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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Bastier PL, Gallet de Santerre O, Bartier S, De Jong A, Trzepizur W, Nouette-Gaulain K, Bironneau V, Blumen M, Chabolle F, de Bonnecaze G, Dufour X, Ameline E, Kérimian M, Latournerie V, Monteyrol PJ, Thiery A, Tronche S, Vergez S, Bequignon E. Guidelines of the French Society of ENT (SFORL): Drug-induced sleep endoscopy in adult obstructive sleep apnea syndrome. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:216-225. [PMID: 35871981 DOI: 10.1016/j.anorl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome. DESIGN A redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data. METHODS The committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results. RESULTS Expert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1-), 19 with low level (GRADE 2+ or 2-) and 1 expert opinion. CONCLUSION Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome.
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Affiliation(s)
- P-L Bastier
- Pôle Tête et Cou, Maison de Santé Protestante de Bordeaux-Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | | | - S Bartier
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Henri-Mondor, 1, rue Gustave-Eiffel, 94000 Créteil, France
| | - A De Jong
- Département d'Anesthésie-Réanimation Saint-Éloi, Hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - W Trzepizur
- Département de Pneumologie et de Médecine du Sommeil, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - K Nouette-Gaulain
- Service d'Anesthésie-Réanimation, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33700 Bordeaux, France
| | - V Bironneau
- Service de Pneumologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - M Blumen
- Centre Médical Veille Sommeil, 59, avenue de Villiers, 75017 Paris, France; Service d'ORL, Hôpital Foch, 40, rue Worth, 92140 Suresnes, France
| | - F Chabolle
- Cabinet d'ORL, 20, rue Parmentier, 92200 Neuilly-sur-Seine, France
| | - G de Bonnecaze
- Service d'ORL et Chirurgie Cervico-Faciale, Hôpital Larrey, 24, chemin de Pouvourville, 31059 Toulouse, France
| | - X Dufour
- Service d'ORL et Chirurgie Cervico-faciale, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - E Ameline
- Cabinet d'ORL, 1, rue des Iris, 41260 La Chaussée-Saint-Victor, France
| | - M Kérimian
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33700 Bordeaux, France
| | - V Latournerie
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - P-J Monteyrol
- Nouvelle Clinique Bordeaux Tondu, avenue Jean-Alfonséa, 33270 Floirac, France
| | - A Thiery
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - S Tronche
- SFORL, 26, rue Lalo, 75016 Paris, France
| | - S Vergez
- Service d'ORL et Chirurgie Cervico-Faciale, Hôpital Larrey, 24, chemin de Pouvourville, 31059 Toulouse, France
| | - E Bequignon
- Service d'ORL, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Sjöblom HM, Nahkuri M, Suomela M, Jero J, Piitulainen JM. Treatment of sleep apnoea with tonsillectomy: a retrospective analysis using long-term follow-up data. Eur Arch Otorhinolaryngol 2022; 279:3727-3732. [PMID: 35338397 PMCID: PMC9130194 DOI: 10.1007/s00405-022-07350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This single-group, retrospective, pre-test-post-test study was performed to examine clinical outcomes in treating obstructive sleep apnoea (OSA) with tonsillectomy alone and had the longest follow-up periods to date. METHODS We analysed 151 tonsillectomies in our district between the years 2004 and 2018 that had either sleep apnoea or snoring listed as a diagnosis. Twenty-one patients met our criteria and were included. Patient records were analysed for home sleep apnoea test and Epworth Sleepiness Scale (ESS) scores. RESULTS We defined success as a > 50% reduction of the Apnoea-Hypopnea Index (AHI) and a total AHI of < 20 post-surgery. The averages before surgery were an AHI of 22.3 and an ESS of 7.22. The success rate was 47.6% after tonsillectomy as the sole treatment for obstructive sleep apnoea in our adult population. Eleven patients were non-responders. The average ESS score reduction was 0.69 and did not reach statistical significance. With follow-up times ranging from 1.8 to 171 months, this study had the longest follow-up period compared to other existing studies. No patient with a follow-up longer than one year was a responder. CONCLUSION Our results support that tonsillectomy is an effective treatment for obstructive sleep apnoea in adults with tonsillar hypertrophy. With less severe OSA than those reported on previously, our patients also had less severe daytime sleepiness before surgery, and daytime sleepiness score reductions did not reach statistical significance. In the future, long-term results should be further analysed.
