scholarly journals Hyoid Suspension With UPPP for the Treatment of Obstructive Sleep Apnea

2021 ◽  
pp. 014556132110011
Author(s):  
Jason Van Tassel ◽  
Eugene Chio ◽  
Dustin Silverman ◽  
Ryan Scott Nord ◽  
Dustin Platter ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Primary Outcome ◽  
Wound Complications ◽  
Apnea Hypopnea Index ◽  
Retrospective Evaluation ◽  
Obstructive Sleep ◽  
Hyoid Suspension ◽  
The Mean ◽  
Removal Of Hardware

This retrospective evaluation of surgical outcomes for hyomandibular suspension when performed with uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea (OSA). Thirty-nine patients with moderate-to-severe OSA were treated with hyoid myotomy and suspension and uvulopalatopharyngoplasty. Patients underwent hyoid advancement and suspension to the mandible (Encore System) with either staged or concurrent UPPP. The primary outcome was a successful surgical result, defined as an apnea hypopnea index (AHI) lower than 20, and a 50% or greater decline in AHI on postoperative polysomnography. Successful surgical results were achieved in 30 (76.9%) out of 39 patients. The mean preoperative AHI improved 69.2% from 49.9 ± 25.6 to 15.4 ± 14.9 ( P < .001) postoperatively. All patients reported clinical improvement of symptoms. There were 4 wound complications and one infection requiring removal of hardware. For patients with multilevel obstructive sleep apnea, hyoid advancement and suspension to the mandible appears efficacious when performed in conjunction with uvulopalatopharyngoplasty.

scholarly journals Hyoid Bone Suspension as a Part of Multilevel Surgery for Obstructive Sleep Apnea Syndrome

2017 ◽  
Vol 22 (03) ◽  
pp. 266-270 ◽  
Author(s):  
Abd Tantawy ◽  
Sherif Askar ◽  
Hazem Amer ◽  
Ali Awad ◽  
Mohammad El-Anwar
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Apnea Hypopnea Index ◽  
Absorbable Suture ◽  
Drug Induced ◽  
Multilevel Surgery ◽  
Obstructive Sleep ◽  
Hyoid Suspension ◽  
The Mean

Introduction Since oropharyngeal surgery alone is often insufficient to treat obstructive sleep apnea (OSA), advances have been developed in hypopharyngeal surgery. Objective To assess hyoid suspension surgery as part of a multilevel OSA surgery, also including palatal surgery. Methods The study included patients with OSA symptoms with apnea hypopnea index (AHI) > 15. They were scheduled for hyoid suspension after a nasoendoscopy during Müller maneuver and drug induced sleep endoscopy (DISE). All patients had body mass index (BMI) < 35 kg/m2. Hyoidothyroidopexy combined with tonsillectomy and palatal suspension was performed in all cases. Results The mean AHI dropped significantly (p < 0.0001) from 68.4 ± 25.3 preoperatively to 25.6 ± 9.52 postoperatively. The mean lowest oxygen (O2) saturation level increased significantly from 66.8 ± 11.3 to 83.2 ± 2.86 (p < 0.0001). In addition, the snoring score significantly decreased (p < 0.0001) from a preoperative mean of 3.4 ± 0.54 to 2 ± 0.7 at 6 months postoperatively. In regard to the Epworth sleepiness scale (ESS), it showed significant improvements (p < 0.0001) as its mean diminished from 13.8 ± 5.4 preoperatively to 5.2 ± 1.6 postoperatively. Conclusion Hyoidothyroidopexy using absorbable suture seems to produce a good outcome in treating OSA. It could be effectively and safely combined with other palatal procedures in the multilevel surgery for OSA.

scholarly journals Effect of continuous positive airway pressure treatment of obstructive sleep apnea-hypopnea in multiple sclerosis: A randomized, double-blind, placebo-controlled trial (SAMS-PAP study)

2021 ◽  
pp. 135245852110103
Author(s):  
Sulaiman Khadadah ◽  
R John Kimoff ◽  
Pierre Duquette ◽  
Vincent Jobin ◽  
Yves Lapierre ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Primary Outcome ◽  
Positive Airway Pressure ◽  
Apnea Hypopnea Index ◽  
Double Blind ◽  
Obstructive Sleep

