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Yıldırım YS, Deveci E, Ozucer B, Kurt Y. Nasal obstruction in adults: how it affects psychological status? J Laryngol Otol 2024; 138:184-187. [PMID: 37615109 DOI: 10.1017/s0022215123001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVE This study investigated the psychological status of patients with unilateral or bilateral complete nasal obstruction. METHOD The study included 49 consecutive cases of unilateral or bilateral complete nasal obstruction. In order to assess participants' personality traits, both groups completed the Personality Belief Questionnaire, State-Trait Anxiety Inventory form, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS The groups were similar in terms of demographic characteristics. Patients with unilateral or bilateral complete nasal obstruction had higher scores on all the psychological assessments compared with the healthy controls, except for the Beck Anxiety Inventory. Although all personality assessment scores were higher in patients, the only differences that were statistically significant were in the dependent, antisocial and avoidant personality trait scores. CONCLUSION The psychological conditions of patients with structural deformities that cause nasal obstruction may be affected, and appropriate treatment should be provided to improve their symptoms and quality of life.
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Affiliation(s)
- Y S Yıldırım
- Department of Otolaryngology Head and Neck Surgery, Doğuş University, Istanbul, Turkey
| | - E Deveci
- Department of Psychiatry, Medipol University, Istanbul, Turkey
| | - B Ozucer
- Private Practice, İstanbul, Turkey
| | - Y Kurt
- Department of Otolaryngology Head and Neck Surgery, KBB Uzmanı, Antalya Finike Devlet Hastanesi, Antalya, Turkey
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Chen Y, Feng X, Shi XQ, Cai W, Li B, Zhao Y. Computational fluid-structure interaction analysis of flapping uvula on aerodynamics and pharyngeal vibration in a pediatric airway. Sci Rep 2023; 13:2013. [PMID: 36737491 PMCID: PMC9898500 DOI: 10.1038/s41598-023-28994-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
The uvula flapping is one of the most distinctive features of snoring and is critical in affecting airway aerodynamics and vibrations. This study aimed to elucidate the mechanism of pharyngeal vibration and pressure fluctuation due to uvula flapping employing fluid-structure interaction simulations. The followings are the methodology part: we constructed an anatomically accurate pediatric pharynx model and put attention on the oropharynx region where the greatest level of upper airway compliance was reported to occur. The uvula was assumed to be a rigid body with specific flapping frequencies to guarantee proper boundary conditions with as little complexity as possible. The airway tissue was considered to have a uniform thickness. It was found that the flapping frequency had a more significant effect on the airway vibration than the flapping amplitude, as the flapping uvula influenced the pharyngeal aerodynamics by altering the jet flow from the mouth. Breathing only through the mouth could amplify the effect of flapping uvula on aerodynamic changes and result in more significant oropharynx vibration.
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Affiliation(s)
- Yicheng Chen
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China
| | - Xin Feng
- Division of Ear, Nose and Throat Surgery, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Xie-Qi Shi
- Department of Clinical Dentistry, Section for Oral and Maxillofacial Radiology, University of Bergen, Bergen, Norway.,Department of Oral Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Weihua Cai
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China. .,School of Energy and Power Engineering, Northeast Electric Power University, Jilin, China.
| | - Biao Li
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China.
| | - Yijun Zhao
- School of Energy Science and Engineering, Harbin Institute of Technology, Harbin, China
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Sleurs K, Postelmans J, Smit JV. Radiofrequency Ablation for Inferior Turbinate Hypertrophy: Predictive Factors for Short and Long-Term Outcomes. Ann Otol Rhinol Laryngol 2022:34894221121407. [PMID: 36082420 DOI: 10.1177/00034894221121407] [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: 11/19/2022]
Abstract
OBJECTIVES Radiofrequency Ablation (RFA) is a widely used technique for treatment of nasal obstruction due to inferior turbinate hypertrophy. This study aims to evaluate short and long-term outcome after RFA. Secondly, predictive factors for this outcome were evaluated. METHODS A prospective clinical study was performed in 65 patients to evaluate short-term outcome and predictive factors (Study A). To evaluate long-term outcome and predictive factors we performed a second clinical study in 124 patients (Study B). Patients scored nasal symptoms on a 1 to 5 points visual analogue scale (VAS) and filled in questionnaires about their comorbidity, previous nasal surgery, and medication use. RESULTS Study A: There was significant short-term (6-8 weeks after RFA) improvement in nasal obstruction (VAS -1.3, P < .001), trouble exercising (VAS -1.5, P < .001), trouble sleeping (VAS -0.9, P < .001), snoring (VAS -1.1, P< .001), and hyposmia (VAS -0.6, P = .004). Smoking (R2 = .065, P = .047) was a predictor for less optimized and previous use of decongestive nasal spray (R2 = .135, P = .005) for better short-term outcome. Study B: Nasal obstruction significantly decreased in the long term (1-5 years after RFA) compared to VAS before RFA (VAS -1.5, P < .001), but slightly increased compared to VAS 6 to 8 weeks after RFA (VAS +0.3, P = .036). Allergy (R2 = .066, P = .006), asthma (R2 = .068, P = .005), and previous use of corticosteroid nasal spray (R2 = .050, P = .016) were associated with a less optimized and older age (R2 = .217, P < .001) with better long-term outcome. CONCLUSION RFA is an efficient treatment for nasal obstruction, and improves sleeping, exercising, snoring, and hyposmia. Predictors for good short-term outcome were previous use of decongestive nasal spray and no smoking. Predictors for a less optimized long-term outcome were allergy, asthma, and previous use of corticosteroid nasal spray. Older age was associated with better long-term outcome.
