Comparison of Minimally Invasive Techniques in Tongue Base Surgery in Patients with Obstructive Sleep Apnea

Objective. To compare the effectiveness and morbidity of 3 microinvasive tongue base surgical procedures combined with uvulopalatopharyngoplasty (UPPP) in supine-dependent obstructive sleep apnea (OSA) patients. Study Design. A prospective, randomized clinical study. Setting. A tertiary referral center. Methods. Fifty OSA patients were randomly advised to undergo UPPP combined with low-temperature bipolar radiofrequency (group 1), submucosal minimally invasive lingual excision with radiofrequency (SMILE-R; group 2), or submucosal minimally invasive lingual excision with a harmonic scalpel (SMILE-H; group 3). The Epworth Sleepiness Scale, the visual analog scale (VAS) for snoring, the pre- and postoperative 3-month polysomnography (PSG) findings, and the decrease in tongue volume using magnetic resonance imaging (MRI) were compared. The operation times, the postoperative pain VAS score, the analgesic requirement, and the time in commencing a normal diet were compared in the 3 groups. Results. The decrease in apnea-hypopnea index (AHI) and supine AHI values at the postoperative 3-month time point was significant in group 2 ( P < .05). The decrease in tongue volume at the 3-month postoperative time point according to the MRI evaluations was higher in groups 1 and 2 ( P < .05). In the subjective comparison of effectiveness, there was no significant difference. The operation time was significantly lower in group 3. In the assessment of postoperative pain, no significant difference was found between the groups. Conclusion. When the PSG findings and MRI were evaluated, UPPP + SMILE-R were found to be more effective. No significant difference was found between the 3 techniques when morbidity and complications were compared.

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Features of melatonin cyrcadian secretion in patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome

Kazan medical journal ◽

10.17816/kmj2019-762 ◽

2019 ◽

Vol 100 (5) ◽

pp. 762-768 ◽

Cited By ~ 1

Author(s):

O A Karpovich ◽

V I Shishko ◽

V R Shulika

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Group 4 ◽

Obstructive Sleep ◽

Group 3 ◽

Group 2 ◽

Hypopnea Syndrome

Aim. To evaluate the features of melatonin cyrcadian production in patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome. Methods. We examines 29 patients with gastroesophageal reflux disease were examined (group 1), 29 patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome (group 2), and 22 patients with obstructive sleep apnea/hypopnea syndrome (group 3). The comparison group included 21 people without gastroesophageal reflux disease and obstructive sleep apnea/hypopnea syndrome (group 4). The content of 6-sulfatoxymelatonin was determined in 24-hour urine and separately in its daytime and night portions by enzyme immune assay. The night/day index was calculated. The compared groups were comparable by gender but the patients with obstructive sleep apnea/hypopnea syndrome and gastroesophageal reflux disease associated with this syndrome differed from the patients from comparison group by older age, which is consistent with epidemiology of sleep apnea. The analysis of the data obtained was performed using the program Statistica 10.0. When comparing quantitative indicators between four independent samples, KruskelWallis test was used. In order to study the relationship between the phenomena, the Spearman rank correlation coefficient was calculated. Results. A significantly increased level of 6-sulfatoxymelatonin in 24-hour urine was determined in group 2 (p=0.0000), as well as in day (0.0000) and night portions (0.015) compared to group 1, in 24-hour urine (p=0.0007) and its day portion (p=0.0001) compared to group 3, in day portion of urine compared to group 4 (p=0.029). In group 2 compared to group 4 a significant shift in melatonin synthesis peak during daytime hours was observed, which is expressed in a statistically significant decrease in the night/day index (p=0.0003). Correlation analysis revealed statistically significant relations between the level of 6-sulfatoxymelatonin in urine and the severity of sleep apnea (in 24-hour urine: r=0.64, p=0.0000; in daytime portion: r=0.62, p=0.0000; in night portion: r=0.40, p=0.003), as well as respiratory monitoring indicators indicating sleep fragmentation due to apnea (the number of awakenings associated with respiratory events: r=0.58; p=0.00001; activation of the central nervous system associated with respiratory efforts: (r=0.50; p=0.0002). Conclusion. The patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome have an increased level of 6-sulfatoxymelatonin in urine associated with the shift of its peak synthesis to daytime hours; the identified changes correlate with apnea/hypopnea index reflecting the severity of apnea and sleep disturbance.