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Affiliation(s)
- Henrik M Sjöblom
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, POB 52, 20521, Turku, Finland. .,Department of Medicine, University of Turku, Turku, Finland.
| | - Max Nahkuri
- Department of Medicine, University of Turku, Turku, Finland
| | - Miika Suomela
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
| | - Jussi Jero
- Department of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaakko M Piitulainen
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Surgery and Cancer Diseases, Turku University Hospital, POB 52, 20521, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
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4
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Kent D, Stanley J, Aurora RN, Levine CG, Gottlieb DJ, Spann MD, Torre CA, Green K, Harrod CG. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:2507-2531. [PMID: 34351849 DOI: 10.5664/jcsm.9594] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), oxygen desaturation index (ODI), increase in lowest oxygen saturation (LSAT), sleep quality, and improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI, and increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, ODI, and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggest that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.
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Affiliation(s)
- David Kent
- Vanderbilt University Medical Center, Nashville, TN
| | | | - R Nisha Aurora
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Daniel J Gottlieb
- VA Boston Healthcare System, Brigham and Women's Hospital, Boston, MA
| | | | - Carlos A Torre
- University of Miami, Miller School of Medicine, Miami FL
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5
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Smith MM, Peterson E, Yaremchuk KL. The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2017; 157:331-335. [PMID: 28349770 DOI: 10.1177/0194599817698671] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to <20. Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.
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Affiliation(s)
- Matthew M Smith
- 1 Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ed Peterson
- 2 Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kathleen L Yaremchuk
- 3 Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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6
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Holmlund T, Franklin KA, Levring Jäghagen E, Lindkvist M, Larsson T, Sahlin C, Berggren D. Tonsillectomy in adults with obstructive sleep apnea. Laryngoscope 2016; 126:2859-2862. [PMID: 27107408 DOI: 10.1002/lary.26038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/29/2016] [Accepted: 03/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To study whether tonsillectomy is effective on obstructive sleep apnea (OSA) in adults with large tonsils. STUDY DESIGN A multicenter prospective interventional study. METHODS The study comprised 28 patients with OSA, an apnea-hypopnea index of > 10, large tonsils (Friedman tonsil size 3 and 4), and age 18 to 59 years. They were derived from 41 consecutive males and females with large tonsils referred for a suspicion of sleep apnea to the ear, nose, and throat departments in Umeå, Skellefteå, and Sunderbyn in northern Sweden. The primary outcome was the apnea-hypopnea index, measured with polygraphic sleep apnea recordings 6 months after surgery. Secondary outcomes included daytime sleepiness, as measured with the Epworth Sleepiness Scale, and swallowing function, using video-fluoroscopy. RESULTS The apnea-hypopnea index was reduced from a mean of 40 units per hour (95% confidence interval [CI] 28-51) to seven units per hour (95% CI 3-11), P < 0.001, at the 6-month follow-up after surgery. The apnea-hypopnea index was reduced in all patients and 18 (64%) were cured. The Epworth Sleepiness Scale was reduced from a mean of 11 (95% CI 8-13) to 6.0 (95% CI 4-7), P < 0.001. A swallowing dysfunction was found in seven of eight investigated patients before surgery. Of those, swallowing function improved in five patients after surgery, whereas no one deteriorated. CONCLUSION Tonsillectomy may be effective treatment for adult patients with OSA and large tonsils. Tonsillectomy may be suggested for adults with OSA and large tonsils. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2859-2862, 2016.
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Affiliation(s)
- Thorbjörn Holmlund
- Department of Clinical Sciences/Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Eva Levring Jäghagen
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Umeå School of Business and Economics/Statistics, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine/Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Torbjörn Larsson
- Department of Clinical Sciences/Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Carin Sahlin
- Department of Public Health and Clinical Medicine/Medicine, Umeå University, Umeå, Sweden
| | - Diana Berggren
- Department of Clinical Sciences/Otorhinolaryngology, Umeå University, Umeå, Sweden
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7
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Ayers CM, Lohia S, Nguyen SA, Gillespie MB. The Effect of Upper Airway Surgery on Continuous Positive Airway Pressure Levels and Adherence: A Systematic Review and Meta-Analysis. ORL J Otorhinolaryngol Relat Spec 2016; 78:119-25. [PMID: 27050814 DOI: 10.1159/000442023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence. METHODS Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective. RESULTS A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H2O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01). CONCLUSION Due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.
