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Menon T, Kalra DK. Sleep Apnea and Heart Failure-Current State-of-The-Art. Int J Mol Sci 2024; 25:5251. [PMID: 38791288 PMCID: PMC11121476 DOI: 10.3390/ijms25105251] [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: 04/08/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Sleep-disordered breathing (SDB), including obstructive and central sleep apnea, significantly exacerbates heart failure (HF) through adverse cardiovascular mechanisms. This review aims to synthesize existing literature to clarify the relationship between SDB and HF, focusing on the pathophysiological mechanisms, diagnostic challenges, and the effectiveness of treatment modalities like continuous positive airway pressure (CPAP) and adaptive servo-ventilation ASV. We analyzed peer-reviewed articles from 2003 to 2024 sourced from PubMed, EMBASE, Scopus, and Web of Science databases. The prevalence of SDB in HF patients is high, often underdiagnosed, and underappreciated. Management strategies, including CPAP and ASV, have been shown to mitigate symptoms and improve cardiac function. However, despite the availability of effective treatments, significant challenges in screening and diagnosis persist, affecting patient management and outcomes. DB significantly impacts HF prognosis. Enhanced screening strategies and broader utilization of therapeutic interventions like CPAP and ASV are essential to improve the management and outcomes of HF patients with concomitant SDB. Future research should focus on refining diagnostic and treatment protocols to optimize care for HF patients with SDB.
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Affiliation(s)
- Tushar Menon
- Division of Cardiology, University of Louisville Hospital, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202, USA
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville Hospital, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202, USA
- Lipid Clinic & Infiltrative Heart Disease Program, Rudd Heart & Lung Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville School of Medicine, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202, USA
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Saba ES, Kim H, Huynh P, Jiang N. Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:480-495. [PMID: 37606313 DOI: 10.1002/lary.30974] [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: 04/18/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Orofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue placement and increase oropharyngeal tone. The objective of this systematic review and meta-analysis is to determine the efficacy of OMT in OSA patients. DATA SOURCES PubMed/Medline, EMBASE, Cochrane, Web of Science. REVIEW METHODS Using PRISMA guidelines, a directed search strategy was performed for randomized control trials (RCTs) published prior to March 24, 2023, featuring 10+ patients with OSA undergoing mono-therapeutic OMT. The primary outcome of interest was apnea-hypopnea index (AHI). Secondary outcomes included subjective sleepiness, sleep-related quality-of-life, and snoring frequency. RESULTS Of the 1244 abstracts that were identified, 7 RCTs involving 310 patients met inclusion criteria. Adult OMT patients had a statistically significant improvement in AHI (MD -10.2; 95% CI, -15.6, -4.8, p < 0.05), subjective sleepiness (Epworth Sleepiness Scale; MD -5.66; 95% CI, -6.82, -4.5, p < 0.05), sleep-related quality-of-life (Pittsburgh Sleep Quality Index; MD -3.00; 95% CI, -4.52, -1.49, p < 0.05), and minimum oxygen saturation (MD 2.71; 95% CI, 0.23, 5.18, p < 0.05) when compared with sham OMT or no therapy. Within the single RCT featuring pediatric OMT patients, patients had poor compliance (<50%) and did not show any improvements in AHI, minimum oxygen saturation, or snoring frequency. CONCLUSION OMT may provide a reasonable alternative for OSA patients who cannot tolerate CPAP or other more established treatment options. OMT benefits appear limited in children due to poor compliance. More studies are required to evaluate compliance and the long-term effects of OMT on OSA outcomes. LEVEL OF EVIDENCE 1 Laryngoscope, 134:480-495, 2024.
