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Savoldi F, Dagassan-Berndt D, Patcas R, Mak WS, Kanavakis G, Verna C, Gu M, Bornstein MM. The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing. Dentomaxillofac Radiol 2024; 53:178-188. [PMID: 38265247 PMCID: PMC11003665 DOI: 10.1093/dmfr/twae001] [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] [Received: 09/05/2023] [Revised: 11/14/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.
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Affiliation(s)
- Fabio Savoldi
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Raphael Patcas
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, 8032, Switzerland
| | - Wing-Sze Mak
- Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Hong Kong SAR
| | - Georgios Kanavakis
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
| | - Min Gu
- Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, Basel, 4058, Switzerland
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Lai WY, Kay DJ, Wei CC, Huang FW, Liang KL, Yen HR. Validation of the traditional Chinese version of the Sinus and Nasal Quality of Life Survey (SN-5) for children. Pediatr Neonatol 2022; 63:410-417. [PMID: 35595617 DOI: 10.1016/j.pedneo.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Persistent sinonasal symptoms are common in children with chronic rhinosinusitis. The Sinus and Nasal Quality of Life (QoL) Survey (SN-5) was the first validated questionnaire measuring sinonasal-related QoL in populations aged 2-12 years. No norm has been established for Chinese-speaking countries. We translated the SN-5 into traditional Chinese and evaluated validity and reliability. METHODS From December 2016 to December 2017, healthy volunteers and children with persistent sinonasal symptoms were enrolled. Guardians of the participants completed the SN-5, a visual analog scale (VAS) of nasal symptoms, and the Obstructive Sleep Apnea-18 (OSA-18); the responses were used to assess internal consistency, discriminant validity, and treatment responsiveness. A nontreatment group was administered the SN-5 1 week later to assess test-retest reliability. RESULTS We recruited 31 healthy volunteers and 85 children with rhinosinusitis, 50 and 35 in the treatment and nontreatment groups, respectively. The SN-5 demonstrated good internal consistency (Cronbach's α = 0.86) and test-retest reliability (0.74, p < 0.01). It exhibited good discriminant validity between the healthy and rhinosinusitis groups (p < 0.001). The SN-5 scores were correlated with the VAS scores (0.63, p < 0.001). The effect size of the SN-5 scores was 0.51. The total SN-5 and OSA-18 scores changed significantly after 4-week treatment (p < 0.05) and demonstrated good responsiveness. The SN-5 and OSA-18 scores were significantly and positively correlated (r2 = 0.53, p < 0.001). CONCLUSION Our traditional Chinese version of the SN-5 is reliable and valid for measuring sinonasal-related QoL in children in Chinese-speaking countries. TRIAL REGISTRATION NUMBER NCT04836403.
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Affiliation(s)
- Wan-Yu Lai
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404327, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404328, Taiwan
| | - David J Kay
- Center for Pediatric ENT-Head and Neck Surgery, Boynton Beach, FL, 33437, USA; University of Miami Leonard M. Miller School of Medicine, Miami, FL, 33136, USA; Nova Southeastern University College of Osteopathic Medicine, Davie, FL, 33328, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL, 33431, USA; Keiser University, Fort Lauderdale, FL, 33309, USA; Kansas City University of Medicine and Bioscience, Kansas City, MO, 64106, USA
| | - Chang-Ching Wei
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, 404327, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, 404328, Taiwan
| | - Fen-Wei Huang
- Department of Medical Research, China Medical University Hospital, Taichung, 404327, Taiwan
| | - Kai-Li Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, 407219, Taiwan; School of Medicine, College of Medicine, National Yang-Ming Chiao Tung University, Taipei, 112304, Taiwan.
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404327, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404328, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung, 404328, Taiwan; Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, 404327, Taiwan; Department of Laboratory Science and Biotechnology, Asia University, 413305, Taiwan.
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The Effect of Septoplasty on Endothelial Function in Patients With Marked Nasal Septal Deviation. J Craniofac Surg 2021; 33:e242-e245. [PMID: 34320581 DOI: 10.1097/scs.0000000000008027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It is known that nasal septal deviation (NSD) has negative effects on the cardiovascular system, but the possible pathophysiological mechanisms of these effects still need to be explained. The aim of this study was to investigate the endothelial dysfunction (ED) caused by NSD and the effects of septoplasty on it. METHODS The study included 40 patients between the ages of 18 to 50 years with a marked NSD indication for septoplasty and 40 healthy age-and gender-matched individuals. Nasal obstruction symptom evaluation scale was used to evaluate the severity of nasal obstruction and the effectiveness of septoplasty. All participants underwent detailed cardiac examination and ultrasonographic measurement of flow-mediated dilatation (FMD). The same cardiac evaluations and nasal obstruction symptom evaluation scale assessments were repeated in the patient group at the postoperative 3rd month. RESULTS The mean FMD value in the control group was significantly higher than preoperative FMD in the patient group (9.1 ± 2.9 versus 7.6 ± 2.4, P = 0.024). In the patient group, preoperative and postoperative FMD values were measured as 7.6 ± 2.4 and 9.0 ± 2.7, respectively, and there was a significant difference between them (P = 0.032). There was no significant difference in FMD values between the control group and postoperative patient group (P = 0.925). CONCLUSIONS This study shows that NSD can cause ED, which is a precursor of atherosclerosis, and that successful septoplasty can improve ED.
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Multiple genetic variations of chronic rhinosinusitis with nasal polyps are associated with respiratory parameters in men with obstructive sleep apnea. Sleep Breath 2021; 26:57-65. [PMID: 33770380 PMCID: PMC8857115 DOI: 10.1007/s11325-021-02356-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/19/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022]
Abstract
Purpose Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a higher risk of obstructive sleep apnea (OSA). However, the relationship between CRSwNP and OSA remains unclear. The aim of this research study was to evaluate the association of multiple single nucleotide polymorphism (SNP) variations in CRSwNP with sleep- and breath-related parameters in men with OSA. Methods We included eight CRSwNP SNPs in 2320 participants after strict screening. For each participant, the genetic risk score (GRS) was calculated based on the cumulative effect of multiple genetic variants of CRSwNP. A bivariate correlation analysis was used to assess the relationship between CRSwNP genetic polymorphisms and polysomnography parameters in men with OSA. Logistic regression analyses were used to assess the relationship between the risk of OSA and CRSwNP genetic polymorphisms. Results In moderate OSA, rs28383314 was related to the oxygen desaturation index, and rs4807532 was positively associated with the microarousal index (r = 0.09, P = 0.03 and r = 0.11, P = 0.01, respectively). The CRSwNP GRS was positively correlated with the oxygen desaturation index and cumulative time percentage with SpO2 < 90% in moderate OSA (r = 0.13, P < 0.001 and r = 0.1, P = 0.01, respectively). There was no association between the CRSwNP GRS and the risk of OSA (OR = 1.007; 95% CI, 0.973–1.042; P = 0.702). Conclusion In men with moderate OSA, single CRSwNP genetic variations correlated with sleep-related parameters, and the cumulative effects of CRSwNP genetic variations were associated with the hypoxic index. CRSwNP may be a predisposing condition for sleep disorders in men with moderate OSA. Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02356-6.
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Värendh M, Janson C, Bengtsson C, Hellgren J, Holm M, Schlünssen V, Johannessen A, Franklin K, Storaas T, Jõgi R, Gislason T, Lindberg E. Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study. Sleep Breath 2021; 25:1851-1857. [PMID: 33469733 PMCID: PMC8590672 DOI: 10.1007/s11325-020-02287-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/26/2020] [Accepted: 12/29/2020] [Indexed: 11/05/2022]
Abstract
Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.