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Affiliation(s)
- Kristien Sleurs
- Department of Ear, Nose, Throat, Head and Neck Surgery, University Hospital of Leuven, Leuven, Belgium
| | - Job Postelmans
- Department of Ear, Nose, Throat, Head and Neck Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jasper V Smit
- Department of Ear, Nose, Throat, Head and Neck Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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He L, Lin Z. An Exploratory Study on the Treatment of Obstructive Apnea-Hypopnea Syndrome by Nasal Cavity Expansion. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6926509. [PMID: 34804458 PMCID: PMC8601791 DOI: 10.1155/2021/6926509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022]
Abstract
Background Respiratory disorder is a disease with a very high incidence, in which obstructive apnea-hypopnea syndrome is the most harmful. It has become a common and frequently occurring disease, which seriously influences the health of the affected population. The pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) is numerous. With the continuous research on OSAHS disease, it has been found that one of its main pathogeneses is caused by the anatomical characteristics of upper airway obstruction induced during sleep. The narrowing and collapse of any plane can affect the ventilation of the upper respiratory tract. In recent years, with the deepening of research, the importance of the upper respiratory tract obstruction as a source of the disease has attracted increasing attention. Nasal stenosis can cause increased nasal resistance, increased pharyngeal inhalation negative pressure, soft palate collapse, and narrow pharyngeal cavity, resulting in open mouth breathing, which can be the initiating factor of the upper airway obstruction. With the development and popularization of nasal endoscopy technology, domestic and foreign scholars have reported more on the treatment of rhinogenic OSAHS with nasal cavity expansion, but they are different. There is still more controversy; the main controversy centered on the effective rate of surgical treatment and the improvement of objective indicators. Therefore, this study performed individualized nasal cavity expansion for patients with OSAHS who are mainly rhinogenic, from subjective symptoms, objective indicators, and effective rate of surgery. Methods and Patients. Conduct research and analysis to provide references for the clinical treatment of such patients. For patients with the obstructive apnea-hypopnea syndrome with nasal congestion, individualized nasal cavity expansion was performed to study the clinical effect of nasal cavity expansion in the treatment of OSAHS. This article mainly screens cases through big data and selects a large hospital in China to perform individualized nasal cavity expansion surgery to treat 43 adult OSAHS patients with nasal congestion. Results There are uploaded sleep monitoring, nasal reflex, nasal resistance, and nasal symptoms before and after surgery. Conclusion Spirometer examination records, along with apnea-hypopnea index and minimum arterial blood oxygen saturation, the minimum cross-sectional area of the nasal cavity, nasal cavity volume, nasal airway resistance, total nasal respiratory volume, and other information. Also we fill in the nasal obstruction symptom assessment scale, sleepiness scale, and study and analyze the surgical effect of nasal cavity expansion.
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Affiliation(s)
- Ling He
- Hebei Eye Hospital, Otolaryngology-Head and Neck Surgery, Xingtai 054001, China
| | - Zhijin Lin
- Xingtai People's Hospital, Doctor-Patient Communication Office, Xingtai 054001, China
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Effect of nasal airflow on respiratory pattern variability in rats. PHYSIOLOGY AND PHARMACOLOGY 2021. [DOI: 10.52547/phypha.26.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Leung TN, Cheng JW, Chan AK. Paediatrics: how to manage obstructive sleep apnoea syndrome. Drugs Context 2021; 10:dic-2020-12-5. [PMID: 33828609 PMCID: PMC8007210 DOI: 10.7573/dic.2020-12-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/19/2021] [Indexed: 02/02/2023] Open
Abstract
Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.
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Affiliation(s)
- Theresa Nh Leung
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - James Wch Cheng
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong SAR, China
| | - Anthony Kc Chan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Reilly EK, Boon MS, Vimawala S, Chitguppi C, Patel J, Murphy K, Doghramji K, Nyquist GG, Rosen MR, Rabinowitz MR, Huntley CT. Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery. Laryngoscope 2020; 131:E1013-E1018. [PMID: 32936959 DOI: 10.1002/lary.28968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/13/2020] [Accepted: 07/07/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS For patients with obstructive sleep apnea (OSA) undergoing sinonasal surgery, there is a lack of consensus on the risk and appropriate postoperative use of continuous positive airway pressure (CPAP). The aim of this study was to assess the tolerability of restarting CPAP on postoperative day one. STUDY DESIGN Prospective cohort study. METHODS A prospective study on patients with OSA on CPAP who required a septoplasty/turbinectomy and/or functional endoscopic sinus surgery (FESS) was performed. Data from the memory card of a patient's CPAP machine and subjective information were obtained on the day of surgery and at scheduled follow-up visits. All subjects were instructed to restart CPAP on the first postoperative night. RESULTS A total of 14 patients were analyzed; nine underwent FESS and five had a septoplasty/turbinectomy. There were no postoperative complications encountered. The only significant change in the first postoperative week was a reduction in the percentage of nights used over 4 hours (P < .05). By the third postoperative visit, average 22-item Sino-Nasal Outcome Test, Nasal Obstruction Symptom Evaluation, and CPAP tolerance scores improved from preoperative values. CPAP pressures, residual apnea-hypopnea index, and number of hours and mean percentage of nights used remained stable throughout the study period. CONCLUSIONS Both quality-of-life and CPAP outcomes improved or remained the same when restarting CPAP immediately postoperatively. Combined with a lack of significant complications, this study suggests that CPAP is well-tolerated when restarted the day after a septoplasty/turbinectomy or FESS. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1013-E1018, 2021.