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Affiliation(s)
- Elias S Saba
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, U.S.A
| | - Hannah Kim
- Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Pauline Huynh
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, U.S.A
| | - Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, U.S.A
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O'Connor-Reina C, Rodriguez-Alcala L, Ignacio JM, Baptista P, Garcia-Iriarte MT, Plaza G. Assessment of Muscular Weakness in Severe Sleep Apnea Patients: A Prospective Study. Otolaryngol Head Neck Surg 2023; 169:725-733. [PMID: 36939539 DOI: 10.1002/ohn.283] [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: 10/25/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE There are no official diagnostic tools to evaluate the weakness of the genioglossus muscle. We have developed a protocol for muscular assessment in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS) and evaluated its effectiveness. STUDY DESIGN Case and controls prospective study. SETTING Sleep Unit Hospital Quironsalud Marbella (Spain). METHODS Twenty-nine cases and 20 controls were recruited. Patients were examined by a phonoaudiologist that performed biometric measurements and the Orofacial Myofunctional Evaluation With Scores (OMES), Friedman, and Epworth Sleepiness Scale (ESS). In addition, upper airway muscle strength measures were performed using the Iowa Oral Performance Instrument (IOPI) and Tongue Digital Spoon (TDS). RESULTS The final cohort consisted of 49 subjects, including 29 cases and 20 controls. According to the univariate and multivariate logistic regression analyses, ESS, OMES protocol, IOPI score, and TDS were associated with severe OSAHS. Multivariate regression revealed an IOPI score below 48 kps with an adjusted odds ratio (OR) of 9.96 (95% confidence interval [CI] 2.5-39.1, p = .001), and a 0.72 specificity (Spe), a 0.79 sensitivity (Sens), and a 0.82 area under the curve (AUC). Similarly, an OMES score lower than 200 had an adjusted risk ratio of 4.02 (95% CI 2-7, p < .001), 1 Spe, 0.79 Sens, and 0.98 AUC; and finally, TDS scores lower than 201 g/cm2 showed an adjusted OR of 27 (95% CI 4.74-153.6, p = .0001), 0.66 Spe, a 0.93 Sens, and a 0.86 AUC. CONCLUSION Our findings suggest that severe OSAHS patients present different muscle patterns than controls.
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Affiliation(s)
- Carlos O'Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, Marbella, Spain
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain
| | - Laura Rodriguez-Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, Marbella, Spain
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, Palmones, Spain
| | - Jose M Ignacio
- Neumology Department, Hospital Quironsalud Marbella, Marbella, Spain
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos de Madrid, Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, Madrid, Spain
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Zhang T, Liu H, Lu Y, Wang Q. The Nexus of Sports-Based Development and Education of Mental Health and Physical Fitness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3737. [PMID: 36834432 PMCID: PMC9967856 DOI: 10.3390/ijerph20043737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Physical inactivity has increased globally, particularly in developed nations. A high proportion of the human population is unable to meet the physical activity recommendation of the World Health Organisation due to hypertension, metabolic syndrome, obesity, and other medical conditions. Non-communicable diseases and mental health problems are becoming more prevalent, particularly in low and middle-income nations. This study aimed to determine the effectivenessof a mentorship programmeon university students' mental health and physical fitness. The intervention comprised the effects of sports-based development and education on physical fitness and mental health. A total of 196 and 234 students from two universities were randomly assigned to the intervention and control groups, respectively. The primary outcomes were engagement in physical activities (number of push-ups for 1 min, the strength of hand grip (kg), and the Jump test while standing (cm)), body fat proportion and psychological resilience, self-efficacy, and relationship with family and schoolmates. Participants in the control group had access to a web-based health education game, whereas the intervention group wassubjected to intensive interventional activities for one month based on the eight principles of the National Research Council and Institute of Medicine. Data were analysed using Analysis of Variance (ANOVA) to compare the physical and mental components between the intervention and control groups. Relative to baseline, all the physical health components (push-ups, sit-ups, and jump tests), psychological resilience, relationship with family members, and self-efficacy increased significantly in the intervention compared to the control group. Body fat composition was significantly reduced in the intervention when compared tothe control group. In conclusion, the mentorship programme effectively improved the participants' physical and psychological health and could be developed further for application in a larger population.