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Pace A, Iannella G, Rossetti V, Visconti IC, Gulotta G, Cavaliere C, De Vito A, Maniaci A, Cocuzza S, Magliulo G, Ciofalo A. Diagnosis of Obstructive Sleep Apnea in Patients with Allergic and Non-Allergic Rhinitis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E454. [PMID: 32911862 PMCID: PMC7559128 DOI: 10.3390/medicina56090454] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Background and objectives: Rhinitis could be considered a risk factor for obstructive sleep apnea (OSA). Studies were conducted to evaluate the relation between OSA and Allergic rhinitis (AR). Non-allergic rhinitis with eosinophilia syndrome (NARES) is a condition with a symptomatology apparently similar to AR. The aim of this study was to evaluate the different presence of OSA in patients suffering from NARES and AR. Materials and Methods: Sixty patients were enrolled and subdivided into NARES, AR and control groups. NARES and AR diagnosis were performed using ARIA (Allergic Rhinitis and its Impact on Asthma) protocol. All patients were screened for OSA with home sleep apnea testing (HSAT) exam analyzing AHI (Apnea Hypopnea Index) values. Results: Results showed that 60% of patients affected by NARES presented OSA. On the contrary, altered AHI was found only in 35% of patients affected by AR and in 10% of patients belonging to the control group. Conclusions: In conclusion, data showed that there was an increased risk of OSA in NARES patients respect to AR patients and healthy patients.
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Affiliation(s)
- Annalisa Pace
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Giannicola Iannella
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Valeria Rossetti
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Irene Claudia Visconti
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Giampiero Gulotta
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Carlo Cavaliere
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Andrea De Vito
- Otorinolaringoatria Department, Santa Maria delle Croci Hospital of Ravenna, Viale Vincenzo Randi, 5, 48121 Ravenna, Italy;
| | - Antonino Maniaci
- Otorinolaringoiatria Department, University of Catania, Piazza Università, 2, 95131 Catania, Italy; (A.M.); (S.C.)
| | - Salvatore Cocuzza
- Otorinolaringoiatria Department, University of Catania, Piazza Università, 2, 95131 Catania, Italy; (A.M.); (S.C.)
| | - Giuseppe Magliulo
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
| | - Andrea Ciofalo
- Organi di Senso Department, Sapienza University of Rome, Via Gregorio VII n.80, 00165 Rome, Italy; (A.P.); (G.I.); (V.R.); (I.C.V.); (G.G.); (C.C.); (A.C.)
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Li Y, Wu J, Guo J, Yu L, Wang J, Li X, Xu S, Zhu M, Feng J, Liu Y. The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial. Trials 2020; 21:595. [PMID: 32605655 PMCID: PMC7329444 DOI: 10.1186/s13063-020-04398-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia. Methods A sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway. Discussion The results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS. Trial registration ClinicalTrials.gov: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).
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Affiliation(s)
- Yuanyuan Li
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Jiali Wu
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghan Guo
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Liming Yu
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Jing Wang
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuhua Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Min Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jinqiu Feng
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Yuehua Liu
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China. .,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.
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Impact of allergic rhinitis on quality of life after powered intracapsular tonsillectomy and adenoidectomy. Am J Otolaryngol 2020; 41:102165. [PMID: 31739999 DOI: 10.1016/j.amjoto.2019.01.008] [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: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) has been reported to worsen quality of life (QoL) after adenotonsillectomy. Although powered intracapsular tonsillectomy and adenoidectomy (PITA) has been widely performed, it is not clear whether comorbid AR may worsen QoL in patients who undergo PITA. PURPOSE To evaluate QoL after PITA in relation to AR. METHODS Children undergoing PITA for sleep-disordered breathing were enrolled and divided into AR and non-AR groups. QoL was evaluated using serial applications of the Obstructive Sleep Apnea-18 (OSA-18) questionnaire and compared between the two groups. RESULTS Of 151 enrolled patients, 73 were categorized into the AR and 78 into non-AR groups. After surgery, patients exhibited marked improvement in OSA-18 scores in both groups, with similar results at each follow-up. The degree of improvement in OSA-18 scores was less in the AR group 3 months after surgery; however, this difference was not significant 6 months after surgery. CONCLUSIONS Although comorbid AR may initially appear to impede improvement in QoL after PITA, QoL was improved similarly 6 months after PITA, irrespective of AR status. In children with comorbid AR, PITA could be safely performed to treat sleep-disordered breathing without concerns regarding worsening of QoL.
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Matsui R, Wong M, Waters B. Alternative Transoral Application of Nasopharyngeal Airways. Anesth Prog 2020; 67:39-44. [DOI: 10.2344/anpr-66-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Transoral application of a nasopharyngeal airway (NPA) is a novel technique for difficult airway management. Clinically, it is an effective alternative for use in nonintubated dental cases under total intravenous anesthesia. This technique can help improve oxygenation and ventilation in clinical situations in which the conventional use of NPAs is ineffective, such as in patients who have findings of obesity; mandibular retrognathia or hypoplasia; maxillary hypoplasia; macroglossia; nasal obstruction secondary to hypertrophic tonsillar, adenoid, and/or lymphoid tissues or nasal polyps; known unusual nasal anatomy (eg, septal deviation); high risk of prolonged epistaxis (eg, patients on anticoagulants); or those who demonstrate mouth-breathing behaviors during deep sedation/nonintubated general anesthesia. After ensuring proper supraglottic placement, the transorally positioned NPA can be further secured with the use of tape for the duration of the dental procedure. Unlike an oropharyngeal airway, this simple and cost-efficient technique facilitates intraoral access for dental treatment.
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Affiliation(s)
- Robert Matsui
- Dental Anesthesiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Wong
- Dental Anesthesiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Brian Waters
- Dental Anesthesiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Garrec P, Legris S, Soyer Y, Vi-Fane B, Jordan L. [Orthodontic management of obstructive sleep-disordered respiratory disorders]. Orthod Fr 2019; 90:321-335. [PMID: 34643519 DOI: 10.1051/orthodfr/2019029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Through his/her knowledge of cranio-facial growth, the orthodontist plays a leading role within the multidisciplinary team that tracks and treats sleep-disordered breathing (SDB) in children. Correction of craniofacial risk factors (maxillary deficiency and retrognathia) is commonly used by practitioners alongside orthodontic treatment such as OMA and RME in the optimal conditions afforded by childhood growth. Myofunctional therapies are performed to restore correct stomatognathic function and play a central role in the management of SDB in children. The orthodontist is therefore a key player in the medical treatment chain of these children.
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Affiliation(s)
- Pascal Garrec
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Sylvie Legris
- AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Yves Soyer
- Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Brigitte Vi-Fane
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, Hôpital Pitié Salpêtrière, AP-HP, UF d'Orthodontie, 75013 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
| | - Laurence Jordan
- Université Paris Diderot-UFR Odontologie, 5 rue Garancière, 75006 Paris, France, AP-HP, Centre de référence des malformations rares de la face et de la cavité buccale O Rares-Hôpital Rothschild, 75012 Paris, France, PSL Research University, Institut de Recherche de Chimie Paris, UMR 8247-Chimie ParisTech, 75005 Paris, France, Société Française de Médecine Dentaire du Sommeil, 13-15 rue de Nancy, 75010 Paris, France
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Oropharyngeal Exercises for Treatment of Pediatric Obstructive Sleep-Disordered Breathing. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00136-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Polysomnographic and pulmonary function changes in patients with sleep problems after septoplasty with turbinectomy. Am J Otolaryngol 2019; 40:187-190. [PMID: 30558896 DOI: 10.1016/j.amjoto.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 11/21/2022]
Abstract
OBJECT To compare Polysomnography and Pulmonary function tests before and after Septoplasty with Turbinectomy in patients complaining of nasal obstruction and sleep problems due to deviated septum with hypertrophic inferior turbinate. METHODS 90 patients underwent Septoplasty with Turbinectomy due to nasal obstruction and sleep problems involved in this study, their sleep quality evaluated by polysomnography before and after the surgery, their pulmonary functions assessed by spirometry before and after the operation. RESULTS The postoperative pulmonary function values; FVC, FEV1, PEFR and postoperative polysomonographic values; AHI, Snoring index/hour, SpaO2 were higher than the preoperative values, and the results were statistically significant (p-values <0.001). CONCLUSION Septoplasty with partial inferior turbinectomy might be a useful operation in the management of nasal obstruction and sleep problems that caused by a deviated nasal septum and hypertrophied inferior turbinate.