Objective: The aim of this study was to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the Fatigue Severity Scale (FSS, preplanned primary outcome), another fatigue measure, sleep quality, somnolence, pain, disability, and quality of life in multiple sclerosis (MS) patients with obstructive sleep apnea-hypopnea (OSAH). Methods: In a randomized, double-blind trial (NCT01746342), MS patients with fatigue, poor subjective sleep quality, and OSAH (apnea-hypopnea index of ⩾ 15 events per hour/sleep), but without severe OSAH (apnea-hypopnea index > 30, and 4% oxygen desaturation index > 15 events/hour or severe somnolence), were randomized to fixed CPAP or sham CPAP for 6 months. Outcome assessments were performed at 3 and 6 months. Results: Of 49 randomized patients, 34 completed the protocol. Among completers, FSS did not improve with CPAP compared to sham at 6 months. FSS tended to improve ( p = 0.09), and sleepiness (Epworth Sleepiness Scale) improved significantly ( p = 0.03) at 3 months with CPAP compared to sham, but there were no other improvements with CPAP at either study evaluation. Conclusion: In non-severe OSAH patients, CPAP did not significantly improve the primary outcome of FSS change at 6 months. In secondary analyses, we found a trend to improved FSS, and a significant reduction in somnolence with CPAP at 3 months.

S296 – Thyroidectomy for Goiter Improves Obstructive Sleep Apnea

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P173-P174
Author(s):  
Mark T Agrama
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Thyroidectomy ◽  
Community Hospital ◽  
Apnea Hypopnea Index ◽  
Tracheal Compression ◽  
Obstructive Sleep ◽  
The Mean ◽  
Postoperative Improvement ◽  
Symptomatic Control

Objectives Evaluate the effects of total thyroidectomy for euthyroid goiter causing tracheal compression on the apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA). Demonstrate a relationship between tracheal compression and OSA. Methods A retrospective study of 8 patients with euthyroid goiter causing tracheal compression who had moderate or severe OSA. Between January 2004 and December 2007, 8 patients with these conditions were treated in a community hospital by the author. At least 1 compressive symptom (dysphagia, dyspnea, and/or orthopnea) was reported by all patients. Computed tomography of the neck and chest was used to confirm the extent of goiter and tracheal compression. OSA was confirmed with preoperative polysomnography. Total thyroidectomy was performed. Postoperative polysomnography was obtained after 90 days. Outcome measures were changes in compressive symptoms and AHI using paired t test. Results All 8 patients reported symptomatic control of compressive symptoms after thyroidectomy. 7 of 8 patients demonstrated postoperative improvement of AHI. The mean postoperative AHI decreased significantly from 52.1 to 36.6 (P < 0.05). Conclusions Total thyroidectomy for goiter causing tracheal compression can significantly improve symptoms and AHI in those patients who have OSA. Evaluation of patients with OSA should include screening for tracheal compression from goiter.

scholarly journals Clinical and Polysomnographic Characteristics of Patients with Extreme Obstructive Sleep Apnea, AHI > 100: A Case-Control Study

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Forogh Soltaninejad ◽  
Negarsadat Neshat ◽  
Mehrzad Salmasi ◽  
Babak Amra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Study Results ◽  
Significant Difference ◽  
Severe Manifestation ◽  
The Mean ◽  
Nocturnal Polysomnography ◽  
Control Study

Background: Severe obstructive sleep apnea (OSA), defined by apnea-hypopnea index (AHI) as more than 30 events per hour, was previously related to more comorbidity. However, limited studies separated the patients with AHI > 100 from those with a less severe manifestation of the disease. Objectives: The current study aimed at describing the characteristics of this subgroup and comparing them with less severe conditions. Methods: A retrospective analysis was conducted on 114 patients with OSA. Nocturnal polysomnography was used to diagnose severe OSA. Patients were categorized into two groups: (1) 60 < AHI < 100 (very severe OSA), (2) AHI ≥ 100 (extreme OSA). Demographic, medical history, and polysomnographic variables were evaluated and compared between the two groups. Results: Extreme OSA was diagnosed in 19 patients, the mean body mass index (BMI) was significantly higher in this group (39.26 ± 5.93 vs. 35.68 ± 6.45 kg/m2, P = 0.025). They also had lower minimal O2 saturation (65.68 ± 10.16 vs. 74.10 ± 8.74, P = 0.003) and more time with < 90% O2 saturation (T < 90%) (81.78 ± 22.57 vs. 58.87 ± 33.14, P = 0.01). OHS prevalence was significantly higher in the group with extreme OSA (P = 0.04). The most frequent comorbidity was hypertension, with an incidence of 60.5%, for the extreme group, although there was no significant difference between the two groups in terms of clinical associations. Conclusions: The current study results suggested that greater BMI and lower minimal O2 saturation, as well as increased T < 90%, were associated with extreme OSA, although no differences were observed in the associated diseases between the compared groups.

