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Morato M, Alcaraz M, Bosco G, Pérez-Martín N, Miranda E, O'Connor-Reina C, Cascón JA, Plaza G. DISE with CPAP: a useful procedure to evaluate upper airway collapsibility. Eur Arch Otorhinolaryngol 2024; 281:3797-3804. [PMID: 38578504 DOI: 10.1007/s00405-024-08618-9] [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: 01/16/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Drug-induced sleep endoscopy (DISE) is commonly performed in patients suffering obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) intolerance. We aimed to evaluate the effects of adding CPAP to DISE to provide understanding of the reason of its failure and better guidance in future therapeutic decisions. METHODS A retrospective observational descriptive study was conducted on CPAP-intolerant patients with moderate-severe OSA. DISE was used to evaluate upper airway collapsibility, and CPAP was tested to better describe anatomical sites of obstruction and to measure the opening pharyngeal pressure. RESULTS Sample size consisted of 38 patients with a mean age of 49 ± 9 years. Mean BMI was 28.4 ± 2.4 kg/m2, mean apnea-hypopnea index (AHI) was 35.4 events per hour ± 20.1, and mean saturation under 90% (TSat90) was 14.5%. In DISE we found a collapse at Velum in 92% of patients, at Oropharyngeal level in 89%, at tongue in 42%, and at epiglottis in 36%. In the subgroup of patients with clinical failure with CPAP, we observed 100% of epiglottic collapse and 50% of tongue obstruction. In this specific population, we recommended personalized surgery and myofunctional therapy. CONCLUSION DISE-CPAP is a useful tool to select the treatment that better fits to each patient taking care all information available. It improves our ability to prescribe a multilevel treatment with an exhaustive topographic evaluation of upper airway collapsibility that complements CPAP classic titration, and it can be helpful to distinguish better candidates for surgery, myofunctional therapy or CPAP.
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Affiliation(s)
- Marta Morato
- Department of Otolaryngology, Hospital QuirónSalud San Jose, Calle Cartagena 111, 28002, Madrid, Spain.
| | - Marta Alcaraz
- Department of Otolaryngology, Hospital Sanitas La Moraleja, Madrid, Spain
| | - Gabriela Bosco
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Nuria Pérez-Martín
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Estefanía Miranda
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | | | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada and Hospital Sanitas La Zarzuela, Universidad Rey Juan Carlos, Madrid, Spain
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Machado RR, Palinkas M, de Vasconcelos PB, Gollino S, Arnoni VW, Prandi MVR, Regalo IH, Siéssere S, Regalo SC. Lower limb balance, ankle dorsiflexion, orofacial tissue pressure, and occlusal force of rugby players. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:173-178. [PMID: 38708318 PMCID: PMC11067736 DOI: 10.1016/j.smhs.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/11/2023] [Accepted: 12/04/2023] [Indexed: 05/07/2024] Open
Abstract
This cross-sectional study examined the lower limb balance, ankle dorsiflexion, orofacial tissue pressure, and occlusal strength of rugby players. Twenty-six participants were divided into groups: rugby players (n = 13) and healthy sedentary adults (n = 13). Participants underwent an analysis of lower limb balance using a composite score (Y-Balance Test). Ankle dorsiflexion was measured using the Lunge Test. The Iowa Oral Performance Instrument was employed to measure orofacial tissue pressure. Bite force was measured with a dynamometer, and T-Scan assessed occlusal contact distribution. Data were analyzed using the t-test (p < 0.05) and ANCOVA with age and weight as covariates, where it is possible to verify that these factors did not influence the results obtained. Significant differences were observed in the balance of the right (p = 0.07) and left (p = 0.02) lower limbs, where rugby players had lower composite scores. There were significant differences in the right (p = 0.005) and left (p = 0.004) lunges, with rugby players showing lower values, as well as lower tongue pressure (p = 0.01) and higher lip pressure (p = 0.03), with significant differences to sedentary participants. There was no significant difference in molar bite force and distribution occlusal contacts between groups. Rugby seems to reduce lower limb displacement, cause ankle hypomobility, lead to changes in orofacial tissues, particularly the tongue and lips. This study is significant for identifying significant differences between rugby players and sedentary individuals, providing new insights into the impact of rugby on health and performance, which can benefit sports training and injury prevention.