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Association between allergic and nonallergic rhinitis and obstructive sleep apnea. Curr Opin Allergy Clin Immunol 2018; 18:16-25. [PMID: 29135515 DOI: 10.1097/aci.0000000000000414] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Allergic rhinitis and nonallergic rhinitis (NAR) are common disorders, which have been considered as potential risk factors for obstructive sleep apnea (OSA). This review summarizes the proposed underlying pathophysiological mechanisms to provide a better understanding of the relationship between these conditions. RECENT FINDINGS In adults, allergic rhinitis and NAR may be considered as symptoms potentiating, rather than risk potentiating factors in the pathophysiology of OSA, whereas in children, these are considered to be independent predictors for sleep-disordered breathing (SDB) and failure of adeno-tonsillectomy, the recommended first-line therapy for children with OSA. Current advances suggest IL-6 may be important in regulating the sleep-wake cycle, and serum soluble IL-6 receptor (sIL-6R) levels may reflect the severity of OSA. Elevated Th17/Treg ratio correlates positively with apnea-hypopnea index of OSA patients, and Th17 and Treg imbalances caused by allergic rhinitis and OSA, respectively, may possibly promote each other, leading to further imbalance. Moreover, obesity is a strong risk factor for OSA, and leptin plays an important role in ventilatory function and upper airway obstruction. The variant trigeminocardiac reflex and nasotrigeminal reflex may also be involved in the association between rhinitis and OSA. SUMMARY Allergic rhinitis/NAR and OSA are closely associated, and each condition can be detrimental to the other. Thus, clinicians should pay attention to the potential presence of allergic rhinitis/NAR in OSA patients and vice versa.
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Zaffanello M, Lippi G, Tenero L, Piazza M, Sacchetto L, Nosetti L, Gasperi E, Piacentini G. Childhood nasal obstruction and sleep-disordered breathing during clinical setting: Myth or reality? ACTA ACUST UNITED AC 2018. [DOI: 10.18621/eurj.410657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Acar M, Cingi C, Sakallioglu O, San T, Yimenicioglu MF, Bal C. The Effects of Mometasone Furoate and Desloratadine in Obstructive Sleep Apnea Syndrome Patients with Allergic Rhinitis. Am J Rhinol Allergy 2018; 27:e113-6. [DOI: 10.2500/ajra.2013.27.3921] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Allergic rhinitis (AR) and obstructive sleep apnea syndrome (OSAS) are worldwide prevalent diseases. These diseases impair patient quality of life. The aim of this study was to investigate and compare the efficacy of treatment of AR on OSAS by objective and subjective methods. Methods The study group was composed of 80 OSAS patients with AR between the ages of 30 and 50 years. The patients were admitted with the complaint of snoring, and they were asked about AR-related symptoms (nasal discharge, nasal itching, sneeze, and nasal obstruction). Daytime somnolence was measured by the Epworth sleepiness scale (ESS). Sleep parameters on polysomnography tests before and after treatment were compared, and the effects of different AR treatment protocols on sleep quality were evaluated. Results When pretreatment and posttreatment apnea–hypopnea index (AHI) values of the groups were compared, the most significant difference was observed in the nasal steroid (Ns) + antihistamine (Ah) group (p < 0.05). The ESS results were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). AHI oxygen saturation <90% were significantly decreased in the Ns and Ns + Ah groups after treatment (p < 0.05). Conclusion Nasal obstruction due to nasal congestion causes increases in airway resistance and can lead to development of OSAS. We concluded that treating AR with Ns has both positive effects on OSAS and daily activity. However, adding Ah to this treatment did not show improved effects compared with placebo treatment.
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Affiliation(s)
- Mustafa Acar
- Ear, Nose, and Throat Department, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Cemal Cingi
- Medical Faculty, Department of Otorhinolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Oner Sakallioglu
- Ear, Nose, and Throat Department, Elazığ Education and Research Hospital, Elazıg, Turkey
| | - Turhan San
- Ear, Nose, and Throat Department, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Cengiz Bal
- Medical Faculty, Department of Biostatistics, Eskisehir Osmangazi University, Eskisehir, Turkey
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Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children. Int J Pediatr Otorhinolaryngol 2018; 107:37-41. [PMID: 29501308 DOI: 10.1016/j.ijporl.2018.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) - as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption - in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep. METHODS A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015. RESULTS 4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p < 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively). Habitual snoring and habitual mouth breathing were highly associated with more frequent bouts of rhinosinusitis, ear infections, and antibiotic use (p < 0.0001 for each parameter). CONCLUSIONS Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.
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Park JE, Bae SH, Choi YJ, Choi WC, Kim HW, Lee UL. The structural changes of pharyngeal airway contributing to snoring after orthognathic surgery in skeletal class III patients. Maxillofac Plast Reconstr Surg 2017; 39:22. [PMID: 28824888 PMCID: PMC5544661 DOI: 10.1186/s40902-017-0120-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two-jaw surgery including mandibular and maxillary backward movement procedures are commonly performed to correct class III malocclusion. Bimaxillary surgery can reposition the maxillofacial bone together with soft tissue, such as the soft palate and the tongue base. We analyzed changes of pharyngeal airway narrowing to ascertain clinical correlations with the prevalence of snoring after two-jaw surgery. METHODS A prospective clinical study was designed including a survey on snoring and three-dimensional (3D) computed tomography (CT) in class III malocclusion subjects before and after bimaxillary surgery. We conducted an analysis on changes of the posterior pharyngeal space find out clinical correlations with the prevalence of snoring. RESULTS Among 67 subjects, 12 subjects complained about snoring 5 weeks after the surgical correction, and examining the 12 subjects after 6 months, 6 patients complained about the snoring. The current findings demonstrated the attenuation of the largest transverse width (LTW), anteroposterior length (APL), and cross-sectional area (CSA) following bimaxillary surgery given to class III malocclusion patients, particularly at the retropalatal level. The average distance of maxillary posterior movements were measured to be relatively higher (horizontal distance 3.9 mm, vertical distance 2.6 mm) in case of new snorers. CONCLUSIONS This study found that bimaxillary surgery could lead to the narrowing of upper airway at the retropalatal or retroglossal level as well as triggering snoring in subjects with class III malocclusion. Based on the current clinical findings, we also found that upper airway narrowing at retropalatal level may contribute to increasing the probability of snoring and that polysonography may need to be performed before orthognathic surgery in subjects with class III malocclusion.
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Affiliation(s)
- Jung-Eun Park
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Seon-Hye Bae
- Department of orthodontics, Estar dental clinic, Seoul, Republic of Korea
| | - Young-Jun Choi
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, South Korea
| | - Won-Cheul Choi
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Hye-Won Kim
- Department of Orthodontics, Dental Center, Chung-Ang University Hospital, Seoul, South Korea
| | - Ui-Lyong Lee
- Department of Oral and Maxillofacial Surgery, Dental Center, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, South Korea
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Bindu B, Singh GP, Chowdhury T, Schaller B. Rhinitis and sleep disorders: The trigeminocardiac reflex link? Med Hypotheses 2017; 103:96-99. [PMID: 28571821 DOI: 10.1016/j.mehy.2017.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
Abstract
Rhinitis, allergic or non-allergic, is an inflammatory condition of the nose. It is associated with a wide range of sleep disorders that are generally attributed to nasal congestion and presence of inflammatory mediators like cytokines and interleukins. However, the pathophysiological mechanisms behind these sleep disorders remain unclear. On the other hand, the trigeminocardiac reflex (TCR) has recently been linked to various sleep disorders like obstructive sleep apnea, sleep bruxism and rapid eye movement (REM) sleep apnea. TCR can be incited by stimulation of the trigeminal nerve or the area innervated by its branches including the nasal mucosa. Trigeminal nasal afferents can be activated on exposure to noxious stimuli (mechanical or chemical) like ammonia vapors, carbon-dioxide, nicotine, hypertonic saline, air-puffs and smoke. In rhinitis, there is associated neuronal hyper-responsiveness of sensory nasal afferents due to inflammation (which can be suppressed by steroids). This may further lead to increased occurrence of TCR in rhinitis. Moreover, there is involvement of autonomic nervous system both in rhinitis and TCR. In TCR, parasympathetic over activity and sympathetic inhibition leads to sudden onset bradycardia, hypotension, apnea and gastric motility. Also, the autonomic imbalance reportedly plays a significant role in the pathophysiology of rhinitis. Thus, considering these facts we hypothesize that the TCR could be the link between rhinitis and sleep disorders and we believe that further research in this direction may yield significant development in our understanding of sleep disorders in rhinitis.
