Severity Analysis of Upper Airway Obstructions: Oesophageal Pressure Versus Snoring Sounds

Background: Paediatric Tracheostomy is a procedure used to ventilate children through a hole in the trachea. Indications for the procedure were once primarily for acute upper airway obstruction due to infections but have now changed. Generally, there is poor knowledge surrounding tracheostomies and a limited knowledge of guidelines amongst health-care professionals. Aim: The aim of this review is to discuss the basis of changes to the indications of paediatric tracheostomy. It will also investigate the key complications related to the procedure and discuss the importance of multidisciplinary teams being aware of the emergency algorithms for dealing with such complications. Findings: Indications have changed due to advancements in medicine with increased life expectancy and survival rates for children with often life threatening congenital conditions. Tracheostomies can offer these children long term ventilatory support. Upper airway obstructions due to infections are now infrequently indicated for tracheostomy due to successful vaccination programs. Complications today are because of obstructions and decannulations. Intra-operative complications are infrequent, due to refinements in surgical technique. Conclusion: Paediatric Tracheostomy is a rapidly evolving field because of continuous advancements in neonatal and intensive care medicine. The indications and complications have changed together over the last four decades. A greater understanding of tracheostomy complications is requiredfor successful management.

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Thoracoabdominal asynchrony failed to grade airway obstructions in foals

Journal of Applied Physiology ◽

10.1152/jappl.2000.88.6.2081 ◽

2000 ◽

Vol 88 (6) ◽

pp. 2081-2087 ◽

Cited By ~ 11

Author(s):

Carrie Miller ◽

Andrew M. Hoffman ◽

Janice Hunter

Keyword(s):

Phase Angle ◽

Upper Airway ◽

Clinical Feature ◽

Resistive Load ◽

Respiratory Inductive Plethysmography ◽

Resistive Loading ◽

Airway Obstructions ◽

Airway Opening ◽

Resistive Loads ◽

Thoracoabdominal Asynchrony

Respiratory inductive plethysmography (RIP) can be used to obtain a valid measure of tidal volume in humans. This device also compares the contributions to ventilation of the thorax and abdomen. Although thoracoabdominal asynchrony is a prominent clinical feature for patients with airway obstruction, the accuracy of the RIP device to assess the severity of obstruction is unclear. This study analyzes how well RIP variables reflect the degree of a fixed external inspiratory plus expiratory resistive load in foals. Foals were employed because the species and age group are commonly afflicted with respiratory disease. Eight conscious, sedated (xylazine 1.25 mg/kg body wt) foals were subjected to randomly ordered resistive loads at the airway opening and, on a separate day, to histamine aerosol challenge. During resistive loading, phase angle changed significantly, as did phase relation ( P ≤ 0.05). However, no significant correlation was found between the degree of change in resistive load and the degree to which phase angle or relation was altered ( r s = 0.41 and 0.25, respectively). In addition, neither phase angle nor relation changed significantly with histamine challenge. We conclude that, although RIP variables changed markedly with fixed upper airway resistive loading, the degree to which they changed was erratic and therefore not useful for grading these obstructions. Furthermore, RIP variables were insensitive measures of histamine-induced bronchoconstriction.

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Hypersomnia Caused by Upper Airway Obstructions; A New Syndrome in Otolaryngology

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947408300516 ◽

1974 ◽

Vol 83 (5) ◽

pp. 670-673 ◽

Cited By ~ 28

Author(s):

F. Blair Simmons ◽

Michael W. Hill

Keyword(s):

Airway Obstruction ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Sleep Studies ◽

Excessive Sleepiness ◽

Airway Obstructions ◽

Submucous Resection

A new cause for excessive sleepiness during the day is gradually emerging from 24-hour polygraph sleep studies: intermittent upper airway obstruction which is usually hypopharyngeal but can also be nasal in origin. Three such cases are described. One was cured by a permanent tracheotomy and another by a submucous resection.

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Efficacy and Co-morbidity of Oral Appliances in the Treatment of Obstructive Sleep Apnea-Hypopnea: a Systematic Review

Critical Reviews in Oral Biology & Medicine ◽

10.1177/154411130401500303 ◽

2004 ◽

Vol 15 (3) ◽

pp. 137-155 ◽

Cited By ~ 111

Author(s):

A. Hoekema ◽

B. Stegenga ◽

L.G.M. de Bont

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Primary Outcome ◽

Upper Airway ◽

Effect Sizes ◽

Obstructive Sleep ◽

Co Morbidity ◽

Airway Obstructions ◽

Craniofacial Complex

The Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. Modification of pharyngeal patency by Oral Appliance (OA) therapy has been suggested as an alternative to various treatment modalities for OSAHS. To determine the evidence base with respect to the efficacy and co-morbidity of OA therapy in OSAHS, we conducted a systematic review of the available literature. Primary outcome measures were the reduction in number of upper-airway obstructions and co-morbidity related to the craniomandibular or craniofacial complex, respectively. Eligible studies regarding efficacy were independently assessed by two assessors using a quality assessment scale. Effect sizes of methodologically sound studies were calculated. In identical interventions, effect sizes were pooled with the use of a random-effects model. Given the scarcity of controlled studies related to co-morbidity, appraisal was confined to a description of eligible studies. Sixteen controlled trials related to efficacy were identified. With respect to the primary outcome measure, OA therapy was clearly more effective than control therapy (pooled effect size, −0.96; 95% confidence interval [CI], −1.49 to −0.42) and possibly more effective than uvulopalatopharyngoplasty. Although patients generally preferred OA therapy, improvement of respiratory variables, such as the number of upper-airway obstructions, was usually better in Continuous Positive Airway Pressure (CPAP) therapy (pooled effect size, 0.83; 95% CI, 0.59 to 1.06). Moreover, specific aspects related to OA design may influence patient-perceived efficacy and preference. Twelve patient-series and one controlled trial related to co-morbidity were identified. Analysis of the data suggests that OA therapy may have adverse effects on the craniomandibular and craniofacial complex. Although CPAP is apparently more effective and adverse effects of OA treatment have been described, it can be concluded that OA therapy is a viable treatment for, especially, mild to moderate OSAHS. Controlled studies addressing the specific indication and co-morbidity of OA therapy are warranted.

