scholarly journals Management of obstructive sleep apnea in children: a Canada-wide survey

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
J. Cousineau ◽  
A.-S. Prévost ◽  
M.-C. Battista ◽  
M. Gervais
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
Neck Surgery ◽  
Cross Sectional Survey ◽  
Drug Induced ◽  
Cross Sectional ◽  
Adenotonsillar Hypertrophy ◽  
Flexible Scope ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnea frequently persists in children following adenotonsillectomy, which is the first-line treatment recommended for obstructive sleep apnea with adenotonsillar hypertrophy. Drug-induced sleep endoscopy (DISE) is a diagnostic tool increasingly used to assess pediatric obstructive sleep apnea, but its use has not been standardized. The overarching goal of this study was to document the current practice of Canadian otolaryngologists managing this population. Methods A nation-wide online cross-sectional survey of Canadian otolaryngologist members of the Canadian Society of Otolaryngology – Head and Neck Surgery and the Association d’otorhinolaryngologie et chirurgie cervico-faciale du Québec. The 58-question electronic survey was developed based on a validated survey redaction guide with the aim to assess management and treatment of pediatric obstructive sleep apnea, as well as indications and performance of DISE. Consensus on practice items was defined by a minimum of 75% similar answers. Results One hundred and nine Canadian otolaryngologists completed the survey on management of pediatric obstructive sleep apnea, among which 12 of them completed the questions on DISE. Overall, there was a poor rate of agreement of 55% among the respondents for the 58 questions altogether. There was a consensus to assess pediatric obstructive sleep apnea clinically ± with videos (82.6%), to assess adenotonsillar hypertrophy clinically (93.6%) and with flexible scope in the office (80.7%), as well as for the airway sites examined endoscopically during DISE. However, there was no consensus regarding anesthetic protocol and scoring system. DISE was mostly performed in cases of persistent obstructive sleep apnea after adenotonsillectomy rather than before performing any surgical procedure. There was no difference in the management of obstructive sleep apnea between otolaryngologists who perform DISE and those who do not. The only difference between otolaryngologists who practice in community centers versus in tertiary care centers was the more frequently use of the Brodsky tonsil scale by the latter ones. Conclusion This Canadian-wide survey highlighted a lack of consensus in the management of pediatric obstructive sleep apnea and DISE. Certain aspects regarding DISE remain unclear, including establishment of its ideal timing in order to eventually avoid unnecessary tonsillectomies.

Preoperative Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

2020 ◽  
Vol 162 (3) ◽  
pp. 400-407 ◽  
Author(s):  
Roy Xiao ◽  
Douglas K. Trask ◽  
Alan H. Kominsky
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Effective Treatment ◽  
Nerve Stimulation ◽  
Hypoglossal Nerve ◽  
Tertiary Care ◽  
Drug Induced ◽  
Hypoglossal Nerve Stimulation ◽  
Obstructive Sleep ◽  
Tongue Position

Objective Hypoglossal nerve stimulation (HGNS) is an effective treatment for patients with obstructive sleep apnea (OSA) who fail continuous positive airway pressure (CPAP). We assessed the relationship between patient characteristics and response to HGNS. Study Design Retrospective cohort study. Setting Single tertiary care institution. Subjects and Methods This study included CPAP-intolerant patients with moderate to severe OSA after HGNS system implantation from November 2015 to December 2017. Patient measures, drug-induced sleep endoscopy (DISE) findings, and apnea-hypopnea indices (AHIs) were recorded. Results Forty-eight patients underwent implantation with the following median measures: age, 66 years; body mass index, 28.6; and neck circumference, 41.0 cm. Patients were classified by Friedman tongue position (II, 27%; III, 56%; IV, 17%) and Mallampati grade (I, 25%; II, 50%; III, 23%; IV, 2%). By DISE, 71% had anterior-posterior palatal collapse. Additionally, 38% had lateral oropharynx collapse; 50%, tongue base collapse; and 27%, epiglottis collapse. Following implantation, median AHI improved from 38.5 to 2.7 ( P < .001), and 92% of patients had no worse than mild OSA (8% moderate). Patients with Friedman tongue position grade II/III experienced greater change in AHI as compared with grade IV (94.2% vs 73.8%, P < .001). Patients with Mallampati score I/II experienced greater improvement versus score III/IV (94.7% vs 66.5%, P < .001). No DISE findings, including any obstruction or collapse, were associated with change in AHI. Conclusion This study further confirms HGNS as an effective treatment of CPAP-intolerant OSA. Office measures such as Friedman tongue position IV and Mallampati III/IV were associated with mildly decreased response. DISE findings were not associated with patient response.

