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Park DY, Cho JH, Jung YG, Choi JH, Kim DK, Kim SW, Kim HJ, Kim HY, Park SK, Park CS, Yang HC, Lee SH, Cho HJ. Clinical Practice Guideline: Clinical Efficacy of Nasal Surgery in the Treatment of Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2023; 16:201-216. [PMID: 36791806 PMCID: PMC10471902 DOI: 10.21053/ceo.2022.01361] [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: 09/29/2022] [Revised: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 02/16/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway obstruction during sleep. To reduce the morbidity of OSA, sleep specialists have explored various methods of managing the condition, including manifold positive airway pressure (PAP) techniques and surgical procedures. Nasal obstruction can cause significant discomfort during sleep, and it is likely that improving nasal obstruction would enhance the quality of life and PAP compliance of OSA patients. Many reliable studies have offered evidence to support this assumption. However, few comprehensive guidelines for managing OSA through nasal surgery encompass all this evidence. In order to address this gap, the Korean Society of Otorhinolaryngology-Head and Neck Surgery (KORL-HNS) and the Korean Society of Sleep and Breathing designated a guideline development group (GDG) to develop recommendations for nasal surgery in OSA patients. Several databases, including OVID Medline, Embase, the Cochrane Library, and KoreaMed, were searched to identify all relevant papers using a predefined search strategy. The types of nasal surgery included septoplasty, turbinate surgery, nasal valve surgery, septorhinoplasty, and endoscopic sinus surgery. When insufficient evidence was found, the GDG sought expert opinions and attempted to fill the evidence gap. Evidence-based recommendations for practice were ranked according to the American College of Physicians' grading system. The GDG developed 10 key action statements with supporting text to support them. Three statements are ranked as strong recommendations, three are only recommendations, and four can be considered options. The GDG hopes that this clinical practice guideline will help physicians make optimal decisions when caring for OSA patients. Conversely, the statements in this guideline are not intended to limit or restrict physicians' care based on their experience and assessment of individual patients.
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Affiliation(s)
- Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hoon Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang-Wook Kim
- Department of Otorhinolaryngology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chan Soon Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Chae Yang
- 9Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Choi JH. Treatments for Adult Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2021.00913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Choi JH. Positive Airway Pressure Prescription and Management for Patients with Obstructive Sleep Apnea. JOURNAL OF RHINOLOGY 2020. [DOI: 10.18787/jr.2020.00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated events of complete or partial upper airway obstruction during sleep and is a chronic sleep disorder that requires long-term comprehensive management. Positive airway pressure (PAP) is recommended for treatment of OSA in adults with excessive daytime sleepiness, decreased sleep-related quality of life, and comorbid hypertension. During PAP therapy, regular follow-up is continuously necessary to evaluate side effects or complications, compliance, and treatment effects such as OSA-related symptoms, quality of life, and consequences. This review provides knowledge about PAP-related background information, indications for PAP prescription including the Korean National Health Insurance criteria, optimal pressure, PAP modes, patient education and support, short-term and long-term management, interpretation of PAP uses, and alternative therapies.
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Virkkula P, Hytönen M, Bachour A, Malmberg H, Hurmerinta K, Salmi T, Maasilta P. Smoking and Improvement after Nasal Surgery in Snoring Men. ACTA ACUST UNITED AC 2018; 21:169-73. [PMID: 17424873 DOI: 10.2500/ajr.2007.21.2991] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The aim of this study was to compare subgroups of smokers and nonsmokers undergoing nasal surgery and to evaluate improvement of nasal stuffiness, snoring, and symptoms related to sleep-disordered breathing after nasal surgery. Methods A cross-sectional prospective study was performed. The study population included 40 consecutive snoring men scheduled for surgical treatment of nasal obstruction. The patients completed nasal and sleep questionnaires, an Epworth sleepiness scale, and a visual analog scale of snoring intensity. They underwent polysomnography, anterior rhinomanometry, acoustic rhinometry, and cephalometric analysis. Results The smokers were younger, they snored longer and louder, and they had higher nasal resistance with decongestion and longer soft palates than the nonsmokers. Nasal stuffiness improved well after surgery, but a decrease of nasal resistance was not related to improvement of subjective snoring. Conclusion Smoking was associated with increased snoring, nasal obstruction, and pharyngeal soft tissue volume. Expectations of patients may influence subjective assessment of snoring after nasal surgery.
