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Yang HC, Umugire A, Song MK, Man SC, Kim HC, Kim J, Vena D, Huyett P, Choi I, Wellman AD. Sleep apnea patients with epiglottic collapse elevate their larynx more with swallowing; videofluoroscopic swallowing study of 80 patients. Sleep Breath 2024:10.1007/s11325-024-03065-6. [PMID: 38795279 DOI: 10.1007/s11325-024-03065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 05/20/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE The epiglottis plays an integral role in the swallowing mechanism and is also implicated as an obstruction site in obstructive sleep apnea (OSA). The underlying causes of epiglottic collapse during sleep remain unclear. This study aimed to investigate the cognitive functions using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the neurophysiological and anatomical factors using videofluoroscopic swallowing studies (VFSS). We compared patients with OSA exhibiting epiglottic collapse to those without, assessing differences in anatomical or neurophysiological characteristics. METHODS The study included 12 patients with epiglottic collapse (Epi-group) and 68 without (non-Epi group), all undergoing overnight polysomnography (PSG), drug-induced sleep endoscopy (DISE), LOTCA, and VFSS. Oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were considered as neurophysiological traits, and laryngeal elevation length (LE) as anatomical trait, and were measured across various test diets (10 ml of liquid, soft, or solid). RESULTS The study comprised 80 individuals, 57 men and 23 women, with no significant age, sex, body mass index or PSG parameters between groups, or DISE findings, with the exception of epiglottic collapse. Swallowing metrics from VFSS were normal, with no differences in OTT, PDT, PTT, or LOTCA scores. Notably, patients with epiglottic collapse showed a greater laryngeal elevation when swallowing soft and solid foods (p = 0.025 and p = 0.048, respectively). CONCLUSIONS Patients with epiglottic collapse do not exhibit neurophysiological or cognitive impairments when compared to non-Epi group. However, the Epi-group displayed a significantly increased laryngeal elevation length. This suggests that anatomical factors may have a more substantial role in the development of epiglottic collapse than neurophysiological factors.
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Affiliation(s)
- Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Alphonse Umugire
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea.
| | - Sung Chung Man
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Jisun Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Phillip Huyett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Insung Choi
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, 42 Jebong-ro Dong-gu, Gwangju, 61479, South Korea.
| | - Andrew D Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Sung CM, Kim HC, Kim J, Kim JG, Lim SC, Shin MH, Nam K, Lee J, Vena D, White DP, Yang HC, Wellman A. Patients with Epiglottic Collapse Are Less Adherent to Autotitrating Positive Airway Pressure Therapy for Obstructive Sleep Apnea. Ann Am Thorac Soc 2022; 19:1907-1912. [PMID: 35969148 PMCID: PMC9667810 DOI: 10.1513/annalsats.202202-118oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/03/2022] [Indexed: 12/30/2022] Open
Abstract
Rationale: The anatomic orientation of the epiglottis is such that it points in the opposite direction to inspiratory flow, thereby potentially making positive airway pressure (PAP) treatment challenging in patients with epiglottic collapse. However, no previous studies have analyzed PAP adherence in these patients. Objectives: This study aimed to analyze adherence to autotitrating PAP (APAP) treatment in patients with epiglottic collapse. Methods: We performed an age- and sex-matched case-control study. On the basis of their overnight level-I polysomnogram, patients were prescribed APAP in a tertiary hospital between July 2018 and March 2019. The site of airway collapse was diagnosed with drug-induced sleep endoscopy. Demographic factors, sleep questionnaire, polysomnography, and APAP usage statistics were analyzed. Results: Eighteen patients with epiglottic collapse (epi-group) and 36 without epiglottic collapse (control group) were analyzed. We found that 22.8% of patients in the epi-group terminated APAP within 2 weeks, whereas only 2.8% of patients in the control group terminated APAP within 2 weeks (P = 0.048). The percentage of days with usage over 4 hours was significantly lower in the epi-group (64.6% vs. 75.6%; P = 0.008). In addition, the adherence failure rate was 66.7% in the epi-group and 33.3% in the control group (P = 0.039). Patients with epiglottic collapse were also found to have lower body mass index, which is an unfavorable predictor of APAP adherence. Conclusions: This study suggests that patients with epiglottic collapse have a higher APAP adherence failure rate than patients without epiglottic collapse. Thus, patients with epiglottic collapse should be followed closely during treatment, and alternative therapies should probably be considered for these patients.
