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Poehlmann Y, Tek F, Beckedorf B, Verse T. [Combined therapy of severe obstructive sleep apnea]. HNO 2024; 72:440-442. [PMID: 38051314 DOI: 10.1007/s00106-023-01394-8] [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] [Accepted: 11/10/2023] [Indexed: 12/07/2023]
Abstract
Obstructive sleep apnea is the most common breathing-related sleep disorder. The spectrum of therapy is wide ranging. The symptom of persistent daytime sleepiness can be an important indicator for reviewing the existing treatment. If polygraphic monitoring shows inadequate treatment under ongoing therapy, a combination of therapies should be considered.
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Affiliation(s)
- Yano Poehlmann
- Department für HNO, Kopf-Hals-Chirurgie, Asklepios Campus Hamburg, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland.
- Semmelweis Universität Budapest, Budapest, Ungarn.
| | - Ferhat Tek
- Department für HNO, Kopf-Hals-Chirurgie, Asklepios Campus Hamburg, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
- Semmelweis Universität Budapest, Budapest, Ungarn
| | - Bjoern Beckedorf
- Department für HNO, Kopf-Hals-Chirurgie, Asklepios Campus Hamburg, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
- Semmelweis Universität Budapest, Budapest, Ungarn
| | - Thomas Verse
- Department für HNO, Kopf-Hals-Chirurgie, Asklepios Campus Hamburg, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Deutschland
- Semmelweis Universität Budapest, Budapest, Ungarn
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2
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Kanotra SP, Rand D, Mulanax C. Transcervical Epiglottopexy: A versatile technique for managing epiglottic prolapse. Otolaryngol Head Neck Surg 2024; 170:380-390. [PMID: 37622519 DOI: 10.1002/ohn.488] [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: 05/11/2023] [Revised: 06/23/2023] [Accepted: 07/29/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Epiglottic prolapse (EP) presents a unique management challenge. The objective of the present case series is to present clinical outcomes using a novel technique of transcervical epiglottopexy (TCE) in etiologically diverse cases of EP and to discuss the evolution of the surgical technique with technical modifications to optimize the surgical procedure. STUDY DESIGN A retrospective case series review. SETTING Tertiary care academic setting. METHODS Pediatric cases with EP over a 3-year period. Demographic data including age, sex, presenting symptoms, operative details, and polysomnographic indices were collected. RESULTS A total of 18 patients with a mean age of 48.88 ± 37.3 months underwent TCE. Sixty-seven percent of patients had high-grade EP (grades 3 and 4). A previous endolaryngeal epiglottopexy had been performed in 5 (28%) patients. Fourteen (78%) patients had a concurrent airway procedure performed including 4 undergoing single-stage laryngotracheal reconstruction. The mean suspension time only for the TCE part ranged from 8 to 17 minutes with a mean of 11.23 ± 3.4 minutes. A stable EP defined as a healed glossoepiglottic adhesion was achieved in all but 1 case with an overall success rate of 95%. All cases with previous failed endoscopic epiglottopexy had a stable epiglottopexy. No immediate complications were noticed. Among the late complications, the most common was the formation of granulation tissue at the site of silastic disc placement which was seen in 3 patients. CONCLUSION TCE using an exo-endolaryngeal technique can achieve stable epiglottopexy in children with EP and can be adapted for any kind of EP.
