Outcomes Assessment of Multi-Level Sleep Surgery in Syndromic Versus Non-Syndromic Children

2020 ◽  
Vol 129 (6) ◽  
pp. 556-564
Author(s):  
Suqrat Munawar ◽  
Alexander P. Marston ◽  
Terral Patel ◽  
Shaun A. Nguyen ◽  
David R. White
Keyword(s):  
Length Of Stay ◽  
Sleep Disordered Breathing ◽  
Healthcare Research ◽  
Chi Square ◽  
Sleep Surgery ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Potential Risks ◽  
Multi Level ◽  
Inpatient Database

Objectives: Analyze the differences in length of stay, cost, disposition, and demographics between syndromic and non-syndromic children undergoing multi-level sleep surgery. Methods: Children with sleep disordered breathing or obstructive sleep apnea that had undergone sleep surgeries were isolated from the 1997 to 2012 editions of the Kids’ Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Children were then classified as syndromic or non-syndromic and stratified by level of sleep surgery (tonsillectomy & adenoidectomy, tonsillectomy & adenoidectomy plus other site surgery, other site surgery). Length of stay and cost were reported with Kruskal–Wallis one-way analysis of variance, disposition with binomial logistic regression, and demographics with chi-square. Results: Syndromic children compared to non-syndromic children were more likely to have surgery beyond just tonsillectomy & adenoidectomy and also had a longer length of stay, higher total cost and non-routine disposition (all P < .001). Syndromic children undergoing tonsillectomy and adenoidectomy plus other site surgery had a longer length of stay compared to syndromic children undergoing tonsillectomy & adenoidectomy (6.00 days vs 3.63 days, P < .001). However, no similar statistically significant difference in length of stay was found in non-syndromic children (2.01 days vs 2.87 days, P > .05). Conclusion: The potential risks/benefits need to be weighed carefully before undertaking sleep surgery in syndromic children. They experience a longer length of stay, higher cost, and non-routine disposition when compared to non-syndromic children. This is especially true when considering the transition from tonsillectomy & adenoidectomy to tonsillectomy & adenoidectomy plus other site surgery, as syndromic children experience a longer length of stay and non-syndromic children do not.

Effect of the CPAP-SAVER Intervention on Adherence

2019 ◽  
pp. 105477381986587
Author(s):  
April L. Shapiro
Keyword(s):  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Intervention Group ◽  
Chi Square ◽  
Cpap Adherence ◽  
Care Groups ◽  
Obstructive Sleep ◽  
Management Protocol ◽  
Significant Difference ◽  
Group Focus

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. Continuous positive airway pressure (CPAP) is the treatment of choice, but adherence is poor, contributing to a myriad of comorbidities that increase health burden. The study purpose was to examine the effect of the CPAP-SAVER intervention on adherence among adults with newly diagnosed OSA. Sixty-six participants were randomly assigned to intervention or standard care groups. Data were analyzed using chi-square, t-tests, and correlations. At one month, there was no significant difference in adherence between groups; CPAP beliefs and attitude were significantly higher and attitude significantly increased for the intervention group. Focus on CPAP beliefs and attitude by practitioners may impact CPAP adherence. With further research and replication of this study in larger samples to determine generalizability, the CPAP-SAVER intervention may provide underpinnings for the eventual development of an OSA-CPAP adherence management protocol.

scholarly journals Facial Profile Shape, Malocclusion and Palatal Morphology in Malay Obstructive Sleep Apnea Patients

2010 ◽  
Vol 80 (1) ◽  
pp. 37-42 ◽  
Author(s):  
S. M. Banabilh ◽  
A. R. Samsudin ◽  
A. H. Suzina ◽  
Sidek Dinsuhaimi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Null Hypothesis ◽  
Control Group ◽  
Class Ii Malocclusion ◽  
Chi Square ◽  
Facial Profile ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Mean