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Affiliation(s)
- Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jisun Kim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Jae Gu Kim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
| | | | - Kwangil Nam
- Department of Anatomy, Chonnam National University Medical School, Hwasun, South Korea
| | - Jongho Lee
- School of Mechanical Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, South Korea; and
| | - Daniel Vena
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David P. White
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery and Department of Anatomy, Chonnam National University Medical School, Gwangju, South Korea
- Chonnam National University Hospital, Gwangju, South Korea
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Lack of ITS sequence homogenization in Erysimum species (Brassicaceae) with different ploidy levels. Sci Rep 2022; 12:16907. [PMID: 36207443 PMCID: PMC9546898 DOI: 10.1038/s41598-022-20194-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
The internal transcribed spacers (ITS) exhibit concerted evolution by the fast homogenization of these sequences at the intragenomic level. However, the rate and extension of this process are unclear and might be conditioned by the number and divergence of the different ITS copies. In some cases, such as hybrid species and polyploids, ITS sequence homogenization appears incomplete, resulting in multiple haplotypes within the same organism. Here, we studied the dynamics of concerted evolution in 85 individuals of seven plant species of the genus Erysimum (Brassicaceae) with multiple ploidy levels. We estimated the rate of concerted evolution and the degree of sequence homogenization separately for ITS1 and ITS2 and whether these varied with ploidy. Our results showed incomplete sequence homogenization, especially for polyploid samples, indicating a lack of concerted evolution in these taxa. Homogenization was usually higher in ITS2 than in ITS1, suggesting that concerted evolution operates more efficiently on the former. Furthermore, the hybrid origin of several species appears to contribute to the maintenance of high haplotype diversity, regardless of the level of ploidy. These findings indicate that sequence homogenization of ITS is a dynamic and complex process that might result in varying intra- and inter-genomic diversity levels.
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Tan SN, Kim JM, Kim J, Sung CM, Kim HC, Lee J, Lim SC, White DP, Yang HC, Wellman DA. Head rotation improves airway obstruction, especially in patients with less severe obstructive sleep apnea without oropharyngeal collapse. PLoS One 2022; 17:e0268455. [PMID: 35609040 PMCID: PMC9129012 DOI: 10.1371/journal.pone.0268455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Head rotation is thought to have an effect on obstructive sleep apnea (OSA) severity. However, keeping the head rotated fully during sleep is difficult to maintain, and the effect of head rotation is not the same in all OSA patients. Thus, this study aimed to identify whether less head rotation has an effect on airway patency and determine the responder characteristics to the head rotation maneuver (HRM). Methods We recruited 221 patients who underwent overnight polysomnography and drug-induced sleep endoscopy (DISE) in a tertiary hospital from June 2019 to July 2020. Airway patency and the site of airway collapse were determined in the supine position with the head at 0, 30, and 60 degrees of rotation (HRM0°, HRM30°, and HRM60°, respectively) during DISE. The site of collapse was determined using the VOTE classification system: the velum (palate), oropharyngeal lateral walls, tongue base, and epiglottis. Each structure was labeled as 0, 1, or 2 (patent, partially obstructed, and completely obstructed, respectively). Airway response to the HRM30° and 60° and the clinical characteristics associated with airway opening were analyzed. Results The study population had a median age of 52 (25–61) years, a body mass index of 26.7(24.6–29.4) kg/m2, and the apnea-hypopnea index (AHI) of 28.2(13.7–71.9) events/h. HRM influenced airway patency positively not only with HRM60° (p<0.001) but also following limited rotation (HRM30°, p<0.001). Patients with tongue base (40.0% with HRM 60°) and epiglottic (52.6% with HRM 60°) collapse responded particularly well to HRM. Multivariate analysis revealed that lower AHI (p<0.001) and an absence of oropharyngeal lateral walls collapse (p = 0.011) were significant predictors of responders to HRM. Conclusion Head rotation improved airway obstruction in OSA patients, even with a small degree of rotation, and should be further explored as a potential form of therapy in appropriately selected patients.
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Affiliation(s)
- Shi Nee Tan
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
- School of Medicine, KPJ University College, Nilai, Negeri Sembilan, Malaysia
| | - Jong-Min Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jisun Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jongho Lee
- School of Mechanical Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - David P. White
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- * E-mail: (HCY); (DAW)
| | - D. Andrew Wellman
- Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States of America
- * E-mail: (HCY); (DAW)
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Loos D, Zhang L, Beemelmanns C, Kurzai O, Panagiotou G. DAnIEL: A User-Friendly Web Server for Fungal ITS Amplicon Sequencing Data. Front Microbiol 2021; 12:720513. [PMID: 34484161 PMCID: PMC8416086 DOI: 10.3389/fmicb.2021.720513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
Trillions of microbes representing all kingdoms of life are resident in, and on, humans holding essential roles for the host development and physiology. The last decade over a dozen online tools and servers, accessible via public domain, have been developed for the analysis of bacterial sequences; however, the analysis of fungi is still in its infancy. Here, we present a web server dedicated to the comprehensive analysis of the human mycobiome for (i) translating raw sequencing reads to data tables and high-standard figures, (ii) integrating statistical analysis and machine learning with a manually curated relational database and (iii) comparing the user’s uploaded datasets with publicly available from the Sequence Read Archive. Using 1,266 publicly available Internal transcribed spacers (ITS) samples, we demonstrated the utility of DAnIEL web server on large scale datasets and show the differences in fungal communities between human skin and soil sites.
