One-stage nasal and multi-level pharyngeal surgery for obstructive sleep apnoea: safety and efficacy

2005 ◽  
Vol 119 (4) ◽  
pp. 272-276 ◽  
Author(s):  
Kenny P Pang
Keyword(s):  
Sleep Apnoea ◽  
Upper Respiratory Tract ◽  
Safety And Efficacy ◽  
Surgical Success ◽  
One Stage ◽  
Obstructive Sleep ◽  
Upper Respiratory ◽  
Multi Level ◽  
Group 2 ◽  
Group 1

A collapsible airway is often the common denominator in sleep-disordered breathing (SDB). The upper respiratory tract includes the nasal passage, nasopharynx, oral cavity, oropharynx, base-of-tongue region and the hypopharynx. It is believed that the highest amount of resistance in the upper respiratory tract is in the nasal cavities, and particularly the nasal valve. Most authors believe that when considering surgical options for patients with obstructive sleep apnoea (OSA) it is imperative to correct nasal pathology together with the other sites of airway obstruction. In this retrospective study, I sought to investigate the safety and efficacy of one-stage nasal and multi-level pharyngeal surgery. I compared two groups of patients: group 1, receiving one-stage nasal and multi-level pharyngeal surgery; and group 2, receiving only multi-level pharyngeal surgery. In group 1, nine out of 12 patients (75 per cent) met the criteria for surgical success, with a mean pre-operative apnoea-hypopnoea index (AHI) decreasing from 36.3 to 8.9 post-operatively (p<0.0002), while in group 2, 25 out of 40 patients met the surgical success criteria (62.5 per cent), with their mean AHI decreasing from 52.6 to 10.2 (p<0.0000). When comparing the surgical success rates between the two groups, it was not statistically significant, at p>0.106. There were no postoperative respiratory-related complications despite having bilateral nasal Merocel (tampon) packing in place (in group 1), and none of the patients in either group had any desaturation, hypoxaemia, apnoea or OSA-related complications. This series suggests that, with adequate post-operative monitoring, it is both safe and efficacious to perform both nasal and multi-level pharyngeal surgery in the one surgical session.

scholarly journals Clinical efficiency of treatment of cough in pediatric practice

2019 ◽  
pp. 194-198 ◽  
Author(s):  
G. Yu. Evstifeeva ◽  
O. Yu. Trusova ◽  
E. I. Danilova ◽  
V. V. Sumenko
Keyword(s):  
Respiratory Tract Infections ◽  
Comparison Group ◽  
Upper Respiratory Tract ◽  
Pediatric Practice ◽  
Upper Respiratory ◽  
Group 2 ◽  
Significant Regression ◽  
Tract Infections ◽  
Efficacy Of Treatment ◽  
Group 1

Cough is one of the most common reasons why parents bring their children to the pediatrician. The article presents the results of a study of the clinical efficacy of treatment of dry cough using Sinecod syrup. A total of 60 children aged 3–15 years with the upper respiratory tract infections and complaints of dry (non-productive) cough were enrolled in the study. In Group 1 (the main group), the children received Sinecod syrup in addition to the standard therapy, in Group 2 (the comparison group) children received Stoptussin-Phyto syrup. The effectiveness of treatment was evaluated based on the clinical examination findings. On Day 8–11 after the first examination, Group 2 showed a decrease in the severity of day and night cough according to VAS by more than 4 points compared with Group 2. Significant regression of the severity of day and night cough in the studied groups was only observed in patients from Group 1. Sleep disorders of the patients normalized.

scholarly journals A comparative analysis of outcomes after surgical reconstruction of stenoses in the upper respiratory tract in children

2021 ◽  
Vol 25 (4) ◽  
pp. 235-243
Author(s):  
A. Yu. Razumovsky ◽  
Z. B. Mitupov ◽  
V. E. Rachkov ◽  
N. S. Stepanenko ◽  
A. V. Adler ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Plastic Surgery ◽  
Costal Cartilage ◽  
Treatment Technique ◽  
Upper Respiratory Tract ◽  
Surgical Time ◽  
Significant Difference ◽  
Upper Respiratory ◽  
Group 2 ◽  
Group 1