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Affiliation(s)
- Erin K Reilly
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Maurits S Boon
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Swar Vimawala
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Chandala Chitguppi
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Jena Patel
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Kira Murphy
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Karl Doghramji
- Department of Sleep Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Colin T Huntley
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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Acoustic analyses of snoring sounds using a smartphone in patients undergoing septoplasty and turbinoplasty. Eur Arch Otorhinolaryngol 2020; 278:257-263. [PMID: 32754872 DOI: 10.1007/s00405-020-06268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Several studies have been performed using recently developed smartphone-based acoustic analysis techniques. We investigated the effects of septoplasty and turbinoplasty in patients with nasal septal deviation and turbinate hypertrophy accompanied by snoring by recording the sounds of snoring using a smartphone and performing acoustic analysis. METHODS A total of 15 male patients who underwent septoplasty with turbinoplasty for snoring and nasal obstruction were included in this prospective study. Preoperatively and 2 months after surgery, their bed partners or caregivers were instructed to record the snoring sounds. The intensity (dB), formant frequencies (F1, F2, F3, and F4), spectrogram pattern, and visual analog scale (VAS) score were analyzed for each subject. RESULTS Overall snoring sounds improved after surgery in 12/15 (80%) patients, and there was significant improvement in the intensity of snoring sounds after surgery (from 64.17 ± 12.18 dB to 55.62 ± 9.11 dB, p = 0.018). There was a significant difference in the F1 formant frequency before and after surgery (p = 0.031), but there were no significant differences in F2, F3, or F4. The change in F1 indicated that patients changed from mouth breathing to normal breathing. The degree of subjective snoring sounds improved significantly after surgery (VAS: from 5.40 ± 1.55 to 3.80 ± 1.26, p = 0.003). CONCLUSION Our results confirm that snoring is reduced when nasal congestion is improved, and they demonstrate that smartphone-based acoustic analysis of snoring sounds can be useful for diagnosis.
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Nguyen DK, Liang J, Durr M. Topical nasal treatment efficacy on adult obstructive sleep apnea severity: a systematic review and meta-analysis. Int Forum Allergy Rhinol 2020; 11:153-161. [PMID: 32713164 DOI: 10.1002/alr.22658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Nasal obstruction is a common complaint in patients with sleep-disordered breathing and obstructive sleep apnea (OSA). Although topical nasal treatments (TNTs) have been shown to reduce nasal resistance and improve nasal obstruction, there is conflicting evidence regarding the role of TNTs in adult OSA. In this systematic review and meta-analysis we aim to evaluate the role of TNTs in adults with OSA. Data sources used included PubMed, Ovid MEDLINE, and Cochrane Central, from January 2001 to July 2019. METHODS Inclusion criteria were English-language studies containing original data on TNTs in adults (≥18 years) with OSA (apnea-hypopnea index [AHI] ≥5). Exclusion criteria were case reports, studies without outcome measures, and concurrent non-TNT treatment for OSA. Two investigators independently reviewed all articles and performed quality assessment using validated tools. Meta-analysis and quality assessment were performed. RESULTS Of the 2180 abstracts identified, 8 studies met inclusion criteria. TNTs included decongestants (4 of 8 studies), corticosteroids (3 of 8), and antihistamines (1 of 8). Outcome measures included AHI (8 of 8), respiratory distress index (RDI; 1 of 8), oxygen-desaturation index (ODI; 3 of 8), minimum SaO2 (MinSaO2 ; 4 of 8), nasal resistance (4 of 8), endoscopic sinus surgery (4 of 8 studies) and standardized rhinoconjunctivitis quality of life questionnaire scores (1 of 8 studies). Qualitatively, all studies showed trends toward improving objective and subjective measures of OSA, although the significance of these improvements varied across studies. A meta-analysis was performed in 5 studies, but TNTs did not reveal a significant change in AHI (p > 0.05). CONCLUSION TNTs may improve minimum oxygen saturation, ODI, RDI, and subjective/quality-of-life measures. Allergic patients may have more improvement in OSA measures compared with nonallergic patients. Future studies are indicated to accurately determine the efficacy of TNTs.