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Affiliation(s)
- Tiejun Zhang
- Sports Ministry, Henan University of Economics and Law, Zhengzhou 450011, China
| | - Huarong Liu
- School of Physical Education, China University of Geosciences, Wuhan 430074, China
| | - Yi Lu
- Sports Teaching and Research Section, Wuhan University of Communications, Wuhan 430205, China
| | - Qinglei Wang
- Faculty of Sport and Exercise Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia
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Barbed Pharyngoplasty for Snoring: Does It Meet the Expectations? A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11030435. [PMID: 36767010 PMCID: PMC9914261 DOI: 10.3390/healthcare11030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
To date, the use of barbed sutures for the surgical management of patients suffering from obstructive sleep apnea and snoring with retropalatal collapse and vibration has significantly increased. A systematic review was carried out, which included clinical studies that used barbed sutures for the treatment of snoring. A qualitative analysis, including six clinical studies, was conducted. Of these, five were studies on barbed pharyngoplasties, and one study involved a minimally invasive surgical procedure. The population consisted of 176 patients, aged 26 to 58 years old. Overall, the included studies showed a mean gain in the snoring Visual Analog Scale of 5.67 ± 1.88, with a mean preoperative value of 8.35 ± 1.17 and a postoperative value of 2.68 ± 1.27. No major complications were described. Given the lack and heterogeneity of this evidence, the conclusion calls for being cautious. In carefully selected snorers and obstructive sleep apnea patients, the use of barbed sutures could represent a valid therapeutic strategy for snoring, ensuring a statistically significant improvement in the subjective parameters. Further studies on a larger scale that assess the role of barbed pharyngoplasties in snoring surgery and more extended follow-up studies are needed in order to confirm these promising results.
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吴 楚, 卢 镇, 陈 李, 聂 国, 卢 永, 陶 晶. [Effects of orofacial myofunctional therapy on postoperative outcomes of upper airway surgery for adults with severe obstructive sleep apnea]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:916-920. [PMID: 36543398 PMCID: PMC10128283 DOI: 10.13201/j.issn.2096-7993.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Indexed: 12/24/2022]
Abstract
Objective:To investigate the effect of orofacial myofunctional therapy on the clinical efficacy of upper airway surgery for adults with severe obstructive sleep apnea(OSA). Methods:A total of 48 patients with OSA who underwent upper airway surgery in the Shenzhen Second People's Hospital from June 2020 to September 2021 were included in this study. These patients were randomly divided into the combination group(21 cases) and the surgery group(27 cases). The effective rate, AHI, minimum blood oxygen saturation, snoring events and Epworth sleepiness scale scores at 6 months after operation were compared and analyzed between the two groups. Results:The proportions of AHI, LSaO2, snoring events, and total snoring time in the combined group at 6 months after operation were(14.77±9.15) times/h, (81.19±6.52)%, (172.43±73.67) times, and(13.16±6.02)%. The proportion of AHI, LSaO2, snoring events, and total snoring time in surgical group at 6 months after operation was(23.87±10.6) times/h, (80.78±4.88)%, (235.81±83.23) times, (17.58±5.94)%. Compared with preoperative 6 months after operation, the proportion of AHI, snoring events, and total snoring time was significantly decreased, and LSaO2was significantly increased, and the differences were statistically significant(P<0.05). The time of snoring and the proportion of snoring to time were significantly improved compared with those in the simple operation group, and the differences were statistically significant(P<0.05). Conclusion:This study verified that orofacial myofunctional therapy can improve the clinical efficacy after upper airway surgery for adults with severe obstructive sleep apnea.
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Affiliation(s)
- 楚城 吴
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
| | - 镇章 卢
- 深圳大学附属华南医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, South China Hospital of Shenzhen University
| | - 李清 陈
- 深圳大学总医院耳鼻咽喉头颈外科Department of Otorhinolaryngology Head and Neck Surgery, Shenzhen University General Hospital
| | - 国辉 聂
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
| | - 永田 卢
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
| | - 晶 陶
- 深圳市第二人民医院耳鼻咽喉头颈外科(广东深圳, 518000)Department of Otorhinolaryngology Head and Neck Surgery, the Second Hosipital of Shenzhen, Shenzhen, 518000, China
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Poncin W, Correvon N, Tam J, Borel J, Berger M, Liistro G, Mwenge B, Heinzer R, Contal O. The effect of tongue elevation muscle training in patients with obstructive sleep apnea: A randomised controlled trial. J Oral Rehabil 2022; 49:1049-1059. [PMID: 36081312 PMCID: PMC9826101 DOI: 10.1111/joor.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/23/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Oropharyngeal myofunctional therapy is a multi-component therapy effective to reduce the severity of obstructive sleep apnoea (OSA). However, existing protocols are difficult to replicate in the clinical setting. There is a need to isolate the specific effectiveness of each component of the therapy. OBJECTIVE To assess the effects of a 6 weeks tongue elevation training programme in patients with OSA. METHODS We conducted a multicentre randomised controlled trial. Eligible participants were adults diagnosed with moderate OSA who presented low adherence to continuous positive airway pressure therapy (mean use <4 h per night). The intervention group completed a 6 weeks tongue elevation training protocol that consisted in anterior tongue elevation strength and endurance tasks with the Iowa Oral Performance Instrument. The control group completed a 6 weeks sham training protocol that involved expiratory muscle training at very low intensity. Polygraphy data, tongue force and endurance, and OSA symptoms were evaluated pre- and post-intervention. The primary outcome was apneoa-hypopnea index (AHI). RESULTS Twenty-seven patients (55 ± 11 years) were recruited. According to modified intention-to-treat analysis (n = 25), changes in AHI and c did not significantly differ between groups. Daytime sleepiness (Epworth Sleepiness Scale) and tongue endurance significantly improved in the intervention group compared to the control group (p = .015 and .022, respectively). In the intervention group, 75% of participants had a decrease in daytime sleepiness that exceeded the minimal clinically important difference. CONCLUSION Six weeks of tongue elevation muscle training had no effect on OSA severity.