Abstract Objective: To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA). Materials and Methods: Subjects were 120 adult Malays aged 18 to 65 years (mean ± standard deviation [SD], 33.2 ± 13.31) divided into two groups of 60. Both groups underwent clinical examination and limited channel polysomnography (PSG). The mean OSA and control values were subjected to t-test and the chi square test. Results: Physical examination showed that 61.7% of the OSA patients were obese, and 41.7% of those obese patients had severe OSA. The mean body mass index (BMI) was significantly greater for the OSA group (33.2 kg/m2 ± 6.5) than for the control group (22.7 kg/m2 ± 3.5; P &lt; .001). The mean neck size and systolic blood pressure were greater for the OSA group (43.6 cm ± 6.02; 129.1 mm Hg ± 17.55) than for the control group (35.6 cm ± 3.52; 114.1 mm Hg ± 13.67; P &lt; .001). Clinical examination showed that the most frequent findings among OSA groups when compared with the control group were convex profiles (71.7%), Class II malocclusion (51.7%), and V palatal shape (53.3%), respectively; the chi square test revealed a significant difference in terms of facial profile and malocclusion class (P &lt; .05), but no significant difference in palatal shape was found. Conclusion: The null hypothesis is rejected. A convex facial profile and Class II malocclusion were significantly more common in the OSA group. The V palatal shape was a frequent finding in the OSA group.

scholarly journals Morphological Diversity of Soft Palate in Nepalese Population: A Retrospective Cephalometric Study

2017 ◽  
Vol 7 (1) ◽  
pp. 18-22
Author(s):  
Chandan Upadhyaya ◽  
Ichchha Neupane ◽  
Binam Sapkota ◽  
Shatakshi Srivastava
Keyword(s):  
Soft Palate ◽  
Age Groups ◽  
Morphological Diversity ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Chi Square ◽  
Radiographic Appearance ◽  
Obstructive Sleep ◽  
Lateral Cephalograms ◽  
Significant Difference

Introduction: Soft palate is a fibromuscular portion constituting the back of roof of the mouth which is essential for phonation, deglutition, respiration and velopharyngeal competence.Objective: To study various morphologies of soft palate, difference in proportion of each type and their differencesamong gender and agegroups in Nepalese sample.Materials & Method: A retrospective study was conducted on patients seeking orthodontic treatment. 263 lateral cephalograms were classified on the basis of radiographic appearance. Analysis was done using SPSS (version 20.0). Pearson chi square and descriptive statistics were performed and level of significance was set at p<0.05. Result: In the order of occurrence; rat tail type of soft palate was most prevalent followed by leaf type, butt type, straightline, crooked type and S shaped. There was no significant difference between male and female subjects (p=0.338) and through age groups (p=0.998).Conclusion: The study highlights various types of soft palate present in Nepalese sample which will help as a reference for research pertaining to cleft palate/ velopharyngeal closure and in obstructive sleep apnoea syndrome in Nepalese population

1065 A Bout of Sleep Apnea or a Posttrauma Nightmare Occurrence?

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A405-A406
Author(s):  
W A Youngren ◽  
K Miller
Keyword(s):  
Sleep Apnea ◽  
Operational Definition ◽  
Self Report ◽  
Trauma Survivors ◽  
Chi Square ◽  
Sleep Study ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Study Results ◽  
Significant Difference

Abstract Introduction The enigmatic nature of Posttrauma Nightmares (PTNs) has left research without an agreed upon operational definition. This is partially due to PTNs often containing well remembered content that is similar to the triggering trauma, but also manifesting as severe nighttime awakenings without a concise or remembered dream narrative. Given that recent research has linked episodes of Obstructive Sleep Apnea (OSA) to PTNs, this study aimed to examine if OSA could explain why some distressed awakenings occur without memory of nightmare content. Methods Participants included 36 trauma survivors who reported experiencing PTNs, recruited from a clinical referral or at a Veterans Affairs Hospital. Presence of OSA was captured from self-reports of previous polysomnography-based sleep study results. PTNs were measured via a self-report measure that assessed past month nightmare frequency and if the content was remembered upon awakening. Analysis included descriptive statistics and chi-square tests. Results Out of the group with a reported diagnosis of OSA (N = 8), 75% (n = 6) reported they did not remember the content of their nightmares upon awakening, whereas out of the group without a reported OSA diagnosis (N = 28), only 4% of participants (n = 1) reported not remembering the content of their nightmares. There was a significant difference between OSA diagnosis and remembering nightmare content (X2 = 57.83, p &lt; 0.001). Conclusion Individuals with diagnosed OSA commonly experienced nightmares that were often not remembered upon awakening, while the group without OSA most often remembered the content of their nightmares. Due to this relationship, it is possible that some PTNs experienced by the OSA group may instead be misinterpreted respiratory events. Understanding the relationship between OSA and PTNs is crucial for developing the most effective treatment course. Support None.