scholarly journals FREQUENCY OF OBESE PEOPLE AT HIGH RISK FOR DEVELOPING OBSTRUCTIVE SLEEP APNEA; A CROSS-SECTIONAL SURVEY

2020 ◽  
Vol 11 (3) ◽  
pp. 39-45
Author(s):  
Komal Atta ◽  
Raza Ahmad ◽  
Ayesha Nawaz ◽  
Iqra Ishtiaq ◽  
Muhammad Farooq
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
High Risk ◽  
Age Groups ◽  
P Value ◽  
Cross Sectional Survey ◽  
Obese People ◽  
Cross Sectional ◽  
Validated Questionnaire ◽  
Obstructive Sleep

ABSTRACT BACKGROUND & OBJECTIVE: Obstructive sleep apnea (OSA) leads to multiple complications which may be life-threatening. In this study we determined the frequency of obese individuals at high risk for developing (OSA). METHODOLOGY: It was a cross-sectional survey. The study was conducted in the Medicine department of Services hospital, Lahore from February 6, 2016 to August 5, 2016. A sample size of 300 healthy obese individuals (BMI ≥ 30kg/m2) aged between 18-60 years who were accompanying a patient or visiting someone admitted, were enrolled in our study. Informed Verbal consent was obtained before administering a structured, validated questionnaire to the significant obese population; Survey was translated into Urdu for ease. The data were stratified for age, gender and BMI of the patients to control the effect modifiers. Post-stratification Chi-square test was used. A p-value ≤ 0.05 was taken as significant. RESULTS: A total of 300 subjects were enrolled. Mean age was calculated as 41.81±11.98 years, while 161(53.7%) individuals were females and 139(46.3%) were males. The frequency of risk of OSA was low in 241(80.3%) and high in 59(19.7%) of the population. The relationships of OSA with age groups and BMI were insignificant with p-value being 0.867 and 0.790 respectively. CONCLUSION: In this study, a significant population of male obese individuals was found to be at high risk for obstructive sleep apnea.

The Quest for a DISE Protocol

2021 ◽  
pp. 019459982110366
Author(s):  
Kristin L. Mooney ◽  
Melissa Brooks Peterson ◽  
Jonathan R. Skirko ◽  
Norman R. Friedman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Treatment Plan ◽  
Tertiary Hospital ◽  
Rank Test ◽  
Measurement Tool ◽  
Breathing Patterns ◽  
Drug Induced ◽  
Flexible Scope ◽  
Obstructive Sleep

Objective The objective of this quality initiative project was to modify our existing institutional drug-induced sleep endoscopy (DISE) protocol so that the surgeon could consistently determine obstructive breathing patterns while minimizing children’s discomfort. Methods A quality initiative study utilizing the well-described plan-do-study-act (PDSA) process was conducted at a tertiary hospital for children with polysomnogram-documented obstructive sleep apnea who were undergoing DISE. A 4-point Likert measurement tool was created. Change in each Likert rating with subsequent PDSA cycle was tested with the Wilcoxon rank sum test (Mann-Whitney), and change across all PDSA cycles was tested with the Kruskal-Wallis equality-of-populations rank test. Results After a series of 4 PDSA cycles with 81 children, the DISE protocol was streamlined from 14 to 9 steps. There was significant improvement for all aspects of the DISE, with a final overall median rating of 1 (excellent) for intravenous (IV) placement, scope insertion, and anesthesiologist and surgeon satisfaction ( P < .01) Discussion For sleep surgeons, DISE is quickly becoming what bronchoscopy is to the airway surgeon. Utilizing inhalational agents to obtain IV access and insert the flexible scope in the rapid “on-off” fashion optimizes DISE success regardless of the primary sedation medication and allows ample time for these agents to dissipate. Implications for Practice Adoption of a DISE protocol that includes nasal premedication and inhalational volatile gases for IV and scope insertion at the onset provides a more predictable level of sedation that is well tolerated by the patient, enabling the otolaryngologist to create an obstructive sleep apnea treatment plan.