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Affiliation(s)
- William Poncin
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland,Institute of Experimental and Clinical Research (IREC), pôle de Pneumologie, ORL et DermatologieUniversité Catholique de LouvainBrusselsBelgium,Service de Pneumologie, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Nils Correvon
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Jonathan Tam
- HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland,Service de Physiothérapie cardio‐respiratoire, département de chirurgie, cœur‐vaisseau et centre interdisciplinaireCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | | | - Mathieu Berger
- Center for Investigation and Research in SleepCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland
| | - Giuseppe Liistro
- Service de Pneumologie, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Benny Mwenge
- Service de Pneumologie, Cliniques universitaires Saint‐LucBrusselsBelgium
| | - Raphael Heinzer
- Center for Investigation and Research in SleepCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland
| | - Olivier Contal
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
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Habumugisha J, Cheng B, Ma SY, Zhao MY, Bu WQ, Wang GL, Liu Q, Zou R, Wang F. A non-randomized concurrent controlled trial of myofunctional treatment in the mixed dentition children with functional mouth breathing assessed by cephalometric radiographs and study models. BMC Pediatr 2022; 22:506. [PMID: 36008795 PMCID: PMC9413933 DOI: 10.1186/s12887-022-03559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to examine the clinical effects of myofunctional treatment on children with functional mouth breathing by cephalometric radiographs and study models. Methods A total of 224 children (6–10 years old; 114 males and 110 females; SNA°: 82.24 ± 1.67°; ANB°: 2.79 ± 0.80°, 28° < SN-GoGn° < 37°) formed three groups: MB-M group (mouth breathers with myofunctional treatment,n = 75); MB-N group (mouth breathers with no treatment,n = 70); NB group (nasal breathers with no treatment, n = 79). A blind evaluation of cephalometric radiographs and study models was conducted at T1(pre-study) and T2 (post-study), respectively. Results Two hundred four children (MB-M:66, MB-N:68, NB:70) completed the present study. At T1, MB-M and MB-N groups, compared to their NB counterpart, had greater anterior lower facial height(P < 0.01) and overjet(P < 0.001) but shorter overbite and maxillary canines width (P < 0.001). At T2, the MB-N group exhibited a higher ANB angle, anterior lower facial height, and overjet, but shorter overbite and maxillary canines width (P < 0.001). From T1 to T2, the anterior lower facial height increased, overbite and the maxillary canines width further decreased in the MB-N group (P < 0.001). However, in the MB-M group, the incisors were retracted, overbite increased (P < 0.001), anterior lower facial height increased insignificantly (P > 0.05), and maxillary canines width increased slightly (P < 0.05). In the NB and MB-M groups, the mandible showed a normal tendency to grow forward, whereas, in the MB-N group, the mandible showed a tendency to grow downward (P < 0.001). Conclusions Mouth breathers demonstrated increased anterior facial height and overjet but reduced overbite and maxillary arch width, which improved significantly following myofunctional treatment. Trial registration TCTR: TCTR20220401001. Registered 1stApril 2022-Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03559-w.