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Affiliation(s)
| | - Jonathan Liang
- Otolaryngology, Kaiser Permanente Northern California, Oakland, CA
| | - Megan Durr
- Otolaryngology, Kaiser Permanente Northern California, Oakland, CA
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Yılmaz Durmaz D, Güneş A. Which is more important: the number or duration of respiratory events to determine the severity of obstructive sleep apnea? Aging Male 2020; 23:119-124. [PMID: 31241414 DOI: 10.1080/13685538.2019.1630062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aim: Apnea-hypopnea index (AHI) take account only the number of apnea and hypopnea regardless of their duration and morphology. The aim of this study was to compare the mean obstructive apnea duration (MOAD), mean mixed apnea duration (MMAD), mean central apnea duration (MCAD), mean total apnea duration (MTAD) and mean hypopnea duration (MHD) with the demographic parameters, blood oxygenation and other polysomnographic sleep parameters in patients diagnosed with severe obstructive sleep apnea (OSA).Materials and methods: A retrospective study included 121 patients who had a diagnosis of severe OSA. The correlations between the MOAD, MMAD, MCAD, MTAD, MHD and patient demographic parameters, blood oxygenation and other polysomnographic sleep parameters were analyzed.Results: Severe OSA patients with longer MOAD and MTAD had shorter Stage N3. Longer MOAD, MMAD, MCAD, MTAD, MHD were related to lower mean oxygen saturation. Longer MOAD and MTAD were associated with higher oxygen desaturation index. MOAD, MMAD, MTAD were positively associated with a duration below oxygen saturation 85%.Conclusions: Respiratory events can have different characteristics even though the average number of events per hour would be similar. Novel parameters like MOAD, MMAD, MCAD, MTAD, MHD could enhance the evaluation and classification of OSA in addition to AHI.
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Affiliation(s)
| | - Aygül Güneş
- Department of Neurology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
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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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12
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Xiong H, Cao H, Huang Y. An optimization method for surgical reduction of hypertrophied inferior turbinate. J Biomech 2019; 99:109503. [PMID: 31767289 DOI: 10.1016/j.jbiomech.2019.109503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/24/2022]
Abstract
Surgical reductions of the hypertrophied inferior turbinate (HIT) can improve nasal obstruction. However, there is currently a lack of personalized and objective methods to guide surgical operations, which results in the excessive or inadequate resection of HIT. In this study, we proposed an optimizing method based on homotopy deformation to determine the resected amount and shape of the tissue by matching the flow resistance in the two nasal passageways. The simulation results obtained using computational fluid dynamics showed that after such an optimization procedure, the most obstructed nasal side could have a similar air flux as the less obstructed side. A 35% and a 56% less tissue resection in the optimizing operation compared to that in the total turbinectomy could well balance the air flow between the two nasal cavities in the simulations for patients 1 and 2 with unilateral nasal obstruction respectively. Compared with the optimization operation, the total turbinectomy made a more aggressive resection of HIT, which could worsen the air conditioning capacity of the nose. A sensitivity test indicated that in the optimization operation, the most constricted region in the nasal cavity should be adequately enlarged. However, more tissue resection than is required for the optimization operation did not improve the flow in the obstructed side strikingly. Simulations of the optimization operation in both nasal cavities for a patient with bilateral nasal obstruction were also performed. The flow rate could reach the normal level and be well balanced in the two sides after such an optimization procedure.
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Affiliation(s)
- Huahui Xiong
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Han Cao
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Yaqi Huang
- School of Biomedical Engineering, Capital Medical University, Beijing, China; Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China.
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Abstract
Purpose The purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5°) on obstructive sleep apnea (OSA) severity and sleep quality. Methods OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE. Results Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8 kg/m2, neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3–22.5] to 10.7 [6.6–16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5–87] to 87 [81–90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7–90.7] vs 88.8 [81.6–93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values. Conclusions Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.
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Kiyohara N, Badger C, Tjoa T, Wong B. A Comparison of Over-the-Counter Mechanical Nasal Dilators: A Systematic Review. JAMA FACIAL PLAST SU 2017; 18:385-9. [PMID: 27367589 DOI: 10.1001/jamafacial.2016.0291] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The internal nasal valve is the narrowest part of the nasal airway and a common site of inspiratory collapse and obstruction of nasal airflow. Over-the-counter mechanical nasal dilators are an alternative to surgical intervention that attempts to improve airflow through the internal nasal valve. OBJECTIVE To determine the efficacy of over-the-counter mechanical nasal dilators and classify these products by mechanism. EVIDENCE REVIEW A database of 33 available over-the-counter mechanical nasal dilators was generated via a PubMed search as well as an internet search via Amazon.com and Google, conducted from April 1, 2013, through December 31, 2015. Products determined to be unavailable or discontinued were excluded from the database. Of the devices examined in published literature, efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Measures of reported sleep quality or patient perception were excluded. FINDINGS An analysis of each product's mechanism revealed 4 broad classes: external nasal dilator strips, nasal stents, nasal clips, and septal stimulators. A review demonstrated 5 studies supporting the use of external nasal dilator strips, 4 studies supporting the use of nasal clips, 1 study supporting the use of nasal stents, and no studies supporting the use of septal stimulators. CONCLUSIONS AND RELEVANCE Our findings suggest that external nasal dilator strips and nasal clips effectively relieve obstruction of the internal nasal valve and may be an alternative to surgical intervention in some patients.