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Affiliation(s)
- Christopher M Ayers
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, S.C., USA
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8
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Camacho M, Li D, Kawai M, Zaghi S, Teixeira J, Senchak AJ, Brietzke SE, Frasier S, Certal V. Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2016; 126:2176-86. [DOI: 10.1002/lary.25931] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/13/2015] [Accepted: 01/29/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Macario Camacho
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine; Tripler Army Medical Center; Honolulu Hawaii
- Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division; Stanford Hospital and Clinics; Stanford California
| | - Dongcai Li
- Shenzhen Key Laboratory of ENT, Institute of ENT & Longgang ENT hospital; Shenzhen, China; Stanford California
| | - Makoto Kawai
- Department of Psychiatry and Behavioral Sciences; Stanford University, School of Medicine; Stanford California
- Sierra Pacific Mental Illness Research Education and Clinical Centers; VA Palo Alto Health Care System; Palo Alto California
| | - Soroush Zaghi
- Department of Head and Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California
| | - Jeffrey Teixeira
- Department of Otolaryngology-Head and Neck Surgery; Walter Reed National Military Medical Center; Bethesda Maryland
| | - Andrew J. Senchak
- Department of Otolaryngology-Head and Neck Surgery; Walter Reed National Military Medical Center; Bethesda Maryland
| | - Scott E. Brietzke
- Department of Otolaryngology-Head and Neck Surgery; Walter Reed National Military Medical Center; Bethesda Maryland
| | - Samuel Frasier
- Department of Otolaryngology-Head and Neck Surgery; Naval Medical Center Portsmouth; Portsmouth Virginia USA
| | - Victor Certal
- Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF & CHEDV Porto; University of Porto; Porto Portugal
- CINTESIS-Center for Research in Health Technologies and Information Systems; University of Porto; Porto Portugal
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Verse T, Wenzel S, Brus J. Multi-level surgery for obstructive sleep apnea. Lingual tonsillectomy vs. hyoid suspension in combination with radiofrequency of the tongue base. Sleep Breath 2015; 19:1361-6. [DOI: 10.1007/s11325-015-1241-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/23/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022]
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Objective versus subjective measurements of palatine tonsil size in adult patients with obstructive sleep apnea/hypopnea syndrome. Eur Arch Otorhinolaryngol 2014; 271:2305-10. [DOI: 10.1007/s00405-014-2944-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/07/2014] [Indexed: 11/27/2022]
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11
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Otake H, Suga K, Suzuki H, Nakada T, Kato K, Yoshida T, Teranishi M, Sone M, Nakashima T. Antimicrobial prophylaxis in tonsillectomy: the efficacy of preoperative single-dose oral administration of azithromycin in preventing surgical site infection. Acta Otolaryngol 2014; 134:181-4. [PMID: 24215215 DOI: 10.3109/00016489.2013.847284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The results indicate that oral administration of azithromycin (AZM) is equivalent to intravenous administration of cefazolin (CEZ) for preventing surgical site infection (SSI) in patients undergoing tonsillectomy, and should be used as cost-effective antimicrobial prophylaxis. OBJECTIVE Staphylococcus aureus, Streptococcus spp., and pharyngeal anaerobes have been described as major pathogens causing SSI in transpharyngeal operations such as tonsillectomy. The purpose of this study was to explore whether administration of AZM, an oral antimicrobial agent, might be equivalent to intravenous administration of a first-generation cefem antimicrobial agent for preventing SSI in patients undergoing tonsillectomy. METHODS Patients undergoing tonsillectomy were divided into an AZM-treated group and a CEZ-treated group, for intergroup comparison of responses. AZM was administered once orally, 2 days before the operation, whereas patients in the CEZ-treated group received CEZ intravenously 30 min before the operation, 4 h postoperatively, and then twice daily for 3 consecutive days beginning the day after the operation. RESULTS There were no significant intergroup differences in mean duration of hospitalization after the operation, incidence of postoperative hemorrhage, postoperative analgesic effect, or hematologic/blood biochemical findings. The incidence of postoperative fever was significantly lower in the AZM-treated group. Diarrhea occurred as an adverse drug reaction in the AZM-treated group, but no clinically significant adverse reactions were noted.
