456 Esomeprazole Use in Upper Airway Stimulation Patients Associated with Lower Functional Threshold

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A180-A180
Author(s):  
Theodore Klug ◽  
Emily Sagalow ◽  
Ashwin Ananth ◽  
Colin Huntley ◽  
Maurits Boon
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clinical Benefit ◽  
Tertiary Care ◽  
Care Facility ◽  
Upper Airway ◽  
Upper Airway Stimulation ◽  
Tertiary Care Facility ◽  
Obstructive Sleep ◽  
Threshold Amplitude

Abstract Introduction Proton pump inhibitors (PPIs) are widely used for gastroesophageal reflux disease (GERD) despite possible side effects including increased susceptibility to infections, secondary hypergastrinemia, and incomplete absorption of micronutrients. Upper airway stimulation (UAS) surgery involves delivering an electrical impulse to the distal hypoglossal nerve for the management of obstructive sleep apnea.. The functional threshold (FT) is the minimum stimulation required to achieve bulk tongue motion. The minimum therapeutic amplitude (MTA) is the lowest voltage required to achieve clinical benefit during titration at postoperative attended overnight polysomnography. We sought to analyze the effect of perioperative PPI use upon patients who had undergone upper airway stimulation (UAS) surgery. We hypothesized that the ion transport-related effects of PPIs would impact the amplitude necessary for tongue protrusion (FT) and clinical benefit (MTA). Methods A retrospective chart review was conducted at a single tertiary care facility. Baseline demographic data, medication history, and comorbidities were collected from December 2014 through August 2019 on patients undergoing UAS surgery. Patients that were taking a PPI at the time of surgery and postoperatively were included. Results 167 patients that underwent UAS surgery between 2014 – 2019 were studied. 74 patients were found to be taking a PPI perioperatively. Specifically, 38 patients were found to be on omeprazole, compared to 17 on pantoprazole, 13 on esomeprazole, 4 on lansoprazole, and 2 on rabeprazole. Overall, esomeprazole was a statistically significant predictor (p=0.0359) of a lower functional threshold amplitude: 1.58 mV in controls as compared to 2.09 mV for omeprazole, 2.12 mV for pantoprazole, 2.14 mV for lansoprazole, and 2.7 mV for rabeprazole. Use of PPI, while associated with lower FT voltage, was not a predictor of statistically significant changes in initial UAS minimum therapeutic amplitude settings. Conclusion The functional threshold amplitude for patients taking esomeprazole was significantly different compared to patients not on a PPI. However, the use of PPI overall was not a statistically significant predictor of initial difference in UAS mean therapeutic amplitude settings. Future studies examining tolerance of therapy and voltage changes over time in patients on proton-pump inhibitors are needed. Support (if any):

Elevated Central and Mixed Apnea Index after Upper Airway Stimulation

2020 ◽  
Vol 162 (5) ◽  
pp. 767-772
Author(s):  
Jena Patel ◽  
Kelly Daniels ◽  
Lauren Bogdan ◽  
Colin Huntley ◽  
Maurits Boon
Keyword(s):  
Care Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Upper Airway ◽  
Retrospective Chart Review ◽  
Comorbid Conditions ◽  
Level Of Evidence ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep ◽  
Post Hoc

Objective Upper airway stimulation (UAS) is used to treat patients with moderate to severe obstructive sleep apnea (OSA). The aim of this study is to report the incidence and potential predictors of elevated central and mixed apnea index (CMAI) after UAS. Study Design Retrospective chart review of patients undergoing UAS. Setting Tertiary care center. Subjects and Methods Included patients underwent UAS for OSA at our institution between 2014 and 2018. Data collected included demographic information, implantation records, and pre- and postoperative polysomnography (PSG) results. CMAI ≥5 was considered elevated. Post hoc univariate analysis was performed to evaluate factors associated with elevated CMAI. Results In total, 141 patients underwent UAS at our institution. This included 94 men and 47 women with a mean age of 61.2 ± 11.0 years and a mean body mass index of 29.1 ± 3.9 kg/m2. Five patients had an elevated CMAI after surgery during UAS titration. Demographics, comorbid conditions, and device settings were not associated with an elevated postoperative CMAI ( P > .05). Conclusion The occurrence of an elevated CMAI after surgery may represent treatment-emergent events. Demographics, comorbid conditions, and UAS device settings were not associated with central and mixed apneic events. Level of Evidence 4