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Affiliation(s)
- Sohit Paul Kanotra
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Dayton Rand
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Catalina Mulanax
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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3
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Kant E, Hardeman JA, Stokroos RJ, Copper MP. Treatment of a floppy epiglottis with upper airway stimulation therapy. Eur Arch Otorhinolaryngol 2024; 281:461-467. [PMID: 37906364 DOI: 10.1007/s00405-023-08268-3] [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: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To evaluate the efficacy of upper airway stimulation therapy in patients with a floppy epiglottis who have experienced continuous positive airway pressure failure or intolerance. METHODS A retrospective single-center cohort study was conducted. Patients who received an Inspire Upper Airway Stimulation system and had a 1-year follow-up were included. Baseline and one-year in-laboratory polysomnography examinations were performed. Patient characteristics, Epworth Sleepiness Scale scores and upper airway stimulation device settings were collected. RESULTS A total of 75 patients were included, of whom 10 had a floppy epiglottis. Patients with a floppy epiglottis had a significant therapeutic response to upper airway stimulation therapy, similar to patients without a floppy epiglottis. According to the Sher's success criteria, 90% of patients with a floppy epiglottis and 68% of patients without a floppy epiglottis were responders to therapy (p = 0.149). In the floppy epiglottis group, the apnea-hypopnea index decreased from 35.1 ± 5.5 events/hour to 11.2 ± 11.3 events/hour (95% CI (15.0, 32.9), p < 0.001), similarly in the non-floppy epiglottis group, the decline was from 36.4 ± 8.3 events/hour to 14.4 ± 9.5 events/hour (95% CI (18.6, 25.2), p < 0.001, between groups p = 0.659). Comparable reductions were observed for the other respiratory parameters. CONCLUSION Treatment of patients with obstructive sleep apnea and a floppy epiglottis can be challenging. Continuous positive airway pressure may aggravate the epiglottis collapse. Upper airway stimulation therapy can be considered an effective alternative treatment option for patients with a floppy epiglottis who have encountered either continuous positive airway pressure failure or intolerance.
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Affiliation(s)
- E Kant
- Department of Otorhinolaryngology, Head and Neck Surgery, Sint Antonius Hospital, Koekoekslaan 1, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J A Hardeman
- Department of Pulmonology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - R J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M P Copper
- Department of Otorhinolaryngology, Head and Neck Surgery, Sint Antonius Hospital, Koekoekslaan 1, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands.
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Kattimani V, Panneerselvam E, Tiwari R, Panga GSK, Sreeram RR. An Overview of Systematic Reviews on the Surgical Management of Obstructive Sleep Apnoea. J Maxillofac Oral Surg 2023; 22:781-793. [PMID: 38105854 PMCID: PMC10719205 DOI: 10.1007/s12663-023-02051-x] [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: 08/24/2023] [Accepted: 10/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Obstructive Sleep Apnoea (OSA) is a common sleep disorder marked by partial or total obstruction of the upper airway while a person is asleep leading to breathing difficulty, reduced oxygenation and frequent awakenings. This condition affects the general health significantly compromising quality of life. The objective of this overview is to thoroughly assess the systematic reviews on current surgical therapies for the management of OSA in terms of patient outcomes. Methods A thorough literature search was performed from inception till 31st December 2022 using PubMed, and Cochrane databases. Studies evaluating the effectiveness and safety of different surgical techniques for the management of OSA were considered. The quality of articles was assessed using AMSTAR (A MeaSurement Tool to Assess systematic Reviews) and Glenny et al. checklist. Results Out of eighteen studies, only seven studies met the inclusion and exclusion criteria. Results showed that the majority of studies were in the pediatric age group except one systematic review which assessed the adult age group. Conclusion None of the published articles had compared all surgical procedures based on the standard evaluating procedure nor followed all reporting guidelines in the primary studies. For better implementation, further multi center studies are warranted with unique reporting criteria and guidelines about pre- as well as post-operative phases. Future research should concentrate on contrasting strategies, combination therapies, and evaluating long-term effects. Supplementary Information The online version contains supplementary material available at 10.1007/s12663-023-02051-x.