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Affiliation(s)
- Nicole Kiyohara
- School of Medicine, University of California-Irvine2Beckman Laser Institute and Medical Clinic, University of California-Irvine
| | - Christopher Badger
- School of Medicine, University of California-Irvine2Beckman Laser Institute and Medical Clinic, University of California-Irvine
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Brian Wong
- Beckman Laser Institute and Medical Clinic, University of California-Irvine4Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine, Orange5Department of Otolaryngology, Head and Neck Surgery, University of California-Irvine6Department of Biomedical Engineering, University of California-Irvine
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Wu H, Zhan X, Zhao M, Wei Y. Mean apnea-hypopnea duration (but not apnea-hypopnea index) is associated with worse hypertension in patients with obstructive sleep apnea. Medicine (Baltimore) 2016; 95:e5493. [PMID: 27902610 PMCID: PMC5134767 DOI: 10.1097/md.0000000000005493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To determine which polysomnography parameters are associated with severity of hypertension.This retrospective study collected data on all patients admitted to our urban, academic center in Beijing with hypertension who had undergone polysomnograms (PSG) and were diagnosed with obstructive sleep apnea (OSA) (apnea-hyponea index [AHI] ≥5/hour). We then compared polysomnographic parameters (AHI, oxygen desaturation index [ODI], lowest oxygen saturation [LOS], and mean apnea-hypopnea duration [MAD]) by hypertension severity in this cohort.There were 596 subjects who met entry criteria. Age, sex distribution, body mass index (BMI), history of current smoking and alcohol were similar among groups. Subjects with longer MAD suffered from more severe hypertension (P = 0.011). There were no relationship between AHI, ODI, and LOS and hypertension in our cohort. There were no significant differences in age, sex, BMI, history of current smoking and alcohol use between hypertension groups. MAD had a small but significant independent association (odds ratio [OR] = 1.072, 95% confidence interval [CI] 1.019-1.128, P = 0.007) with moderate to severe hypertension, using logistic regression analysis that accounted for age, sex, BMI, history of current smoking and alcohol, AHI, and LOS.Chinese inpatients with longer MAD by PSG face higher odds of moderate to severe hypertension. The mechanism of these effects may be due to aggravated nocturnal hypoxaemia and hypercapnia, as well as disturbed sleep architecture. These results suggest that additional information available in the polysomnogram, such as MAD, should be considered when evaluating OSA patients.
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Kempfle JS, BuSaba NY, Dobrowski JM, Westover MB, Bianchi MT. A cost-effectiveness analysis of nasal surgery to increase continuous positive airway pressure adherence in sleep apnea patients with nasal obstruction. Laryngoscope 2016; 127:977-983. [PMID: 27653626 DOI: 10.1002/lary.26257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/01/2016] [Accepted: 07/25/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nasal surgery has been implicated to improve continuous positive airway pressure (CPAP) compliance in patients with obstructive sleep apnea (OSA) and nasal obstruction. However, the cost-effectiveness of nasal surgery to improve CPAP compliance is not known. We modeled the cost-effectiveness of two types of nasal surgery versus no surgery in patients with OSA and nasal obstruction undergoing CPAP therapy. STUDY DESIGN Cost-effectiveness decision tree model. METHODS We built a decision tree model to identify conditions under which nasal surgery would be cost-effective to improve CPAP adherence over the standard of care. We compared turbinate reduction and septoplasty to nonsurgical treatment over varied time horizons from a third-party payer perspective. We included variables for cost of untreated OSA, surgical cost and complications, improved compliance postoperatively, and quality of life. RESULTS Our study identified nasal surgery as a cost-effective strategy to improve compliance of OSA patients using CPAP across a range of plausible model assumptions regarding the cost of untreated OSA, the probability of adherence improvement, and a chronic time horizon. The relatively lower surgical cost of turbinate reduction made it more cost-effective at earlier time horizons, whereas septoplasty became cost-effective after a longer timespan. CONCLUSIONS Across a range of plausible values in a clinically relevant decision model, nasal surgery is a cost-effective strategy to improve CPAP compliance in OSA patients with nasal obstruction. Our results suggest that OSA patients with nasal obstruction who struggle with CPAP therapy compliance should undergo evaluation for nasal surgery. LEVEL OF EVIDENCE 2c Laryngoscope, 127:977-983, 2017.
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Affiliation(s)
- Judith S Kempfle
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, University Tübingen Medical Center, Tübingen, Germany
| | - Nicholas Y BuSaba
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - John M Dobrowski
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Michael B Westover
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Matt T Bianchi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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Leal RB, Gomes MC, Granville-Garcia AF, Goes PSA, de Menezes VA. Development of a questionnaire for measuring health-related quality of life among children and adolescents with mouth breathing. Am J Rhinol Allergy 2016; 29:e212-5. [PMID: 26637572 DOI: 10.2500/ajra.2015.29.4258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mouth breathing can exert an influence on quality of life and should be evaluated within a multidimensional context. However, there is no specific questionnaire to measure the impact of mouth breathing on quality of life. OBJECTIVE To develop and validate a questionnaire for measuring the impact of mouth breathing on quality of life among children and adolescents. METHODS Thirty-six items were evaluated by six health care professionals, one parent and one child with mouth breathing. After a qualitative evaluation, a modified set of 32 items was developed. The modified Mouth Breather Quality of Life (MBQoL) questionnaire was submitted to a pretest with a sample of 30 children and adolescents diagnosed with mouth breathing to evaluate comprehension, the order of the items, and the form of administration. The MBQoL questionnaire was then administered to 60 children and adolescents (30 mouth breathers and 30 nose breathers) for the evaluation of construct validity, internal consistency, and reproducibility. All the participants answered the questionnaire, and 50% of each group answered the questionnaire a second time after a 1-week interval (test-retest). RESULTS Higher MBQoL scores (which indicated poorer quality of life) were significantly associated with mouth breathing. The Cronbach α coefficient for the items of the questionnaire was 0.88, and the Spearman correlation coefficient for test-retest reliability demonstrated that the questionnaire was reproducible (r = 0.993; p < 0.01). CONCLUSION Through this validation study, the MBQoL questionnaire demonstrated a good performance in the evaluation of the quality of life of children and adolescents with mouth breathing and may be a useful tool in clinical studies as well as public health programs. However, further studies are needed to establish its applicability in other populations with respiration disorders.