Introduction. Definition " upper respiratory tract stenosis " (URTS) includes a large number of nosologies. The most common are cicatricial stenoses, in particular, post-intubation ones as well as bilateral paralysis of the larynx. An important issue for nowadays is choosing the curative modality for such patients.Purpose. To compare outcomes after treating children with URTS.Material and methods. The authors have assessed results of treatment of 110 patients who had reconstructive surgery in 2010-2019. Patients were divided into two groups depending on the nosology: stenosis of the upper respiratory tract (n = 71) and bilateral paralysis of the larynx (n-39). In each group, four types of surgeries were performed: costal cartilage plasty, plasty with T-tube (TT), a modified version of plasty with TT, plasty with a stent. The choice of treatment technique was determined mostly by the tendency to make this or that type of surgery in authors' departments, as well as by the nosology, severity of the disease and patient's age. Decannulation terms, surgical time, early and late postoperative complications as well as relapse-free period were assessed.Results. 66% patients were decannulated in Group 1; in Group 2 - 69%. Group 1 a statistically reliable comparison was possible between the following techniques: costal cartilage plasty and laryngeal stent plasty (p > 0.005) as well as plasty with TT implantation and the proposed modified technique (p > 0.005). While using Mann-Whitney test and Log Rank, the authors found out that in Group 1 there were no significant difference in surgical time, relapse-free period and stenosis degree (p > 0.005). However, decannulation terms after plastic surgery of the larynx with costal cartilage implantation are longer than after plastic surgery with stent implantation (p < 0.005). In Group 2, the authors compared three abovementioned curative modalities, excluding laryngeal plasty with TT implantation. Thus, surgical time for costal cartilage plasty is longer, if to compare to other two techniques (p < 0.005). There is also no significant difference in decannulation terms and relapse-free periods between all three techniques (p > 0.005).Conclusion. The results obtained have demonstrated the effectiveness of long-term stenting with TT placement in children, mainly with cicatricial stenoses, and in older children. The trial also revealed that laryngoplasty with costal cartilage in children with bilateral laryngeal paralysis is an effectiveness choice too.

scholarly journals Prospects of application of cone beam computed tomography for analyzing upper respiratory tract pathologies in patients with dentition system diseases

2020 ◽  
Vol 17 (3) ◽  
pp. 346-352
Author(s):  
S. P. Rubnikovich ◽  
I. S. Abelskaya ◽  
Yu. L. Denisova ◽  
S. V. Sirak ◽  
V. G. Shishov
Keyword(s):  
Respiratory Tract ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Study Group ◽  
Upper Respiratory Tract ◽  
Sleep Apnoea Syndrome ◽  
Obstructive Sleep ◽  
Upper Respiratory ◽  
Distal Occlusion

The goal of the study was to analyze the upper respiratory tract condition indicators obtained by means of сone beam computed tomography (CBCT) for patients with dentition system diseases and obstructive sleep apnoea syndrome. Patients were divided into 3 study groups. The control group (the 1st study group) included the CBCT data obtained for 33 healthy patients. The 2nd study group included the CBCT data obtained for 136 patients with dentition system diseases (partial secondary edentia combined with chronic generalized periodontitis) without sleep disorder signs. The 3rd study group included the CBCT data obtained for 70 patients with partial secondary edentia combined with deep distal occlusion and obstructive sleep apnoea syndrome (OSAS). The CBCT method using the proposed diagnosis criteria made it possible to identify not only dentition system diseases, but also the dysfunction of the upper respiratory tract, in particular the OSAS causes. It was found with confidence that the reduction of the upper respiratory tract diagnostic indicators by 40 % or more, as compared to the regulatory indicators of healthy patients, led to the dysfunction of the respiratory tract and the apnoea development. Deep distal occlusion and secondary edentia conditioned the presence of the upper respiratory tract concave configuration and the localization of the minimum cross-sectional area below the occlusion plane, which increases the probability of development and progression of the obstructive sleep apnoea syndrome.