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Affiliation(s)
- Barkha Bindu
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder Pal Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
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Uz U, Günhan K, Yılmaz H, Ünlü H. The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps. Auris Nasus Larynx 2017; 44:708-712. [PMID: 28442168 DOI: 10.1016/j.anl.2017.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/06/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters. METHODS Twenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery. RESULTS Nasal resistance decreased after the surgery (p<0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p<0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p=0.009 and 0.019, respectively). CONCLUSION In patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders.
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Affiliation(s)
- Uzdan Uz
- Department of Otorhinolaryngology, Bayindir Government Hospital, 35840, Bayindir, Izmir, Turkey.
| | - Kıvanç Günhan
- Department of Otorhinolaryngology, Celal Bayar University, 45010, Uncubozkoy, Manisa, Turkey
| | - Hikmet Yılmaz
- Department of Neurology, Celal Bayar University, 45010, Uncubozkoy, Manisa, Turkey
| | - Halis Ünlü
- Department of Otorhinolaryngology, Ekol Hospital, 35640, Çigli, İzmir, Turkey
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The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep 2017; 7:46615. [PMID: 28418014 PMCID: PMC5394537 DOI: 10.1038/srep46615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/22/2017] [Indexed: 11/21/2022] Open
Abstract
Adenotonsillar regrowth in children after adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) is often seen in clinical treatment, however, the relationship between allergic disease and adenotonsillar regrowth remains unclear. In this retrospective study, children were assigned to either the recurrence or control group, and subdivided by age at operation. Among children over 36 months, those in the recurrence group had more allergic disease and higher IgE, IL-4, and IL-5 levels than the same-aged children in control group. The Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores for nasal symptoms and activity were higher in children older than 36 months in recurrence group. The results of immunohistochemistry and immunofluorescence showed that FoxP3+ cells (Tregs) were less, while GATA3+ cells (Th2 cells) were more in recurrence group for all ages. Allergic status and low levels of FoxP3 were proved as independent risk factors for adenotonsillar regrowth by multivariate logistic regression. These results indicate that allergic disease is a risk factor for adenotonsillar regrowth in children following T&A for OSA, and this risk increases with age. The decreased level of Tregs and subsequent changes in immune function play an important role in the pathogenesis of adenotonsillar regrowth.
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Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath 2017; 21:1025-1032. [PMID: 28315149 DOI: 10.1007/s11325-017-1489-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/09/2017] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Data in the literature suggest that myofunctional therapy (MT) may be able to play a role in the treatment of children with sleep-disordered breathing (SDB). Our study investigated the effectiveness of MT in reducing respiratory symptoms in children with SDB by modifying tongue tone. METHODS Polysomnographic recordings were performed at baseline to assess obstructive sleep apnea (OSA) severity in 54 children (mean age 7.1 ± 2.5 years, 29 male) with SDB. Patients were randomly assigned to either the MT or no-MT group. Myofunctional evaluation tests, an assessment of tongue strength, tongue peak pressure, and endurance using the Iowa Oral Performance Instrument (IOPI), and nocturnal pulse oximetry were performed before (T0) and after (T1) 2 months of treatment. RESULTS MT reduced oral breathing (83.3 vs 16.6%, p < 0.0002) and lip hypotonia (78 vs 33.3%, p < 0.003), restored normal tongue resting position (5.6 vs 33.4%, p < 0.04), and significantly increased mean tongue strength (31.9 ± 10.8 vs 38.8 ± 8.3, p = 0.000), tongue peak pressure (34.2 ± 10.2 vs 38.1 ± 7.0, p = 0.000), and endurance (28.1 ± 8.9 vs 33.1 ± 8.7, p = 0.01) in children with SDB. Moreover, mean oxygen saturation increased (96.4 ± 0.6 vs 97.4 ± 0.7, p = 0.000) and the oxygen desaturation index decreased (5.9 ± 2.3 vs 3.6 ± 1.8, p = 0.001) after MT. CONCLUSIONS Oropharyngeal exercises appear to effectively modify tongue tone, reduce SDB symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of SDB.
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Shusterman D, Baroody FM, Craig T, Friedlander S, Nsouli T, Silverman B. Role of the Allergist-Immunologist and Upper Airway Allergy in Sleep-Disordered Breathing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:628-639. [PMID: 27923646 DOI: 10.1016/j.jaip.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sleep-disordered breathing in general and obstructive sleep apnea in particular are commonly encountered conditions in allergy practice. Physiologically, nasal (or nasopharyngeal) obstruction from rhinitis, nasal polyposis, or adenotonsillar hypertrophy are credible contributors to snoring and nocturnal respiratory obstructive events. Nevertheless, existing practice parameters largely relegate the role of the allergist to adjunctive treatment in cases of continuous positive airway pressure intolerance. OBJECTIVES To survey active American Academy of Allergy, Asthma & Immunology members regarding their perceptions and practices concerning sleep-disordered breathing in adult and pediatric patients with rhinitis, and to review the medical literature concerning this connection to identify therapeutic implications and research gaps. METHODS Members of the Work Group on Rhinitis and Sleep-disordered Breathing composed and distributed a Web-based clinically oriented survey to active American Academy of Allergy, Asthma & Immunology members in mid-2015. The group, in addition, conducted an English-language literature review using PubMed and other sources. RESULTS Survey results were returned by 339 of 4881 active members (7%). More than two-third of respondents routinely asked about sleep problems, believed that sleep-disordered breathing was a problem for at least a "substantial minority" (10%-30%) of their adult patients, and believed that medical therapy for upper airway inflammatory conditions could potentially help ameliorate sleep-related complaints. Literature review supported the connection between high-grade nasal congestion/adenotonsillar hypertrophy and obstructive sleep apnea, and at least in the case of pediatric patients, supported the use of anti-inflammatory medication in the initial management of obstructive sleep apnea of mild-to-moderate severity. CONCLUSIONS Clinical allergy practice and the medical literature support a proactive role for allergists in the diagnosis and management of sleep-disordered breathing.
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Sekkal S, Casas L, Haddam N, Bouhacina L, Scheers H, Taleb A, Nemery B. Sleep disturbances and neurotoxicity in workers exposed to hydrocarbons. An observational study from Algeria. Am J Ind Med 2016; 59:129-36. [PMID: 26725468 DOI: 10.1002/ajim.22561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Occupational exposure to solvents may lead to neurotoxicity and sleep disturbances. We aimed to investigate the association of occupational exposure to petroleum-derived hydrocarbons with neurotoxicity and sleep disturbance symptoms. METHODS We included male workers handling/distributing petroleum products (exposed, n = 250) and electricians (non-exposed, n = 250) from two companies in Tlemcen (Algeria). Neurotoxicity was evaluated with the Q-16 questionnaire, and sleep disturbances with the Epworth and the Berlin questionnaires. Multivariable Poisson regression models with robust error variances were applied obtaining risk ratios (RR) and their 95% confidence interval (CI). RESULTS Overall, the prevalence of reported neurotoxicity and sleep disturbance symptoms was higher in exposed than in non-exposed workers. Significant adjusted associations were observed for neurotoxicity, snoring, and excessive sleepiness (RR = 2.2, CI: 1.7-2.8; RR = 1.4; CI: 1.1-1.7; RR = 1.3, CI: 1.2-1.5, respectively). No significant associations were observed with the Epworth score. CONCLUSIONS Our questionnaire-based cross-sectional study suggests that exposure to petroleum-derived hydrocarbons is associated with self-reported sleep disturbances and neurotoxicity symptoms.