Diagnosis of Retrolingual Obstruction during Drug-Induced Sleep Endoscopy versus Polysomnography with Nasopharyngeal Tube in Patients with Obstructive Sleep Apnea

2021 ◽  
pp. 000348942110059
Author(s):  
Jian Qiao ◽  
Jie Qin ◽  
Dengxiang Xing ◽  
Shuhua Li ◽  
Dahai Wu
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Lateral Wall ◽  
Patient Characteristics ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Drug Induced ◽  
Cross Sectional ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep

Objective: To compare the retrolingual obstruction during drug-induced sleep endoscopy (DISE) with the retrolingual obstruction during polysomnography with nasopharyngeal tube (NPT-PSG). Methods: A cross-sectional study of 77 consecutive patients with moderate and severe obstructive sleep apnea (OSA) was conducted. After 15 patients were excluded from the study for not completing DISE or NPT-PSG successfully, 62 patients were included in this study. Retrolingual sites of obstruction grade 2 determined by DISE according to the VOTE (velum, oropharynx lateral wall, tongue base, and epiglottis) classification were considered as retrolingual obstruction, while apnea-hypopnea index (AHI) ≥ 15 events/hour determined by NPT-PSG was considered as retrolingual obstruction. The extent of agreement between DISE and NPT-PSG findings was evaluated using unweighted Cohen’s kappa test. Results: The 62 study participants (11 moderate OSA, 51 severe OSA) had a mean (SD) age of 39.8 (9.9) years, and 58 (94%) were men. No statistically significant differences between included and excluded patients were observed in patient characteristics. The extent of agreement in retrolingual obstruction between DISE and NPT-PSG was 80.6% (Cohen k = 0.612; 95% CI, 0.415-0.807). Conclusion: Retrolingual obstruction requiring treatment showed good agreement between DISE and NPT-PSG, suggesting that NPT-PSG may also be a reliable method to assess the retrolingual obstruction.

scholarly journals Scholastic and Cognitive Achievement Following Adenotonsillectomy in Children with Obstructive Sleep Apnea

2020 ◽  
Vol 5 (10) ◽  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
University Hospital ◽  
Scholastic Achievement ◽  
Control Group ◽  
Care Hospital ◽  
Adenotonsillar Hypertrophy ◽  
Neurocognitive Tests ◽  
Obstructive Sleep

Objective: To evaluate the effect of adenotonsillectomy (AT), in children with Obstructive Sleep Apnea (OSA), on the cognitive and scholastic achievement. Study Design: Prospective study Sitting: Tertiary care hospital (Minia university hospital) Subjects and Methods: 50 children were selected, complaining of symptoms of (OSA) and seeking adenotonsillectomy compared to another control group of 50 children without symptoms of OSA. The study sample were subjected to clinical evaluation where hypertrophied palatine tonsils and Adenoid were the cause of OSA. Polysomnography, audiological evaluation were done and All 50 children underwent a battery of neurocognitive tests including process-oriented intelligence scales (Stanford Binet Intelligence scale and Illinois Test of psycholinguistic ability) pre and post adenotonsillectomy to reveal the effect of (AT) on the cognitive and scholastic achievement of those children. Results: Children with OSA had lower scores in neurocognitive tests (Illinois test and Stanford Binet intelligent scale), as well as. In Academic performance in comparison to the control group. After 8 months from AT, the children with OSA demonstrated highly significant improvement in IQ, Mental age, auditory perceptual assessment (APA), PLA of VSM (Visual sequential memory), AA (Auditory association) VA (Visual association), AC (Auditory closure), VC (Visual closure), GC (Grammatic closure) and SB (Sound Blending). Conclusions: School performance and Neurocognitive functions are worsened in children with Adenotonsillar hypertrophy, this effect is reversible as improvement occurred after their removal.

scholarly journals Inverse Cross-sectional and Longitudinal Relationships between Diabetic Retinopathy and Obstructive Sleep Apnea in Type 2 Diabetes

2021 ◽  
Vol 1 (1) ◽  
pp. 100011
Author(s):  
Jakob Grauslund ◽  
Lonny Stokholm ◽  
Anne S. Thykjær ◽  
Sören Möller ◽  
Caroline S. Laugesen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Obstructive Sleep Apnea ◽  
Diabetic Retinopathy ◽  
Sleep Apnea ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Longitudinal Relationships

scholarly journals Stress in obstructive sleep apnea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jasmine L. Wong ◽  
Fernando Martinez ◽  
Andrea P. Aguila ◽  
Amrita Pal ◽  
Ravi S. Aysola ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Depressive Symptoms ◽  
Sleep Apnea ◽  
Perceived Stress ◽  
Stress Reduction ◽  
Psychological Symptoms ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
General Anxiety Disorder ◽  
Obstructive Sleep