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Affiliation(s)
- Daniel Loos
- Systems Biology and Bioinformatics Group, Leibniz Institute for Natural Product Research and Infection Biology, Jena, Germany
| | - Lu Zhang
- Systems Biology and Bioinformatics Group, Leibniz Institute for Natural Product Research and Infection Biology, Jena, Germany
| | - Christine Beemelmanns
- Chemical Biology of Microbe-Host Interactions Group, Leibniz Institute for Natural Product Research and Infection Biology, Jena, Germany
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany.,National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology, Jena, Germany
| | - Gianni Panagiotou
- Systems Biology and Bioinformatics Group, Leibniz Institute for Natural Product Research and Infection Biology, Jena, Germany.,Systems Biology and Bioinformatics Group, School of Biological Sciences, Faculty of Science, The University of Hong Kong, Pokfulam, China
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Kim HY, Sung CM, Jang HB, Kim HC, Lim SC, Yang HC. Patients with epiglottic collapse showed less severe obstructive sleep apnea and good response to treatment other than continuous positive airway pressure: a case-control study of 224 patients. J Clin Sleep Med 2021; 17:413-419. [PMID: 33094721 DOI: 10.5664/jcsm.8904] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES The purpose of this study was to analyze patients with epiglottic collapse, especially their clinical characteristics related to obstructive sleep apnea and phenotype labeling using drug-induced sleep endoscopy. METHODS An age-sex matched case-control study was conducted to compare the clinical characteristics of patients with epiglottic collapse (Epi group) and patients without epiglottic collapse (non-Epi group). All patients underwent drug-induced sleep endoscopy January, 2015, to March, 2019, in a tertiary hospital for suspected sleep apnea symptoms. Demographic factors, underlying disease, overnight polysomnography, and their phenotype labeling using drug-induced sleep endoscopy were analyzed. RESULTS There was no difference in age, sex, the prevalence of hypertension, diabetes, cerebrovascular disease, and coronary artery disease. However, the body mass index was significantly lower in patients in the Epi group (P < .001). Additionally, the apnea-hypopnea index was lower (P = .001), and the lowest oxygen saturation was significantly higher in the Epi group (P = .042). The phenotype labeling on drug-induced sleep endoscopy showed that the prevalence of velum concentric collapse and oropharyngeal lateral wall collapse was lower, and that of tongue-base collapse was higher in the Epi group. Multilevel obstructions were more common in the Epi group. However, the Epi group showed a good response to mandibular advancement or positional therapy. CONCLUSIONS Although there was no difference in the underlying characteristics and self-reported symptom scores between the groups, the patients with epiglottic collapse showed significantly lower body mass index and obstructive sleep apnea severity. Additionally, patients with epiglottic collapse were expected to respond well to oral devices or positional therapy.
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Affiliation(s)
- Hee-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Chung-Man Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Hye-Bin Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Hong Chan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Chul Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung Chae Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
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Overview of Recent Advances in Surgical Treatments for OSA. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lukhele T, Nyoni H, Mamba BB, Msagati TAM. Unraveling bacterial diversity in oil refinery effluents. Arch Microbiol 2020; 203:1231-1240. [PMID: 33079208 DOI: 10.1007/s00203-020-02062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
Oil refinery effluents are among stressful environments, and they are characterized by alkaline pH, high concentrations of dissolved solids, electrical conductivity, and metals (mainly Fe, Al, B, Sr, Mn, Cu, Ni). In this study, bacterial diversity in these habitats was inferred from full-length 16S rRNA gene sequences obtained from the PacBio® sequencing platform. The results have shown low bacterial diversity in both raw and treated effluents, with sequences representing only two phyla: Firmicutes and Proteobacteria. Sequences from the raw effluents represent four major genera: Bacillus, Wenzhouxiangella, Rhodabaculum, and Halomonas. Whilst bacterial communities from the treated effluents are relatively more diverse as sequences represent five dominant genera: Pseudoxanthomonas, Brevundimonas, Pseudomonas, Rhodobaculum and Rhizobium. Most of the genera represented in the dataset are halophilic or halotolerant microbes known to have the competency to catabolize a broad spectrum of organic and inorganic pollutants. Hypothetically, these bacteria may be relevant for biotechnological and industrial applications, particularly for the remediation of saline industrial wastes.
