryngol 2014; 272:357-62. [PMID: 24890976 DOI: 10.1007/s00405-014-3096-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/08/2014] [Indexed: 12/14/2022]
Abstract
The aim of this study was to investigate the relationship between nasal structure and olfactory function in patients with obstructive sleep apnea (OSA). Olfaction and nasal structure of 76 adults with OSA diagnosed by polysomnography were measured using acoustic rhinometry and the Sniffin, Sticks (SS) smell test at Anzhen Hospital, a major academic center in Beijing, China. We tested the hypothesis that nasal structure in these patients would correlate with objectively measured olfactory performance. Minimum cross-sectional area (MCA) of the nose was significantly correlated with SS composite score (r = 0.434, p < 0.001), a result that was driven by two of the test's three components: olfactory threshold (OT) (r = 0.385, p = 0.001) and olfactory discrimination (OD) (r = 0.370, p = 0.001) but not olfactory identification (OI) (p > 0.05). Additionally, nasal volume (NV) was associated with composite SS score (r = 0.350, p = 0.002), a finding driven by OT (r = 0.283, p = 0.014). These data suggest that nasal structure affects parameters of olfactory function, likely via alterations in nasal airflow. Thus, anatomic abnormalities and diseases involving airflow (such as OSA) may cause, in part, olfactory dysfunction that is amenable to treatment. We speculate that surgery that alters nasal volume and MCA may improve olfactory performance.
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Affiliation(s)
- Dan Fu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, People's Republic of China
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