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Affiliation(s)
- Samira Sekkal
- Laboratory of Medical Toxicology “Toximed,” Faculty of Medicine; University Abou Bekr; Tlemcen Algeria
| | - Lidia Casas
- Department of Public Health and Primary Care; Centre Environment and Health; KU Leuven; Leuven Belgium
| | - Nahida Haddam
- Laboratory of Medical Toxicology “Toximed,” Faculty of Medicine; University Abou Bekr; Tlemcen Algeria
| | - Linda Bouhacina
- Laboratory of Medical Toxicology “Toximed,” Faculty of Medicine; University Abou Bekr; Tlemcen Algeria
| | - Hans Scheers
- Department of Public Health and Primary Care; Centre Environment and Health; KU Leuven; Leuven Belgium
| | - Abdesselam Taleb
- Laboratory of Medical Toxicology “Toximed,” Faculty of Medicine; University Abou Bekr; Tlemcen Algeria
| | - Benoit Nemery
- Department of Public Health and Primary Care; Centre Environment and Health; KU Leuven; Leuven Belgium
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Wilhelm CP, deShazo RD, Tamanna S, Ullah MI, Skipworth LB. The nose, upper airway, and obstructive sleep apnea. Ann Allergy Asthma Immunol 2015; 115:96-102. [PMID: 26250769 DOI: 10.1016/j.anai.2015.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Chelle P Wilhelm
- Division of Clinical Immunology/Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Division of Pulmonary/Critical Care/Sleep Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Richard D deShazo
- Division of Clinical Immunology/Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; Division of Pulmonary/Critical Care/Sleep Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Sadeka Tamanna
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - M Iftekhar Ullah
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Leigh Baldwin Skipworth
- Division of Clinical Immunology/Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Cunha RAD, Cunha DAD, Bezerra LÂ, Melo ACCD, Peixoto DM, Tashiro T, Silva HJD. Aeração nasal e força muscular respiratória em crianças respiradoras orais. REVISTA CEFAC 2015. [DOI: 10.1590/1982-021620151753315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo: OBJETIVO: observar se existe relação entre força muscular respiratória e área da aeração nasal em crianças respiradoras orais. MÉTODOS: trata-se de um estudo do tipo observacional, transversal comparativo entre dois grupos. Participaram 32 crianças com Respiração Oral secundária à rinite alérgica (21 meninos e 11 meninas) e 30 respiradoras nasais sem rinite alérgica (09 meninos e 21 meninas), 7 a 12 anos, submetidas à avaliação da aeração nasal com o espelho de Altmann e à avaliação da força muscular respiratória com o manovacuômetro digital (MVD(r)30). RESULTADOS: não houve correlação entre aeração nasal e força muscular respiratória em cada subgrupo. Houve diferença comparando-se valores das pressões expiratórias máximas entre meninos e meninas respiradores orais (p=0,0064) e entre meninos e meninas respiradores nasais (p=0,0030). Também houve diferença das pressões inspiratórias máximas entre meninos e meninas respiradores orais (p=0,0324) e entre meninos e meninas respiradores nasais (p=0,0210). CONCLUSÃO: não foi possível confirmar a relação entre a área de aeração nasal e a força muscular respiratória nos respiradores orais.
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Radzikowska J, Gronkiewicz Z, Kukwa A, Lisik W, Czarnecka AM, Krzeski A, Kukwa W. Nasopharyngeal chordoma in a patient with a severe form of sleep-disordered breathing: A case report. Oncol Lett 2015; 10:1805-1809. [PMID: 26622754 DOI: 10.3892/ol.2015.3393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/22/2015] [Indexed: 12/18/2022] Open
Abstract
Nasopharyngeal chordoma is a rare type of malignant neoplasm that originates in the remnants of the notochord, a primitive tissue of embryonic origin preserved outside the axial skeleton. Approximately one-third of chordomas are located in the base of the skull, in the midline of the body. The slow growth rate of the tumor, which gradually fills the nasopharyngeal cavity, contributes to a delayed oncological diagnosis. Among its isolated and non-specific symptoms, the obstruction of the nasopharynx is dominant, thus, sleep-disordered breathing (SDB) may occur. The current study presents the case of a 32-year-old female patient who was incidentally diagnosed with a nasopharyngeal chordoma during a diagnostic examination for SDB. The diagnostic examination was performed as a part of a research program for pathologically obese patients who qualified for bariatric surgery. Following tumor resection, a significant improvement in various polysomnographic parameters occurred, including a decrease in the apnea hypopnea index from 53.5 to 6.4 and an increase in the mean saturation rate from 92.5 to 95%, confirming that an association exists between tumor obstruction of the nasopharynx and SDB. The incidental diagnosis of this rare type of neoplasm drew attention to diagnostic and therapeutic problems associated with nasopharyngeal chordomas. Furthermore, it indicated the necessity for the accurate laryngological examination of patients with SDB.
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Affiliation(s)
- Joanna Radzikowska
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Zuzanna Gronkiewicz
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Andrzej Kukwa
- Department of Otolaryngology and Head and Neck Disease, University of Varmia and Mazuria School of Medicine, Olsztyn 10-082, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw 02-005, Poland
| | - Anna M Czarnecka
- Department of Oncology, Military Institute of Medicine, Warsaw 04-141, Poland
| | - Antoni Krzeski
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
| | - Wojciech Kukwa
- Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw 00-739, Poland
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Kim DK, Han DH. Impact of allergic rhinitis on quality of life after adenotonsillectomy for pediatric sleep-disordered breathing. Int Forum Allergy Rhinol 2015; 5:741-6. [DOI: 10.1002/alr.21529] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/06/2015] [Accepted: 02/26/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Chuncheon Sacred Heart Hospital, Hallym University College of Medicine; Chuncheon Korea
| | - Doo Hee Han
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
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Nakajima M, Kase Y, Kamijo A, Inoue T, Araki R. Postural and Conditional Variations of Nasal Patency in Patients under General Anesthesia Approximating Sleep as Assessed with Acoustic Rhinometry. ACTA ACUST UNITED AC 2015; 118:651-6. [DOI: 10.3950/jibiinkoka.118.651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Yasuhiro Kase
- Department of Otolaryngology, Saitama Medical University
| | - Atsushi Kamijo
- Department of Otolaryngology, Saitama Medical University
| | - Tomoe Inoue
- Department of Otolaryngology, Saitama Medical University
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Abstract
Allergic rhinitis is a common pediatric problem with significant comorbidities and potential complications. This article is an overview of the epidemiology, pathophysiology, and current therapeutic strategies. Allergic rhinitis management in a specific child is age dependent and influenced by the severity and frequency of the symptoms and the presence of any concurrent conditions. Current strategies permit symptomatic control and improved quality of life for most patients.