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Cardiovascular risk and mortality in end-stage renal disease patients undergoing dialysis: sleep study, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life: a prospective, double blind, randomized controlled clinical trial. BMC Nephrol 2013; 14:215. [PMID: 24103561 PMCID: PMC3851595 DOI: 10.1186/1471-2369-14-215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/03/2013] [Indexed: 11/16/2022] Open
Abstract
Background Chronic kidney disease (CKD) is one of the most serious public health problems. The increasing prevalence of CKD in developed and developing countries has led to a global epidemic. The hypothesis proposed is that patients undergoing dialysis would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity, compromising quality of life. Methods/Design A prospective, consecutive, double blind, randomized controlled clinical trial is proposed to address the effect of dialysis on sleep, pulmonary function, respiratory mechanics, upper airway collapsibility, autonomic nervous activity, depression, anxiety, stress and quality of life in patients with CKD. The measurement protocol will include body weight (kg); height (cm); body mass index calculated as weight/height2; circumferences (cm) of the neck, waist, and hip; heart and respiratory rates; blood pressures; Mallampati index; tonsil index; heart rate variability; maximum ventilatory pressures; negative expiratory pressure test, and polysomnography (sleep study), as well as the administration of specific questionnaires addressing sleep apnea, excessive daytime sleepiness, depression, anxiety, stress, and quality of life. Discussion CKD is a major public health problem worldwide, and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension. Sleep disorders are common in patients with renal insufficiency. Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep, and to investigate the negative influences of haemodialysis in the physiological variables of sleep, and autonomic nervous system, and respiratory mechanics and thereby compromise the quality of life of patients. Trial registration The protocol for this study is registered with the Brazilian Registry of Clinical Trials (ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN: U1111-1127-9390 [http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/]).
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Tan LTH, Tan AKL, Hsu PP, Loh ICY, Yuen HW, Chan YH, Lu PKS. Effects of tonsillectomy on sleep study parameters in adult patients with obstructive sleep apnea—a prospective study. Sleep Breath 2013; 18:265-8. [DOI: 10.1007/s11325-013-0875-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/30/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
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Giannasi LC, Matsui MY, de Freitas Batista SR, Hardt CT, Gomes CP, Amorim JBO, de Carvalho Aguiar I, Collange L, dos Reis dos Santos I, Dias IS, de Oliveira CS, de Oliveira LVF, Gomes MF. Effects of neuromuscular electrical stimulation, laser therapy and LED therapy on the masticatory system and the impact on sleep variables in cerebral palsy patients: a randomized, five arms clinical trial. BMC Musculoskelet Disord 2012; 13:71. [PMID: 22587485 PMCID: PMC3479060 DOI: 10.1186/1471-2474-13-71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 04/25/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Few studies demonstrate effectiveness of therapies for oral rehabilitation of patients with cerebral palsy (CP), given the difficulties in chewing, swallowing and speech, besides the intellectual, sensory and social limitations. Due to upper airway obstruction, they are also vulnerable to sleep disorders. This study aims to assess the sleep variables, through polysomnography, and masticatory dynamics, using electromiography, before and after neuromuscular electrical stimulation, associated or not with low power laser (Gallium Arsenide- Aluminun, =780 nm) and LED (= 660 nm) irradiation in CP patients. METHODS/DESIGN 50 patients with CP, both gender, aged between 19 and 60 years will be enrolled in this study. The inclusion criteria are: voluntary participation, patient with hemiparesis, quadriparesis or diparetic CP, with ability to understand and respond to verbal commands. The exclusion criteria are: patients undergoing/underwent orthodontic, functional maxillary orthopedic or botulinum toxin treatment. Polysomnographic and surface electromyographic exams on masseter, temporalis and suprahyoid will be carry out in all sample. Questionnaire assessing oral characteristics will be applied. The sample will be divided into 5 treatment groups: Group 1: neuromuscular electrical stimulation; Group 2: laser therapy; Group 3: LED therapy; Group 4: neuromuscular electrical stimulation and laser therapy and Group 5: neuromuscular electrical stimulation and LED therapy. All patients will be treated during 8 consecutive weeks. After treatment, polysomnographic and electromiographic exams will be collected again. DISCUSSION This paper describes a five arm clinical trial assessing the examination of sleep quality and masticatory function in patients with CP under non-invasive therapies. TRIAL REGISTRATION The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC RBR-994XFS.