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Affiliation(s)
- Rossana B Leal
- Department of Dentistry, Caruaru Higher Education Association, Caruaru, Pernambuco, Brazil
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18
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Hisamatsu KI, Kudo I, Makiyama K. The effect of compound nasal surgery on obstructive sleep apnea syndrome. Am J Rhinol Allergy 2016; 29:e192-6. [PMID: 26637568 DOI: 10.2500/ajra.2015.29.4254] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasal surgery often fails to ameliorate the symptoms of obstructive sleep apnea syndrome (OSAS). We developed a compound nasal surgery (CNS) method that consists of septoplasty combined with submucosal inferior turbinectomy and posterior nasal neurectomy to ensure low nasal resistance during sleep. OBJECTIVE To clarify the effect of CNS on OSAS, pre- and postoperative changes in sleep-related events were studied by using polysomnography, the Epworth sleepiness scale (ESS), the visual analog scale for snoring, and health-related quality of life (QOL). METHODS Forty-five consecutive patients with OSAS and with nasal problems underwent CNS. Three months later, the postoperative effect on OSAS was assessed by using polysomnography findings, daytime sleepiness by the ESS, nasal allergy symptoms, and health-related QOL. Snoring was assessed by the family by using a visual analog scale. RESULTS The indices of apnea, apnea-hypopnea, oxygen desaturation, and arousal; the ESS; allergic symptom score; health-related QOL; and snoring on a visual analog scale were all significantly improved. CONCLUSIONS CNS improves OSAS events without any pharyngeal surgical procedure in selected patients. If high nasal resistance associated with OSAS is present, then CNS should thus be considered.
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Affiliation(s)
- Ken-ichi Hisamatsu
- Tsuchiura Snoring and Sleep-Disordered Breathing Center, Nihon University Hospital, Tsuchiura City, Ibaraki Prefecture, Japan
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Liu HT, Lin YC, Kuan YC, Huang YH, Hou WH, Liou TH, Chen HC. Intranasal Corticosteroid Therapy in the Treatment of Obstructive Sleep Apnea: A Meta-Analysis of Randomized Controlled Trials. Am J Rhinol Allergy 2016; 30:215-21. [DOI: 10.2500/ajra.2016.30.4305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aim To assess the efficacy of intranasal corticosteroid therapy in the treatment of obstructive sleep apnea (OSA) based on current evidence. Methods A number of medical literature data bases: PubMed, Cochrane Library, Scopus, and CINAHL, were searched comprehensively to identify randomized controlled trials (RCT) that reported on the efficacy of intranasal corticosteroid therapy for OSA. The selected studies were subjected to a meta-analysis and a risk-of-bias assessment. Results Seven RCTs met our eligibility criteria, five of these were included in our meta-analysis. The results indicated that intranasal corticosteroid therapy has a better effect in decreasing the apnea-hypopnea index compared with those participants who received placebo (standard mean difference 0.95 [95% confidence interval, -1.42 to -0.47]) (n = 221, I2 = 62%). Conclusion Our study results showed that patients who received intranasal corticosteroid therapy had a significant improvement in OSA. However, this evidence was limited by the potential risk of bias and heterogeneity of the selected RCTs.
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Affiliation(s)
- Hsien-Ta Liu
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chin Lin
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Occupational Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Kuan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei, Taiwan
| | - Yao-Hsien Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
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Migueis DP, Thuler LCS, Lemes LNDA, Moreira CSS, Joffily L, Araujo-Melo MHD. Systematic review: the influence of nasal obstruction on sleep apnea. Braz J Otorhinolaryngol 2016; 82:223-31. [PMID: 26830959 PMCID: PMC9449074 DOI: 10.1016/j.bjorl.2015.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Obstructive sleep apnea syndrome (OSAS) is a common disorder that can lead to cardiovascular morbidity and mortality, as well as to metabolic, neurological, and behavioral consequences. It is currently believed that nasal obstruction compromises the quality of sleep when it results in breathing disorders and fragmentation of sleep. However, recent studies have failed to objectively associate sleep quality and nasal obstruction. Objective The aim of this systematic review is to evaluate the influence of nasal obstruction on OSAS and polysomnographic indices associated with respiratory events. Methods Eleven original articles published from 2003 to 2013 were selected, which addressed surgical and non-surgical treatment for nasal obstruction, performing polysomnography type 1 before and after the intervention. Results/conclusions In most trials, nasal obstruction was not related to the apnea–hypopnea index (AHI), indicating no improvement in OSAS with reduction in nasal resistance. However, few researchers evaluated other polysomnography indices, such as the arousal index and rapid eye movement (REM) sleep percentage. These could change with nasal obstruction, since it is possible that the nasal obstruction does not completely block the upper airways, but can increase negative intrathoracic pressure, leading to sleep fragmentation.
