Integrated TCM care program combined with intranasal corticosteroids to treat pediatric obstructive sleep apnea: A case series study

2019 ◽  
Vol 6 ◽  
pp. S89
Author(s):  
Lai Wan-Yu ◽  
Yen Hung-Rong
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Case Series ◽  
Care Program ◽  
Intranasal Corticosteroids ◽  
Obstructive Sleep ◽  
Case Series Study ◽  
Series Study

scholarly journals Endoscopic Harmonic Midline Partial Glossectomy in Obstructive Sleep Apnea

2021 ◽  
pp. 98-104
Author(s):  
A. I. Elkawa ◽  
Y. I. Aglan ◽  
M. A. Hagras
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Case Series ◽  
University Hospital ◽  
Obstructive Sleep ◽  
Case Series Study ◽  
Prospective Case Series ◽  
Series Study ◽  
Partial Glossectomy ◽  
Posterior Midline

Aim: Our study was done to evaluate the role of Endoscopic posterior midline partial glossectomy as a surgical modality for the hypopharyngeal collapse in obstructive sleep apnea patients. Study design: Prospective case series study. Place and Duration of Study: Tanta university hospital, otolaryngology department, from October 2017 till March 2019. Methodology: This was a prospective case series study, conducted on 10 patients from 2017 -2019 with tongue base collapse and normal craniofacial angles, the patients were evaluated preoperative and 6 months postoperative subjectively by Epworth sleepiness scale (ESS) and objectively by polysomnography and lateral cephalometry. Results: Our study included 10 patients with age (mean ± SD48.70±4.08), BMI( mean ±SD24.45±1.56), 5 patients showed a significant reduction in AHI with a success rate of 50% with a significant change in ESS and the non-significant changes in cephalometric parameters. Conclusion: Transoral endoscopic posterior midline partial glossectomy can improve the surgical outcomes of obstructive sleep apnea patients.

scholarly journals Multilevel Sleep Surgery Including the Palate in Nonsyndromic, Neurologically Intact Children with Obstructive Sleep Apnea

OTO Open ◽  
2019 ◽  
Vol 3 (2) ◽  
pp. 2473974X1985147
Author(s):  
Jason E. Cohn ◽  
George E. Relyea ◽  
Srihari Daggumati ◽  
Brian J. McKinnon
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
Case Series ◽  
T Test ◽  
Velopharyngeal Insufficiency ◽  
Apnea Hypopnea Index ◽  
Sleep Surgery ◽  
Obstructive Sleep ◽  
Neurologically Intact

Objective To examine the effects of multilevel sleep surgery, including palate procedures, on obstructive sleep apnea parameters in the pediatric population. Study Design A case series with chart review was conducted to identify nonsyndromic, neurologically intact pediatric patients who underwent either uvulectomy or uvulopalatopharyngoplasty as part of multilevel sleep surgery from 2011 through 2017. Setting A tertiary care, university children’s hospital. Subjects and Methods Unpaired Student t test was used to compare average pre- and postsurgical apnea-hypopnea index (AHI) and oxygen saturation nadir (OSN). Paired Student t test was used to compare the mean pre- and postsurgical AHI and OSN within the same patient for the effects of adenotonsillectomy (T&A) vs multilevel sleep surgery. Results In patients who underwent T&A previously, multilevel sleep surgery, including palate procedures, resulted in improved OSA severity in 6 (86%) patients and worsened OSA in 1 (14%) patient. Multilevel sleep surgery, including palate procedures, significantly decreased mean AHI from 37.98 events/h preoperatively to 8.91 events/h postoperatively ( P = .005). However, it did not significantly decrease OSN. Conclusion This study includes one of the largest populations of children in whom palate procedures as a part of multilevel sleep surgery have been performed safely with no major complications and a low rate of velopharyngeal insufficiency. Therefore, palatal surgery as a part of multilevel sleep surgery is not necessarily the pariah that we have traditional thought it is in pediatric otolaryngology.

scholarly journals 0598 Blurred Binaries: The Clinical Management of Obstructive Sleep Apnea in Transgender Patients

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A229-A229
Author(s):  
B Peters-Mathews ◽  
M Lee ◽  
A Sabzpoushan
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Gender Identity ◽  
Mood Disorders ◽  
Case Series ◽  
Careful Consideration ◽  
Comorbid Conditions ◽  
Loss To Follow Up ◽  
Obstructive Sleep