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Affiliation(s)
- Lilian Chrystiane Giannasi
- Department of Biosciences and Oral Diagnosis, School of Dentistry, São Paulo State University, São José dos Campos, SP, Brazil
- Sleep Laboratory, Nove de Julho University, Sao Paulo, SP, Brazil
| | - Miriam Yumi Matsui
- Department of Biosciences and Oral Diagnosis, School of Dentistry, São Paulo State University, São José dos Campos, SP, Brazil
| | | | - Camila Teixeira Hardt
- Department of Biosciences and Oral Diagnosis, School of Dentistry, São Paulo State University, São José dos Campos, SP, Brazil
| | - Carla Paes Gomes
- Department of Biosciences and Oral Diagnosis, School of Dentistry, São Paulo State University, São José dos Campos, SP, Brazil
| | - José Benedito Oliveira Amorim
- Department of Biosciences and Oral Diagnosis, School of Dentistry, São Paulo State University, São José dos Campos, SP, Brazil
| | | | - Luanda Collange
- Sleep Laboratory, Nove de Julho University, Sao Paulo, SP, Brazil
| | | | | | | | | | - Mônica Fernandes Gomes
- Department of Biosciences and Oral Diagnosis, School of Dentistry, São Paulo State University, São José dos Campos, SP, Brazil
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Stow NW, Sale PJP, Lee D, Joffe D, Gallagher RM. Simultaneous Tonsillectomy and Nasal Surgery in Adult Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2012; 147:387-91. [DOI: 10.1177/0194599812444256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Although adenotonsillectomy is the accepted treatment for obstructive sleep apnea (OSA) in the pediatric population, tonsillectomy has not been widely adopted in adults, and its success in this group has not been well reported. Despite the lack of current evidence, there may be an important role for tonsillectomy in selected adult cases, and further study is required. This is a pilot study from a larger group of subjects currently enrolled and awaiting surgery and repeat polysomnography. Study Design Retrospective series with chart review. Setting Tertiary referral teaching hospitals. Subjects and Methods Thirteen consecutive eligible subjects with tonsillar hypertrophy and OSA were identified after treatment. These patients had undergone pre- and postoperative polysomnography for assessment of the severity of sleep-disordered breathing. Post hoc analysis of key parameters was performed by Wilcoxon signed rank and paired t tests. Tonsillectomy was performed on all subjects, using the diathermy dissection technique. Nasal surgery was performed simultaneously in 11 subjects for symptomatic nasal blockage unresponsive to medical treatment. Results There was a statistically significant improvement in the severity of OSA after surgery. The total Respiratory Disturbance Index (RDI) was significantly decreased from median values of 31.7 to 5.5 ( P = .0002). The RDI in rapid eye movement and non–rapid eye movement sleep and the arousal index were also significantly decreased. Conclusion In selected adult subjects, tonsillectomy with intercurrent nasal surgery should be considered an effective treatment for OSA and may reduce the requirement for continuous positive airway pressure, oral appliances, or further therapeutic intervention.
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Affiliation(s)
- Nicholas W. Stow
- Department of Otolaryngology Head & Neck Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Phillip J. P. Sale
- Department of Otolaryngology Head & Neck Surgery, Royal North Shore Hospital, Sydney, Australia
| | | | - David Joffe
- Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia
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Oliveira LVF, Aguiar IC, Hirata RP, Faria Junior NS, Reis IS, Sampaio LMM, Oliveira CS, Carvalho PTC, Leitao Filho FSS, Giannasi LC, Pinto LA, Malheiros CA, Freitas WR. Sleep study, respiratory mechanics, chemosensitive response and quality of life in morbidly obese patients undergoing bariatric surgery: a prospective, randomized, controlled trial. BMC Surg 2011; 11:28. [PMID: 22004426 PMCID: PMC3213198 DOI: 10.1186/1471-2482-11-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/17/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity is a major public health problem in both developed and developing countries alike and leads to a series of changes in respiratory physiology. There is a strong correlation between obesity and cardiopulmonary sleep disorders. Weight loss among such patients leads to a reduction in these alterations in respiratory physiology, but clinical treatment is not effective for a long period of time. Thus, bariatric surgery is a viable option. METHODS/DESIGN The present study involves patients with morbid obesity (BMI of 40 kg/m2 or 35 kg/m2 to 39.9 kg/m2 with comorbidities), candidates for bariatric surgery, screened at the Santa Casa de Misericórdia Hospital in the city of Sao Paulo (Brazil). The inclusion criteria are grade III morbid obesity, an indication for bariatric surgery, agreement to participate in the study and a signed term of informed consent. The exclusion criteria are BMI above 55 kg/m2, clinically significant or unstable mental health concerns, an unrealistic postoperative target weight and/or unrealistic expectations of surgical treatment. Bariatric surgery candidates who meet the inclusion criteria will be referred to Santa Casa de Misericórdia Hospital and will be reviewed again 30, 90 and 360 days following surgery. Data collection will involve patient records, personal data collection, objective assessment of HR, BP, neck circumference, chest and abdomen, collection and analysis of clinical preoperative findings, polysomnography, pulmonary function test and a questionnaire on sleepiness. DISCUSSION This paper describes a randomised controlled trial of morbidly obese patients. Polysomnography, respiratory mechanics, chemosensitive response and quality of life will be assessed in patients undergoing or not undergoing bariatric surgery. TRIAL REGISTRATION The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC (RBR-9k9hhv).