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Creatinine Clearance in Patients with Obstructive Sleep Apnea

Medical Laboratory Technology Journal ◽

10.31964/mltj.v7i1.378 ◽

2021 ◽

Vol 7 (1) ◽

pp. 59

Author(s):

Seda Beyhan Sagmen ◽

Nesrin Kiral ◽

Ali Fidan ◽

Elif Torun Parmaksiz ◽

Coskun Dogan ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Endothelial Dysfunction ◽

Creatinine Clearance ◽

Control Group ◽

Apnea Hypopnea Index ◽

Obstructive Sleep ◽

Significant Difference ◽

Group 2 ◽

Group 1

During an apnea, hemodynamic complications such as hypoxemia, a rise in systemic and pulmonary arterial pressure, and changes in heart rate occur in patients with obstructive sleep apnea (OSA). Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction. Hypertension is common in patients with OSA. This study aims to assess OSA patients' renal functions and investigate the creatinine clearance (CC) values across OSA patients with and without hypertension. The study included 530 individuals with OSA and 60 individuals with an apnea-hypopnea index (AHI) of <5. CC calculated with the Cockcroft-Gault Equation. Patients with OSA divide into two groups as the group of patients with hypertension (HT) (group 1) and without HT (group 2). The study included 339 (64%) male and 191 (36%) female patients. It found that 32.4% of OSA patients had HT (Group 1). There was a significant difference in CC and urea levels between groups 1 and 2 (p<0.001; p=0.005). While CC was low in the OSA group, CC values were not statistically significantly different between the OSA patients and the control group (p>0.05). A statistically significant difference was detected in urea and creatinine levels between the OSA and control groups (p=0.005; p=0.012). Creatinine clearance decreases in patients with OSA in the presence of HT. Patients with OSA often experience cardiovascular disorders, and glomerular endothelial dysfunction occurs in OSA patients.

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Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea

Ear Nose & Throat Journal ◽

10.1177/01455613211029783 ◽

2021 ◽

pp. 014556132110297

Author(s):

Giannicola Iannella ◽

Claudio Vicini ◽

Jerome R. Lechien ◽

Claudia Ravaglia ◽

Venerino Poletti ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Retrospective Study ◽

Sleep Apnea ◽

High Risk ◽

Respiratory Disease ◽

Severe Form ◽

Obstructive Sleep ◽

Significant Difference ◽

Group 2 ◽

Group 1

Objectives: The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA). Methods: Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19. Results: 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups ( P = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, P = .01). Conclusions: According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA. Current Knowledge/Study Rationale: Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease. Study Impact: According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.

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Postoperative monitoring of children with obstructive sleep apnea syndrome

Orvosi Hetilap ◽

10.1556/oh.2014.29879 ◽

2014 ◽

Vol 155 (18) ◽

pp. 703-707 ◽

Cited By ~ 1

Author(s):