scholarly journals Gender differences in the influence of obstructive sleep apnea on optic nerve head circulation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tomoaki Shiba ◽  
Mao Takahashi ◽  
Tadashi Matsumoto ◽  
Yuichi Hori
Keyword(s):  
Gender Differences ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Optic Nerve ◽  
Optic Nerve Head ◽  
Laser Speckle ◽  
Laser Speckle Flowgraphy ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
The Mean

AbstractWe investigated gender differences in the optic nerve head (ONH) microcirculation status in association with obstructive sleep apnea (OSA) by using laser speckle flowgraphy (LSFG). We evaluated 150 men (60.5 ± 11.0 yrs) and 45 women (63.0 ± 10.6 yrs) who underwent overnight polysomnography. The mean blur rate (MBR), maximum (Max) MBR, and minimum (Min) MBR were evaluated. The parameters were analyzed separately for the tissues, vessels, and throughout the ONH (All). The apnea hypopnea index (AHI: times/hr), the lowest SpO2%, and the mean SpO2% were calculated as indicators of OSA. We investigated which MBR sections are correlated with OSA parameters separately in the men and women. All MBR sections in the women were significantly positively correlated with the lowest SpO2. In the men, no MBR section was correlated with any OSA parameters. The factors contributing independently to MBR-Tissue were height (β = 0.31) and lowest SpO2 (β = 0.30). The lowest SpO2 in the women was significantly positively correlated with Max MBR-Tissue, Max MBR-All, and Min MBR-All. Our results confirmed a gender difference in characteristics of ONH microcirculation in association with OSA.

scholarly journals 0567 Hypoxic Burden and Apnea-Hypopnea Duration in Patients with Positional Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A217-A218
Author(s):  
J A Ramzy ◽  
R Rengan ◽  
M Mandal ◽  
S Rani ◽  
M E Vega Sanchez ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Apnea Hypopnea Index ◽  
Apnea Test ◽  
Positional Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Respiratory Event ◽  
The Mean

Abstract Introduction Recently, the measurement of the hypoxic burden and apnea-hypopnea duration has been shown to correlate with mortality in patients with obstructive sleep apnea (OSA). We hypothesized that in patients with mild positional OSA (apnea-hypopnea index [AHI] &lt; 5 events/hr in the non-supine position) the hypoxic burden would be increased and apnea-hypopnea duration shortened and similar to patients with non-positional OSA. Methods Fourteen patients with positional OSA and 24 patients non-positional OSA with similar severity of OSA based on the respiratory event index (REI) were included. All patients had a home sleep apnea test for suspected OSA. The hypoxic burden was calculated by the multiplication of REI and the mean area under the desaturation curves. Results Thirty-eight patients [12 (35%) males, 50±12 yrs, BMI 35±7 kg/m2, Epworth Sleepiness Scale (ESS) 11±8, REI 10±3 events/hr, apnea-hypopnea duration 19±4 sec, mean SaO2 94±2%, lowest SaO2 79±8%, % total sleep time (TST) SaO2 &lt; 90% 11±16%, hypoxic burden 30±17 %min/hr] completed the study. Fourteen patients [9 (64%) males, 46±14 yrs, BMI 31±6 kg/m2, ESS 7±5, REI 9±3 events/hr, mean SaO2 94±2%, lowest SaO2 81±6%, %TST SaO2 &lt; 90% 4±6%] had positional OSA (supine REI 16±7 events/hr, non-supine REI 3±1 events/hr) and 24 patients had non-positional OSA [3 (13%) males, 52±10 yrs, BMI 38±7 kg/m2, ESS 12±9, REI 10±3 events/hr, mean SaO2 94±2%, lowest SaO2 77±9%, %TST SaO2 &lt; 90% 14±19%]. The hypoxic burden was elevated in both the positional and non-positional OSA patients with no difference between the groups (26±19 %min/hr and 32±15 %min/hr, respectively, p=0.13). The apnea-hypopnea duration was similar in positional and non-positional OSA patients (20±3 sec and 18±4 sec, respectively, p=0.08 sec). Conclusion In patients with mild positional OSA the hypoxic burden, which has been associated with cardiovascular mortality, is elevated and similar to patients with non-positional OSA. Support None