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Sin S, Wootton DM, McDonough JM, Nandalike K, Arens R. Anterior nasal resistance in obese children with obstructive sleep apnea syndrome. Laryngoscope 2014; 124:2640-4. [PMID: 24615829 DOI: 10.1002/lary.24653] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/27/2014] [Accepted: 02/19/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate nasal resistance in obese children with and without obstructive sleep apnea syndrome (OSAS), study the correlation between nasal resistance and severity of OSAS using the apnea-hypopnea index (AHI), and examine the association of gender and body mass index (BMI) with this measurement. STUDY DESIGN Retrospective analysis. METHODS Active anterior rhinomanometry was used to determine anterior nasal resistance (aNR) during wakefulness in the supine position during tidal breathing. Thirty obese children with OSAS (aged 13.8 ± 2.6 years, BMI z score 2.6 ± 0.4) and 32 matched obese controls (aged 13.6 ± 2.3 years, BMI z score 2.4 ± 0.4), were studied. Unpaired t tests and Spearman correlation were performed. RESULTS The OSAS group had significantly higher aNR than the non-OSAS group during inspiration (P = .012) and expiration (P = .003). A significant correlation between inspiratory aNR and AHI was found for the OSAS group (r = 0.39, P = .04). The aNR did not correlate with BMI z score or with either gender. CONCLUSIONS We noted a higher aNR in obese children with OSAS as compared to obese controls, and the aNR on inspiration correlated significantly with AHI. These findings suggest that a causal or augmentative effect of high inspiratory aNR may exist for obese children who exhibit OSAS. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Sanghun Sin
- Division of Respiratory and Sleep Medicine, the Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York
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31
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Xi J, Si X, Kim J, Su G, Dong H. Modeling the pharyngeal anatomical effects on breathing resistance and aerodynamically generated sound. Med Biol Eng Comput 2014; 52:567-77. [PMID: 24816830 DOI: 10.1007/s11517-014-1160-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Abstract
The objective of this study was to systematically assess the effects of pharyngeal anatomical details on breathing resistance and acoustic characteristics by means of computational modeling. A physiologically realistic nose-throat airway was reconstructed from medical images. Individual airway anatomy such as the uvula, pharynx, and larynx was then isolated for examination by gradually simplifying this image-based model geometry. Large eddy simulations with the FW-H acoustics model were used to simulate airflows and acoustic sound generation with constant flow inhalations in rigid-walled airway geometries. Results showed that pharyngeal anatomical details exerted a significant impact on breathing resistance and energy distribution of acoustic sound. The uvula constriction induced considerably increased levels of pressure drop and acoustic power in the pharynx, which could start and worsen snoring symptoms. Each source anatomy was observed to generate a unique spectrum with signature peak frequencies and energy distribution. Moreover, severe pharyngeal airway narrowing led to an upward shift of sound energy in the high-frequency range. Results indicated that computational aeroacoustic modeling appeared to be a practical tool to study breathing-related disorders. Specifically, high-frequency acoustic signals might disclose additional clues to the mechanism of apneic snoring and should be included in future acoustic studies.
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Affiliation(s)
- Jinxiang Xi
- School of Engineering and Technology, Central Michigan University, 1200 South Franklin Street, Mount Pleasant, MI, 48858, USA,
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Ting H, Huang RJ, Lai CH, Chang SW, Chung AH, Kuo TY, Chang CH, Shih TS, Lee SD. Evaluation of candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers. SENSORS 2014; 14:8126-49. [PMID: 24803198 PMCID: PMC4063033 DOI: 10.3390/s140508126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 04/19/2014] [Accepted: 04/25/2014] [Indexed: 11/16/2022]
Abstract
Background: Sleepiness-at-the-wheel has been identified as a major cause of highway accidents. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography. Methods: Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy), heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting. Results: 63.6% of professional bus drivers were diagnosed as having sleep disordered breathing and had a higher body mass index, neck circumference, systolic blood pressure, arousal index and desaturation index than those professional bus drivers without evidence of sleep disordered breathing. Simple home-based candidate measures: (1) Pulse oximetry, oxygen-desaturation indices by ≥3% and 4% (r = 0.87∼0.92); (2) Pulse oximetry, pulse-rising indices by ≥7% and 8% from a baseline (r = 0.61∼0.89); and (3) ApneaLink airflow detection, apnea-hypopnea indices (r = 0.70∼0.70), based on recording-time or Actigraphy-corrected total sleep time were all significantly correlated with, and had high agreement with, corresponding polysomnographic apnea-hypopnea indices [(1) 94.5%∼96.6%, (2) 93.8%∼97.2%, (3) 91.1%∼91.3%, respectively]. Conversely, no validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables. Conclusions: The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, specifically for professional drivers.
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Affiliation(s)
- Hua Ting
- Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40201, Taiwan.
| | - Ren-Jing Huang
- Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40245, Taiwan.
| | - Ching-Hsiang Lai
- Department of Medical Informatics, Chung Shan Medical University, Taichung 40201, Taiwan.
| | - Shen-Wen Chang
- Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40245, Taiwan.
| | - Ai-Hui Chung
- Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40245, Taiwan.
| | - Teng-Yao Kuo
- PhD Program of Mechanical and Aeronautical Engineering, Feng Chia University, Taichung 40724, Taiwan.
| | - Ching-Haur Chang
- Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan.
| | - Tung-Sheng Shih
- Institute of Labor Policy and Occupational Safety and Health, Ministry of Labor Affairs, Executive Yuan, Taipei 22143, Taiwan.
| | - Shin-Da Lee
- Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40201, Taiwan.
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Sagit M, Sarli B, Guler S, Namuslu M, Celik HT, Kurtul S, Korkmaz F, Somdas MA. Assessment of early atherosclerotic findings in patients with nasal polyposis. Auris Nasus Larynx 2014; 41:179-84. [DOI: 10.1016/j.anl.2013.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/15/2013] [Accepted: 09/20/2013] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW An inconsistent link between sleep-disordered breathing (SDB) and allergic rhinitis has been reported in the literature for decades. This review attempts to highlight some of the recent epidemiological studies purporting and refuting this connection, discuss possible mechanisms for this relationship and discuss how treatment of allergic rhinitis can help ameliorate SDB. RECENT FINDINGS Recently, a large systematic review that included 18 studies and 27 000 individuals of the association between allergic rhinitis and SDB in children was published supporting a correlation between SDB and allergic rhinitis. SUMMARY Although the evidence generally supports a connection between SDB and allergic rhinitis, this connection is not definitive and the mechanism linking these two diseases remains poorly understood. In addition to epidemiological studies, several small studies have demonstrated an improvement in SDB upon treatment of allergic rhinitis; however, large studies using objective measures to quantify SDB and allergic rhinitis are needed.
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Pelteret JPV, Reddy BD. Development of a computational biomechanical model of the human upper-airway soft-tissues toward simulating obstructive sleep apnea. Clin Anat 2013; 27:182-200. [PMID: 24515574 DOI: 10.1002/ca.22313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/27/2013] [Accepted: 07/27/2013] [Indexed: 11/11/2022]
Abstract
Numerous challenges are faced in investigations aimed at developing a better understanding of the pathophysiology of obstructive sleep apnea (OSA). The anatomy of the tongue and other upper-airway tissues, and the ability to model their behavior, are central to such investigations. We present details of the construction and development of a soft-tissue model of the human upper airway, with the ultimate goal of simulating obstructive sleep apnea. The steps taken to produce a representative anatomical geometry, of which the associated muscle histology is also captured, are documented. An overview of the mathematical models used to describe tissue behavior, both at a macro- and microscopic level, is given. A neurological model, which mimics the proprioceptive capabilities of the body, is described as it is applies to control of the active dynamics of the tongue. A simplified scenario, which allows for the manipulation of several environmental influences, is presented. It is demonstrated that the response of the genioglossus is qualitatively similar to that determined through experimental techniques. Furthermore, insights into the stress distribution developed within the tongue are discussed. It is shown that changes in almost any aspect of the breathing or physiological conditions invoke a significant change in the response of the airway dilators. The results of this study provide further evidence of the importance of modeling and simulation techniques as an aid in understanding the complex behavior of the human body.