Abstract Introduction Transgender patients require careful clinical assessment to identify the effects of hormones on their risk of obstructive sleep apnea. Testosterone increases sleep apnea risk and assigned males at birth may develop the condition earlier. Estrogen and progesterone are known to reduce sleep apnea risk. Depending on the use of supplemental hormones and surgical status, the risk of sleep apnea may be altered in a transgender patient. Comorbid conditions, including mood disorders and obesity, may further impact sleep. This topic has not been well-studied, and this pilot project identifies special needs that exist in transgender populations. Methods This retrospective chart review included 25 subjects who identify as transgender who have been managed at an urban sleep disorders center from 2017 to 2019. The case series was assessed to identify characteristics that impact the diagnosis and treatment of obstructive sleep apnea (natural and supplemental hormonal effects, surgical effects, comorbid conditions, etc.). Results The average age of the cohort was 34 years (range 16 to 76). Fourteen subjects were assigned females at birth and identify as men and 11 subjects were assigned males at birth and identify as women. Preferred pronoun usage was concordant with gender identity in 21 subjects, discordant in 1 subject, and gender-neutral (they/them) was used by 3 subjects. Based on 24 subjects, the average BMI was 35.5 (range 23.5 to 53.1). The measured neck circumference was <16 inches in 9 subjects, >17 inches in 6 subjects,and a risk factor for sleep apnea based on birth-assigned sex but not gender identity in 4 subjects. Hormone therapy was used by 24 subjects to enhance their gender identities. When documented, 6 subjects had mastectomies and 2 also had total hysterectomies. Anxiety or depression had been diagnosed in 20 subjects. Testing revealed sleep apnea in 18 subjects. Loss to follow up affected 9 subjects. Conclusion Transgender patients deserve respectful evaluation and careful consideration regarding risk factors for obstructive sleep apnea that may be impacted by gender-affirming hormonal therapy or surgery, and weight gain. Higher rates of mood disorders and loss to follow up may put these patients at long-term risk. Support N/A

Polysomnography Outcomes after Supraglottoplasty in Children with Obstructive Sleep Apnea

2019 ◽  
Vol 161 (4) ◽  
pp. 694-698 ◽  
Author(s):  
Bharat Bhushan ◽  
James W. Schroeder ◽  
Kathleen R. Billings ◽  
Nicholas Giancola ◽  
Dana M. Thompson
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
Case Series ◽  
Apnea Hypopnea Index ◽  
Historical Cohort ◽  
Tertiary Care Medical Center ◽  
Obstructive Sleep ◽  
The Mean ◽  
The Impact

ObjectiveLaryngomalacia has been reported to contribute to the severity of obstructive sleep apnea (OSA) in children. It is unclear if surgical treatment of laryngomalacia improves polysomnography (PSG) outcomes in these patients. The objective of this study is to report the impact of supraglottoplasty on PSG parameters in children with laryngomalacia-related OSA.Study DesignRetrospective case series.SettingTertiary care medical center.Subjects and MethodsHistorical cohort study of consecutive children with laryngomalacia who underwent supraglottoplasty and who had undergone overnight PSG before and after surgery.ResultsForty-one patients were included in the final analysis: 22 (53.6%) were male, and 19 (46.3%) were female. The mean ± SEM age of patients at preoperative PSG was 1.3 ± 0.89 years (range, 0.003-2.9). In entire cohort, the mean obstructive apnea-hypopnea index score was reduced from 26.6 events/h before supraglottoplasty to 7.3 events/h after surgery ( P = .003). Respiratory disturbance index was reduced from 27.3 events/h before supraglottoplasty to 7.8 events/h after surgery ( P = .003). The percentage of REM sleep decreased from 30.1% ± 2.4 to 24.8% ± 1.3 ( P = .04). Sleep efficiency was improved ( P = .05).ConclusionOverall, supraglottoplasty significantly improved several PSG outcomes in children with laryngomalacia. However, mild to moderate OSA was still present postoperatively in most children. This suggested a multifactorial cause for OSA in this population.