Heart rate increment: an electrocardiological approach for the early detection of obstructive sleep apnoea/hypopnoea syndrome

2004 ◽  
Vol 107 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Frédéric ROCHE ◽  
Emilia SFORZA ◽  
David DUVERNEY ◽  
Jean-René BORDERIES ◽  
Vincent PICHOT ◽  
...  
Keyword(s):  
Heart Rate ◽  
Frequency Domain ◽  
Obstructive Sleep Apnoea ◽  
Predictive Accuracy ◽  
Holter Monitoring ◽  
Developed Countries ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Group 2 ◽  
Group 1

The prevalence of OSAHS (obstructive sleep apnoea/hypopnoea syndrome) is high in developed countries and it is estimated that the vast majority of patients remain undiagnosed. On the basis of physiological evidence, we evaluated the frequency component of HRI (heart rate increment) as a simple and inexpensive screening tool for OSAHS detection in a first group of patients (group 1) and validated their discriminant capacity in a second group (group 2). The predictive accuracy of hourly %VLFI (frequency-domain HRI variable obtained from nocturnal ECG Holter monitoring) was analysed by comparison with an hour-by-hour respiratory disturbances index assessed by complete polysomnography in 28 consecutive clinically suspected OSAHS patients for group 1 and in 35 patients for group 2. OSAHS was present in 20 patients according to a mean hourly apnoea plus hypopnoea index >10 in group 1, and prevalence reached 77.1% in group 2. Sensitivity, specificity and positive and negative predictive accuracy were calculated and an ROC (receiver operating characteristic) curve was constructed for several polysomnographic threshold values. In group 1, hourly %VLFI appeared as an evident predictor of the apnoea/hypopnoea index (W=0.848, P<0.0001; where W is the area under the curve obtained using ROC curve analysis). Using an appropriate threshold (value ≥3.2%), %VLFI demonstrated a sensitivity of 78.1% and a specificity of 70.4%. These thresholds applied to group 2 yielded a sensitivity of 73.9% and a specificity of 76.6%. Frequency-domain analysis of the HRI appears to be a powerful tool for OSAHS prediction. The simplicity of its analysis and use makes of it a particularly well-suited variable for routine mass screening in high-risk populations undergoing ECG Holter monitoring.

scholarly journals Comparison of different cephalometric variables in patients with and without history of snoring

2017 ◽  
Vol 5 (12) ◽  
pp. 5283
Author(s):  
Azhar Khan ◽  
Mohamad Imran ◽  
Mohammed Imran ◽  
Shoib N. Parkar ◽  
Mueed U. Islam ◽  
...  
Keyword(s):  
Hyoid Bone ◽  
Sleep Apnea Syndrome ◽  
Sleep Apnoea ◽  
Control Group ◽  
Mandibular Plane ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
History Of ◽  
Group 2 ◽  
Group 1

Background: Obstructive sleep apnea syndrome has a high prevalence among adults. Cephalometric variables can be a valuable method for evaluating patients with this syndrome. The objective of this study is to evaluate and compare the craniofacial variables in subjects with and without snoring by cephalometric analysis.Methods: 40 patients were included in the study who were divided into two groups; group 1 of 20 snoring patients and group 2 control group of 20 non-snoring patients and were evaluated and compared for various cephalometric variables.Results: The distance from the hyoid bone to the mandibular plane (MP-H) was the only variable that showed a statistically significant correlation between two groups.Conclusions: Cephalometric variables are useful tools for evaluating the patients with snoring who are predisposed to obstructive sleep apnoea. The distance from the hyoid bone to the mandibular plane showed a statistically significant correlation between two groups.

scholarly journals Treatment outcomes of obstructive sleep apnoea in obese community-dwelling children: the NANOS study

2015 ◽  
Vol 46 (3) ◽  
pp. 717-727 ◽  
Author(s):  
María Luz Alonso-Álvarez ◽  
Joaquin Terán-Santos ◽  
Ana Isabel Navazo-Egüia ◽  
Mónica Gonzalez Martinez ◽  
María José Jurado-Luque ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Significant Risk ◽  
Dietary Treatment ◽  
Sleep Apnoea ◽  
Obese Children ◽  
Obstructive Sleep ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3–14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1)assessments. Their mean body mass index (BMI) at T1was 27.6±4.7 kg·m−2, corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h−1. Among group 1 children, 21.2% had an RDI ≥3 events·h−1at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01–2.23; p<0.05) in obese children surgically treated, and RDI at T0as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09–3.02 (p<0.03) and OR 8.71, 95% CI 1.24–61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up.