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Affiliation(s)
- Jean-Paul V Pelteret
- Centre for Research in Computational and Applied Mechanics, University of Cape Town, Cape Town, Western Cape, South Africa
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Cavaliere M, Russo F, Iemma M. Awake versus drug-induced sleep endoscopy: Evaluation of airway obstruction in obstructive sleep apnea/hypopnoea syndrome. Laryngoscope 2013; 123:2315-8. [DOI: 10.1002/lary.23881] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Matteo Cavaliere
- Department of Otorhinolaryngology; University Hospital San Giovanni di Dio e Ruggi d'Aragona; Salerno; Italy
| | - Federico Russo
- Department of Otorhinolaryngology; University Hospital San Giovanni di Dio e Ruggi d'Aragona; Salerno; Italy
| | - Maurizio Iemma
- Department of Otorhinolaryngology; University Hospital San Giovanni di Dio e Ruggi d'Aragona; Salerno; Italy
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Thompson A, Sardana N, Craig TJ. Sleep impairment and daytime sleepiness in patients with allergic rhinitis: the role of congestion and inflammation. Ann Allergy Asthma Immunol 2013; 111:446-51. [PMID: 24267356 DOI: 10.1016/j.anai.2013.05.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/18/2013] [Accepted: 05/21/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the association of rhinitis with stress, fatigue, decrease productivity, inflammation, and sleep disordered breathing. DATA SOURCES Medical literature obtained from OVID and PubMed searches in February 2013 using the search terms "sleep," "rhinitis," "allergic rhinitis," "somnolence," and "fatigue". STUDY SELECTIONS Studies were selected based on the US Preventive Services Task Force levels 1, 2, and 3. RESULTS Allergic rhinitis is a disease that severely affects patients' quality of life and is increasing in prevalence worldwide. Nasal congestion is reported as the most common and bothersome symptom; it is often associated with sleep-disordered breathing, a likely cause of sleep impairment in rhinitis-affected individuals. The end result is a reduced quality of life and productivity and an increase in daytime sleepiness, fatigue, and stress. Current treatment modalities include intranasal corticosteroids, which have been found to reduce nasal congestion. Clinical trials on intranasal corticosteroids have provided data on sleep-related end points, and these studies report that the improved nasal congestion is associated with improved quality of life with better sleep and reduced daytime fatigue. Alternate therapies, including montelukast, also decrease nasal congestion and positively influence sleep, but to a lesser extent. CONCLUSION This review examines nasal congestion and cytokine changes and the associated sleep impairment in allergic rhinitis patients and the effect on daytime performance. It elaborates the adverse effects of disturbed sleep on quality of life and how therapies directed at reducing nasal congestion can relieve such effects.
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Affiliation(s)
- Alison Thompson
- Penn State University, Hershey Medical Center, Hershey, Pennsylvania
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Snoring exclusively during nasal breathing: a newly described respiratory pattern during sleep. Sleep Breath 2013; 18:159-64. [PMID: 23716022 DOI: 10.1007/s11325-013-0864-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/05/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study is to describe a distinctive respiratory pattern seen in subjects with inferior turbinate hypertrophy, nasal obstruction, and a polysomnogram-proven diagnosis of primary snoring or mild obstructive sleep apnea. These subjects demonstrated increased snoring with purely nasal breathing and alleviation of snoring with oral breathing. The study design is case series with chart review. The setting was a university-based tertiary care hospital. METHODS A retrospective chart review was performed for patients with complaints of nasal obstruction with associated inferior turbinate hypertrophy and a polysomnogram-proven diagnosis of mild obstructive sleep apnea or primary snoring. Demographic and polysomnography information were collected and analyzed. Snoring and airflow patterns were reviewed. RESULTS Twenty-five subjects were identified as having met the inclusion and exclusion criteria on polysomnography for either primary snoring or mild obstructive sleep apnea with inferior turbinate hypertrophy and no other significant nasal deformity or abnormality. Seventeen (68 %) of these patients had polysomnograms which demonstrated snoring during nasal breathing and alleviation of snoring with oral breathing. Of the 17 who snored during nasal breathing, ten of the subjects were female and seven of the subjects were male. The mean age was 27 years (range 18 to 68 years). The mean apnea-hypopnea index was 2.3 events/h (range 0 to 9.7 events/h). The mean body mass index was 25 kg/m(2) (range 20 to 43 kg/m(2)). CONCLUSION Our study describes a newly recognized pattern of snoring in patients with a polysomnogram-proven diagnosis of either primary snoring or mild obstructive sleep apnea. This pattern of breathing demonstrates patients who snore during nasal breathing even with known nasal obstruction present and subsequently have resolution or improvement of the snoring with oral breathing.
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González-Núñez V, Valero AL, Mullol J. Impact of sleep as a specific marker of quality of life in allergic rhinitis. Curr Allergy Asthma Rep 2013; 13:131-41. [PMID: 23247762 DOI: 10.1007/s11882-012-0330-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Allergic rhinitis (AR) is a common disorder, which represents a considerable burden both on individual patients and society. It is associated with bothersome symptoms, which may impair usual daily activities, sleep quality, and productivity. Associated with impaired sleep, quality of life is significantly impaired in AR patients. AR significantly contributes to sleep-disordered breathing through multiple mechanisms, with the greatest impact mediated through nasal obstruction. Sleep impairment is very common in AR patients and has a significant impact on disease-specific measures of general health and quality of life. The degree of sleep disturbance is directly related to the severity of the disease. Nasal congestion also demonstrates circadian rhythm and positional variability, worsening during nighttime hours and in supine position. Increased sleep disordered events lead to poor sleep with fatigue and daytime somnolence, impaired performance, productivity and social functioning, and an increased risk of associated diseases.
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Abstract
Breathing waveform extracted via nasal thermistor is the most common method to study respiratory function in sleep studies. In essence, this is a temporal waveform of mean temperatures in the nostril region that at every time step collapses two-dimensional data into a single point. Hence, spatial heat distribution in the nostrils is lost along with valuable functional and anatomical cues. This article presents the construction and experimental validation of a spatiotemporal profile for the breathing function via thermal imaging of the nostrils. The method models nasal airflow advection by using a front-propagating level set algorithm with optimal parameter selection. It is the first time that the full two-dimensional advantage of thermal imaging is brought to the fore in breathing computation. This new multi-dimensional measure is likely to bring diagnostic value in sleep studies and beyond.
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Koinis-Mitchell D, Craig T, Esteban CA, Klein RB. Sleep and allergic disease: a summary of the literature and future directions for research. J Allergy Clin Immunol 2012; 130:1275-81. [PMID: 22867694 DOI: 10.1016/j.jaci.2012.06.026] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/15/2012] [Accepted: 06/13/2012] [Indexed: 01/30/2023]
Abstract
Atopic diseases, such as asthma and allergic rhinitis, are common conditions that can influence sleep and subsequent daytime functioning. Children and patients with allergic conditions from ethnic minority groups might be particularly vulnerable to poor sleep and compromised daytime functioning because of the prevalence of these illnesses in these groups and the high level of morbidity. Research over the past 10 years has shed light on the pathophysiologic mechanisms (eg, inflammatory mediators) involved in many atopic diseases that can underlie sleep disruptions as a consequence of the presence of nocturnal symptoms. Associations between nocturnal symptoms and sleep and poorer quality of life as a result of missed sleep have been demonstrated across studies. Patients with severe illness and poor control appear to bear the most burden in terms of sleep impairment. Sleep-disordered breathing is also more common in patients with allergic diseases. Upper and lower airway resistance can increase the risk for sleep-disordered breathing events. In patients with allergic rhinitis, nasal congestion is a risk factor for apnea and snoring. Finally, consistent and appropriate use of medications can minimize nocturnal asthma or allergic symptoms that might disrupt sleep. Despite these advances, there is much room for improvement in this area. A summary of the sleep and allergic disease literature is reviewed, with methodological, conceptual, and clinical suggestions presented for future research.
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Affiliation(s)
- Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior and the Bradley/Hasbro Children's Research Center, Brown Medical School, Providence, RI, USA.
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Okuro RT, Morcillo AM, Ribeiro MÂGO, Sakano E, Conti PBM, Ribeiro JD. Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children. J Bras Pneumol 2012; 37:471-9. [PMID: 21881737 DOI: 10.1590/s1806-37132011000400009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/09/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate submaximal exercise tolerance and respiratory muscle strength in relation to forward head posture (FHP) and respiratory mode in children, comparing mouth-breathing (MB) children with nasal-breathing (NB) children. METHODS This was a controlled, analytical cross-sectional study involving children in the 8-12 year age bracket with a clinical otorhinolaryngology diagnosis of MB, recruited between October of 2010 and January of 2011 from the Mouth Breather Clinic at the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. The exclusion criteria were obesity, asthma, chronic respiratory diseases, heart disease, and neurological or orthopedic disorders. All of the participants underwent postural assessment and the six-minute walk test (6MWT), together with determination of MIP and MEP. RESULTS Of the 92 children in the study, 30 presented with MB and 62 presented with NB. In the MB group, the differences between those with moderate or severe FHP and those with normal head posture, in terms of the mean MIP, MEP and six-minute walk distance (6MWD), were not significant (p = 0.079, p = 0.622, and p = 0.957, respectively). In the NB group, the mean values of MIP and MEP were higher in the children with moderate FHP than in those with normal head posture (p = 0.003 and p = 0.004, respectively). The mean MIP, MEP, and 6MWD were lower in the MB group than in the NB group. Values of MIP and MEP were highest in the children with moderate FHP. CONCLUSIONS Respiratory biomechanics and exercise capacity were negatively affected by MB. The presence of moderate FHP acted as a compensatory mechanism in order to improve respiratory muscle function.