Topical Triamcinolone on “Sweet Spots” to Block Dynamic Pain after Tonsillectomy and Uvulo-Palato-Pharyngo-Plasty

2020 ◽  
pp. 000348942095360
Author(s):  
Joshua Kuang-Chao Chen ◽  
David M. Niddam ◽  
Tao-Hsin Tung ◽  
Lieber Po-Hung Li
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Case Series ◽  
Retrospective Case ◽  
Average Improvement ◽  
Obstructive Sleep ◽  
Apnea Syndrome ◽  
Sweet Spots

Objectives: Severe pain on swallowing (or dynamic pain) has long been a problem in patients receiving tonsillectomy and uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome and/or snoring. We have previously verified that dynamic pain after laser-assisted uvulopalatoplasty could immediately be mitigated by local treatments with topical triamcinolone on the “sweet spots” of the wounds. This study aimed to assess the efficacy of applying triamcinolone on “sweet spot” in surgical incisions instead of whole surgical wounds to alleviate dynamic pain of some oropharyngeal surgeries such as tonsillectomy and uvulopalatopharyngoplasty. Methods: This study is a retrospective case series based on chart review of the participants. Forty-five subjects (31 males; 12~68 years, mean 34 years) with obstructive sleep apnea syndrome and/or snoring treated with tonsillectomy or uvulopalatopharyngoplasty were studied. Local treatments were done to sweet spots with triamcinolone on the 1st, 2nd, 3rd, and 7th days after the surgery. Evaluation of dynamic pain relief was performed by using a visual analogous scale. Results: Sweet spots treatment led to instantaneous reduction of dynamic pain. The average improvement level was ≥72% ( P ≤ .002). No gender effect was noted. Conclusion: Dynamic pain after tonsillectomy and uvulopalatopharyngoplasty could immediately be mitigated by local treatments upon sweet spots. Local treatments upon sweet spots were highly suggested to begin early post-operatively and be included in the take-home routines for patients receiving tonsillectomy and uvulopalatopharyngoplasty.

Polysomnography in Pediatric Otolaryngology: If Not Obstructive Sleep Apnea, What Is It?

2017 ◽  
Vol 157 (6) ◽  
pp. 1053-1059 ◽  
Author(s):  
Christine H. Heubi ◽  
Jareen Meinzen-Derr ◽  
Sally R. Shott ◽  
David F. Smith ◽  
and Stacey L. Ishman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disturbances ◽  
Case Series ◽  
Central Sleep Apnea ◽  
Categorical Variables ◽  
Periodic Limb Movements ◽  
Continuous Variables ◽  
Retrospective Case ◽  
Obstructive Sleep

Objective To determine common polysomnographic (PSG) diagnoses for children referred by otolaryngologists. Study Design Retrospective case series with chart review. Setting Single tertiary pediatric hospital (2010-2015). Subjects and Methods Review of the medical records of 1258 patients undergoing PSG by otolaryngology referral. Patients who underwent previous otolaryngologic surgery were excluded. Data distributions were evaluated using means with standard deviations for continuous variables and frequencies with percentages for categorical variables. Results A total of 1258 patients were included; 55.9% were male, 64.5% were Caucasian, 16.6% had Down syndrome, and 48% had public insurance. The median age at the time of PSG was 5.2 years (range = 0.2-18.94). Indications for PSG were sleep-disordered breathing (SDB; 69.4%), restless sleep (12.7%), airway anomalies (7.5%), and laryngomalacia (7.2%). SDB was seen in 73.4%, obstructive sleep apnea (OSA) in 53.2%, OSA + central sleep apnea (CSA) in 4.5%, CSA in 0.9%, and non-OSA snoring in 15%. Other diagnoses included periodic limb movements of sleep (PLMS; 7.4%), hypoventilation (6.8%), and nonapneic hypoxemia (2.6%). SDB was more common in younger children and seen in 91.4% of children <12 months and in 69.2% of children ≥24 months, while non-OSA snoring was more common with increasing age (3.7% in children <12 months, 17.7% of children ≥24 months). PLMS were seen in 8.9% of children ≥24 months and in no children <12 months. Conclusion While OSA and snoring were the most common diagnoses reported, PLMS, alveolar hypoventilation, and CSA occurred in 7.4%, 6.8%, and 5.4%, respectively. These findings indicate that additional diagnoses other than OSA should be considered for children seen in an otolaryngology clinic setting who undergo PSG for sleep disturbances.

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