AbstractPeople with obstructive sleep apnea (OSA) often have psychological symptoms including depression and anxiety, which are commonly treated with anti-depression or anti-anxiety interventions. Psychological stress is a related symptom with different intervention targets that may also improve mental state, but this symptom is not well characterized in OSA. We therefore aimed to describe stress in relation to other psychological symptoms. We performed a prospective cross-sectional study of 103 people, 44 untreated OSA (mean ± s.d. age: 51.2 ± 13.9 years, female/male 13/31) and 57 healthy control participants (age: 46.3 ± 13.8 years, female/male 34/23). We measured stress (Perceived Stress Scale; PSS), excessive daytime sleepiness (Epworth Sleepiness Scale; ESS), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder; GAD-7). We compared group means with independent samples t-tests and calculated correlations between variables. Mean symptom levels were higher in OSA than control, including PSS (mean ± s.d.: OSA = 15.3 ± 6.9, control = 11.4 ± 5.5; P = 0.002), GAD-7 (OSA = 4.8 ± 5.0, control = 2.1 ± 3.9; P = 0.02), PHQ-9 (OSA = 6.9 ± 6.1, control = 2.6 ± 3.8; P = 0.003) and ESS (OSA = 8.1 ± 5.3, control = 5.0 ± 3.3; P = 0.03). Similar OSA-vs-control differences appeared in males, but females only showed significant differences in PHQ-9 and ESS, not PSS or GAD-7. PSS correlated strongly with GAD-7 and PHQ-9 across groups (R = 0.62–0.89), and moderately with ESS. Perceived stress is high in OSA, and closely related to anxiety and depressive symptoms. The findings support testing stress reduction in OSA.

428 Baroreflex sensitivity during handgrip in obstructive sleep apnea with and without CPAP

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A169-A170
Author(s):  
Amrita Pal ◽  
Fernando Martinez ◽  
Ravi Aysola ◽  
Ronald Harper ◽  
Luke Henderson ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Baroreflex Sensitivity ◽  
Muscle Sympathetic Nerve Activity ◽  
Cross Sectional Study ◽  
Autonomic Regulation ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Healthy Control ◽  
Significant Measure

Abstract Introduction Obstructive sleep apnea (OSA) disrupts multiple aspect of autonomic regulation; it is unclear whether intervention with continuous positive airway pressure (CPAP) can correct such disruptions. One key index of autonomic regulation is baroreflex sensitivity (BRS), an index that indicates heart rate (HR) changes to blood pressure (BP) alterations, and which is a significant measure for evaluating long-term cardiovascular changes induced by OSA. BRS can be assessed from BP and HR changes during an autonomic challenge task such as handgrip (HG). In a cross-sectional study, we assessed BRS during HG in untreated OSA (OSA_un) and CPAP treated OSA (CPAP), together with healthy control (CON) participants to determine if CPAP can recover BRS. Methods We collected ECG and continuous beat-by-beat BP from 95 people: 32 newly-diagnosed OSA_un (51.5±13.9years; AHI 21.0±15.3events/hour; 20male); 31 CPAP (49.4±14.0years; 22.4±14.1events/hour in initial diagnosis; 23male); and 32 CON (44.1±13.8years; 10male). We acquired data over 7 mins, during which people performed three 30s HGs (60 s baseline, 90 s recovery, 80% maximum strength). We calculated BRS over the 7 min period using sequence analysis in AcqKnowledge 5.0 BRS, followed by group comparisons using ANOVA. We also analyzed BP, HR and their variabilities: BPV and HRV (sympathetic-vagal). Results Mean arterial BP increases during HG were similar in all groups, although baseline mean arterial BP was higher in OSA_unc and CPAP, relative to CON (p &lt; 0.05; OSA_un:mean±std, 90±11mmHg; CPAP: 88±10mmHg; CON 82±13mmHg). BRS was lower in OSA_un and CPAP, relative to CON (p &lt; 0.05; OSA_un: 13.1±7.6 ms/mmHg; CPAP: 13.7±9.0 ms/mmHg; control 18.3±11.9 ms/mmHg). Other cardiovascular measures of BPV, HR and HRV in addition to BP showed significant increases in response to HG, but these changes were similar in all 3 groups. Conclusion BRS during HG was reduced in both OSA_un and CPAP compared to CON, while HG evoked similar overall changes in BP and HR in all three groups. Although CPAP reduces sympathetic tone measured as Muscle Sympathetic Nerve Activity (MSNA), BRS appears to be unaffected by the intervention. Irreversible changes in the baroreflex network may occur with OSA that are not altered with CPAP usage. Support (if any) NR-017435, HL135562

Sign in / Sign up

Export Citation Format

Share Document