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Gonzaga C, Bertolami A, Bertolami M, Amodeo C, Calhoun D. Obstructive sleep apnea, hypertension and cardiovascular diseases. J Hum Hypertens 2015; 29:705-12. [DOI: 10.1038/jhh.2015.15] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/07/2015] [Accepted: 01/23/2015] [Indexed: 11/09/2022]
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Abstract
Obstructive sleep apnea is a common, chronic disorder characterized by the cessation or reduction in airflow due to periodic mechanical obstruction of the upper airway passage during sleep. Symptoms and signs of sleep apnea include daytime sleepiness, fatigue, poor concentration, snoring, resuscitative snorts, and related occupational accidents. Sleep apnea is classified into 3 types based on its severity and management varies accordingly. The first step in treatment is to identify correctible causes and educate patients on lifestyle modifications. Positive airway pressure is the preferred treatment modality and can be delivered via 3 different modes. Oral appliances are of 3 types and are generally indicated in mild to moderate obstructive sleep apnea. Surgery is a final therapeutic option that focuses on the removal of excessive tissue from different sites of the pharyngeal airway.
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Kee K, Naughton MT. Obstructive sleep apnea: should weight loss be prescribed? Expert Rev Respir Med 2013; 7:1-3. [DOI: 10.1586/ers.12.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Operative technique of upper airway stimulation: an implantable treatment of obstructive sleep apnea. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otot.2012.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Latshang TD, Bloch KE. How to Treat Patients with Obstructive Sleep Apnea Syndrome during an Altitude Sojourn. High Alt Med Biol 2011; 12:303-7. [DOI: 10.1089/ham.2011.1055] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tsogyal D. Latshang
- Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Konrad E. Bloch
- Sleep Disorders Center, Pulmonary Division, University Hospital of Zurich and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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Alves C, Caminha JMPC, da Silva AM, Mendonça D. Compliance to continuous positive airway pressure therapy in a group of Portuguese patients with obstructive sleep apnea syndrome. Sleep Breath 2011; 16:555-62. [PMID: 21688210 DOI: 10.1007/s11325-011-0542-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 05/05/2011] [Accepted: 06/06/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an emerging public health concern. Although different treatments for OSAHS had been proposed, continuous positive airway pressure (CPAP) is the first-line treatment in moderate to serious OSAHS in which success can be achieved by increasing compliance to CPAP. MATERIALS AND METHODS This study analyzes long-term CPAP compliance in patients with OSAHS on CPAP therapy for at least 1 month, who began CPAP therapy between January 2004 and December 2006, followed up at a Portuguese Sleep Outpatient Clinic in Santo António Hospital. Only effective data of CPAP use had been considered. During the first year of CPAP therapy, 96 patients were enrolled and followed up, but 15 patients had discontinued CPAP treatment. CPAP was used on average 5.1 h per day and in 80.1% of the total follow-up days. When compliance is defined as the use of CPAP for a minimum of 4 h per day in at least 70% of the follow-up days, only 54% of patients were classified as compliants during the first year. RESULTS AND CONCLUSION No statistically significant differences were found throughout the first year (p > 0.05) in terms of the percentage of compliants, controlling for demographic and clinic variables. None of the demographic and clinical baseline variables studied were found to be significant predictor of CPAP compliance (p > 0.05). This study diagnosed a low compliance to CPAP therapy in the studied sample, warning to the need of developing further studies in this area and to the need of implementing strategies to increase CPAP compliance.