Effect of Gender, Age, and Profound Disease on Upper Airway Stimulation Outcomes

2020 ◽  
Vol 129 (8) ◽  
pp. 772-780
Author(s):  
Jena Patel ◽  
Kelly Daniels ◽  
Lauren Bogdan ◽  
Colin Huntley ◽  
Maurits Boon
Keyword(s):  
Treatment Response ◽  
Initial Treatment ◽  
Care Center ◽  
Tertiary Care ◽  
Upper Airway ◽  
Retrospective Chart Review ◽  
Response To Treatment ◽  
Level Of Evidence ◽  
Upper Airway Stimulation ◽  
Obstructive Sleep

Objective: To evaluate treatment outcomes of upper airway stimulation (UAS) in obstructive sleep apnea (OSA) patients based on patient age, gender, and preoperative disease severity. Methods: Retrospective chart review of patients undergoing UAS from 2014 to 2018 at a tertiary care center. Data collected included demographic information, implantation records, and pre- and postoperative polysomnography (PSG) results. Profound OSA was defined as AHI >65 and age ≥65 was considered advanced age. The primary outcome measured was initial treatment response, defined as a post-operative AHI <20 with a >50% reduction from baseline. Results: 145 patients underwent UAS at our institution including 98 males and 47 females with a mean age of 61.7 ± 11.5 years, mean BMI of 29.1 ± 3.9 kg/m2, and mean preoperative AHI of 34.1 ± 18.2 events/hour. After surgery, patients had a significantly lower mean AHI of 8.6 ± 15.0 events/hour (<0.001). Older patients had a lower initial treatment response rate (78%) when compared to their younger counterparts (94%) ( P = 0.005). Male gender and profound disease status did not significantly impact treatment response rates; young age was the only variable found to predict early treatment response on multivariate analysis ( P = 0.003). Conclusion: Although the overall OSA population showed significant postoperative AHI reduction with UAS, patients age ≥65 years were less likely to have an initial response to treatment, when compared to their younger counterparts. A larger proportion of elderly patients and patients with profound OSA had residual moderate disease (AHI > 15) after UAS. Level of Evidence: 4

The Effect of Lateral Pharyngeal Collapse Patterns on Therapy Response in Upper Airway Stimulation Surgery

2021 ◽  
pp. 000348942098797
Author(s):  
John Flynn ◽  
Christopher Boyd ◽  
Sreeya Yalamanchali ◽  
David Rouse ◽  
Sara Goodwin ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Upper Airway ◽  
Therapy Response ◽  
Apnea Hypopnea Index ◽  
Drug Induced ◽  
Level Of Evidence ◽  
Upper Airway Stimulation ◽  
Effect Change ◽  
Academic Center ◽  
Obstructive Sleep

Objectives: Obstructive sleep apnea (OSA) is characterized by repeated upper airway collapse while sleeping which leads to intermittent hypoxemia. Upper airway stimulation (UAS) is a commonly practiced modality for treating OSA in patients who cannot tolerate, or do not benefit from, positive airway pressure (PAP). The purpose of this study is to identify the effect of lateral pharyngeal collapse patterns on therapy response in UAS. Methods: A retrospective cohort study from a single, tertiary-care academic center was performed. Patients who underwent UAS between October 2016 and July 2019 were identified and analyzed. Drug-induced Sleep Endoscopy (DISE) outcomes between Apnea-Hypopnea Index (AHI) responders and AHI non-responders were compared. Those with complete concentric collapse at the velopharynx were not candidates for UAS. Results: About 95 patients that underwent UAS were included in this study. Pre- to Post-UAS demonstrated significant improvements in Epworth Sleepiness Scale (12.0 vs 4.0, P = .001), AHI (29.8 vs 5.4, P < .001) and minimum oxygen saturation (79% vs 83%, P < .001). No DISE findings significantly predicted AHI response after UAS. Specifically, multiple types of lateral pharyngeal collapse patterns did not adversely effect change in AHI or AHI response rate. Conclusion: Demonstration of lateral pharyngeal collapse on DISE, in the absence of complete concentric velopharyngeal obstruction, does not appear to adversely affect AHI outcomes in UAS patients. Level of Evidence VI

Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

2020 ◽  
Vol 11 (3) ◽  
pp. 3251-3260
Author(s):  
Makrand B Mane
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Care Facility ◽  
Early Death ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tertiary Care Facility ◽  
Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

scholarly journals Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Hussein Hassan Rizk ◽  
Ahmed Adel Elamragy ◽  
Ghada Sayed Youssef ◽  
Marwa Sayed Meshaal ◽  
Ahmad Samir ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Care Facility ◽  
Period 2 ◽  
Peripheral Embolization ◽  
Tertiary Care Facility ◽  
Few Data ◽  
Healthcare Associated ◽  
Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

scholarly journals Assessment of diabetes among tuberculosis patients presenting at a tertiary care facility in Pakistan

2016 ◽  
Vol 5 ◽  
pp. S248 ◽  
Author(s):  
Muhammad Irfan ◽  
Naseem Salahuddin ◽  
Qamar Masood ◽  
Owais Ahmed ◽  
Umme Salama Moosajee ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Tuberculosis Patients ◽  
Tertiary Care Facility

Radionecrosis after Treating Oral Cavity & Oropharyngeal SCC

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P43-P44
Author(s):  
Sundip H Patel ◽  
Mike Yao ◽  
Tara Brennan
Keyword(s):  
Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tertiary Care ◽  
Care Facility ◽  
Tertiary Care Facility ◽  
Pertinent Data ◽  
Associated Risk Factors ◽  
Oropharynx Squamous Cell Carcinoma

Objective 1) The primary goal of this study was to evaluate the incidence of radionecrosis among patients treated with radiation therapy for oral cavity & oropharynx squamous cell carcinoma at our institution. Many patients with oral cavity & oropharyngeal cancers receive radiation to preserve the tongue, knowing the risks of post-treatment radionecrosis. However, recent protocols have intensified chemo-radiotherapy in an effort to improve local control while possibly increasing risk. 2) Among those patients with radionecrosis, we also analyzed their cancer treatment regimen, associated risk factors, the severity of the radionecrosis and the resulting treatment they recieved. Methods We performed a retrospective review of all adult patients at our tertiary care facility with biopsy proven squamous cell carcinoma of the oral cavity & oropharynx from 1999 to 2007 who completed a full course of radiotherapy at our facility with at least 6 months follow-up. Medical charts were reviewed for the presence of radionecrosis as well as for other corresponding, pertinent data. Results After reviewing 241 patients, a total of 107 patients were included. 5 of 65 with oropharynx disease had radionecrosis, revealing an incidence of 7.7%. Among the oral cavity group there were 8 out of 42 patients with radionecrosis, revealing an incidence of 19%. The overall incidence among our treatment group was 12.1%. Conclusions Radiation-induced necrosis of the oral cavity & oropharynx is still a significant complication in the treatment of head and neck cancer and poses a higher risk in the oral cavity than the oropharynx.

Upper Airway Stimulation Therapy for Obstructive Sleep Apnea

2021 ◽  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Novel Therapy ◽  
Upper Airway Stimulation ◽  
Current State ◽  
Obstructive Sleep ◽  
Long Term Follow Up ◽  
Physician Extenders ◽  
Primary Care Practitioners

Upper Airway Stimulation Therapy for Obstructive Sleep Apnea provides the current state of knowledge regarding this novel therapy. It reviews the pathophysiologic basis of sleep apnea and the specific mechanism by which upper airway stimulation provides airway support in this disorder. It also provides practical insights into this therapy related to patient selection, clinical outcomes, surgical technique, long-term follow-up, and adverse events and offers recommendations for those aspiring to develop an upper airway stimulation program. It provides an overview of unique populations and circumstances that may extend the utility of the procedure, and that may provide challenges in management, as well as thoughts on the future of this technology. This textbook is intended for all practitioners who have interest or care for sleep disordered breathing, including sleep medicine physicians, pulmonologists, otolaryngologists, primary care practitioners, as well as physician extenders.

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