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Affiliation(s)
- Vivekanand Kattimani
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
| | | | - Rahul Tiwari
- Narsinhbhai Patel Dental College and Hospital, Sankalchand Patel University, Visnagar, Gujarat India
| | | | - Roopa Rani Sreeram
- SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522509 India
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Van den Bossche K, Van de Perck E, Vroegop AV, Verbraecken JA, Braem MJ, Dieltjens M, Op de Beeck S, Vanderveken OM. Quantitative Measurement of Pharyngeal Dimensions During Drug-induced Sleep Endoscopy for Oral Appliance Outcome. Laryngoscope 2023; 133:3619-3627. [PMID: 37366240 DOI: 10.1002/lary.30823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To quantitatively investigate the effect of mandibular advancement devices (MADs) on pharyngeal airway dimensions in a transverse plane as measured during drug-induced sleep endoscopy (DISE). METHODS Data from 56 patients, treated with MAD at 75% maximal protrusion and with baseline Apnea-Hypopnea Index ≥10 events/h, were analyzed. For each patient, three snapshots were selected from DISE video footage at baseline, with MAD presence, and during chin lift, resulting in 498 images (168/168/162, baseline/MAD/chin lift). Cross-sectional areas, anteroposterior (AP) and laterolateral (LL) dimensions on both retroglossal and retro-epiglottic levels were measured. To define the effect of MAD and chin lift on pharyngeal dimensions, linear mixed-effect models were built. Associations between MAD treatment response and pharyngeal expansion (MAD/chin lift) were determined. RESULTS Significant differences were found between retroglossal cross-sectional areas, AP, and LL dimensions at baseline and with MAD presence. At a retro-epiglottic level, only LL dimensions differed significantly with MAD presence compared to baseline, with significant relation of LL expansion ratio to treatment response (p = 0.0176). After adjusting the response definition for the sleeping position, greater retroglossal expansion ratios were seen in responders (1.32 ± 0.48) compared to non-responders (1.11 ± 0.32) (p = 0.0441). No significant association was found between response and pharyngeal expansion by chin lift. CONCLUSION Our observations highlight the additional value of quantitative pharyngeal airway measurements during DISE with MAD presence in evaluating MAD treatment outcome. These findings demonstrate an increase in retroglossal airway dimensions during DISE, with MAD presence, and more pronounced increase in retroglossal expansion ratios in MAD treatment responders compared to non-responders after sleeping position correction. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3619-3627, 2023.
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Affiliation(s)
- Karlien Van den Bossche
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Anneclaire V Vroegop
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan A Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marc J Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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Francia C, Lugo R, Moffa A, Casale M, Giorgi L, Iafrati F, Di Giovanni S, Baptista P. Defining Epiglottic Collapses Patterns in Obstructive Sleep Apnea Patients: Francia-Lugo Classification. Healthcare (Basel) 2023; 11:2874. [PMID: 37958018 PMCID: PMC10647320 DOI: 10.3390/healthcare11212874] [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: 07/28/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Obstructive Sleep Apnea (OSA) is characterized by repetitive collapse of the upper airway during sleep. Drug-Induced Sleep endoscopy (DISE) is used to identify the collapse site. Among the possible sites of collapse, the epiglottis occurs more frequently than previously described. In this study, we reviewed DISE findings and classified different epiglottic collapse patterns. We found 104 patients (16.4%) with epiglottis collapse (primary 12.5% and secondary 3.9%). We described the following patterns of epiglottis collapse: Anterior-Posterior (AP) collapse with rigid component "trapdoor type" (48%); AP collapse with lax component "floppy type" (13.5%); Lateral- Lateral (LL) collapse with omega shape component "book type" (14.5%); and secondary due to lateral pharyngeal wall or tongue base collapse (24%). The identification of the epiglottic collapse pattern is crucial in decision-making when attempting to ameliorate OSA. These findings in OSA phenotyping could influence the type of treatment chosen.
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Affiliation(s)
| | | | - Antonio Moffa
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
- School of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Manuele Casale
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
- School of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Lucrezia Giorgi
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Francesco Iafrati
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
- School of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Simone Di Giovanni
- Integrated Therapies in Otolaryngology, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
- School of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Peter Baptista
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
- ENT Department, Al Zahra Private Hospital Dubai, Dubai 23614, United Arab Emirates
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