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Affiliation(s)
- Thabile Lukhele
- Institute of Nanotechnology and Water Sustainability (iNanoWS), College of Science Engineering and Technology, University of South Africa, Florida Science Campus, Johannesburg, South Africa
| | - Hlengilizwe Nyoni
- Institute of Nanotechnology and Water Sustainability (iNanoWS), College of Science Engineering and Technology, University of South Africa, Florida Science Campus, Johannesburg, South Africa
| | - Bhekie Brilliance Mamba
- Institute of Nanotechnology and Water Sustainability (iNanoWS), College of Science Engineering and Technology, University of South Africa, Florida Science Campus, Johannesburg, South Africa.,State Key Laboratory of Separation and Membranes, Membrane Processes, National Center for International Joint Research on Membrane Science and Technology, Tianjin, 300387, People's Republic of China
| | - Titus Alfred Makudali Msagati
- Institute of Nanotechnology and Water Sustainability (iNanoWS), College of Science Engineering and Technology, University of South Africa, Florida Science Campus, Johannesburg, South Africa. .,School of Life Sciences and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Tengeru, P O Box 447, Arusha, United Republic of Tanzania.
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Jeong SH, Man Sung C, Lim SC, Yang HC. Partial epiglottectomy improves residual apnea-hypopnea index in patients with epiglottis collapse. J Clin Sleep Med 2020; 16:1607-1610. [PMID: 32620192 DOI: 10.5664/jcsm.8640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Continuous positive airway pressure treatment aggravates airway obstruction in patients with epiglottis collapse. In these patients, partial epiglottectomy can resolve epiglottis collapse by partial excision of the obstructed epiglottis. However, patients with epiglottic collapse usually have simultaneous obstructions on multiple levels, such as the soft palate, base of the tongue, etc. Therefore, sleep apnea cannot be controlled merely by resolving epiglottis collapse. The use of additional continuous positive airway pressure treatment after partial epiglottectomy is considered essential. However, no studies have yet evaluated the effect of partial epiglottectomy on continuous positive airway pressure treatment. In this study, we report on 2 patients with obstructive sleep apnea who underwent partial epiglottectomy. These 2 patients used autotitrating positive airway pressure treatment pre- and postoperatively. The present case report will provide insight into the effects of partial epiglottectomy on the use of positive-pressure devices.
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Affiliation(s)
- Se-Hyun Jeong
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea
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Sung CM, Kim HC, Yang HC. The clinical characteristics of patients with an isolate epiglottic collapse. Auris Nasus Larynx 2019; 47:450-457. [PMID: 31733977 DOI: 10.1016/j.anl.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We analyzed the clinical characteristics of patients with isolated epiglottic collapse (IEC) who had an epiglottic anteroposterior (AP) collapse as the only cause of snoring during drug-induced sleep endoscopy (DISE). METHODS A retrospective analysis of 334 consecutive DISE examinations was performed. Patients who had only epiglottic AP collapse were designated as the IEC group. There were four age- and sex-matched controls for each case, and these patients were designated as the control group. Demographic factors, polysomnography findings, cephalometry, and awake nasopharyngoscopic findings were analyzed. RESULTS A total of 11 IEC cases and 44 controls were included. The IEC group had a significantly lower apnea-hypopnea index, higher minimum oxygen saturation level, lower body mass index, and shorter mandible plane to hyoid distance than the controls. However, there were no differences in epiglottic shape or curvature between the two groups. In addition, no IEC was noted during awake endoscopy. Nine (81.8%) epiglottic collapses were resolved with the mouth open and jaw thrust maneuver, which simulated the use of an oral appliance. Six (54.4%) were resolved with head turning, mimicking the lateral sleep position. CONCLUSION The clinical characteristics of IEC patients differed from the control group, and IEC could not be identified during awake endoscopy. Therefore, patients with severe snoring but AHI < 5 or mild sleep apnea on polysomnographic findings and DISE, should be considered likely to have IEC. In addition, use of an oral appliance is recommended as an effective treatment for IEC.
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Affiliation(s)
- Chung Man Sung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebong-ro Dong-gu, Gwangju 61469, South Korea
| | - Hong Chan Kim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebong-ro Dong-gu, Gwangju 61469, South Korea
| | - Hyung Chae Yang
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebong-ro Dong-gu, Gwangju 61469, South Korea.
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