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Affiliation(s)
- Luis VF Oliveira
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | - Isabella C Aguiar
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | - Raquel P Hirata
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | - Newton S Faria Junior
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | - Israel S Reis
- Sleep Laboratory, Nove de Julho University, Sao Paulo, Brazil
| | - Luciana MM Sampaio
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | - Claudia S Oliveira
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | - Paulo TC Carvalho
- Master's and Doctoral Degree Program in Rehabilitation Sciences, Nove de Julho University, Sao Paulo, Brazil
| | | | | | - Lia Azevedo Pinto
- Psychology Service, Santa Casa de Misericórdia Hospital, Sao Paulo, Brazil
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Youshani AS, Thomas L, Sharma RK. Day case tonsillectomy for the treatment of obstructive sleep apnoea syndrome in children: Alder Hey experience. Int J Pediatr Otorhinolaryngol 2011; 75:207-10. [PMID: 21131063 DOI: 10.1016/j.ijporl.2010.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/28/2010] [Accepted: 10/30/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the safety of paediatric adeno-tonsillectomy for obstructive sleep apnoea syndrome (OSAS) performed as a day case procedure. METHODOLOGY Postoperative airway related complications were prospectively evaluated in children undergoing adeno-tonsillectomy for OSAS over a 12-month period in a tertiary care centre. All data was analysed and descriptive statistics performed. RESULTS The overall incidence of postoperative airway related complications were 21 (10.4%) in 202 consecutively operated children. Eleven were in children with other medical co-morbidities (n=37) of which 8 occurred after 6h. Amongst those without any medical illnesses (n=165), two (1.2%) developed OSAS related complication after 6h of surgery only one of which needed medical/nursing intervention. The incidence of postoperative desaturations after 6h was 21.6% in those with co-morbidities. CONCLUSION It is safe to perform day case adeno-tonsillectomy for OSAS in children without any medical co-morbidities while those with other medical illnesses should be planned as in-patient procedures.
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Affiliation(s)
- Amir Saam Youshani
- Alder Hey Children's NHS Foundation Trust, Alder Road, Liverpool L12 2AP, United Kingdom.
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Cahali MB, Soares CFDP, Dantas DADS, Formigoni GGS. Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation? Clinics (Sao Paulo) 2011; 66:1347-52. [PMID: 21915482 PMCID: PMC3161210 DOI: 10.1590/s1807-59322011000800007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/22/2011] [Accepted: 04/22/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults. INTRODUCTION Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown. METHODS We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data. RESULTS We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea. CONCLUSIONS There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.
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Affiliation(s)
- Michel Burihan Cahali
- Department of Otolaryngology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil.
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Abstract
Endoscopic evaluation of the upper airway in patients with sleep disordered breathing (SDB) using rigid and flexible endoscopes is a typical investigation in otorhinolaryngology. Visualizing the anatomic structure as well as the dynamic mechanism of snoring and pharyngeal obstruction during wakefulness, natural sleep, and under sedation are of special interest. The results obtained have increased our understanding of SDB with obstruction of the upper airway. Videoendoscopy under sedation (ViSe) has become increasingly established as a tool to identify the therapeutic concept in cases of CPAP failure, leading to changes compared to the concept derived from basic awake endoscopy. The success of mandibular advancement devices can be adequately predicted. However, it remains unclear to what extent the success rate of surgery can be improved by ViSe. Further research into these approaches is needed in order to become valuable tools in the diagnostic work-up of patients with sleep apnea.