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

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
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.

scholarly journals Neuropsychological development of children with biliary atresia after liver transplantation

2021 ◽  
Vol 23 (3) ◽  
pp. 66-72
Author(s):  
A. V. Syrkina ◽  
I. E. Pashkova ◽  
A. R. Monakhov ◽  
O. V. Silina ◽  
E. V. Chekletsova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Surgical Treatment ◽  
Biliary Atresia ◽  
Psychomotor Development ◽  
Two Stage ◽  
Neuropsychological Development ◽  
One Stage ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Background. In young children, the most common liver disease leading to transplantation is biliary atresia. Liver transplantation has fundamentally improved the survival rate of children with biliary atresia. Studies on developmental outcomes in children are mostly limited to small samples; there are no such studies in the Russian Federation.Objective: to determine the cognitive outcomes in children undergoing one-stage or two-stage surgical treatment of biliary atresia.Materials and Methods. 83 children were divided into groups: 36 children underwent transplantation without previous surgical interventions (group 1), 47 children underwent the Kasai palliative portoenterostomy (group 2). Inclusion criteria: 24 months of age or younger at the moment of transplantation, no medical history of neurological pathology. All children were examined before transplantation and at 1, 3, 6 and 12 months after liver transplantation. Psychomotor development was assessed using the Griffiths Psychomotor Development Scale for children under 24 months (translated by E.S. Keshishian), the Griffiths Intellectual Development Scale for children aged 2 to 8 years, and the Modified Checklist for Autism in Toddlers, Revised, for children 16-30 months old.Results. All children had developmental delays at the time of transplantation. Up to 50% of the children had signs of cachexia, with a shoulder circumference of less than 3 percentile. Only two children showed obvious hepatic encephalopathy in the form of depressed consciousness. After liver transplantation, 94% of group 1 children recovered their preoperative psychomotor development levels, and only 68% in group 2 made these gains. At 3 and 6 months after transplantation, about 80% of group 1 children showed normal psychomotor development, whereas in group 2, only 61% did. By 12 months after liver transplantation, the difference between the groups was more evident: 83.3% of group 1 children and only 53.2% of group 2 children were developing according to age. The difference between the groups was statistically significant (p < 0.05).Conclusion. Children who received one-stage treatment of biliary atresia and underwent liver transplantation have better neuropsychological development within a year after surgery than children with two-stage surgical treatment.

scholarly journals Long-term outcome of endocardial-only versus combined endocardial-epicardial homogenization of the scar for treatment of ventricular tachycardia in patients with ischemic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Long Term Outcome ◽  
Obstructive Sleep ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Abstract Introduction We investigated the ablation success of scar homogenization with combined (epicardial + endocardial) versus endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. Method Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial scar homogenization and group 2: endocardial +epicardial scar homogenization. Patients with previous open heart surgery were excluded. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue &gt;1.5 mV and severe scar &lt;0.5 mV. Non-inducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up twice a year for 5 years with implantable device interrogations. Results A total of 361 (Group 1: 291 and group 2: 70) patients were included in the study (mean age: 67 years, male: 88.4%). At 5 years, significantly higher number of patients from group 2 remained arrhythmia-free (figure 1). Of those patients, 87 (45%) and 51 (89%) from group 1 and 2 respectively were off-anti-arrhythmic drugs (AAD) (p&lt;0.001). After adjusting for age, gender, hypertension, diabetes, and obstructive sleep apnea, scar homogenization using endo-epicardial approach was associated with 51% less recurrence compared to the endocardial ablation strategy (Hazard Ratio: 0.49, 95% CI: 0.27–0.89, p: 0.02). Conclusion In this series of patients with ischemic cardiomyopathy and VT, endo-epicardial scar homogenization was associated with a lower need for AAD and a significantly lower recurrence rate at 5-years of follow-up compared to the endocardial ablation alone. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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