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Affiliation(s)
- Claudia Alves
- Department of Orthopedics, Santo António Hospital, Oporto, Portugal
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Fleetham JA. Medical and surgical treatment of obstructive sleep apnea syndrome, including dental appliances. HANDBOOK OF CLINICAL NEUROLOGY 2011; 98:441-57. [DOI: 10.1016/b978-0-444-52006-7.00029-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Holty JEC, Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2010; 14:287-97. [DOI: 10.1016/j.smrv.2009.11.003] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 11/09/2009] [Accepted: 11/10/2009] [Indexed: 11/16/2022]
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Managing hypertension in obstructive sleep apnea: the interplay of continuous positive airway pressure, medication and chronotherapy. J Hypertens 2010; 28:875-82. [PMID: 20087211 DOI: 10.1097/hjh.0b013e328336ed85] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertension is highly prevalent and usually uncontrolled among patients with obstructive sleep apnea despite multiple interventions, namely lifestyle modifications, use of antihypertensive drugs and continuous positive airway pressure application. Main prognosticators of the blood pressure (BP) reduction with continuous positive airway pressure therapy are high levels of BP, severity of apnea and daytime sleepiness. The long-term effect of continuous positive airway pressure on BP is still inconclusive, and compliance issues constitute a major limitation. There is no clear evidence for preference for a specific type of antihypertensive drug, and selection should primarily be guided by the patient's cardiometabolic profile and associated clinical conditions. Furthermore, as hypertensive patients with obstructive sleep apnea frequently exhibit a disturbed circadian BP pattern, chronotherapy emerges as a possible therapeutic supplement.
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Yu S, Liu F, Wang Q, Han F, Deng L, Liang H, Cui Z. Effect of Revised UPPP Surgery on Ambulatory BP in Sleep Apnea Patients with Hypertension and Oropharyngeal Obstruction. Clin Exp Hypertens 2010; 32:49-53. [DOI: 10.3109/10641960902993079] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McNicholas WT. Cardiovascular outcomes of CPAP therapy in obstructive sleep apnea syndrome. Am J Physiol Regul Integr Comp Physiol 2007; 293:R1666-70. [PMID: 17634199 DOI: 10.1152/ajpregu.00401.2007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Considerable evidence is now available of an independent association between obstructive sleep apnea syndrome (OSAS) and cardiovascular disease. The association is particularly strong for systemic arterial hypertension, but there is growing evidence of an association with ischemic heart disease and stroke. The mechanisms underlying cardiovascular disease in patients with OSAS are still poorly understood. However, the pathogenesis is likely to be a multifactorial process involving a diverse range of mechanisms, including sympathetic overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation, and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. Therapy with continuous positive airway pressure (CPAP) has been associated with significant benefits to cardiovascular morbidity and mortality, both in short-term studies addressing specific aspects of morbidity, such as hypertension, and more recently in long-term studies that have evaluated major outcomes of cardiovascular morbidity and mortality. However, there is a clear need for further studies evaluating the impact of CPAP therapy on cardiovascular outcomes. Furthermore, studies on the impact of CPAP therapy have provided useful information concerning the role of basic cell and molecular mechanisms in the pathophysiology of OSAS.
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Affiliation(s)
- Walter T McNicholas
- Respiratory Sleep Disorders Unit, St. Vincent's Univ. Hospital, Elm Park, Dublin 4, Ireland.
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Gagnadoux F, Meurice JC. [Obstructive sleep apnea syndrome]. Rev Mal Respir 2007; 24:673-6. [PMID: 17519826 DOI: 10.1016/s0761-8425(07)91142-0] [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)
- F Gagnadoux
- Département de Pneumologie, CHU d'Angers, France.
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Hartenbaum N, Collop N, Rosen IM, Phillips B, George CFP, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL, Rosekind MR. Sleep Apnea and Commercial Motor Vehicle Operators:. J Occup Environ Med 2006; 48:S4-37. [PMID: 16985410 DOI: 10.1097/01.jom.0000236404.96857.a2] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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