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Affiliation(s)
- J T Maurer
- Schlafmedizinisches Zentrum,Universitäts-Hals-Nasen-Ohren-Klinik Mannheim, Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg, 68135, Mannheim, Deutschland.
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Abstract
The current guideline discusses conservative and surgical therapy of obstructive sleep apnea (OSA) in adults from the perspective of the ear, nose and throat specialist. The revised guideline was commissioned by the German Society of Ear-Nose-Throat, Head-Neck Surgery (DG HNO KHC) and compiled by the DG HNO KHC's Working Group on Sleep Medicine. The guideline was based on a formal consensus procedure according to the guidelines set out by the German Association of Scientific Medical Societies (AWMF) in the form of a"S2e guideline". Research of the literature available on the subject up to and including December 2008 forms the basis for the recommendations. Evaluation of the publications found was made according to the recommendations of the Oxford Centre for Evidence-Based Medicine (OCEBM). This yielded a recommendation grade, whereby grade A represents highly evidence-based studies and grade D those with a low evidence base.
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Palatine Tonsil Size and its Correlation with Subjective Tonsil Size in Patients with Sleep-Disordered Breathing. Otolaryngol Head Neck Surg 2009; 141:716-21. [DOI: 10.1016/j.otohns.2009.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 09/09/2009] [Accepted: 09/16/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE: To investigate the correlation of subjective tonsil size with real palatine tonsil size and to compare the differences of each parameter according to subjective tonsil size and between children and adults. STUDY DESIGN: Prospective evaluation of subjective tonsil size (0–4+) and real palatine tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), total tonsil volume (TTV), and embedded tonsil volume (ETV) within the tonsillar fossa. SETTING: Tertiary-care rhinologic clinic. SUBJECTS AND METHODS: We measured TH, TW, TT, TTV, and ETV in 277 children and 63 adults with sleep-disordered breathing (SDB). RESULTS: In both children and adults, subjective tonsil size was significantly correlated with TTV, TH, TW, and TT (correlation coefficients 0.199–0.427 for children and 0.462–0.551 for adults). In children, TTV increased in proportion to subjective tonsil size, but about 45 percent and 34 percent of tonsils markedly deviated from the mean value of their TTV in size 2 and 3 groups, respectively. In adults, TTV of subjective tonsil size 3 and 4 groups was significantly larger than that of size 1 and 2 groups. CONCLUSIONS: Real palatine tonsil size correlated with subjective tonsil size in both children and adults with SDB. Although there is a statistical correlation in children between TTV and subjective tonsil size, there is significant discordance in size 2 and 3 groups, thus greatly limiting the value of subjective tonsil size assessment in the majority of children. However, adult subjective tonsil size may reflect real palatine tonsil size and may help predict it preoperatively.
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Abstract
During the past two decades, different methods of upper airway evaluation for patients with obstructive sleep apnea (OSA) have been investigated. Although clinical assessment is the basis of any diagnostic workflow in OSA, the Mueller maneuver is apparently of no importance. Imaging techniques have increased our knowledge of the pathophysiology of OSA. Cephalometry is done only if maxillomandibular advancement is planned; dynamic investigations such as computed tomography and magnetic resonance imaging are able to picture the pharyngeal collapse and have the capacity to simulate the effect of interventions on OSA severity. So far, video endoscopy under sedation can only predict the success of oral appliances. Multichannel pressure recordings depict the distribution of obstructive events in the upper or lower pharyngeal segment during the entire night. The impact of sophisticated upper airway evaluation remains limited compared with standard clinical assessment. Further research is needed to develop valuable tools for the diagnostic workup of patients with OSA.
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Abstract
Skeletal surgeries, specifically orthognathic procedures are an integral part of the treatment regimen for patients with airway issues. As evaluation mechanisms for, research into, and treatment options for, patients with airway issues have become refined, so have the techniques used to treat them become more focused and less prescriptive. The diagnosis for the severity of the airway compromise has also undergone an evolutionary change, with the diagnostic criteria becoming more restrictive and the equipment for diagnosing them more sophisticated.
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Affiliation(s)
- David A Bitonti
- National Naval Medical Center, Bethesda, MD 20889-5600, USA.
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