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Pulse Arterial Tone and Airway Obstruction in Sleep Apnea

Otolaryngology ◽

10.1016/j.otohns.2008.05.268 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P83-P83 ◽

Cited By ~ 1

Author(s):

Jose E Barrera ◽

Andrew B. Holbrook ◽

Juan Santos ◽

Gerald R Popelka

Keyword(s):

Sleep Apnea ◽

Airway Obstruction ◽

Real Time ◽

Upper Airway ◽

Airway Narrowing ◽

Obstructive Sleep ◽

Airway Obstructions ◽

Surgical Treatments ◽

Arterial Tone ◽

Continuous Pulse

Objective Determine if continuous pulse arterial tone (PAT) amplitude correlates with upper airway obstructions observed during simultaneous real-time magnetic resonance imaging (RT-MRI) in subjects with Obstructive Sleep Apnea (OSA). Methods A prospective series of 20 subjects diagnosed with mild to severe OSA by polysomnography, Fujita classification, Functional Outcomes of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Score (ESS) underwent continuous RT-MRI during a 90-minute nap without sedation. The upper airway at the mid-saggittal plane was visualized in real time (33 fps) using a sliding window algorithm (RTHawk system). Continuous pulse arterial tone amplitude was simultaneously monitored (Watch-PAT, Itamar Inc, Israel). Results Changes in PAT amplitude were in phase with upper airway narrowing and obstruction from tongue, soft palate, and epiglottis movements. Airway obstructive events occurred coincident to 60% or greater decreases in PAT amplitude. The image sequence associated with each PAT amplitude decrease demonstrated the precise location of the obstruction. Pre-surgical site of airway obstruction and post-surgical cause of persistent obstruction was clearly identified. Conclusions RT-MRI with simultaneous and continuous PAT signal recording during natural sleep is an innovative and improved method for more precisely characterizing airway obstructions in patients with mild to severe OSA. This approach may be valuable for planning surgical treatments, potentially improving the success of these procedures.

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Acute Infectious Upper Airway Obstructions in Children

Seminars in Pediatric Infectious Diseases ◽

10.1053/j.spid.2005.11.003 ◽

2006 ◽

Vol 17 (1) ◽

pp. 5-10 ◽

Cited By ~ 25

Author(s):

Laura Loftis

Keyword(s):

Upper Airway ◽

Airway Obstructions

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Numerical and experimental study of expiratory flow in the case of major upper airway obstructions with fluid–structure interaction

Journal of Fluids and Structures ◽

10.1016/j.jfluidstructs.2007.08.004 ◽

2008 ◽

Vol 24 (2) ◽

pp. 250-269 ◽

Cited By ~ 33

Author(s):

F. Chouly ◽

A. Van Hirtum ◽

P.-Y. Lagrée ◽

X. Pelorson ◽

Y. Payan

Keyword(s):

Experimental Study ◽

Fluid Structure Interaction ◽

Upper Airway ◽

Fluid Structure ◽

Structure Interaction ◽

Airway Obstructions ◽

Expiratory Flow

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Peripheral vascular resistance increases after termination of obstructive apneas

Journal of Applied Physiology ◽

10.1152/jappl.2001.91.5.2359 ◽

2001 ◽

Vol 91 (5) ◽

pp. 2359-2365 ◽

Cited By ~ 11

Author(s):

Amit Anand ◽

Stacia Remsburg-Sailor ◽

Sandrine H. Launois ◽

J. Woodrow Weiss

Keyword(s):

Blood Flow ◽

Vascular Resistance ◽

Forearm Blood Flow ◽

Upper Airway ◽

Blood Velocity ◽

Peripheral Vascular ◽

Arterial Diameter ◽

Peripheral Vasoconstriction ◽

Airway Obstructions ◽

Forearm Vascular Resistance

The mechanisms by which obstructive apneas produce intermittent surges in arterial pressure remain poorly defined. To determine whether termination of obstructive apneas produce peripheral vasoconstriction, we assessed forearm blood flow during and after obstructive events in sleeping patients experiencing spontaneous upper airway obstructions. In all subjects, heart rate was monitored with an electrocardiogram and blood pressure was monitored continuously with digital plethysmography. In 10 patients ( protocol 1), we used forearm plethysmography to assess forearm blood flow, from which we calculated forearm vascular resistance by performing venous occlusions during and after obstructive episodes. In an additional four subjects, we used simultaneous Doppler and B-mode images of the brachial artery to measure blood velocity and arterial diameter, from which we calculated brachial flow continuously during spontaneous apneas ( protocol 2). In protocol 1, forearm vascular resistance increased 71% after apnea termination (29.3 ± 15.4 to 49.8 ± 26.5 resistance units, P < 0.05) with all patients showing an increase in resistance. In protocol 2, brachial resistance increased at apnea termination in all subjects (219.8 ± 22.2 to 358.3 ± 46.1 mmHg · l−1 · min; P = 0.01). We conclude that termination of obstructive apneas is associated with peripheral vasoconstriction.

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