Pálma Benedek ◽

Gabriella Kiss ◽

Eszter Csábi ◽

Gábor Katona

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Preoperative Evaluation ◽

Sleep Apnea Syndrome ◽

Study Patient ◽

Severe Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

Significant Difference ◽

Apnea Syndrome

Introduction: Treatment of pediatric obstructive sleep apnea syndrome is surgical. The incidence of postoperative respiratory complications in this population is 5–25%. Aim: The aim of the authors was to present the preoperative evaluation and monitoring procedure elaborated in Heim Pál Children Hospital, Budapest. Method: 142 patients were involved in the study. Patient history was obtained and physical examination was performed in all cases. Thereafter, polysomnography was carried out, the severity of the obstructive sleep apnea syndrome was determined, and the patients underwent tonsilloadenotomy. Results: 45 patients with mild, 50 patients with moderate and 47 patients with severe obstructive sleep apnea syndrome were diagnosed. There was no complication in patients with mild disease, while complications were observed in 6 patients in the moderate group and 24 patients in the severe group (desaturation, apnea, stridor, stop breathing) (p<0.000). In patients with severe obstructive sleep apnea syndrome, no significant difference was noted in preoperative apnoea-hypapnea index (p = 0.23) and in nadir oxygen saturation values (p = 0.73) between patients with and without complication. Conclusions: Patients with severe obstructive sleep apnea syndrome should be treated in hospital where pediatric intensive care unit is available. Orv. Hetil., 2014, 155(18), 703–707.

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Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽

10.1159/000516243 ◽

2021 ◽

pp. 1-8

Author(s):

Lifeng Li ◽

Demin Han ◽

Hongrui Zang ◽

Nyall R. London

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Obstruction ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Nasal Surgery ◽

Subjective Sleep Quality ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

Objective: The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. Methods: Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. Results: By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (p < 0.05), while the Apnea-Hypopnea Index (AHI) changed little (p = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all p < 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (p < 0.05), except with the AHI (p > 0.05). Conclusion: Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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Effect of Cooling Irrigating Saline in Tongue Base Ablation in Obstructive Sleep Apnea

OTO Open ◽

10.1177/2473974x21989599 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2473974X2198959

Author(s):

Ahmed Yassin Bahgat

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Controlled Trial ◽

Tongue Base ◽

Control Group ◽

University Hospitals ◽

Energy Field ◽

Obstructive Sleep ◽

Prospective Randomized Controlled Trial ◽

Significant Difference

Objective Plasma is formed by creating a high-density energy field within an electrically conductive fluid such as saline. Sometimes ablated bits of tissue get stuck between the electrodes of the wand, obstructing the suction channel. The purpose of this study is to investigate the effect of cooling the irrigating saline during ablation of the hypertrophied tongue base in patients with obstructive sleep apnea. Study Design Prospective randomized controlled trial. Setting An otorhinolaryngology department in Main University hospitals. Methods Sixty adult patients with obstructive sleep apnea and tongue base hypertrophy underwent tongue base ablation surgery. Patients were randomly divided into 2 groups of 30 patients each: cooled saline and room temperature saline. The Coblation wand used was the EVac 70 Xtra HP (Smith & Nephew). Results In this study, a significant difference in operative time (mean ± SD) was seen between groups: 21.2 ± 5.5 minutes in the cold group and 47 ± 9.5 minutes in the control group ( P = .001). The wands in the cold group did not obstruct, while all the wands in the control group were obstructed by tissue clogs with variable degrees, hence wasting more time to clean the wands’ tips. Conclusion Cooling the irrigating saline overcame the problem of wand clogs, and the wand tip did not occlude at all during the procedures, thus saving time lost in wand cleaning and demonstrating a faster and safer surgical procedure. Further studies are needed to identify the hemostatic effect of the cooled saline over the regular one.

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Obstructive sleep apnea and CPAP therapy alter distinct transcriptional programs in subcutaneous fat tissue

SLEEP ◽

10.1093/sleep/zsz314 ◽

2019 ◽

Vol 43 (6) ◽

Cited By ~ 1

Author(s):

Sina A Gharib ◽

Amanda L Hurley ◽

Michael J Rosen ◽

James C Spilsbury ◽

Amy E Schell ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Subcutaneous Adipose Tissue ◽