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.

scholarly journals Polysomnographic and clinical characteristics of positional obstructive sleep apnea patients

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Seda Beyhan Sagmen ◽  
Sevda Cömert
Keyword(s):  
Body Mass Index ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Body Mass ◽  
Severe Disease ◽  
Upper Airway ◽  
Neck Circumference ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
The Mean

Abstract Background Obstructive sleep apnea is a condition characterized by the complete or partial obstruction of the upper airway during sleep. This study aimed to compare the clinical and polysomnographic characteristics of our obstructive sleep apnea patients according to their positional and non-positional features. Results Two hundred eighty patients were included in the study. One hundred two patients (36.43%) were female, while 178 patients (63.57%) were male. While 88 (31.43%) of these patients were defined as positional patients, 192 (68.57%) were defined as non-positional patients. The mean age of the positional patients (46.78 ± 9.66) was lower than the mean age of the non-positional patients (50.90 ± 10.96) (p 0.001). Similarly, the mean body mass index of the positional patients (29.39 ± 3.80) was lower than the mean body mass index of the non-positional patients (33.30 ± 6.45) (p < 0.001). Neck circumference values of the positional patients (40.36 ± 2.65) were lower compared to the non-positional patients (43.32 ± 2.54) (p < 0.001). Sleep values were compared based on the presence of positional sleep apnea. In the positional patients, sleep duration, sleep efficiency (percentage), duration of stage N3, minimum, and mean saturation values were found to be higher compared to the non-positional patients, while nightlong apnea hypopnea index, apnea index, percentage of sleep time with oxygen saturation below 90%, oxygen desaturation index, mean heart rate, and periodic limb movement index values were found to be lower (p < 0.05). The rate of severe sleep apnea (7.95%) in the positional patients was lower than the non-positional patients (53.65%) (p < 0.001). Conclusion In the light of these data, positional OSA is a very important condition presented in 31.43% of OSA patients and it was determined that these patients were younger, had less body mass index, and shorter neck circumference. The rate of severe disease was found to be lower in positional OSA patients

scholarly journals Uvulopalatopharyngoplasty and barbed reposition pharyngoplasty with and without hyoid suspension for obstructive sleep apnea hypopnea syndrome: A comparison of long-term functional results

2020 ◽  
Author(s):  
Antonio Minni ◽  
Fabrizio Cialente ◽  
Massimo Ralli ◽  
Andrea Colizza ◽  
Quirino Lai ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Protective Factor ◽  
Surgical Techniques ◽  
Functional Results ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Hyoid Suspension ◽  
Hypopnea Syndrome

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common condition; when conservative approaches are not effective, surgical techniques aimed at reducing the airway obstruction effect are used. This retrospective study aimed at comparing the functional outcomes in patients with OSAHS undergoing uvulopalatopharyngoplasty (UPPP) according to Fairbanks and barbed reposition pharyngoplasty (BRP) according to Mantovani, with or without hyoid suspension (HS). One-hundred twenty-two consecutive OSAHS patients who underwent surgical treatment were included in the study. Patients were divided into 4 groups; all patients underwent preoperative and postoperative polysomnography (PSG) with apnea/hypopnea index (AHI) and oxygen desaturation index (ODI) evaluation, and Epworth Sleepiness Scale (ESS) evaluation. The results were analyzed according to the different surgical procedures, in relation to the preoperative PSG and anthropometric data. A significant reduction was observed at 18-month follow-up for patients in BRP group for BMI (p = 0.004), ESS (p < 0.0001), ODI (p < 0.0001), and AHI (p < 0.0001). Risk factors for poor postoperative AHI reduction were evaluated; preoperative AHI was the strongest independent protective factor, while preoperative ODI was the strongest risk factor. The association of HS with UPPP or BRP showed significant results in terms of higher postoperative AHI reduction only when associated to UPPP (p < 0.0001). This study showed that the BRP technique was more effective compared to UPPP for patients with OSAHS. The association of HS showed greater benefits in UPPP compared to BRP.  Randomized prospective trials with longer follow-up are necessary to confirm our results and formulate a more accurate indication of the optimal therapeutic strategy.

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