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Affiliation(s)
- Rafael R. Machado
- School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | - Marcelo Palinkas
- School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM), Ribeirão Preto, Brazil
| | | | - Sara Gollino
- School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | | | | | - Isabela H. Regalo
- School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | - Selma Siéssere
- School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM), Ribeirão Preto, Brazil
| | - Simone C.H. Regalo
- School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
- National Institute for Translational Medicine (INCT-TM), Ribeirão Preto, Brazil
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Rodriguez Alcala C, Rodriguez Alcala L, Ignacio Garcia JM, Plaza G, Baptista P, Lujan G, Mazzei P, Ibañez-Rodriguez JA, O’Connor-Reina C. Use of Ultrasound to Verify the Impact of Telemedicine Myofunctional Therapy on Sleep Apnea Syndrome: Study Protocol Proposal. Life (Basel) 2024; 14:197. [PMID: 38398705 PMCID: PMC10890081 DOI: 10.3390/life14020197] [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: 12/13/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
The anatomy of the upper airways influences the risk of obstructive sleep apnea (OSA). The size of soft tissue structures, such as the tongue, soft palate, and lateral walls of the pharynx, contributes to the pathogenesis of OSA. New lines of treatment for sleep apnea, such as myofunctional therapy (MT), aim to strengthen the oropharyngeal musculature to improve the defining parameters of apnea. The present protocol uses ultrasound imaging to measure the size of the lingual musculature non-invasively and cost-effectively and evaluates the changes in its morphology. Eligible patients include those with OSA who have undergone submental cervical ultrasound and drug-induced sleep endoscopy before starting MT with the AirwayGym app. Follow-up evaluations are conducted at 3 months after beginning treatment. Patients diagnosed with OSA via questionnaires and polysomnography or respiratory polygraphy are evaluated anatomically and functionally using the Iowa Oral Performance Instrument, a tongue digital spoon, somnoscopy, and submental cervical ultrasound to assess their responses to the AirwayGym app. The lingual thickness (mm) and volume (cm3) and the distance between both lingual arteries (mm) are measured. The AirwayGym app helps users and therapists monitor the patient performance of MT. Incorporating submental ultrasound can be a useful non-invasive tool to evaluate OSA and MT.
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Affiliation(s)
| | - Laura Rodriguez Alcala
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | | | - Guillermo Plaza
- Otorhinolaryngology Department, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28943 Madrid, Spain;
- Otorhinolaryngology Department, Hospital Sanitas la Zarzuela, 28023 Madrid, Spain
| | - Peter Baptista
- Otorhinolaryngology Department, Clínica Universitaria de Navarra, 31008 Pamplona, Spain
| | - Guillermina Lujan
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Paula Mazzei
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Juan Antonio Ibañez-Rodriguez
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Carlos O’Connor-Reina
- Otorhinolaryngology Department, Hospital Quironsalud Marbella, 29680 Marbella, Spain; (L.R.A.); (P.M.); (J.A.I.-R.)
- Otorhinolaryngology Department, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
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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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Koecklin KHU, Kato C, Abe Y, Yabushita T, Kokai S, Ono T. Histological and contractile changes in the genioglossus muscle after nasal obstruction in growing rats. Sci Rep 2023; 13:6245. [PMID: 37069178 PMCID: PMC10110532 DOI: 10.1038/s41598-023-32921-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
The aim of the study was to address the genioglossus muscle physiological and histological changes after unilateral nasal obstruction in growing rats. Fifty-four 6-day-old male Wistar albino rats were randomly divided into control (n = 27) and experimental (n = 27) groups. Unilateral nasal obstruction was performed at 8 days old. Contractile properties of the genioglossus whole muscle were measured at 5-, 7- and 9-week-old, including the twitch and tetanic forces, contraction time, half-decay time, and fatigue index. The histological characteristics of the genioglossus were also evaluated at 5-, 7- and 9-week-old, analyzing the myosin heavy chain composition of the slow, fast, IIa and IIb muscle fiber type, by measuring the number, rate, diameter and cross-sectional area. The maximal twitch force, and tetanic force at 60 Hz and 80 Hz force was significantly increased at all ages after nasal obstruction. The fatigue index was decreased at 5 weeks-old after nasal obstruction. The diameter and cross-sectional area of the fast, IIa and IIb muscle fiber types were increased at 7 and 9 weeks after nasal obstruction, while only the diameter of IIa type and cross-sectional area of IIb type were increased at 5 weeks-old after nasal obstruction. Nasal obstruction during growth affects the whole genioglossus muscle contractile properties and histological characteristics, increasing its force, the diameter and area of its muscle fibers. These changes in the genioglossus muscle may affect the normal growth, development and function of the craniofacial complex.
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Affiliation(s)
| | - Chiho Kato
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasunori Abe
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | | | - Satoshi Kokai
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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