Subcutaneous Fat ◽

Study Group ◽

Cpap Therapy ◽

Obstructive Sleep ◽

Group 2 ◽

Subcutaneous Adipose ◽

Group 1

Abstract Obstructive sleep apnea (OSA) has been linked to dysregulated metabolic states, and treatment of sleep apnea may improve these conditions. Subcutaneous adipose tissue is a readily samplable fat depot that plays an important role in regulating metabolism. However, neither the pathophysiologic consequences of OSA nor the effects of continuous positive airway pressure (CPAP) in altering this compartment’s molecular pathways are understood. This study aimed to systematically identify subcutaneous adipose tissue transcriptional programs modulated in OSA and in response to its effective treatment with CPAP. Two subject groups were investigated: Study Group 1 was comprised of 10 OSA and 8 controls; Study Group 2 included 24 individuals with OSA studied at baseline and following CPAP. For each subject, genome-wide gene expression measurement of subcutaneous fat was performed. Differentially activated pathways elicited by OSA (Group 1) and in response to its treatment (Group 2) were determined using network and Gene Set Enrichment Analysis (GSEA). In Group 2, treatment of OSA with CPAP improved apnea-hypopnea index, daytime sleepiness, and blood pressure, but not anthropometric measures. In Group 1, GSEA revealed many up-regulated gene sets in OSA subjects, most of which were involved in immuno-inflammatory (e.g. interferon-γ signaling), transcription, and metabolic processes such as adipogenesis. Unexpectedly, CPAP therapy in Group 2 subjects was also associated with up-regulation of several immune pathways as well as cholesterol biosynthesis. Collectively, our findings demonstrate that OSA alters distinct inflammatory and metabolic programs in subcutaneous fat, but these transcriptional signatures are not reversed with short-term effective therapy.

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Comparisons of Thyroid Hormone, Intelligence, Attention, and Quality of Life in Children with Obstructive Sleep Apnea Hypopnea Syndrome before and after Endoscopic Adenoidectomy

BioMed Research International ◽

10.1155/2015/523716 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Hui-Wei Feng ◽

Tao Jiang ◽

Hong-Ping Zhang ◽

Zhe Wang ◽

Hai-Ling Zhang ◽

...

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Thyroid Hormone ◽

Intelligence Quotient ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

Hypopnea Syndrome

Objective. The aim of this study was to compare the differences in thyroid hormone, intelligence, attention, and quality of life (QoL) of children with obstructive sleep apnea hypopnea syndrome (OSAHS) before and after endoscopic adenoidectomy.Method. A total of 35 OSAHS children (21 males and 14 females with a mean age of6.81±1.08years) were included in this study for analyzing the levels of thyroid hormone, intelligence, attention, and QoL. There were 22 children underwent endoscopic adenoidectomy with bilateral tonsillectomy (BT), while the other 13 children who underwent endoscopic adenoidectomy without bilateral tonsillectomy without BT.Results. Our results revealed no significant difference in serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) levels in OSAHS children before and after endoscopic adenoidectomy (allP>0.05). However, there were significant differences in full-scale intelligence quotient (FIQ) (92.45±5.88versus106.23±7.39,P<0.001), verbal intelligence quotient (VIQ) (94.17±15.01versus103.91±9.74,P=0.006), and performance intelligence quotient (PIQ) (94.12±11.04versus104.31±10.05,P=0.001), attention (98.48±8.74versus106.87±8.58,P<0.001), and total OSA-18 scores (87.62±17.15versus46.61±10.15,P<0.001) between before and after endoscopic adenoidectomy in OSAHS children.Conclusion. Our findings provided evidence that the intelligence, attention, and QoL of OSAHS children may be significantly improved after endoscopic adenoidectomy.

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Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10061255 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1255

Author(s):

Hiroyuki Ishiyama ◽

Masayuki Hideshima ◽

Shusuke Inukai ◽

Meiyo Tamaoka ◽

Akira Nishiyama ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Pilot Study ◽

Reduction Rate ◽

Oral Appliance ◽

Respiratory Resistance ◽

Obstructive Sleep ◽

Respiratory Event ◽

Significant Difference ◽

Treatment Responses

The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, p < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA (p < 0.05). There was no significant difference in non-responders (p > 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5–28.0; p = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.

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Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.v8i4.1650 ◽

2021 ◽

pp. 1-7

Author(s):

Carlos Mena Canata ◽

Rebeca Noemí Ruiz Vallejos

Keyword(s):

Quality Of Life ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Rural Areas ◽

Urban Areas ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

The Impact

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

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