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Kreivi HR, Virkkula P, Lehto JT, Brander PE. Upper airway symptoms in primary snoring and in sleep apnea. Acta Otolaryngol 2012; 132:510-8. [PMID: 22217396 DOI: 10.3109/00016489.2011.644803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONCLUSIONS Upper airway symptoms were common in subjects referred for sleep study. In particular, nasal stuffiness and airway dryness already seemed to bother snorers before development of obstructive sleep apnea syndrome (OSAS). Mouth dryness increased with severity of obstructive sleep apnea (OSA). OBJECTIVES Upper airway symptoms are common in patients with OSAS. However, prevalence of these symptoms is unknown in primary snoring and mild OSA. We evaluated frequency of upper airway symptoms in a large group of patients referred for diagnostic sleep studies. METHODS We examined 524 consecutive subjects (69% men, mean ± SD age 51 ± 12 years, apnea-hypopnea index (AHI) 15 ± 21, body mass index 31 ± 6) by a questionnaire-based survey. The subjects filled in a questionnaire enquiring about current upper airway symptoms and history of nasal and pharyngeal disorders before the sleep study. RESULTS Frequent upper airway symptoms among study subjects were common: 56% of the patients reported throat dryness, 55% mouth dryness, 54% nasal stuffiness, 52% nose dryness, 33% sneezing, 33% postnasal drip, and 24% rhinorrhea. The patients with moderate or severe OSAS (AHI ≥15 and Epworth sleepiness score ≥10) suffered from mouth dryness more often (71% vs 40%, p < 0.01) than those with mild or no OSAS.
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Affiliation(s)
- Hanna-Riikka Kreivi
- Division of Pulmonary Diseases, Department of Medicine, Helsinki University Central Hospital, Finland.
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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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Mesquita J, Solà-Soler J, Fiz JA, Morera J, Jané R. All night analysis of time interval between snores in subjects with sleep apnea hypopnea syndrome. Med Biol Eng Comput 2012; 50:373-81. [PMID: 22407477 PMCID: PMC3314810 DOI: 10.1007/s11517-012-0885-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/25/2012] [Indexed: 11/16/2022]
Abstract
Sleep apnea–hypopnea syndrome (SAHS) is a serious sleep disorder, and snoring is one of its earliest and most consistent symptoms. We propose a new methodology for identifying two distinct types of snores: the so-called non-regular and regular snores. Respiratory sound signals from 34 subjects with different ranges of Apnea-Hypopnea Index (AHI = 3.7–109.9 h−1) were acquired. A total number of 74,439 snores were examined. The time interval between regular snores in short segments of the all night recordings was analyzed. Severe SAHS subjects show a shorter time interval between regular snores (p = 0.0036, AHI cp: 30 h−1) and less dispersion on the time interval features during all sleep. Conversely, lower intra-segment variability (p = 0.006, AHI cp: 30 h−1) is seen for less severe SAHS subjects. Features derived from the analysis of time interval between regular snores achieved classification accuracies of 88.2 % (with 90 % sensitivity, 75 % specificity) and 94.1 % (with 94.4 % sensitivity, 93.8 % specificity) for AHI cut-points of severity of 5 and 30 h−1, respectively. The features proved to be reliable predictors of the subjects’ SAHS severity. Our proposed method, the analysis of time interval between snores, provides promising results and puts forward a valuable aid for the early screening of subjects suspected of having SAHS.
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Affiliation(s)
- J Mesquita
- Department ESAII, Universitat Politècnica de Catalunya, Barcelona, Spain.
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46
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Ishman SL, Smith DF, Benke JR, Nguyen MT, Lin SY. The prevalence of sleepiness and the risk of sleep-disordered breathing in children with positive allergy test. Int Forum Allergy Rhinol 2011; 2:139-43. [PMID: 22162486 DOI: 10.1002/alr.20104] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 09/28/2011] [Accepted: 10/02/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Stacey L Ishman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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47
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Rhinitis and sleep. Sleep Med Rev 2011; 15:293-9. [DOI: 10.1016/j.smrv.2010.12.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 12/01/2010] [Accepted: 12/04/2010] [Indexed: 12/12/2022]
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48
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Abstract
An overview of available literature on the use of protective facemasks by children for protection from respiratory infectious agents reveals relatively few articles dealing specifically with the topic, despite their use during recent outbreaks (eg, severe acute respiratory syndrome, pandemic influenza). Little is known about the physiological and psychological burdens imposed by these devices and a child's ability to correctly use and tolerate them. This article focuses on the myriad issues associated with protective facemask use by children in the hope of educating public health personnel, healthcare professionals, and families on their limitations and associated risks, and in the hope of fostering much-needed research.
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Affiliation(s)
- Raymond Roberge
- Technology Research Branch, National Institute for Occupational Safety and Health, 626 Cochrans Mill Road, Pittsburgh, PA 15236, USA.
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Nakazaki C, Noda A, Yasuda Y, Nakata S, Koike Y, Yasuma F, Murohara T, Nakashima T. Continuous positive airway pressure intolerance associated with elevated nasal resistance is possible mechanism of complex sleep apnea syndrome. Sleep Breath 2011; 16:747-52. [PMID: 21830062 DOI: 10.1007/s11325-011-0570-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/07/2011] [Accepted: 07/22/2011] [Indexed: 12/18/2022]
Abstract
PURPOSE Complex sleep apnea syndrome (CompSAS) is diagnosed after an elimination of obstructive events with continuous positive airway pressure (CPAP), when a central apnea index ≥5/h or Cheyne-Stokes respiration pattern emerges in patients with obstructive sleep apnea syndrome (OSAS). However, the pathophysiology of CompSAS remains controversial. METHODS Of the 281 patients with suspected OSAS, all of whom underwent polysomnography conducted at Nagoya University Hospital, we enrolled 52 patients with apnea-hypopnea index ≥15/h (age 51.4 ± 13.3 years). The polysomnographic findings, left ventricular ejection fraction (LVEF), and nasal resistance were compared between the CompSAS patients and OSAS patients. RESULTS Forty-three patients were diagnosed with OSAS and nine patients with central sleep apnea syndrome by natural sleep PSG. Furthermore, 43 OSAS patients were classified into the OSAS patients (OSAS group, n = 38) and the CompSAS patients (CompSAS group, n = 5) by the night on CPAP PSG. The nasal resistance was significantly higher in CompSAS group than in OSAS group (0.30 ± 0.10 vs. 0.19 ± 0.07 Pa/cm(3)/s, P = 0.004). The arousal index, percentage of stage 1 sleep, and oxygen desaturation index were significantly decreased, and the percentage of stage REM sleep was significantly increased in the OSAS group with the initial CPAP treatment, but not in the CompSAS group. In addition, the patients with CompSAS showed normal LVEF. CONCLUSION CPAP intolerance secondary to an elevated nasal resistance might relate to frequent arousals, which could presumably contribute to an increase in central sleep apnea. Further evaluation in a large study is needed to clarify the mechanism of CompSAS.
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Affiliation(s)
- Chie Nakazaki
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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50
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Proença M, Fagundes Xavier R, Ramos D, Cavalheri V, Pitta F, Cipulo Ramos E. Efeito imediato e a curto prazo do cigarro sobre o transporte mucociliar nasal de fumadores. REVISTA PORTUGUESA DE PNEUMOLOGIA 2011; 17:172-6. [DOI: 10.1016/j.rppneu.2010.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 12/22/2010] [Indexed: 01/14/2023] Open
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