scholarly journals Comparison of Mortality Rate Between Bipolar Hemiarthroplasty and Proximal Femoral Nail Anti-rotation for Intertrochanteric Fractures in Sanglah Hospital, Bali

2020 ◽  
Vol 1 (1) ◽  
pp. 36-42
Author(s):  
I Wayan Suryanto Dusak ◽  
I Gusti Ngurah Wien Aryana ◽  
Cokorda Gde Oka Dharmayuda ◽  
I Wayan Subawa ◽  
Hans Kristian Nugraha ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Proximal Femoral Nail ◽  
Bipolar Hemiarthroplasty ◽  
Intertrochanteric Fractures ◽  
Chi Square ◽  
Femoral Nail ◽  
Significant Difference ◽  
Fixation Treatment ◽  
Multi Center Study

Introduction: Intertrochanteric fractures occur in about 50% of all hip fracture events, with a mortality rate within 1 year after fracture reaching 15 to 20%. The most common treatment nowadays is either the bipolar hemiarthroplasty procedure or proximal femoral nail anti-rotation (PFNA), although there is still no consensus regarding which is better from the two, especially on patient mortality.Method: This study was an observational study using a retrospective cohort design. A total of 102 study subjects who met the inclusion requirements were grouped into 2 groups, one with bipolar hemiarthroplasty fixation treatment and another with PFNA fixation treatment. Mortality rate was recorded by survey 2 years after surgery.Results: Chi-square test showed that 2-year mortality rate after intertrochanteric fracture treated with bipolar hemiarthroplasty (21.4%) was significantly higher than the PFNA group (10.3%) (p = 0.028). Bipolar hemiarthroplasty group also had longer length of stay (50%) than the PFNA group (32.4%), albeit statistically insignificant (p = 0.13). There was no significant difference between the 2-year mortality rate and length of stay (p = 0.976).Conclusion: Patients with intertrochanteric fractures who underwent bipolar hemiarthroplasty have significantly higher 2- year mortality rate than similar patients underwent fixation with PFNA, while they did not experience higher length of stay than the PFNA group. Future prospective, multi center study with larger sample size will be likely to validate similar fixation choice needed to decrease the mortality rate in intertrochanteric fractures.

scholarly journals 1094 Depression Is Not Associated With The Presence Of Or The Severity Of Obstructive Sleep Apnea: Retrospective Study Of 841 Polysomnography Subjects

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A416-A416
Author(s):  
K Im ◽  
L Kim ◽  
R Immen
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Significant Proportion ◽  
Chi Square ◽  
Relative Paucity ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Chi Square Analysis

Abstract Introduction Both depression and obstructive sleep apnea (OSA) are very common medical conditions. Studies showed a co-occurrence of depression and OSA with a higher prevalence of one if the other is present. However, there is relative paucity of studies assessing the rate of depression based on the OSA severity. Methods Retrospective analysis of data collected from patients undergoing polysomnography (PSG) at an academic sleep disorders center was performed. A total of 841 subjects were included and stratified into four groups using AHI. A Chi-square analysis was applied to assess the association of varying levels of AHI and the presence of depression. Results Although a significant proportion of patients with AHI greater than 5 endorsed depression (60/165 in group with AHI 15 or greater and 115/278 in group with AHI between 5 and 15), this finding was also replicated in patients with AHI less than 5 (86/202 in AHI between 1 and 5 and 88/196 in those with AHI less than 1). As there was significant difference in rate of depression among women (54.1%) and men (26.1%) (p &lt;0.0001), Chi-square analysis was performed for the rate of depression based on the level of AHI, adjusted for gender. In women the rate of depression from the most severe AHI to less severe AHI group were 0.48, 0.53, 0.60, and 0.53 respectively and in men it was 0.30, 0.27, 0.20, and 0.27 respectively, with no statistical difference between any groups. Conclusion Among patients who seek PSG assessment, depression appears to be more prevalent than the general public. Rate of depression is much higher among women than men in this group. However, the presence of OSA or severity of OSA does not have any correlation with the rate of depression in both women and men. These findings might be suggestive of the complexity of the association between depression and OSA. One limitation of this study is the dichotomous nature of depression (presence or absence of). The finding from this study warrants a future study utilizing a numerical rating scale of depression for severity measure to correlate it with the severity of OSA. Support NA.