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Affiliation(s)
- Debora Petrungaro Migueis
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Luiz Claudio Santos Thuler
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil; Clinical Investigation Division, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
| | | | - Chirlene Santos Souza Moreira
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Lucia Joffily
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Maria Helena de Araujo-Melo
- Postgraduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil; Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.
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The role of nasal treatments in snoring and obstructive sleep apnoea. Curr Opin Otolaryngol Head Neck Surg 2015; 23:39-46. [PMID: 25565285 DOI: 10.1097/moo.0000000000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review highlights recent advances and views on the role of the nose in snoring and obstructive sleep apnoea. RECENT FINDINGS Recent reviews and past randomized controlled trials generally agree that nasal surgery may improve quality of life in snoring and obstructive sleep apnoea. There have been no published randomized controlled trials regarding nasal treatments in snoring or obstructive sleep apnoea in the past year. SUMMARY Snoring and obstructive sleep apnoea are upper airway disorders in which the role of the nose has been well researched. Studies support that nasal surgery improves quality of life in snoring, but it may not lead to resolution of snoring. Likewise, nasal treatments for obstructive sleep apnoea increase the quality of life and treatment compliance in some patients. Further stratification of patients who may benefit from nasal intervention may clarify the role of nasal surgery.
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Deniz M, Gultekin E, Ciftci Z, Alp R, Ozdemir DN, Isik A, Demirel OB. Nasal mucociliary clearance in obstructive sleep apnea syndrome patients. Am J Rhinol Allergy 2015; 28:178-80. [PMID: 25198014 DOI: 10.2500/ajra.2014.28.4094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The main objective of this study was to investigate the correlation between the level of mucociliary dysfunction and severity of obstructive sleep apnea syndrome (OSAS). The effect of smoking in OSAS patients on mucociliary dysfunction was also assessed. METHODS It is a descriptive study that compares variables between groups (univariate analysis). In this clinical trial 122 patients with varying degrees of OSAS and 49 healthy volunteers were included (n = 171). Patients were divided into three groups as having mild, moderate, and severe OSAS, according to their apnea hypopnea index (AHI) values. (AHI values are typically categorized as 5-15/hr, mild OSAS; 15-30/hr, moderate OSAS; and >30/hr, severe OSAS.) The control group was comprised of healthy subjects. Each group was divided into smoking and nonsmoking subgroups. The mucociliary rates of the subjects were measured using the saccharin test. Statistical analysis was performed with the GraphPad Prism Version 3 pocket program. RESULTS Mild and moderate OSAS groups showed similar results with control group (p = 0.869), but severe OSAS patients showed a statistically significant difference with control group (Kruskal-Wallis [KW] = 32.28; p = 0.0032 and p < 0.05). Although in the moderate OSAS group the mucociliary clearance rates showed a tendency to decrease, this decrease was not significant (p = 0.453). A statistically significant difference was observed between smokers and nonsmokers in terms of mucociliary clearance times in all groups (KW = 18.24; p = 0.001). CONCLUSION The nasal mucociliary system is significantly deteriorated in severe OSAS patients and they should be meticulously observed to prevent sinonasal infections. Measures to enhance mucociliary activity in these patients should be taken. Smoking, a well-known inhibitor of mucociliary activity, also has a negative impact on the mucociliary function of OSAS patients and quitting smoking would be of benefit for these patients.
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Affiliation(s)
- Mahmut Deniz
- Department of Otorhinolaryngology, Namık Kemal University, Tekirdag, Turkey
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Engstrøm M, Beiske KK, Hrubos-Strøm H, Aarrestad S, Sand T. Obstruktiv søvnapné. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1954-6. [DOI: 10.4045/tidsskr.15.0392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Is septoplasty effective on habitual snoring in patients with nasal obstruction? Eur Arch Otorhinolaryngol 2014; 272:1687-91. [PMID: 25182390 DOI: 10.1007/s00405-014-3260-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/28/2014] [Indexed: 02/03/2023]
Abstract
We aimed to find out whether snoring relieve with nasal surgery in patients with nasal obstruction. Sixty-four patients who underwent septoplasty under general anesthesia with complaint of nasal obstruction and snoring at Haydarpasa Numune Education and Research Hospital were enrolled in the study. All patients were evaluated by otolaryngological examination. Septal deviation was graded as mild, moderate and severe with endoscopy. Variables examined included age, sex, body mass index. All patients also completed the questionnaires, including Nose Obstruction Symptom Evaluation scale (NOSE), Epworth Sleepiness Scale (ESS), and Snore Symptom Inventory (SSI) before and after septoplasty. NOSE scale, ESS, and SSI scores showed statistically significant improvement after nasal surgery (p < 0.01) but we could not find any statistically significant association between septal deviation grading and improvement in scores of NOSE scale, ESS, and SSI (p > 0.05). Added to this, the association between body mass index (BMI) and improvement in scores of NOSE scale, ESS, and SSI did not reach statistical significance (p > 0.05). Our results demonstrated that septoplasty is effective on the subjective parameters of nasal obstruction in habitual snorers irrespective of the nasal septal deviation and severity of BMI.
