scholarly journals Pediatric Obstructive Sleep Apnea: Surgical Techniques beyond Tonsillectomy and Adenoidectomy

2016 ◽  
Vol 7 (2) ◽  
pp. 109-114
Author(s):  
Amal Isaiah ◽  
Ron B Mitchell
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Surgical Techniques ◽  
Standard Of Care ◽  
The United States ◽  
Treatment Modalities ◽  
Childhood Health ◽  
Persistent Symptoms ◽  
Obstructive Sleep ◽  
Controversial Topic

ABSTRACT Sleep disordered breathing (SDB) affects 1 in 10 children in the United States and poses a growing threat to childhood health. Although tonsillectomy and adenoidectomy is considered the standard of care for treatment of pediatric SDB, up to 25% of children present with persistent symptoms after surgery. Success of treatment modalities, such as continuous positive airway pressure (CPAP) is affected by compliance. Management of residual SDB is a complex, and often controversial topic. Here we discuss options for managing childhood SDB that persists after initial management with tonsillectomy. How to cite this article Isaiah A, Mitchell RB. Pediatric Obstructive Sleep Apnea: Surgical Techniques beyond Tonsillectomy and Adenoidectomy. Int J Head Neck Surg 2016;7(2):109-114.

Maternal and fetal outcomes in pregnancies with obstructive sleep apnea

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Eloise Passarella ◽  
Nicholas Czuzoj-Shulman ◽  
Haim A. Abenhaim
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Temporal Trends ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Tertiary Hospital ◽  
Elevated Risk ◽  
Obstructive Sleep ◽  
Study Interval ◽  
United States Healthcare

Abstract Objectives Obstructive sleep apnea (OSA) is linked to many health comorbidities. We aimed to ascertain if OSA correlates with a rise in poor obstetrical outcomes. Methods Employing the United States’ Healthcare Cost and Utilization Project – National Inpatient Sample, we performed our retrospective cohort study including all women who delivered between 2006 and 2015. ICD-9 codes were used to characterize women as having a diagnosis of OSA. Temporal trends in pregnancies with OSA were studied, baseline features were evaluated among gravidities in the presence and absence of OSA, and multivariate logistic regression analysis was utilized in assessing consequences of OSA on patient and newborn outcomes. Results Of a total 7,907,139 deliveries, 3,115 belonged to patients suffering from OSA, resulting in a prevalence of 39 per 100,000 deliveries. Rates rose from 10.14 to 78.12 per 100,000 deliveries during the study interval (p<0.0001). Patients diagnosed with OSA were at higher risk of having pregnancies with preeclampsia, OR 2.2 (95% CI 2.0–2.4), eclampsia, 4.1 (2.4–7.0), chorioamnionitis, 1.4 (1.2–1.8), postpartum hemorrhage, 1.4 (1.2–1.7), venous thromboembolisms, 2.7 (2.1–3.4), and to deliver by caesarean section, 2.1 (1.9–2.3). Cardiovascular and respiratory complications were also more common among these women, as was maternal death, 4.2 (2.2–8.0). Newborns of OSA patients were at elevated risk of being premature, 1.3 (1.2–1.5) and having congenital abnormalities, 2.3 (1.7–3.0). Conclusions Pregnancies with OSA were linked to an elevated risk of poor maternal and neonatal outcomes. During pregnancy, OSA patients should receive attentive follow-up care in a tertiary hospital.

scholarly journals Obstructive Sleep Apnea and Severe Maternal-Infant Morbidity/Mortality in the United States, 1998-2009

SLEEP ◽  
2014 ◽  
Vol 37 (5) ◽  
pp. 843-849 ◽  
Author(s):  
Judette M. Louis ◽  
Mulubrhan F. Mogos ◽  
Jason L. Salemi ◽  
Susan Redline ◽  
Hamisu M. Salihu
Keyword(s):  
United States ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
The United States ◽  
Obstructive Sleep ◽  
Infant Morbidity

scholarly journals 0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A280-A281
Author(s):  
S E Neill ◽  
R Majid
Keyword(s):  
Health Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
The United States ◽  
Initial Study ◽  
Diagnostic Value ◽  
Obstructive Sleep ◽  
Medicare Patients ◽  
Care Costs

Abstract Introduction The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs. Methods A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented. Results 429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA. Conclusion Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP. Support N/A

Comparison of early postoperative pain among surgical techniques for obstructive sleep apnea

2012 ◽  
Vol 269 (11) ◽  
pp. 2433-2440 ◽  
Author(s):  
Timur Akcam ◽  
Hasan Huseyin Arslan ◽  
Suleyman Deniz ◽  
Hakan Genc ◽  
Omer Karakoc ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Postoperative Pain ◽  
Surgical Techniques ◽  
Obstructive Sleep

scholarly journals Lateral-Expansion Pharyngoplasty: Combined Technique for the Treatment of Obstructive Sleep Apnea Syndrome

2019 ◽  
Vol 24 (01) ◽  
pp. e107-e111 ◽  
Author(s):  
José Antonio Pinto ◽  
Luciana Balester Mello de Godoy ◽  
Heloisa dos Santos Sobreira Nunes ◽  
Kelly Elia Abdo ◽  
Gabriella Spinola Jahic ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep Apnea Syndrome ◽  
Sleep Apnea Syndrome ◽  
Surgical Techniques ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Lateral Expansion ◽  
Obstructive Sleep ◽  
Apnea Syndrome

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a multifactorial disease characterized by episodes of partial or complete collapse during sleep of different regions of the upper airway. Surgery for OSAS evolved with the introduction of different techniques, considering new surgical concept of reconstruction of the upper airway. Objective To retrospectively evaluate the effectiveness of a new approach aimed at reducing pharyngeal collapse by combining two surgical techniques: lateral and expansion pharyngoplasty. Methods We reviewed the medical records of 38 patients with OSAS undergoing lateral/expansion pharyngoplasty from January 2012 to December 2016. The following data were collected: patient age, gender, and pre- and postoperative body mass index (BMI), Epworth sleepiness scale (ESS) scores, snoring visual analogue scale (VAS) scores, and polysomnography (PSG) results. Results The PSG results showed a significant reduction in the apnea/hypopnea index (AHI) from 22.4 ± 27.3 events/h preoperatively to 13.6 ± 17.9 events/h postoperatively (p = 0.009), with postoperative AHI reduction greater than 50% in 63.2% of the patients. There was also a significant reduction in the microarousal index (19.5 ± 22.6 vs 11.0 ± 13.4 events/h; p = 0.001) and in the minimum oxygen saturation (82.6 ± 10.3 vs 86.9 ± 11.1; p = 0.007). Conclusions Lateral-expansion pharyngoplasty represents a new surgical strategy for the treatment of OSAS in patients with palatal collapse by combining two different techniques: lateral and expansion pharyngoplasty. The two techniques, performed as a one-stage procedure, led to improvements in excessive daytime sleepiness, snoring, and PSG respiratory parameters by acting on lateral and retropalatal collapse, producing favorable results with good applicability in otolaryngology clinical practice.

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