scholarly journals Modalities of treatment for sleep disordered breathing

2016 ◽  
Vol 2 (3) ◽  
pp. 361-369 ◽  
Author(s):  
Win Tin ◽  
Khin Maung Ohn
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Clinical Presentation ◽  
Cardiac Complications ◽  
Additional Information ◽  
Obstructive Sleep ◽  
Multi Level ◽  
Google Search ◽  
Disordered Breathing

Sleep disordered breathing is a spectrum of diseases that includes snoring, upperairway resistance syndrome and obstructive sleep apnea. It occurs more in obese males, resulting in hypertension and cardiac complications if untreated. There are various treatments, conservatively and surgically, starting from simple tonsillectomy to multi-level surgeries and multi discipline. Literature review was carried out on the pathophysiology, clinical presentation, complications, diagnosis and various treatments, using internet Google, search PubMed. Additional information was obtained by cross referencing, using text and journals in the medical libraries.Asian J. Med. Biol. Res. September 2016, 2(3): 361-369

556 Hospital Length of Stay for Patients with Small and Medium Burns Impacted by Distance to Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S118-S119
Author(s):  
Stephen Sibbett ◽  
Jamie Oh ◽  
Saman Arbabi ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Location ◽  
Chi Square ◽  
Hispanic Males ◽  
Burn Care ◽  
Burn Center ◽  
Significant Difference ◽  
Hospital Stays

Abstract Introduction Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay. Methods Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn center from 2011 to 2018. Inclusion was limited to patients from the burn center state. Patients were grouped by distance from the home zip code to the burn center (≤100 and &gt;100 miles) according to what might be ground or air transport. Chi-square and Mann-Whitney tests were used to determine differences between groups by race, burn size (TBSA), hospital length of stay (LOS), LOS/TBSA, mortality, and disposition to home. Burn size was categorized by TBSA into small (0–20%), medium (21–50%) and large (51–100%) burns. Results Our study population was predominantly white, non-Hispanic males. Mean burn size was significantly higher in patients who traveled more than the &gt;100 miles to the burn center (Table). Mean LOS/TBSA was not significant between the two groups. However, controlling for burn size, patients with small and medium burns that lived farther from the burn center had significantly longer hospital stays. There was no significant difference in length of stay for patients with large burns, mortality or disposition to home between the two distance groups. Conclusions At a burn center with a large catchment area, patients with burn size &lt; 50%TBSA who lived more than 100 miles from the burn center had significantly longer hospital stays than those who lived closer to the burn center. This may indicate that patients who are referred to a regional burn center for care of smaller burns may require care beyond the level of their local hospitals. It is worth noting that using burn size as an indication of complexity of care may be misleading as body site location of the burn (e.g. hand, face or feet) impacts the recovery. Applicability of Research to Practice For a burn center that serves patients across a vast region, this investigation might be useful in identifying opportunities to provide care for patients who live far from tertiary burn care.