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Affiliation(s)
- Janvier Habumugisha
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Bo Cheng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Shu-Yu Ma
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Min-Yue Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Wen-Qing Bu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Gao-Li Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Qiong Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China
| | - Rui Zou
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China.
| | - Fei Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, 98 Xi Wu Road, Xi'an, Shaanxi, 710004, People's Republic of China.
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Garaycochea O, Baptista P, Calvo-Imirizaldu M, Terrasa D, Moffa A, Casale M, Alcalde J, O'Connor-Reina C, Plaza G, Fernández S. Surgical anatomy of the lingual nerve for palate surgery: where is located and how to avoid it. Eur Arch Otorhinolaryngol 2022; 279:5347-5353. [PMID: 35771281 PMCID: PMC9519696 DOI: 10.1007/s00405-022-07432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the anatomic relationship of the lingual nerve with the lateral oropharyngeal structures. METHODS An anatomic dissection of the lateral oropharyngeal wall was conducted in eight sides from four fresh-frozen cadaveric heads. Small titanium clips were placed along the lingual nerve and the most anterior and medial border of the medial pterygoid muscle. Radiological reconstructions were employed for optimal visualization; the coronal view was preferred to resemble the surgical position. The distance between the lingual nerve and the medial pterygoid muscle at its upper and lower portion was measured radiologically. The trajectory angle of the lingual nerve with respect to the pterygomandibular raphe was obtained from the intersection between the vector generated between the clips connecting the upper and lower portion of the medial pterygoid muscle with the vector generated from the lingual nerve clips. RESULTS The mean distance from the upper portion of the medial pterygoid muscle and superior lingual nerve clips was 10.16 ± 2.18 mm (mean ± standard deviation), and the lower area of the medial pterygoid muscle to the lingual nerve was separated 5.05 ± 1.49 mm. The trajectory angle of the lingual nerve concerning to the vector that describes the upper portion of the most anterior and medial border of the medial pterygoid muscle with its lower part was 43.73º ± 11.29. CONCLUSIONS The lingual nerve runs lateral to the lateral oropharyngeal wall, from superiorly-inferiorly and laterally-medially, and it is closer to it at its lower third.
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Affiliation(s)
- Octavio Garaycochea
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain. .,Otorhinolaryngology Department, Hospital Clínic de Barcelona, c/ Paris 146-3º-2ª, 08036, Barcelona, Spain.
| | - Peter Baptista
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Marta Calvo-Imirizaldu
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - David Terrasa
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Antonio Moffa
- School of Medicine, Campus Bio-Medico University, Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Manuele Casale
- School of Medicine, Campus Bio-Medico University, Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Juan Alcalde
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, Spain
| | - Secundino Fernández
- Department of Otorhinolaryngology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Obstructive Sleep Apnea Syndrome: From Symptoms to Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042459. [PMID: 35206645 PMCID: PMC8872290 DOI: 10.3390/ijerph19042459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 01/16/2023]
Abstract
Obstructive sleep apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete recurrent episodes of upper airway collapse that occur during the night. The OSA manifests with a reduction (hypopnea) or complete cessation (apnea) of airflow in the upper airways, associated with breathing effort. OSA is a frequent and often underestimated pathology affecting between 2 and 5% of the middle-aged population. Typical nocturnal symptoms are the persistent snoring and awakenings with dyspnea sensation. On the other hand, diurnal symptoms could be sleepiness, headaches, asthenia, neurological disorders, and impaired personal relationships. Surgery of the velo-pharyngeal region had a huge evolution going from ablative techniques (UP3 and LAUP) to remodeling techniques of the pharyngeal lateral walls.
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O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Alcala L, Rodríguez Ruiz E, Garcia Iriarte MT, Casado Morente JC, Baptista P, Plaza G. Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing. J Clin Med 2021; 10:5772. [PMID: 34945068 PMCID: PMC8707643 DOI: 10.3390/jcm10245772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 12/31/2022] Open
Abstract
Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence-only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea-hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie.
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Affiliation(s)
- Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | | | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Elisa Rodríguez Ruiz
- Pulmonology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (J.M.I.G.); (E.R.R.)
| | | | - Juan Carlos Casado Morente
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29603 Marbella, Spain; (C.O.-R.); (L.R.A.); (J.C.C.M.)
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, 31008 Pamplona, Spain;
| | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28942 Madrid, Spain
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