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Stapleton AL, Chang YF, Soose RJ, Gillman GS. The impact of nasal surgery on sleep quality: a prospective outcomes study. Otolaryngol Head Neck Surg 2014; 151:868-73. [PMID: 25073754 DOI: 10.1177/0194599814544629] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE (1) Evaluate the impact of nasal airway surgery on sleep quality using validated outcome measurements, (2) compare the utility of Epworth Sleepiness Scale (ESS) versus Pittsburgh Sleep Quality Index (PSQI) as a reflection of sleep quality, and (3) identify perioperative variables that might correlate with a beneficial effect of nasal surgery on sleep quality. STUDY DESIGN Prospective outcome study of patients with symptomatic nasal obstruction undergoing nasal airway surgery. SETTING Academic medical center. METHODS Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, ESS, PSQI, and Ease-of-Breathing and Sleep Quality Likert scales preoperatively and 3 months postoperatively. A nonparametric analysis compared pre- and postoperative values, and associations were examined using Spearman correlations. RESULTS Sixty-one patients completed the study. Mean NOSE scores decreased significantly from 68.2 preoperatively to 17.5 three months after surgery. Mean ESS scores and PSQI scores improved (P < .0001) over that same interval (7.5 to 5.3 and 7.8 to 4.6, respectively). There was a correlation seen between the degree of change in both NOSE scores and Ease-of-Breathing scores and the change in sleep quality measured using the PSQI or Sleep Quality Likert scores. The PSQI correlated better with Sleep Quality Likert scores than the ESS. Overall, 86.9% of subjects reported subjective improvement in sleep quality postoperatively. CONCLUSION In patients undergoing nasal airway surgery there may be a secondary improvement in subjective sleep quality. The degree of change in sleep quality correlates with the severity of nasal obstruction preoperatively and the degree of improvement in obstruction with surgery.
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Affiliation(s)
- Amanda L Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yue-Fang Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ryan J Soose
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Grant S Gillman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Yalamanchali S, Cipta S, Waxman J, Pott T, Joseph N, Friedman M. Effects of Endoscopic Sinus Surgery and Nasal Surgery in Patients with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2014; 151:171-5. [PMID: 24687940 DOI: 10.1177/0194599814528296] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/26/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the impact of combined nasal surgery and endoscopic sinus surgery on the objective measurements of obstructive sleep apnea (OSA) and sleep architecture by comparing polysomnographic data before and after combined surgery in patients with OSA. STUDY DESIGN Case series with chart review. SETTING A single clinical site. SUBJECTS AND METHODS Patients with OSA and chronic rhinosinusitis who underwent combined nasal surgery and endoscopic sinus surgery and preoperative and postoperative polysomnography were identified. Patient charts were reviewed and preoperative and postoperative body mass index, apnea-hypopnea index (AHI), mean and minimum oxygen saturation, sleep efficiency, and sleep staging were compared. RESULTS Fifty-six patients were included in our study. Patients were divided into 3 groups on the basis of the severity of OSA: those with mild OSA (n = 9), those with moderate OSA (n = 23), and those with severe OSA (n = 24). After combined nasal and sinus surgery, the mean AHI significantly decreased from 33.5 ± 22.0 to 29.4 ± 20.8 (P = .009) in our overall population. Specifically, AHI improved significantly in patients with moderate OSA (from 22.3 ± 4.8 to 20.7 ± 8.2, P = .023) and severe OSA (from 52.3 ± 21.4 to 43.6 ± 23.9, P = .034), while patients with mild OSA did not have significant changes in AHI. Successful surgical procedures were achieved in only 2 of 56 patients. CONCLUSION Although combined nasal and sinus surgery may slightly improve AHI in a certain group of patients, it does not cure OSA or have a significant clinical impact.
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Affiliation(s)
- Sreeya Yalamanchali
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Stephanie Cipta
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Jonathan Waxman
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Thomas Pott
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Ninos Joseph
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Michael Friedman
- Chicago ENT Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA Rush University Medical Center, Chicago, Illinois, USA
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Brenner MJ, Goldman JL. Obstructive Sleep Apnea and Surgery: Quality Improvement Imperatives and Opportunities. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014; 2:20-29. [PMID: 25013745 DOI: 10.1007/s40136-013-0036-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnea (OSA) is more common in surgical candidates than in the general population and may increase susceptibility to perioperative complications that range from transient desaturation to catastrophic injuries. Understanding the potential impact of OSA on patients' surgical risk profile is of particular interest to otolaryngologists, who routinely perform airway procedures-including surgical procedures for treatment of OSA. Whereas the effects of OSA on long-term health outcomes are well documented, the relationship between OSA and surgical risk is not collinear, and clear consensus on the nature of the association is lacking. Better guidelines for optimization of pain control, perioperative monitoring, and surgical decision making are potential areas for quality improvement efforts. Many interventions have been suggested to mitigate the risk of adverse events in surgical patients with OSA, but wide variations in clinical practice remain. We review the current literature, emphasizing recent progress in understanding the complex pathophysiologic interactions noted in OSA patients undergoing surgery and outlining potential strategies to decrease perioperative risks.
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Affiliation(s)
- Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, 1904, Taubman Center, University of Michigan School of Medicine,, 1500 East Medical Center Drive SPC 5312, Ann Arbor, MI 48109-5312, USA,
| | - Julie L Goldman
- Division of Otolaryngology, James Graham Brown Cancer, Center, University of Louisville School of Medicine, 529 S, Jackson St, 3rd Floor, Louisville, KY 40202, USA,
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