413 Inpatient Sleep Screens: Effective for Screening but Poor Follow Up

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A164-A164
Author(s):  
Upneet Chawla ◽  
Avneet Chadha ◽  
Abigail Martin ◽  
Elizabeth Culnan ◽  
Aaron Kirkpatrick ◽  
...  
Keyword(s):  
Program Effectiveness ◽  
Categorical Variables ◽  
Apnea Hypopnea Index ◽  
Chi Square ◽  
Obstructive Sleep ◽  
Outpatient Group ◽  
Significant Difference ◽  
Inpatient Group ◽  
Portable Monitors

Abstract Introduction Only 20% of adult Americans with Obstructive Sleep Apnea (OSA) are thought to have been diagnosed. Portable monitors (PM) can provide shorter time to diagnosis and treatment in at risk populations including inpatients. Data on inpatient sleep screen testing outcomes and population phenotypes are limited. We hypothesized that inpatients undergoing sleep screens via PM have higher disease severity but are less adherent to follow up. Methods We conducted a retrospective observational study comparing severity of OSA based on apnea-hypopnea index (AHI) and compliance with follow up between patients who received inpatient vs. outpatient sleep screens. There was a total of 347 patients, 18 years and older, who received a sleep screen from August 2017 to August 2018. Exclusion criteria were cancellations/no shows (13.56% inpatients vs. 13.51% outpatients) or loss of data (26.12% inpatients vs. 23.72% outpatients). For analysis, t-test and chi-square were used for continuous and categorical variables respectively. Results The patients diagnosed with severe OSA were more than double in the inpatient group vs. the outpatient group, 46.7% and 21.7% respectively. The inpatient group had a higher average AHI (30/h) compared to the outpatient group (20.3/h). 30.7% of the inpatient group were adherent with their follow up vs. 83.3% of the outpatient group. A chi-square test of independence demonstrated a significant difference between testing location and follow up (p &lt; .001). Those in the inpatient group were significantly older (mean 60.4 years old) than the outpatient group (47.5 years old). There was no significant difference in gender between the groups. The inpatient group had significantly higher average body mass index (39.9 kg/m2) when compared to the outpatient group (34.3 kg/m2). Conclusion Hospitalized patients screened for OSA with portable monitors are significantly more likely to have severe disease when compared to outpatients. Despite this, adherence to follow up is poor. Systematic evaluation of inpatient OSA screening program effectiveness and factors impacting adherence to follow up and treatment are needed. Support (if any):

scholarly journals Interhemispheric Brain Switching Correlates with Severity of Sleep-Disordered Breathing for Obstructive Sleep Apnea Patients

2019 ◽  
Vol 9 (8) ◽  
pp. 1568
Author(s):  
Yuwen Li ◽  
Zhimin Zhang ◽  
Guohun Zhu ◽  
Hongping Gan ◽  
Deyin Liu ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Brain Activity ◽  
Sleep Stages ◽  
Interhemispheric Asymmetry ◽  
Switching Rate ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Disordered Breathing

(1) Background: Alternating interhemispheric slow-wave activity during sleep is well-established in birds and cetaceans, but its investigation in humans has been largely neglected. (2) Methods: Fuzzy entropy was used to calculate a laterality index (LI) from C3 and C4 EEG channels. The subjects were grouped according to an apnoea-hypopnoea index (AHI) for statistical analyses: Group A AHI < 15 (mild); Group B 15 ≤ AHI < 30 (moderate); Group C AHI ≥ 30 (severe). The LI distribution was analysed to characterise the brain activity variation in both hemispheres, and the cross-zero switching rate was given statistical tests to find the correlations with the severity of obstructive sleep apnea and sleep states, i.e., wake (W), light sleep (LS), deep sleep (DS), and REM. (3) Results: EEG brain switching activity was observed in all sleep stages, and the LI distribution shows that, for obstructive sleep apnea patients, the interhemispheric asymmetry of brain activity is more obvious than healthy people. A one-way ANOVA revealed a significant difference of switching rate among three groups (F(2,95) = 7.23, p = 0.0012), with Group C shows the least, and also a significant difference among four sleep stages (F(3,94) = 5.09, p = 0.0026), with REM the highest. (4) Conclusions: The alternating interhemispheric activity is confirmed ubiquitous for humans during sleep, and sleep-disordered breathing intends to exacerbate the interhemispheric asymmetry.

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